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De Silva R, Silva D, Piumika L, Abeysekera I, Jayathilaka R, Rajamanthri L, Wickramaarachchi C. Impact of global smoking prevalence on mortality: a study across income groups. BMC Public Health 2024; 24:1786. [PMID: 38965521 PMCID: PMC11225136 DOI: 10.1186/s12889-024-19336-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/02/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Smoking significantly contributes to the mortality rates worldwide, particularly in non-communicable and preventable diseases such as cardiovascular ailments, respiratory conditions, stroke, and lung cancer. This study aims to analyse the impact of smoking on global deaths, and its association with mortality across the main income groups. METHODS The comprehensive analysis spans 199 countries and territories from 1990 to 2019. The study categorises countries into four income groups: high income, upper middle income, lower middle income, and low income. RESULTS The findings underscore the profound impact of global tobacco smoking on mortality. Notably, cardiovascular disease mortality is notably affected in both upper-middle-income and high-income groups. Chronic respiratory disease mortality rates show a significant impact across all income groups. Moreover, stroke-related mortality is observed in the lower-middle, upper-middle, and high-income groups. These results highlight the pervasive influence of smoking prevalence on global mortality, affecting individuals across various socioeconomic levels. CONCLUSION The study underscores the critical implications of smoking on mortality rates, particularly in high-income countries. It emphasises the urgency of targeted interventions in these regions to address the specific challenges posed by tobacco smoking on public health. Policy recommendations include implementing prohibitive measures extending to indoor public areas such as workplaces and public transportation services. Furthermore, allocating funds for research on tobacco and health, is imperative to ensure policymakers are consistently informed about emerging facts and trends in this complex domain.
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Affiliation(s)
- Roshinie De Silva
- SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
| | - Disuri Silva
- SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
| | - Lakindu Piumika
- SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
| | - Isuri Abeysekera
- SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
| | - Ruwan Jayathilaka
- SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka.
| | - Lochana Rajamanthri
- SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
| | - Colinie Wickramaarachchi
- SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
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Lu R, Qin Y, Xie C, Tan X, Zhu T, Tan J, Wang S, Liang J, Qin Z, Pan R, Pei P, Sun D, Su L, Lan J. Secondhand smoke exposure can increase the risk of first ischemic stroke: A 10.7-year prospective cohort study in China. Ann Epidemiol 2024; 92:25-34. [PMID: 38367798 DOI: 10.1016/j.annepidem.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Passive smoking is considered a major public health issue in China. Prospective evidence regarding the link between secondhand smoke (SHS) and ischemic stroke in China is scarce. METHODS The China Kadoorie Biobank (CKB) study in Liuzhou City recruited 50,174 participants during 2004-2008. Of these 30,456 never-smokers were included in our study. The median follow-up period was 10.7 years. The incidence of ischemic stroke was obtained through the China Disease Surveillance Points (DSP) system and the Health Insurance (HI) database. Cox proportional risk models were used to evaluate the association between SHS exposure and ischemic stroke. RESULTS During 320,678 person-years of follow-up, there were 2059 patients with ischemic stroke observed and the incidence of ischemic stroke was 6.42 per thousand person-years. Participants exposed to SHS daily faced a 21 % higher risk of ischemic stroke (HR = 1.21, 95 %CI: 1.09-1.34) compared to those exposed to SHS less than once a week. Subgroup analyses revealed that daily SHS exposure was linked to heightened risk of ischemic stroke among women, non-employed, and non-weekly tea drinkers. CONCLUSIONS Daily SHS exposure was associated with higher risks of ischemic stroke. Proactive tobacco control strategies are necessary to decrease the risk of ischemic stroke in never smokers.
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Affiliation(s)
- Rumei Lu
- School of Public Health, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, China
| | - Yulu Qin
- Liuzhou Center for Disease Prevention and Control, Liuzhou, Guangxi Zhuang Autonomous Region 545007, China
| | - Changping Xie
- Liuzhou Center for Disease Prevention and Control, Liuzhou, Guangxi Zhuang Autonomous Region 545007, China
| | - Xiaoping Tan
- Liuzhou Center for Disease Prevention and Control, Liuzhou, Guangxi Zhuang Autonomous Region 545007, China
| | - Tingping Zhu
- Liuzhou Center for Disease Prevention and Control, Liuzhou, Guangxi Zhuang Autonomous Region 545007, China
| | - Jinxue Tan
- Liuzhou Center for Disease Prevention and Control, Liuzhou, Guangxi Zhuang Autonomous Region 545007, China
| | - Sisi Wang
- Liuzhou Center for Disease Prevention and Control, Liuzhou, Guangxi Zhuang Autonomous Region 545007, China
| | - Jiajia Liang
- Liuzhou Center for Disease Prevention and Control, Liuzhou, Guangxi Zhuang Autonomous Region 545007, China
| | - Zhongshu Qin
- Liuzhou Center for Disease Prevention and Control, Liuzhou, Guangxi Zhuang Autonomous Region 545007, China
| | - Rong Pan
- Liuzhou Center for Disease Prevention and Control, Liuzhou, Guangxi Zhuang Autonomous Region 545007, China
| | - Pei Pei
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
| | - Dianjianyi Sun
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China; Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Xueyuan Road, Haidian District, Beijing 100191, China
| | - Li Su
- School of Public Health, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, China.
| | - Jian Lan
- Liuzhou Center for Disease Prevention and Control, Liuzhou, Guangxi Zhuang Autonomous Region 545007, China.
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Flor LS, Anderson JA, Ahmad N, Aravkin A, Carr S, Dai X, Gil GF, Hay SI, Malloy MJ, McLaughlin SA, Mullany EC, Murray CJL, O'Connell EM, Okereke C, Sorensen RJD, Whisnant J, Zheng P, Gakidou E. Health effects associated with exposure to secondhand smoke: a Burden of Proof study. Nat Med 2024; 30:149-167. [PMID: 38195750 PMCID: PMC10803272 DOI: 10.1038/s41591-023-02743-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024]
Abstract
Despite a gradual decline in smoking rates over time, exposure to secondhand smoke (SHS) continues to cause harm to nonsmokers, who are disproportionately children and women living in low- and middle-income countries. We comprehensively reviewed the literature published by July 2022 concerning the adverse impacts of SHS exposure on nine health outcomes. Following, we quantified each exposure-response association accounting for various sources of uncertainty and evaluated the strength of the evidence supporting our analyses using the Burden of Proof Risk Function methodology. We found all nine health outcomes to be associated with SHS exposure. We conservatively estimated that SHS increases the risk of ischemic heart disease, stroke, type 2 diabetes and lung cancer by at least around 8%, 5%, 1% and 1%, respectively, with the evidence supporting these harmful associations rated as weak (two stars). The evidence supporting the harmful associations between SHS and otitis media, asthma, lower respiratory infections, breast cancer and chronic obstructive pulmonary disease was weaker (one star). Despite the weak underlying evidence for these associations, our results reinforce the harmful effects of SHS on health and the need to prioritize advancing efforts to reduce active and passive smoking through a combination of public health policies and education initiatives.
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Affiliation(s)
- Luisa S Flor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Jason A Anderson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Noah Ahmad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aleksandr Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Sinclair Carr
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Gabriela F Gil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew J Malloy
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Susan A McLaughlin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erin M O'Connell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chukwuma Okereke
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Reed J D Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joanna Whisnant
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
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Akter S, Islam MR, Rahman MM, Rouyard T, Nsashiyi RS, Hossain F, Nakamura R. Evaluation of Population-Level Tobacco Control Interventions and Health Outcomes: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2322341. [PMID: 37418258 PMCID: PMC10329215 DOI: 10.1001/jamanetworkopen.2023.22341] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/22/2023] [Indexed: 07/08/2023] Open
Abstract
Importance Smoking causes considerable noncommunicable diseases, perinatal morbidity, and mortality. Objective To investigate the associations of population-level tobacco-control policies with health outcomes. Data Sources PubMed, EMBASE, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and EconLit were searched from inception to March 2021 (updated on 1 March 2022). References were manually searched. Study Selection Studies reporting on associations of population-level tobacco control policies with health-related outcomes were included. Data were analyzed from May to July 2022. Data Extraction and Synthesis Data were extracted by 1 investigator and cross-checked by a second investigator. Analyses were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Main Outcomes and Measures The primary outcomes were respiratory system disease (RSD), cardiovascular disease (CVD), cancer, mortality, hospitalization, and health care utilization. The secondary outcomes were adverse birth outcomes, such as low birth weight and preterm birth. Random-effects meta-analysis was used to estimate pooled odds ratios (ORs) and 95% CIs. Results Of 4952 records identified, 144 population-level studies were included in the final analysis; 126 studies (87.5%) were of high or moderate quality. The most frequently reported policies were smoke-free legislation (126 studies), followed by tax or price increases (14 studies), multicomponent tobacco control programs (12 studies), and a minimum cigarette purchase age law (1 study). Smoke-free legislation was associated with decreased risk of all CVD events (OR, 0.90; 95% CI, 0.86-0.94), RSD events (OR, 0.83; 95% CI, 0.72-0.96), hospitalization due to CVD or RSD (OR, 0.91; 95% CI, 0.87-0.95), and adverse birth outcomes (OR, 0.94; 95% CI, 0.92-0.96). These associations persisted in all sensitivity and subgroup analyses, except for the country income category, for which a significant reduction was only observed in high-income countries. In meta-analysis, there was no clear association of tax or price increases with adverse health outcomes. However, for the narrative synthesis, all 8 studies reported statistically significant associations between tax increases and decreases in adverse health events. Conclusions and Relevance In this systematic review and meta-analysis, smoke-free legislation was associated with significant reductions in morbidity and mortality related to CVD, RSD, and perinatal outcomes. These findings support the need to accelerate the implementation of smoke-free laws to protect populations against smoking-related harm.
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Affiliation(s)
- Shamima Akter
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Md. Rashedul Islam
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Md. Mizanur Rahman
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Thomas Rouyard
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | | | - Fahima Hossain
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Ryota Nakamura
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
- Graduate School of Economics, Hitotsubashi University, Tokyo, Japan
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Lax MB, Zoeckler JM. Occupational Disease in New York State: An Update. New Solut 2023; 32:304-323. [PMID: 36799954 DOI: 10.1177/10482911231152896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
An assessment of occupational disease in New York State was undertaken that partially replicated and expanded earlier work from 1987. Utilizing an expanded conception of occupational disease, the assessment used a variety of data sources and methods to provide estimates of mortality and morbidity of occupational disease; workers exposed to specific workplace hazards; disparities in occupational disease among racial/ethnic groups and gender; costs and distribution of costs of occupational disease; and accessible occupational medical resources. Examples of the pathways work may impact health in some of the major health issues of current import including stress-related health conditions; substance use; and overweight/obesity were included. The report contains recommendations for addressing the problem of occupational disease in New York State and advocates for the convening of a statewide group to develop an occupational disease prevention agenda.
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Affiliation(s)
- Michael B Lax
- Occupational Health Clinical Center, Department of Family Medicine State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Jeanette M Zoeckler
- Occupational Health Clinical Center, Department of Family Medicine State University of New York Upstate Medical University, Syracuse, NY, USA
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Yizengaw MA, Chemeda K, Kumela K, Tesfaye BT. In-hospital outcomes of patients with a hypertensive emergency at a medical center, Ethiopia: A prospective observational study. Health Sci Rep 2022; 5:e845. [PMID: 36189406 PMCID: PMC9498224 DOI: 10.1002/hsr2.845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 12/01/2022] Open
Abstract
Background Hypertensive emergency is associated with substantial complications and loss of life across the world. Early identification and treatment of hypertensive emergency complications are critical to prevent or avoid any consequences. Despite this, in Ethiopia, studies addressing mortality rate and its predictors as well as complications of hypertensive emergency are limited. Aims This study aim to evaluate in-hospital mortality of patients admitted with a hypertensive emergency at the emergency ward of Jimma Medical Center. Methods A consecutive sample of 140 adult (≥18 years of age) patients with a hypertensive emergency were recruited from September 1, 2020 to February 25, 2021 at Jimma Medical Center, Ethiopia and were followed up from admission to discharge/death. Patients who declined to participate and readmitted during the study period were excluded. To assess factors associated with in-hospital mortality, bivariate and multivariate Cox regression analyses were performed. A p value of less than 0.05 was used to declare the statistical significance. Results Over three-fourths of the study participants, that is, 108 (77.1%), were males with a mean (±standard deviation) age of 52.8 ± 13.6 years. Hemorrhagic stroke, 53 (38.0%), and acute kidney injury, 38 (27.1%), were the most common complications of hypertensive emergency. The average (±standard deviation) length of stay in the hospital was 8.53 ± 3.61 days. During in-hospital follow-up, 16 patients (11.4%, 95% confidence interval: 6.7-17.9) died. Multivariate Cox regression analysis showed that there was a significant relationship between patients not doing regular physical exercise before the current admission (adjusted hazard ratio = 4.629, 95% confidence interval: 1.171-18.294, p = 0.015) and in-hospital mortality. Conclusion More than one-tenth of patients with hypertensive emergency death was recorded at Jimma Medical Center. The frequent complications of hypertensive emergency were hemorrhagic stroke and acute renal injury. Not doing regular physical exercise before the current admission raises the likelihood of in-hospital death. Therefore, strengthening and encouraging patients to perform regular physical exercise is imperative.
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Affiliation(s)
- Mengist Awoke Yizengaw
- Department of Clinical Pharmacy, School of Pharmacy, Institute of HealthJimma UniversityJimmaEthiopia
| | - Kisi Chemeda
- Department of PharmacyJimma Medical CenterJimmaEthiopia
| | - Kabaye Kumela
- Department of Clinical Pharmacy, School of Pharmacy, Institute of HealthJimma UniversityJimmaEthiopia
| | - Behailu Terefe Tesfaye
- Department of Clinical Pharmacy, School of Pharmacy, Institute of HealthJimma UniversityJimmaEthiopia
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Sifat AE, Nozohouri S, Archie SR, Chowdhury EA, Abbruscato TJ. Brain Energy Metabolism in Ischemic Stroke: Effects of Smoking and Diabetes. Int J Mol Sci 2022; 23:ijms23158512. [PMID: 35955647 PMCID: PMC9369264 DOI: 10.3390/ijms23158512] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 02/06/2023] Open
Abstract
Proper regulation of energy metabolism in the brain is crucial for maintaining brain activity in physiological and different pathophysiological conditions. Ischemic stroke has a complex pathophysiology which includes perturbations in the brain energy metabolism processes which can contribute to worsening of brain injury and stroke outcome. Smoking and diabetes are common risk factors and comorbid conditions for ischemic stroke which have also been associated with disruptions in brain energy metabolism. Simultaneous presence of these conditions may further alter energy metabolism in the brain leading to a poor clinical prognosis after an ischemic stroke event. In this review, we discuss the possible effects of smoking and/or diabetes on brain glucose utilization and mitochondrial energy metabolism which, when present concurrently, may exacerbate energy metabolism in the ischemic brain. More research is needed to investigate brain glucose utilization and mitochondrial oxidative metabolism in ischemic stroke in the presence of smoking and/or diabetes, which would provide further insights on the pathophysiology of these comorbid conditions and facilitate the development of therapeutic interventions.
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Hashemi-Aghdam MR, Shafiee G, Ebrahimi M, Ejtahed HS, Yaseri M, Motlagh ME, Qorbani M, Heshmat R, Kelishadi R. Trend of passive smoking and associated factors in Iranian children and adolescents: the CASPIAN studies. BMC Public Health 2022; 22:603. [PMID: 35351076 PMCID: PMC8962519 DOI: 10.1186/s12889-022-13045-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 03/22/2022] [Indexed: 01/19/2023] Open
Abstract
Background It is well documented that, similar to active smokers, passive smokers are also at an increased risk of developing non-communicable diseases, and it could impose high financial costs on the healthcare system. This study aimed to evaluate the trend of passive smoking and related determinants during the three phases of a school-based surveillance program. Methods This is a secondary study using the national data obtained from three phases of the surveillance program entitled The Childhood and Adolescence Surveillance and Prevention of Adult Noncommunicable Disease (CASPIAN) study, conducted from 2008 to 2014 on Iranian children and adolescents living in urban and rural areas of 30 provinces in Iran. Participants were selected by cluster multistage sampling method. Results Overall, the study participants consisted of 33,288 students (50.5% boys) with a mean (± SD) age of 12.8 ± 3.2 years. The passive smoking rate was significantly increased from 35.6% in 2008 to 43.2% in 2015 among children and adolescents. According to the multivariate logistic regression, father’s university education, mother’s employment, life satisfaction, and socioeconomic status had a protective role regarding second-hand smoke exposure. In contrast, the father’s self-employment had a positive role in increasing the rate of passive smoking. Conclusion Considering the increasing trend of passive smoking and its considerable adverse health effects, it is necessary to implement large-scale public interventions to reduce the rate and hazards of exposure to tobacco smoke.
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Brust JC. Stroke and Substance Abuse. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rates, Predictors, and Impact of Smoking Cessation after Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2021; 30:106012. [PMID: 34330020 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/12/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Smoking cessation after a first cardiovascular event reduces the risk of recurrent vascular events and mortality. This systematic review and meta-analysis aimed to summarize data on the rates, predictors, and the impact of smoking cessation in patients after a stroke or transient ischemic attack (TIA). METHODS MEDLINE, EMBASE and Web of Science were searched to identify all published studies providing relevant data through May 20, 2021. Random-effects meta-analysis method was used to pool proportions. Some findings were summarized narratively. RESULTS Twenty-five studies were included. The pooled smoking cessation rates were 51.0% (8 studies, n = 1738) at 3 months, 44.4% (7 studies, n = 1920) at 6 months, 43.7% (12 studies, n = 1604) at 12 months, and 49.8% (8 studies, n = 2549) at 24 months or more of follow-up. Increased disability and intensive smoking cessation support programs were associated with a higher likelihood of smoking cessation, whereas alcohol consumption and depression had an inverse effect. Two studies showed that patients who quit smoking after a stroke or a TIA had substantially lower risk of recurrent stroke, death, and a composite of stroke, myocardial infarction, and death. CONCLUSION Smoking cessation in stroke survivors is associated with reduced recurrent vascular events and death. About half of smokers who experience a stroke or a TIA stop smoking afterwards. Those with low post-stroke disability, who consume alcohol, or have depression are less likely to quit. Intensive support programs can increase the likelihood of smoking cessation.
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Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC, Turan TN, Williams LS. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke 2021; 52:e364-e467. [PMID: 34024117 DOI: 10.1161/str.0000000000000375] [Citation(s) in RCA: 1236] [Impact Index Per Article: 412.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Azarpazhooh MR, Bogiatzi C, Spence JD. Stroke Prevention: Little-Known and Neglected Aspects. Cerebrovasc Dis 2021; 50:622-635. [PMID: 34044404 DOI: 10.1159/000515829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Abstract
Combining available therapies has the potential to reduce the risk of stroke by 80% or more. A comprehensive review of all aspects of stroke prevention would be very lengthy; in this narrative review, we focus on some aspects of stroke prevention that are little-known and/or neglected. These include the following: (1) implementation of a Mediterranean diet; (2) B vitamins to lower homocysteine; (3) coordinated approaches to smoking cessation; (4) intensive lipid-lowering therapy; (5) lipid lowering in the elderly; (6) physiologically individualized therapy for hypertension based on renin/aldosterone phenotyping; (7) avoiding excessive blood pressure reduction in patients with stiff arteries; (8) treatment of insulin resistance with pioglitazone in stroke patients with prediabetes and diabetes; (9) impaired activation of clopidogrel in patients with variants of CYP2C19; (10) aspirin pseudoresistance due to enteric coating; (11) rationale for anticoagulation in patients with embolic stroke of unknown source; (12) pharmacologic properties of direct-acting oral anticoagulants that should be considered when choosing among them; (13) the identification of which patients with asymptomatic carotid stenosis are at a high enough risk to benefit from carotid endarterectomy or stenting; and (14) the importance of age in choosing between endarterectomy and stenting. Stroke prevention could be improved by better recognition of these issues and by implementation of the principles derived from them.
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Affiliation(s)
- M Reza Azarpazhooh
- Division of Neurology and Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Chrysi Bogiatzi
- Department of Neurology, McMaster University, Hamilton, Ontario, Canada
| | - J David Spence
- Stroke Prevention & Atherosclerosis Research Center, Robarts Research Institute, Western University, London, Ontario, Canada
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Preoperative Dependent Functional Status Is Associated With Poor Outcomes After Carotid Endarterectomy and Carotid Stenting in Both Symptomatic and Asymptomatic Patients. Ann Vasc Surg 2021; 76:114-127. [PMID: 34004321 DOI: 10.1016/j.avsg.2021.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/17/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Both Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the most common procedures to treat patients with symptomatic, and asymptomatic high-grade carotid stenosis. Poor preoperative functional status (FS) is increasingly being recognized as predictor for postoperative outcomes. The purpose of this study is to determine the impact of preoperative functional status on the outcomes of patients who undergo CEA or CAS. METHODS Data was obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from the years 2011-2018. All patients in the database who underwent CEA or CAS during this time period were identified. Patients were then further divided into 2 subgroups: FS-Independent and FS-dependent. Bivariate and multivariate analyses was performed for pre, intra and post-operative variables with functional status. Outcomes for treatment of symptomatic carotid disease were compared to those with asymptomatic disease among the cohort of functionally dependent patients. RESULTS A total of 27,163 patients (61.2% Males, 38.8% Females) underwent CEA (n = 26,043) or CAS (n = 1,120) from 2011-2018. Overall, primary outcomes were as follows: mortality 0.77% (n = 210) and stroke 1.87% (n = 507).Risk adjusted multivariate analysis showed that FS-D patients undergoing CEA had higher mortality (AOR 3.06, CI 1.90-4.92, P < 0.001), longer operative times (AOR 1.36, CI 1.17-1.58, P< 0.001) higher incidence of unplanned reoperation (AOR 1.68, CI 1.19-2.37, P = 0.003), postoperative pneumonia (AOR 5.43, CI 1.62 - 18.11, P = 0.006) and ≥3 day LOS (AOR 3.05, CI 2.62-3.56, P < 0.001) as compared to FS-I patients. FS-D patients undergoing CAS had higher incidence of postoperative pneumonia (AOR 20.81, CI 1.66-261.54, P = 0.019) and higher incidence of LOS ≥3 days (AOR 2.18, CI 1.21-3.93, P < .01) as compared to FS-I patients. Survival analysis showed that the best 30-day survival was observed in FS-I patients undergoing CEA, followed by FS-I patients undergoing CAS, followed by FS-D patients undergoing CEA, followed by FS-D patients undergoing CAS. FS-D status increased mortality after CEA by 2.11%. When the outcomes of CAS and CEA were compared to each other for the cohort of FS-D patients, CAS was associated with higher incidence of stroke (AOR 3.46, CI 0.32-1.97, P= 0.046), shorter operative times (AOR 0.25, CI 0.12-0.52, P < 0.001) and higher incidence of pneumonia (AOR 11.29, CI 1.32-96.74, P = 0.027). Symptomatic patients undergoing CEA had higher LOS as compared to symptomatic patients undergoing CAS, and asymptomatic patients undergoing CEA or CAS. CONCLUSIONS FS-D patients, undergoing CEA have higher mortality as compared to FS-I patients undergoing CAS. FS-D patients undergoing CAS have higher incidence of postoperative pneumonia and longer LOS as compared to FS-I patients. For the cohort of FS-D patients undergoing either CEA or CAS, CAS was associated with higher risk of stroke and reduced operative times. Risk benefit ratio for any carotid intervention should be carefully assessed before offering it to FS-D patients. Preoperative Dependent Functional Status Is Associated with Poor Outcomes After Carotid Endarterectomy and Carotid Stenting in Both Symptomatic and Asymptomatic Patients.
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Sex, Knowledge, and Attitude of Stroke Survivors Attending Bebe Herbal Center on Risk Factors before and after Stroke. Stroke Res Treat 2021; 2021:6695522. [PMID: 34007438 PMCID: PMC8102117 DOI: 10.1155/2021/6695522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/23/2021] [Accepted: 04/22/2021] [Indexed: 12/26/2022] Open
Abstract
Objective The objective of this study was to investigate the extent stroke survivors who attended an herbal center knew of stroke risk factors and whether significant sex differences existed. Study Design. This was a cross-sectional study conducted from January to June 2018 at Bebe Herbal Center, and it involved two well-trained assistants who interviewed 149 first-time stroke survivors after consent and ethical approval were obtained. The survivors self-reported their knowledge, attitude, and beliefs on risk factors before and after stroke. Statistical Analyses. Means of continuous variables were compared using Student's unpaired t-test, while categorical variables between males and the females were analyzed using Pearson's chi-square test. P < 0.05 was taken as significant. Results Mean age of men (64.81 ± 1.24 yrs) was significantly higher than that of women (61.39 ± 1.42 yrs) (F = 0.096, t = 1.79, df = 147; P < 0.05). More men than women were 60 years and above while more women than men were below 60 years. Pearson's chi-square test showed significant association of sex with education (χ2 = 12.31; df = 3, P < 0.006), occupation (χ2 = 23.65; df = 4, P < 0.001), alcohol intake (χ2 = 24.23; df = 1; P < 0.001), and smoking (χ2 = 9.823; df = 1; P < 0.001). The commonest risk factor suffered was hypertension (73.1%), followed by alcohol intake (59.1%), smoking (31.5%), and diabetes mellitus (26.7%); these affected men more than women. Male survivors unaware of their hypertensive status were more likely to have stroke than females, and age had a significant effect on the likelihood of developing a stroke; the same was occupation. Conclusions These survivors suffered mainly from hypertension, triggered by psychosocial problems and diabetes mellitus; their stroke seemed fueled by unrecognized hypertension, unrecognized diabetes mellitus, ignorance of hyperlipidemia, and wide-scale belief in witchcraft as risk factor. Awareness programs in the third world should take these observations into consideration.
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15
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Haung Z, Hong SA, Tejativaddhana P, Puckpinyo A, Myint MNHA. Multiple self-care behaviors and associated factors in community-dwelling patients with hypertension in Myanmar. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:363-376. [PMID: 32581415 PMCID: PMC7276404 DOI: 10.18999/nagjms.82.2.363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study aimed to identify the prevalence of self-care behaviors and the associated factors among hypertensive patients in primary care in Myanmar. This cross-sectional study was conducted from April to May 2019 among 410 hypertensive patients in Myitkyina Township, Kachin State, Myanmar. Hypertensive patients aged 30–70 years old and being registered at the community health centers in Myitkyina Township were selected using multi-stage cluster random sampling. Self-care behaviors were measured by Hypertensive Self-Care Activity Level Effect (H-SCALE). Chi-square test and multiple logistic regression analysis were used to explore the associated factors. Prevalence of adherence to multiple self-care behaviors were low: avoidance of tobacco use at 50.2%, followed by physical activity at 24.9%, medication at 24.1%, weight management at 9.5%, and healthy diet at 2.7%, while abstinence from harmful alcohol drinking was high at 97.8%. Multiple logistic regression analysis indicated that younger patients, low family income, inadequate knowledge, and no comorbidity were associated with non-adherence to medication. Living in rural area and having poor self-efficacy were associated with non-adherence to weight management, while being younger, female and having poor self-efficacy were also associated with non-adherence to physical activity. Compared with Kachin, other ethnics were more likely to be non-adherent to avoidance of tobacco use. Although a majority of respondents were not harmful drinkers, adherence to medication, healthy diet, physical activity, weight management and avoidance of tobacco use were very low. Health practitioners should provide education programs for hypertensive patients to direct them towards practical techniques in managing their blood pressure.
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Affiliation(s)
- Ze Haung
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand.,Township Department of Public Health, Myitkyina, Myanmar
| | - Seo Ah Hong
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
| | | | - Apa Puckpinyo
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
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Klein AP, Yarbrough K, Cole JW. Stroke, Smoking and Vaping: The No-Good, the Bad and the Ugly. ANNALS OF PUBLIC HEALTH AND RESEARCH 2021; 8:1104. [PMID: 34322688 PMCID: PMC8315328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Both stroke and smoking continue to be major public health crises in the United States, with stroke being the third and fourth leading cause of death among women and men, respectively. The goal of this review will be to provide clinicians a succinct overview regarding the epidemiology, economics, and biology of stroke in the setting of smoking and electronic cigarette use. Special attention will be given to the escalating public health crisis of electronic cigarette use, emphasizing mechanistic relationships of stroke and lung injury. Readers will be made aware of the need for continued scientific advancement and study regarding these relationships, as well as the need for improved governmental and public health efforts to curb these ongoing public health crises.
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Affiliation(s)
- Adam P Klein
- Department of Neurology, University of Maryland School of Medicine, USA
| | - Karen Yarbrough
- Department of Neurology, University of Maryland School of Medicine, USA
| | - John W Cole
- Department of Neurology, Veterans Affairs Maryland Health Care System and the University of Maryland School of Medicine, USA
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Abstract
Patients with asymptomatic carotid stenosis (ACS) are at very high risk of coronary events, so they should all receive intensive medical therapy. What is often accepted as “best medical therapy” is usually suboptimal. Truly intensive medical therapy includes lifestyle modification, particularly smoking cessation and a Mediterranean diet. All patients with ACS should receive intensive lipid-lowering therapy, should have their blood pressure well controlled, and should receive B vitamins for lowering of plasma total homocysteine (tHcy) if levels are high; a commonly missed cause of elevated tHcy is metabolic B12 deficiency, which should be diagnosed and treated. Most patients with ACS would be better treated with intensive medical therapy than with either carotid endarterectomy (CEA) or stenting (CAS). A process called “treating arteries instead of treating risk factors” markedly reduced the risk of ACS in an observational study; a randomized trial vs. usual care should be carried out. The few patients with ACS who could benefit (~15%, or perhaps more if recent evidence regarding the risk of intraplaque hemorrhage is borne out) can be identified by a number of features. These include microemboli on transcranial Doppler, intraplaque hemorrhage, reduced cerebrovascular reserve, and echolucency of plaques, particularly “juxtaluminal black plaque”. No patient should be subjected to CAS or CEA without evidence of high-risk features, because in most cases the 1-year risk of stroke or death with intervention is higher with either CEA (~2%) or CAS (~4%) than with intensive medical therapy (~0.5%). Most patients, particularly the elderly, would be better treated with CEA than CAS. Most strokes can be prevented in patients with ACS, but truly intensive medical therapy is required.
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Affiliation(s)
- J David Spence
- Neurology & Clinical Pharmacology, Western University, London, ON, Canada.,Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, London, ON, Canada
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18
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Gonzalez JE, Cooke WH. Acute effects of electronic cigarettes on arterial pressure and peripheral sympathetic activity in young nonsmokers. Am J Physiol Heart Circ Physiol 2020; 320:H248-H255. [PMID: 33164580 DOI: 10.1152/ajpheart.00448.2020] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Electronic cigarettes (e-cigarettes) are marketed as an alternative to smoking for those who want to decrease the health risks of tobacco. Tobacco cigarettes increase heart rate (HR) and arterial pressure, while reducing muscle sympathetic nerve activity (MSNA) through sympathetic baroreflex inhibition. The acute effects of e-cigarettes on arterial pressure and MSNA have not been reported: our purpose was to clarify this issue. Using a randomized crossover design, participants inhaled on a JUUL e-cigarette containing nicotine (59 mg/mL) and a similar placebo e-cigarette (0 mg/mL). Experiments were separated by ∼1 mo. We recorded baseline ECG, finger arterial pressure (n = 15), and MSNA (n = 10). Subjects rested for 10 min (BASE) and then inhaled once every 30 s on an e-cigarette that contained nicotine or placebo (VAPE) for 10 min followed by a 10-min recovery (REC). Data were expressed as Δ means ± SE from BASE. Heart rate increased in the nicotine condition during VAPE and returned to BASE values in REC (5.0 ± 1.3 beats/min nicotine vs. 0.1 ± 0.8 beats/min placebo, during VAPE; P < 0.01). Mean arterial pressure increased in the nicotine condition during VAPE and remained elevated during REC (6.5 ± 1.6 mmHg nicotine vs. 2.6 ± 1 mmHg placebo, during VAPE and 4.6.0 ± 1.7 mmHg nicotine vs. 1.4 ± 1.4 mmHg placebo, during REC; P < 0.05). MSNA decreased from BASE to VAPE and did not restore during REC (-7.1 ± 1.6 bursts/min nicotine vs. 2.6 ± 2 bursts/min placebo, during VAPE and -5.8 ± 1.7 bursts/min nicotine vs. 0.5 ± 1.4 bursts/min placebo, during REC; P < 0.05). Our results show that acute e-cigarette usage increases mean arterial pressure leading to a baroreflex-mediated inhibition of MSNA.NEW & NOTEWORTHY The JUUL e-cigarette is the most popular e-cigarette in the market. In the present study, inhaling on a JUUL e-cigarette increased mean arterial pressure and heart rate, and decreased muscle sympathetic nerve activity (MSNA). In contrast, inhaling on a placebo e-cigarette without nicotine elicited no sympathomimetic effects. Although previous tobacco cigarette studies have demonstrated increased mean arterial pressure and MSNA inhibition, ours is the first study to report similar responses while inhaling on an e-cigarette. Listen to this article's corresponding podcast at @ https://ajpheart.podbean.com/e/aerosolized-nicotine-and-cardiovascular-control/.
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Affiliation(s)
- Joshua E Gonzalez
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
| | - William H Cooke
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
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19
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Skipina TM, Soliman EZ, Upadhya B. Association between secondhand smoke exposure and hypertension: nearly as large as smoking. J Hypertens 2020; 38:1899-1908. [PMID: 32890262 DOI: 10.1097/hjh.0000000000002478] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: Active smoking is a widely accepted risk factor for cardiovascular disease and is recognized as a major public health problem. Passive smoking, also known as secondhand smoke exposure (SHSE), is thought to have similar cardiovascular consequences and the risk has been postulated to be equivalent to that of active smoking. A major component of this risk involves the connection with chronic hypertension. There are several population-based observational studies investigating the relationship between SHSE and chronic hypertension, all of which demonstrate a positive association. Given that SHSE appears to be a risk factor for chronic hypertension, SHSE should also be a risk factor for hypertensive end-organ disease. Many studies have sought to investigate this relationship, but this has yet to be fully elucidated. In this review, we focus on the current evidence regarding the association between SHSE and hypertension as well as exploration of the links between SHSE and hypertensive end-organ damage.
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Affiliation(s)
- Travis M Skipina
- Cardiovascular Medicine Section, Department of Internal Medicine
| | - Elsayed Z Soliman
- Cardiovascular Medicine Section, Department of Internal Medicine
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Bharathi Upadhya
- Cardiovascular Medicine Section, Department of Internal Medicine
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20
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Oshunbade AA, Yimer WK, Valle KA, Clark D, Kamimura D, White WB, DeFilippis AP, Blaha MJ, Benjamin EJ, O'Brien EC, Mentz RJ, Fox ER, O'Mara CS, Butler J, Correa A, Hall ME. Cigarette Smoking and Incident Stroke in Blacks of the Jackson Heart Study. J Am Heart Assoc 2020; 9:e014990. [PMID: 32517526 PMCID: PMC7429065 DOI: 10.1161/jaha.119.014990] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Blacks are disproportionately affected by stroke compared with whites; however, less is known about the relationship between stroke and cigarette smoking in blacks. Therefore, we evaluated the relationship between cigarette smoking and all incident stroke in the JHS (Jackson Heart Study). Methods and Results JHS participants without a history of stroke (n=4410) were classified by self-reported baseline smoking status into current, past (smoked at least 400 cigarettes/life), or never smokers at baseline (2000-2004). Current smokers were further classified by smoking intensity (number of cigarettes smoked per day [1-19 and ≥20]) and followed up for incident stroke (through 2015). Hazard ratios (HRs) for incident stroke for current and past smoking compared with never smoking were estimated with adjusted Cox proportional hazard regression models. After adjusting for cardiovascular risk factors, the risk for stroke in current smokers was significantly higher compared with never smokers (HR, 2.48; 95% CI, 1.60-3.83) but there was no significant difference between past smokers and never smokers (HR, 1.10; 95% CI, 0.74-1.64). There was a dose-dependent increased risk of stroke with smoking intensity (HR, 2.28 [95% CI, 1.38-3.86] and HR, 2.78 [95% CI, 1.47-5.28] for current smokers smoking 1-19 and ≥20 cigarettes/day, respectively). Conclusions In a large cohort of blacks, current cigarette smoking was associated with a dose-dependent higher risk of all stroke. In addition, past smokers did not have a significantly increased risk of all stroke compared with never smokers, which suggests that smoking cessation may have potential benefits in reducing the incidence of stroke in blacks.
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Affiliation(s)
- Adebamike A Oshunbade
- Division of Cardiology Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Wondwosen K Yimer
- Department of Data Sciences University of Mississippi Medical Center Jackson MS
| | - Karen A Valle
- Department of Data Sciences University of Mississippi Medical Center Jackson MS
| | - Donald Clark
- Division of Cardiology Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Daisuke Kamimura
- Division of Cardiology Department of Medicine University of Mississippi Medical Center Jackson MS.,Department of Medical Science and Cardiorenal Medicine Yokohama City University Graduate School of Medicine Yokohama Japan
| | | | | | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease Baltimore MD
| | - Emelia J Benjamin
- Department of Medicine Boston University School of Medicine Boston MA.,Department of Epidemiology Boston University School of Public Health Boston MA
| | - Emily C O'Brien
- Duke University Medical Center Duke Clinical Research Institute Durham NC
| | - Robert J Mentz
- Duke University Medical Center Duke Clinical Research Institute Durham NC
| | - Ervin R Fox
- Division of Cardiology Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Charles S O'Mara
- Division of Vascular Surgery Department of Surgery University of Mississippi Medical Center Jackson MS
| | - Javed Butler
- Division of Cardiology Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Adolfo Correa
- Division of Cardiology Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Michael E Hall
- Division of Cardiology Department of Medicine University of Mississippi Medical Center Jackson MS
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21
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Haghani A, Arpawong TE, Kim JK, Lewinger JP, Finch CE, Crimmins E. Female vulnerability to the effects of smoking on health outcomes in older people. PLoS One 2020; 15:e0234015. [PMID: 32497122 PMCID: PMC7272024 DOI: 10.1371/journal.pone.0234015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022] Open
Abstract
Cigarette smoking is among the leading risk factors for mortality and morbidity. While men have a higher smoking prevalence, mechanistic experiments suggest that women are at higher risk for health problems due to smoking. Moreover, the comparison of smoking effects on multiple conditions and mortality for men and women has not yet been done in a population-based group with race/ethnic diversity. We used proportional hazards models and restricted mean survival time to assess differences in smoking effects by sex for multiple health outcomes using data from the U.S. Health and Retirement Study (HRS), a population-representative cohort of individuals aged 50+ (n = 22,708, 1992-2014). Men had experienced more smoking pack-years than women (22.0 vs 15.6 average pack-years). Age of death, onset of lung disorders, heart disease, stroke, and cancer showed dose-dependent effects of smoking for both sexes. Among heavy smokers (>28 pack-years) women had higher risk of earlier age of death (HR = 1.3, 95%CI:1.03-1.65) and stroke (HR = 1.37, 95%CI:1.02-1.83). Risk of cancer and heart disease did not differ by sex for smokers. Women had earlier age of onset for lung disorders (HR = 2.83, 95%CI:1.74-4.6), but men risk due to smoking were higher (Smoking-Sex interaction P<0.02) than women. Passive smoke exposure increased risk of earlier heart disease (HR = 1.33, 95%CI:1.07-1.65) and stroke (HR:1.54, 95%CI:1.07-2.22) for non-smokers, mainly in men. Smoking cessation after 15 years partially attenuated the deleterious smoking effects for all health outcomes. In sum, our results suggest that women are more vulnerable to ever smoking for earlier death and risk of stroke, but less vulnerable for lung disorders. From an epidemiological perspective, sex differences in smoking effects are important considerations that could underlie sex differences in health outcomes. These findings also encourage future mechanistic experiments to resolve potential mechanisms of sex-specific cigarette smoke toxicity.
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Affiliation(s)
- Amin Haghani
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Thalida Em Arpawong
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Jung Ki Kim
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Juan Pablo Lewinger
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Caleb E. Finch
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Eileen Crimmins
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
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22
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Patel R, Chauhan S. Gender differential in health care utilisation in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Cao L, Lindstedt I, Edvinsson ML, Ping NN, Cao YX, Edvinsson L. Secondhand cigarette smoke induces increased expression of contractile endothelin receptors in rat coronary arteries via a MEK1/2 sensitive mechanism. SCAND CARDIOVASC J 2020; 55:50-55. [PMID: 32400208 DOI: 10.1080/14017431.2020.1762916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Cigarette smoke, a strong risk factor for cardiovascular diseases, upregulates contractile endothelin (ET) receptors in coronary arteries. The present study examined the effects of second hand cigarette smoke exposure on the contractile endothelin receptors and the role of the MEK1/2 pathway in rat coronary arteries. Design: Rats were exposed to secondhand smoke (SHS) for 8 weeks followed by intraperitoneal injection of a MEK1/2 inhibitor, U0126 daily for another 4 weeks. Contractile responses of isolated coronary arteries were recorded by a sensitive wire myograph. The receptor protein expression levels were examined by Western blotting. Results: The results showed that SHS in vivo caused increased expression of ET receptors ETA and ETB, and that the MEK1/2 blocker U0126 significantly reversed SHS exposure-increased ETA-mediated contractile responses and protein levels. Similar alterations were observed in ETB receptors. U0126 showed dose-dependent effects on SHS-induced response on contractile property and protein levels of the ETB receptor. However, only the higher dose U0126 (15 mg/kg) had inhibitory effects on the ETA receptor. Conclusions: Taken together, our data show that SHS increases contractile ET receptors and MEK1/2 pathway inhibitor offsets SHS exposure-induced ETA and ETB receptor upregulation in rat coronary arteries.
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Affiliation(s)
- Lei Cao
- Division of Experimental Vascular Research, Institute of Clinical Sciences in Lund, Lund University, Lund, Sweden.,Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Isak Lindstedt
- Division of Experimental Vascular Research, Institute of Clinical Sciences in Lund, Lund University, Lund, Sweden
| | - Marie-Louise Edvinsson
- Division of Experimental Vascular Research, Institute of Clinical Sciences in Lund, Lund University, Lund, Sweden
| | - Na-Na Ping
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Yong-Xiao Cao
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Lars Edvinsson
- Division of Experimental Vascular Research, Institute of Clinical Sciences in Lund, Lund University, Lund, Sweden
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Zhu B, Chen D, Jin C, Song P, Li F. Improved treatment capacity and quality of care: the effectiveness of the stroke prevention and treatment system in Shanghai, China from 2012-2017. Glob Health Med 2020; 2:3-8. [PMID: 33330767 DOI: 10.35772/ghm.2020.01006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/09/2020] [Accepted: 02/19/2020] [Indexed: 11/08/2022]
Abstract
Because of the high mortality, recurrence, and rate of disability of stroke, a stroke prevention and treatment system was instituted in Shanghai in 2012; this system includes 11 municipal hospitals, 25 district hospitals, and 240 community health centers. Community health centers focus on early screening in the community, health management of high-risk individuals, and secondary prevention and rehabilitation of stroke patients. Residents' health profiles are utilized by community health centers to proactively identify the population at higher risk. District hospitals are responsible for screening for vascular lesions in high-risk individuals, including carotid artery and intracranial artery screening, and standardized treatment of stroke patients. Municipal hospitals concentrate on complex and emergency care for acute onset stroke. The system specifies care for all stages of stroke management. The development of the system has improved the capacity of and quality of care for stroke patients. The rate at which patients undergo intravenous thrombolysis and the percentage of patients with a door-to-needle time of less than 60 minutes have increased significantly. However, the primary and secondary prevention of stroke is insufficient, the stroke rehabilitation system is incomplete, and the quality of care in primary healthcare facilities is limited. An evaluation system and payment mechanisms are needed to incentivize healthcare personnel to fulfill their responsibilities and to ensure the system's operation.
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Affiliation(s)
- Bifan Zhu
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China
| | - Duo Chen
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China
| | - Chunlin Jin
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China
| | - Peipei Song
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China.,Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Fen Li
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China
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Scutelnic A, Streit S, Sarikaya H, Jung S, Heldner MR. [Primary Prevention of Acute Stroke]. PRAXIS 2020; 109:277-289. [PMID: 32183656 DOI: 10.1024/1661-8157/a003395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Primary Prevention of Acute Stroke Abstract. Strokes are frequent. Vascular risk factors are increasing the stroke risk. Most vascular risk factors are treatable. Their therapy is important in the primary prevention of stroke. According to the INTERSTROKE study, arterial hypertension, inactivity, overweight, dyslipidemia, smoking, unhealthy diet, cardiac pathologies such as major arrhythmia, diabetes mellitus, stress/depression and overconsumption of alcohol are the most important treatable vascular risk factors. In this article, we will also report on at present less well known treatable vascular risk factors such as sleep apnea, atheromatosis of the aortic arch and of arteries supplying the brain, migraine with aura and chronic inflammatory disorders and infections.
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Affiliation(s)
- Adrian Scutelnic
- Departement für Neurologie, Inselspital, Universitätsspital und Universität Bern, Bern
| | - Sven Streit
- Berner Institut für Hausarztmedizin (BIHAM), Inselspital, Universitätsspital und Universität Bern, Bern
| | - Hakan Sarikaya
- Departement für Neurologie, Inselspital, Universitätsspital und Universität Bern, Bern
| | - Simon Jung
- Departement für Neurologie, Inselspital, Universitätsspital und Universität Bern, Bern
| | - Mirjam R Heldner
- Departement für Neurologie, Inselspital, Universitätsspital und Universität Bern, Bern
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Pistilli M, Howard VJ, Safford MM, Lee BK, Lovasi GS, Cushman M, Malek AM, McClure LA. Association of secondhand tobacco smoke exposure during childhood on adult cardiovascular disease risk among never-smokers. Ann Epidemiol 2019; 32:28-34.e1. [PMID: 30799203 PMCID: PMC6441374 DOI: 10.1016/j.annepidem.2019.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/11/2018] [Accepted: 01/25/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Adult secondhand tobacco smoke (SHS) exposure is related to stroke and coronary heart disease (CHD) risk, but long-term effects are less clear. We evaluated whether childhood SHS exposure affects subsequent stroke or CHD risk among adult black and white never-smokers followed for stroke and CHD. METHODS In this prospective cohort study, inverse probability weights were calculated to correct for bias due to attrition and survey nonresponse. Cox proportional hazards models were used to assess hazard ratios and 95% confidence intervals for stroke or CHD, separately, by number of childhood household smokers. RESULTS Of 13,142 eligible participants, 6136 had childhood SHS exposure assessed. Baseline mean (SD) age was 63.5 (9.0), 65% were female, 30% black, 46% reported 0 childhood household smokers, 36% reported 1, and 18% reported 2+. In 60,649 person-years, 174 strokes were observed (2.9% of participants), and in 45,195 person-years, 114 CHD events were observed (2.1% of participants). The weighted and adjusted hazard ratios (95% confidence intervals) of stroke for 2+ versus 0 childhood household smokers was 1.66 (1.29-2.13) and was 1.15 (0.82-1.59) for CHD. CONCLUSIONS We observed a significant association between childhood SHS exposure and stroke, but not CHD, after age 45 years and adjusting for missing information.
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Affiliation(s)
- Maxwell Pistilli
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama, Birmingham
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Brian K Lee
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Mary Cushman
- Department of Medicine, College of Medicine, University of Vermont, Burlington
| | - Angela M Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
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Lim HL, Teh CH, Kee CC, Mohd Ghazali S, Pan SA, Lim KH. Exposure to second-hand smoke among secondary school-going adolescents: Findings from the Malaysian Adolescent Health Risk Behaviour (MyAHRB) study. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105818789961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Exposure to second-hand smoke (SHS) is one of the main causes of morbidity and it has been proven to be associated with an increased likelihood of smoking initiation among adolescents. Nonetheless, evidence on SHS exposure among Malaysian adolescents is scarce. Therefore, this article aims to demonstrate the magnitude and factors associated with SHS exposure among school-going adolescents in selected secondary schools in Peninsular Malaysia. Methods: Data were derived from the Malaysian Adolescent Health Risk Behaviour (MyAHRB) study conducted in 2013. A total of 2599 adolescent were recruited into the study using a two-stage proportionate-to-size sampling method. Data were obtained from self-administered questionnaires. Descriptive analysis and multivariable logistic regression were performed to determine the risk factors/predictors associated with SHS. Results: More than half of the respondents had been exposed to SHS during the last one week (56.4%), and SHS exposure was significantly higher among respondents who smoked (94.0% vs. 49.9%, p <0.001). Multivariable analysis revealed that the likelihood of exposure to SHS was higher among those who smoked (adjusted odds ratio (aOR) 12.90, 95% confidence interval (CI): 8.01–20.4), had at least one parent/guardian who smoked (aOR 5.49, 95% CI: 4.41–6.94) and adolescents of Malay descent (aOR 2.10, 95% CI: 1.68–2.63). Conclusion: Our findings suggested that the effectiveness of anti-smoking measures implemented in recent years to protect adolescents from the health risks of passive smoking were less evident. Therefore, educational and awareness programmes that emphasize the negative health impacts of SHS exposure on Malaysian adolescents, particularly when among smoking adults, should be intensified to help in preventing adoption of smoking behaviours among adolescents.
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Affiliation(s)
- Hui Li Lim
- Hospital Sultan Haji Ahmad Shah, Jalan Maran, Malaysia
| | - Chien Huey Teh
- Institute for Medical Research, Ministry of Health, Kuala Lumpur, Malaysia
| | - Chee Cheong Kee
- Institute for Medical Research, Ministry of Health, Kuala Lumpur, Malaysia
| | | | | | - Kuang Hock Lim
- Institute for Medical Research, Ministry of Health, Kuala Lumpur, Malaysia
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Abstract
BACKGROUND Stroke is one of the leading causes of death and disability for adult men and women worldwide, and a number of studies have explored the influences of smoking on stroke. However, few studies have discussed the relationship between stroke and smoking with consideration of the following factors: sex, the number of cigarettes smoked per day, stroke subtype, and the follow-up duration. Consequently, we aimed to extend previous work by using a systematic review to explore the relationship between stroke and cigarette smoking in reference to the above factors. METHODS A systematic review was conducted using the PubMed, Embase, and Cochrane Central Register databases and the following search criteria: ["stroke" (MeSH) and "smoking" (MeSH)]. All analyses were conducted with Stata, and funnel plots and Egger regression asymmetry tests were used to assess publication bias. RESULTS The meta-analysis included 14 studies involving 303134 subjects. According to the meta-analysis, smokers had an overall increased risk of stroke compared with nonsmokers, with a pooled odds ratio (OR) of 1.61 (95% confidence interval [CI]: 1.34-1.93, P < .001). A subgroup analysis conducted based on smoking status revealed ORs of 1.92 (95% CI: 1.49-2.48) for current smokers and 1.30 (95% CI: 0.93-1.81) for former smokers. In addition, the relationship between stroke of any type and smoking status was also statistically significant; current smokers had an increased risk of stoke compared with nonsmokers (OR: 1.46, 95% CI: 1.04-2.07, P < .001), which was influenced by sex (men: OR: 1.54, 95% CI: 1.11-2.13, P = .002; women: OR: 1.88, 95% CI: 1.45-2.44, P < .023). From the analysis, we also observed that passive smoking increased the overall risk of stroke by 45% (OR: 1.45, 95% CI: 1.0-2.11, P < .05). Based on the dose-response meta-analysis, the risk of stroke increased by 12% for each increment of 5 cigarettes per day.
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Affiliation(s)
- Biqi Pan
- Department of Traditional Chinese Medicine, GuangDong Women and Children Hospital
| | - Xiao Jin
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine
| | - Liu Jun
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, China
| | - Shaohong Qiu
- Department of Traditional Chinese Medicine, GuangDong Women and Children Hospital
| | - Qiuping Zheng
- Department of Traditional Chinese Medicine, GuangDong Women and Children Hospital
| | - Mingwo Pan
- Department of Traditional Chinese Medicine, GuangDong Women and Children Hospital
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Shah H, Altaf A, Salahuddin M, Ullah Jan M, Khan A. Cardiovascular risk factors of hypertension, smoking and obesity: Emerging concerns among Pathan and Persian young adults? Med J Islam Repub Iran 2018; 32:129. [PMID: 30815424 PMCID: PMC6387808 DOI: 10.14196/mjiri.32.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Indexed: 11/24/2022] Open
Abstract
Background: Hypertension was considered as a disease of the elderly but due to unhealthy dietary and lifestyle changes its incidence has increased in younger population. Smoking and obesity are emerging concerns the world is facing globally in younger age groups. This study is therefore aimed to identify these cardiovascular risk factors among Pathan and Persian young adults. Methods: It was a cross-sectional study carried out at multiple undergraduate, postgraduate educational institutes and hospitals using non-probability convenient sampling among young adults aged between 15 to 40 years for a period of six months from Apr 1st, 2017 to Sep 30th, 2017. Mean±SD was calculated for continuous variables and categorical variables were expressed as frequencies. Chi-square test and Fisher exact test were used for statistical analysis. Results: A total of 708 subjects were included. Mean±SD age was 26.12±3.7 years. Out of 708, 300(42.37%) were smokers with 209 (29.52%) active and 91 (12.85%) passive smokers. Among smokers, 216 (30.5%) were males while 84 (11.87%) were females. A total of 432 (61.02%) subjects were not doing any exercise, and 636 (89.83%) were consuming junk food. A total of 165 (23.3%) subjects were overweight, and 15 (2.1%) were obese. Stage-1 hypertension was present in 72 (10.2%), while 16 (2.25%) subjects had stage-2 hypertension. Conclusion: There is an increased prevalence of cardiovascular risk factors which includes hypertension, smoking, and obesity among Pathan and Persian young adults.
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Affiliation(s)
- Hammad Shah
- Cardiology Department, Rehman Medical Institute, Peshawar, Pakistan
| | - Afrasyab Altaf
- Cardiology Department, Rehman Medical Institute, Peshawar, Pakistan
| | - Momin Salahuddin
- Cardiology Department, Rehman Medical Institute, Peshawar, Pakistan
| | - Muneeb Ullah Jan
- Medicine Department, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Adnan Khan
- Paediatric Department, Rehman Medical Institute, Peshawar, Pakistan
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Tamura T, Kadomatsu Y, Tsukamoto M, Okada R, Sasakabe T, Kawai S, Hishida A, Hara M, Tanaka K, Shimoshikiryo I, Takezaki T, Watanabe I, Matsui D, Nishiyama T, Suzuki S, Endoh K, Kuriki K, Kita Y, Katsuura-Kamano S, Arisawa K, Ikezaki H, Furusyo N, Koyanagi YN, Oze I, Nakamura Y, Mikami H, Naito M, Wakai K. Association of exposure level to passive smoking with hypertension among lifetime nonsmokers in Japan: a cross-sectional study. Medicine (Baltimore) 2018; 97:e13241. [PMID: 30508907 PMCID: PMC6283225 DOI: 10.1097/md.0000000000013241] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Brief exposure to passive smoking immediately elevates blood pressure. However, little is known about the association between exposure to passive smoking and chronic hypertension. We aimed to examine this association in a cross-sectional study, after controlling multiple potential confounders.Participants included 32,098 lifetime nonsmokers (7,216 men and 24,882 women) enrolled in the Japan Multi-Institutional Collaborative Cohort Study. Passive smoking was assessed using a self-administered questionnaire. The single question about exposure to passive smoking had five response options: "sometimes or almost never," "almost every day, 2 hours/day or less," "almost every day, 2 to 4 hours/day," "almost every day, 4 to 6 hours/day," and "almost every day, 6 hours/day or longer." Hypertension was defined as any of the following: systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or use of antihypertensive medication. Multivariate-adjusted odds ratio (OR) and 95% confidence interval (CI) for hypertension were estimated by exposure level to passive smoking using unconditional logistic regression models.The multivariate-adjusted OR for hypertension in those exposed almost every day was 1.11 (95% CI: 1.03-1.20) compared with those exposed sometimes or almost never. The OR for a 1-hour per day increase in exposure was 1.03 (95% CI: 1.01-1.06, Pfor trend = .006). This association was stronger in men than in women; the ORs were 1.08 (95% CI: 1.01-1.15, Pfor trend = .036) and 1.03 (95% CI: 1.00-1.05, Pfor trend = .055), respectively.Our findings suggest importance of tobacco smoke control for preventing hypertension.
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Affiliation(s)
- Takashi Tamura
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya
| | - Yuka Kadomatsu
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya
| | - Mineko Tsukamoto
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya
| | - Rieko Okada
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya
| | - Tae Sasakabe
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya
- Department of Public Health, Aichi Medical University School of Medicine, Nagakute
| | - Sayo Kawai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya
- Department of Public Health, Aichi Medical University School of Medicine, Nagakute
| | - Asahi Hishida
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya
| | - Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga
| | - Keitaro Tanaka
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga
| | - Ippei Shimoshikiryo
- Department of International Island and Community Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima
| | - Toshiro Takezaki
- Department of International Island and Community Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima
| | - Isao Watanabe
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto
| | - Daisuke Matsui
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto
| | - Takeshi Nishiyama
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Sadao Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Kaori Endoh
- Laboratory of Public Health, Division of Nutritional Sciences, School of Food and Nutritional Sciences, University of Shizuoka, Shizuoka
| | - Kiyonori Kuriki
- Laboratory of Public Health, Division of Nutritional Sciences, School of Food and Nutritional Sciences, University of Shizuoka, Shizuoka
| | - Yoshikuni Kita
- Faculty of Nursing Science, Tsuruga Nursing University, Tsuruga
| | - Sakurako Katsuura-Kamano
- Department of Preventive Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima
| | - Kokichi Arisawa
- Department of Preventive Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima
| | - Hiroaki Ikezaki
- Department of Environmental Medicine and Infectious Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Norihiro Furusyo
- Department of Environmental Medicine and Infectious Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Yuriko N Koyanagi
- Division of Cancer Information and Control, Aichi Cancer Center Research Institute, Nagoya
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya
| | - Yohko Nakamura
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba
| | - Haruo Mikami
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba
| | - Mariko Naito
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya
- Department of Oral Epidemiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya
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Munakomi S. Reader response: Smoking cessation and outcome after ischemic stroke or TIA. Neurology 2018; 90:1082. [DOI: 10.1212/wnl.0000000000005631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Spence JD. Accuracy of Cardiovascular Risk Prediction Varies by Neighborhood Socioeconomic Position. Ann Intern Med 2018; 168:680-681. [PMID: 29710254 DOI: 10.7326/l18-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- J David Spence
- Robarts Research Institute, Western University, London, Ontario, Canada (J.D.S.)
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Yao Y, Chen X, Wu S, Guo L, Zhang H, Zhu Q, Tang J, Luan F, Zhao Y, Lv F, He Y. Thyroid nodules in centenarians: prevalence and relationship to lifestyle characteristics and dietary habits. Clin Interv Aging 2018; 13:515-522. [PMID: 29662307 PMCID: PMC5892957 DOI: 10.2147/cia.s162425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Thyroid nodules (TNs) are common thyroid lesions in older population. Few studies have focused on the prevalence of TNs and their relationship to lifestyle characteristics and dietary habits in centenarians. The current study aimed at determining the prevalence of TNs in Chinese centenarians by using high-resolution ultrasound (US) equipment and at investigating its relationship to lifestyle characteristics and dietary habits. Participants and methods The current study was part of the China Hainan Centenarian Cohort Study that was conducted in Hainan, an iodine-sufficient region in People’s Republic of China. A total of 874 permanent residents aged ≥100 years (mean age =102.8±2.8 years) without any missing data were included in the analysis. Results Among the participants, 649 of them were detected at least one TN under the US examinations. The overall prevalence rate of TNs was 74.3%. The prevalence of TNs was higher in participants who were women, had hypertension, had diabetes, and were underweight compared with their counterparts. Multivariate logistic regression analyses showed that being female, hypertensive, and diabetic; betel quid consumption; and red meat consumption were independent risk factors, while being underweight and nut consumption were independent protective factors for TNs. Conclusion Our findings indicate that the presence of TNs was highly prevalent in Chinese centenarians, particularly in women. In addition to gender, having hypertension, having diabetes, and being underweight, the presence of TNs was independently associated with betel quid, red meat, and nut consumption. Further prospective studies are warranted to verify these associations in populations from different age strata, races, cultures, and iodine supplementation.
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Affiliation(s)
- Yao Yao
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xianghui Chen
- Department of Ultrasonography, Hainan Branch of PLA General Hospital, Sanya, People's Republic of China
| | - Shengzheng Wu
- Department of Ultrasonography, Hainan Branch of PLA General Hospital, Sanya, People's Republic of China
| | - Liang Guo
- Department of Ultrasonography, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hao Zhang
- Department of Health Policy and Management, Texas A&M University, College Station, TX, USA
| | - Qiao Zhu
- Central Laboratory, Hainan Branch of Chinese PLA General Hospital, Sanya, People's Republic of China
| | - Jie Tang
- Department of Ultrasonography, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Fuxin Luan
- Central Laboratory, Hainan Branch of Chinese PLA General Hospital, Sanya, People's Republic of China
| | - Yali Zhao
- Central Laboratory, Hainan Branch of Chinese PLA General Hospital, Sanya, People's Republic of China
| | - Faqin Lv
- Department of Ultrasonography, Hainan Branch of PLA General Hospital, Sanya, People's Republic of China
| | - Yao He
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, People's Republic of China
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Lim KH, Teh CH, Nik Mohamed MH, Pan S, Ling MY, Mohd Yusoff MF, Hassan N, Baharom N, Dawam ND, Ismail N, Ghazali SM, Cheong KC, Chong KH, Lim HL. Exposure to tobacco secondhand smoke and its associated factors among non-smoking adults in smoking-restricted and non-restricted areas: findings from a nationwide study in Malaysia. BMJ Open 2018; 8:e017203. [PMID: 29317411 PMCID: PMC5780697 DOI: 10.1136/bmjopen-2017-017203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Secondhand smoke (SHS) has been associated with increased morbidity and mortality. Therefore, the aims of the paper are to assess SHS exposure among non-smoking adults in Malaysia attending various smoking-restricted and non-restricted public areas according to the Control of Tobacco Product Regulations (CTPR) as well as its relationship with various sociodemographic variables. DESIGN Data were extracted from a cross-sectional study, the Global Adults Tobacco Survey (GATS) 2011 which involved 3269 non-smokers in Malaysia. Data was obtained through face-to-face interviews using a validated pre-tested questionnaire. Factors associated with exposure to SHS were identified via multivariable analysis. RESULTS The study revealed that almost two-thirds of respondents were exposed to SHS in at least one public area in the past 1 month, with a significantly higher exposure among males (70.6%), those with higher educational attainment (81.4%) and higher income (quintile 1%-73.9%). Besides, the exposure to SHS was almost four times higher in non-restricted areas compared with restricted areas under the CTPR (81.9% vs 22.9). Multivariable analysis revealed that males and younger adults at non-restricted areas were more likely to be exposed to SHS while no significant associated factors of SHS exposure was observed in restricted areas. CONCLUSIONS The study revealed the prevalence of SHS exposure was higher among Malaysian adults. Although smoke-free laws offer protection to non-smokers from exposure to SHS, enforcement activities in restricted areas should be enhanced to ensure strict public abidance. In addition, legislation of restricted areas should also be extended to greatly reduce the SHS exposure among non-smokers in Malaysia.
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Affiliation(s)
| | | | | | - Sayan Pan
- Institute of Public Health, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Miaw Yn Ling
- Institute of Public Health, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | | | - Noraryana Hassan
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Nizam Baharom
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | | | - Norliana Ismail
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | | | | | - Kar Hon Chong
- Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang, Malaysia
| | - Hui Li Lim
- Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang, Malaysia
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Pascal Iloh GU, Collins PI. Awareness of health effects of exposure to secondhand smoke from cigarettes: A cross-sectional study of never-smoked adult primary care patients in Eastern Nigeria. Avicenna J Med 2017; 7:164-170. [PMID: 29119083 PMCID: PMC5655647 DOI: 10.4103/ajm.ajm_23_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Cigarette smoking whether actively or passively is a growing public health problem. Despite the wealth of information on the hazards of active cigarette smoking, awareness of the health effects of passive smoking on human population is often neglected in Nigeria. Aim: The study was aimed at describing the awareness of health effects of exposure to secondhand smoke from cigarettes among never-smoked adult primary care patients in Eastern Nigeria. Materials and Methods: A hospital-based study carried out on a cross-section of 500 adult patients in a primary care clinic in Nigeria. Data were collected using pretested, structured, and interviewer-administered questionnaire. Exposure to secondhand smoke was defined as exposure to cigarette smoke in a never-smoked adult patient in the previous 1 year. Data were analyzed using Statistical Package for Social Sciences version 21 for the calculation of percentages for categorical variables. Bivariate analysis involving Chi-square test was used to test for significance of association between categorical variables at P < 0.05. Results: The age of the respondents ranged from 18 to 74 years, with a mean age of 36 ± 12.4 years. There were 180 (36.0%) males with 320 (64%) females, with a sex ratio of 1.8. Awareness of general health effects of secondhand smoke on adults, children, and pregnant women was 95.6%, 92.8%, and 65.2%, respectively. The most common specific health effects the respondents were aware for adults, children, and obstetric population were lung cancer (95.6%), precipitation of asthmatic condition (92.8%), and delivery of small babies (65.2%), respectively. The predominant source of awareness of information was radio (93.6%). Awareness of general health effects of exposure to secondhand smoke on adults (P = 0.041), children (P = 0.031), and obstetrics population (P = 0.02) was significantly associated with exposure status. Conclusion: The most common health effects of secondhand smoke the respondents had highest awareness were lung cancer, precipitation of asthmatic attacks, and delivery of small babies in adults, children, and obstetric population, respectively. Awareness of general health effects on adults, children, and obstetrics population was significantly associated with exposure status. The current level of awareness should be improved while effort should be intensified to address identified areas of low level of awareness.
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Affiliation(s)
| | - Peace Ifeoma Collins
- Department of Nutrition and Dietetics, Federal Medical Centre, Umuahia, Abia State, Nigeria
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Koizumi H, Hoshi K, Yamamoto D, Asari Y, Kumabe T. Relationship between Stroke Events during Pachinko Play and Prognosis. J Stroke Cerebrovasc Dis 2017; 26:2971-2975. [PMID: 28939050 DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/08/2017] [Accepted: 07/23/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND This study investigated whether pachinko play influences the outcome of stroke events, and identified the significant variables affecting outcomes. METHODS We reviewed the medical and imaging records of 2075 consecutive patients with stroke from January 2003 through June 2012. The remaining patients were divided into 2 groups, the pachinko players group (PP) and the non-pachinko players group (NPP). Background factors were recorded on admission. Multivariate logistic regression analysis was used to identify the factors significantly correlated with Glasgow Outcome Scale (GOS) score and risk of death at the time of discharge. RESULTS The PP group exhibited higher prevalence of hypertension and current smoking compared with the NPP group. However, no difference was found in outcomes between the PP and NPP groups. Multivariate analysis identified the dependent predictive variables for GOS as age (adjusted β = -.18, 95% confidence interval [CI]: -.22 to -.14, P <.001), Glasgow Coma Scale (GCS) score on admission (adjusted β = .64, 95% CI: .60 to .68, P <.001), and history of hypertension (adjusted β = -.06, 95% CI: -.10 to -.02, P = .007). Logistic regression analysis showed that age (odds ratio = 1.02, 95% CI: 1.01 to 1.04, P <.001) and GCS score on admission (odds ratio = .72, 95% CI: .69 to .75, P <.001) were significantly associated with death at the time of discharge. CONCLUSIONS Patients with stroke during playing pachinko have higher prevalence of hypertension and higher smoking rate, but pachinko play itself was not a critical factor determining the outcome of patients with stroke in our emergency center.
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Affiliation(s)
- Hiroyuki Koizumi
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan; Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
| | - Keika Hoshi
- Department of Hygiene, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Daisuke Yamamoto
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Yasushi Asari
- Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Tagelsir S, Gameraddin MB, Babiker MS, Gareeballah A, Abdelmaboud S, Salih S. Doppler sonographic assessment of carotid arteries in Sudanese stroke patients. Brain Circ 2017; 3:114-120. [PMID: 30276311 PMCID: PMC6126262 DOI: 10.4103/bc.bc_5_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/01/2017] [Accepted: 06/06/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: Hypertension, diabetes, and smoking were considered to be associated with several public health problems. OBJECTIVE: the study aims to explore the hemodynamic of carotid arteries in association with hypertension, diabetes, and smoking in Sudanese stroke patients. MATERIALS AND METHODS: In a quantitative descriptive study, fifty patients with stroke were scanned by B-mode and Doppler sonography. Carotid arteries were investigated with a 7-MHz linear transducer by a standard carotid sonography protocol. RESULTS: The average Doppler resistive index (RI) was 0.71 ± 0.084 and intima-media thickness was 1.39 ± 0.78 mm. The end diastolic velocities (EDVs) and peak systolic velocities (PSVs) of common carotid arteries were significantly changed in smokers and hypertensive (P < 0.05). The elevation of RI in right and left CCAs were significantly correlated with smokers (P = 0.017 and 0.010 respectively). Hemorrhagic stroke was most prevalent in hypertensive rather than diabetic and smokers. The carotid hemodynamics changed significantly in hypertensive and smokers more than diabetics. CONCLUSION: EDV and PSV were significantly correlated with hypertension and tobacco smoking rather than diabetes. Hypertension, diabetes, and smoking have an association with stroke and hand significant effect on carotid artery hemodynamic and atherosclerotic disease. The Doppler RIs were significantly correlated with smokers. Patients with risk factors of stroke should be scanned with Doppler sonography as early as possible.
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Affiliation(s)
- Sarah Tagelsir
- Department of Surgery, Khartoum Teaching Hospital, Khartoum, Sudan
| | - Moawia Bushra Gameraddin
- Diagnostic Radiological Technology, Faculty of Applied Sciences, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia
| | - Mahmoud S Babiker
- Diagnostic Radiological Technology, Faculty of Applied Sciences, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia
| | - Awadia Gareeballah
- Department of Radiology, Faculty of Radiological Sciences and Medical Imaging, Alzaiem Alazhari University, Khartoum, Sudan
| | - Suzan Abdelmaboud
- Department of Radiology, Faculty of Radiological Sciences and Medical Imaging, Alzaiem Alazhari University, Khartoum, Sudan
| | - Suliman Salih
- Diagnostic Radiological Technology, Faculty of Applied Sciences, Taibah University, Al-Madinah Al-Munawarah, Saudi Arabia
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Abstract
OBJECTIVE "Green collar" workers serve in occupations that directly improve environmental quality and sustainability. This study estimates and compares the prevalence of select physical and chemical exposures among green versus non-green U.S. workers. METHODS Data from the U.S. 2010 National Health Interview Survey (NHIS) Occupational Health Supplement were linked to the Occupational Information Network (ONET) Database. We examined four main exposures: 1) vapors, gas, dust, fumes (VGDF); 2) secondhand tobacco smoke; 3) skin hazards; 4) outdoor work. RESULTS Green-collar workers were significantly more likely to report exposure to VGDF and outdoor work than nongreen-collar workers [adjusted odds ratio (AOR) = 1.25; 95% CI = 1.11 to 1.40; AOR = 1.44 (1.26 to 1.63), respectively]. Green-collar workers were less likely to be exposed to chemicals (AOR = 0.80; 0.69 to 0.92). CONCLUSIONS Green-collar workers appear to be at a greater risk for select workplace exposures. As the green industry continues to grow, it is important to identify these occupational hazards in order to maximize worker health.
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Hou L, Han W, Jiang J, Liu B, Wu Y, Zou X, Xue F, Chen Y, Zhang B, Pang H, Wang Y, Wang Z, Hu Y, Li J. Passive smoking and stroke in men and women: a national population-based case-control study in China. Sci Rep 2017; 7:45542. [PMID: 28361935 PMCID: PMC5374519 DOI: 10.1038/srep45542] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/27/2017] [Indexed: 12/27/2022] Open
Abstract
An association between passive smoking and stroke is unclear in China, particularly the association with hemorrhagic stroke. This study included 16205 deaths due to stroke aged ≥30 years and 16205 non-stroke controls randomly selected and frequency-matched to cases on gender and age. Smoking of spouses, defined as ≥1 cigarette per day for up to 1 year, was taken as a measure of exposure to passive smoking of subjects that was retrospectively ascertained by interviewing surviving spouses. After adjustment for variables, passive smoking increased the risk of death by 10% (odds ratio (OR), 1.10; 95% confidence interval (CI), 1.05-1.16) for all strokes, by 10% (OR, 1.10; 95% CI, 1.04-1.16) for hemorrhagic stroke, and by 12% (OR, 1.12; 95% CI, 1.03-1.23) for ischemic stroke, compared with non-exposure. This finding was highly consistent in men or women and in smokers or non-smokers, and was generally consistent among zones of China despite geographic diversity. The risk significantly increased with exposure-years and quantity of cigarettes smoked daily by spouses. This study indicated that passive smoking is associated with deaths from all-type strokes. It is highly advisable for the government to promote strong tobacco prevention and cessation programs and smoke-free environments.
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Affiliation(s)
- Lei Hou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Jingmei Jiang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Boqi Liu
- Cancer Institute & Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Yanping Wu
- Cancer Institute & Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Xiaonong Zou
- Cancer Institute & Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Fang Xue
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Yuanli Chen
- Cancer Institute & Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Biao Zhang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Haiyu Pang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Yuyan Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Zixing Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Yaoda Hu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Junyao Li
- Cancer Institute & Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
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Amiri M, Kargar M, Borhanihaghighi A, Soltani F, Zare N. The effect of nurse-led care on stability time in therapeutic range of INR in ischemic stroke patients receiving warfarin. Appl Nurs Res 2017; 33:96-101. [PMID: 28096031 DOI: 10.1016/j.apnr.2016.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/15/2016] [Accepted: 10/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The current study is designed in order to investigate the effect of nurse-led care (the supportive and educational measurements by nurses) on stability time in therapeutic range of INR in ischemic stroke patients receiving Warfarin. METHOD In this quasi-experimental study, 80 ischemic stroke patients were investigated, 40 patients in experimental group and 40 in the control group referred to the nurse-based warfarin clinics affiliated to Shiraz University of Medical Sciences. The mean±SD duration of the intervention was 144±84days. The patients based on the percentage stability time in the therapeutic range of INR were classified into 3 groups of good control (>75%), medium control (60-75%), and poor control groups (<60%). The results were analyzed using qui-square and independent t-test according to these categories. RESULTS 38 patients in the experimental group and 39 in the control group had the therapeutic range of INR 2-3. The percentage of the stability time in the therapeutic range of INR (mean±SD) in the experimental group was 64.08%±18.7 and in the control group it was 44.58%±25.12 (P<0.001). The percentage of total INRs within the therapeutic range was 52.5% in the experimental group and 40.6% in the control group (P=0.001). CONCLUSIONS In conclusion, using the stroke prevention guidelines, thrombotic therapy protocols and familiarity with patients' diagnosis and risk factors in the experimental group led to more patients' stability time (The time that patients could remain stable within the INR therapeutic range) in their therapeutic range of INR as the best indicator of clinical performance.
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Affiliation(s)
- Mina Amiri
- PHD Candidate, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Kargar
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Fahimeh Soltani
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najafe Zare
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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da Silveira Fleck A, Carneiro MFH, Barbosa F, Thiesen FV, Amantea SL, Rhoden CR. Monitoring an outdoor smoking area by means of PM 2.5 measurement and vegetal biomonitoring. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2016; 23:21187-21194. [PMID: 26662301 DOI: 10.1007/s11356-015-5878-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/24/2015] [Indexed: 06/05/2023]
Abstract
The extension of pollutant accumulation in plant leaves associated with its genotoxicity is a common approach to predict the quality of outdoor environments. However, this approach has not been used to evaluate the environmental quality of outdoor smoking areas. This study aims to evaluate the effects of environmental tobacco smoke (ETS) by assessing particulate matter 2.5 μm (PM2.5) levels, the pollen abortion assay, and trace elements accumulated in plant leaves in an outdoor smoking area of a hospital. For this, PM2.5 was measured by active monitoring with a real time aerosol monitor for 10 days. Eugenia uniflora trees were used for pollen abortion and accumulated element assays. Accumulated elements were also assessed in Tradescantia pallida leaves. The median concentration of PM2.5 in the smoking area in all days of monitoring was 66 versus 34 μg/m3 in the control area (P < 0.001). In addition, the elements Al, Cd, Cu, Ni, Pb, Rb, Sb, Se, and V in Tradescantia pallida and Al, Ba, Cr, Cu, Fe, Mg, Pb, and Zn in Eugenia uniflora were in higher concentration in the smoking area when compared to control area. Smoking area also showed higher rate of aborted grains (26.1 ± 10.7 %) compared with control (17.6 ± 4.5 %) (P = 0.003). Under the study conditions, vegetal biomonitoring proved to be an effective tool for assessing ETS exposure in outdoor areas. Therefore, vegetal biomonitoring of ETS could be a complement to conventional analyses and also proved to be a cheap and easy-handling tool to assess the risk of ETS exposure in outdoor areas.
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Affiliation(s)
- Alan da Silveira Fleck
- Laboratório de Estresse Oxidativo e Poluição Atmosférica, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Prédio 3, CEP: 90050-170, Porto Alegre, RS, Brazil
| | - Maria Fernanda Hornos Carneiro
- Laboratório de Toxicologia e Essencialidade de Metais, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Fernando Barbosa
- Laboratório de Toxicologia e Essencialidade de Metais, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Flavia Valladão Thiesen
- Instituto de Toxicologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Sergio Luis Amantea
- Laboratório de Estresse Oxidativo e Poluição Atmosférica, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Prédio 3, CEP: 90050-170, Porto Alegre, RS, Brazil
- Instituto de Educação e Pesquisa (IEP)-Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Claudia Ramos Rhoden
- Laboratório de Estresse Oxidativo e Poluição Atmosférica, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Prédio 3, CEP: 90050-170, Porto Alegre, RS, Brazil.
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Lee PN, Thornton AJ, Forey BA, Hamling JS. Environmental Tobacco Smoke Exposure and Risk of Stroke in Never Smokers: An Updated Review with Meta-Analysis. J Stroke Cerebrovasc Dis 2016; 26:204-216. [PMID: 27765554 DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/09/2016] [Accepted: 09/12/2016] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The study aimed to review the epidemiological evidence relating environmental tobacco smoke exposure to stroke in never smokers. METHODS The study is similar to our review in 2006, with searches extended to March 2016. RESULTS Twelve further studies were identified. A total of 28 studies varied considerably in design, exposure indices used, and disease definition. Based on 39 sex-specific estimates and the exposure index current spousal exposure (or nearest equivalent), the meta-analysis gave an overall fixed-effect relative risk estimate of 1.23 (95% confidence interval: 1.16-1.31), with significant (P < .05) heterogeneity. There was no significant heterogeneity by sex, continent, fatality, disease end point, or degree of adjustment for potential confounding factors. Relative risks were less elevated in prospective studies (1.15, 1.06-1.24) than in case-control studies (1.44, 1.22-1.60) or cross-sectional studies (1.40, 1.21-1.61). They also varied by publication year, but with no trend. A significant increase was not seen in studies that excluded smokers of any tobacco (1.07, .97-1.17), but was seen for studies that included pipe- or cigar-only smokers, occasional smokers, or long-term former smokers. No elevation was seen for hemorrhagic stroke. Relative risk estimates were similar using ever rather than current exposure, or total rather than spousal exposure. Eleven studies provided dose-response estimates, the combined relative risk for the highest exposure level being 1.56 (1.37-1.79). Many studies have evident weaknesses, recall bias, and particularly publication bias being major concerns. CONCLUSIONS Although other reviewers inferred a causal relationship, we consider the evidence does not conclusively demonstrate this. We repeat our call for publication of data from existing large prospective studies.
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Affiliation(s)
- Peter N Lee
- PN Lee Statistics and Computing Ltd, Sutton, Surrey, United Kingdom.
| | | | - Barbara A Forey
- PN Lee Statistics and Computing Ltd, Sutton, Surrey, United Kingdom
| | - Jan S Hamling
- PN Lee Statistics and Computing Ltd, Sutton, Surrey, United Kingdom
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Chung JK, Nakajima S, Plitman E, Iwata Y, Uy D, Gerretsen P, Caravaggio F, Chakravarty MM, Graff-Guerrero A. Β-Amyloid Burden is Not Associated with Cognitive Impairment in Schizophrenia: A Systematic Review. Am J Geriatr Psychiatry 2016; 24:923-39. [PMID: 27526990 PMCID: PMC5026886 DOI: 10.1016/j.jagp.2016.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 01/28/2016] [Accepted: 03/30/2016] [Indexed: 12/31/2022]
Abstract
Current literature suggests that the pathology of schizophrenia (SCZ) has developmental origins. However, the neurodevelopmental theory of SCZ cannot solely explain progressive neurodegenerative processes in the illness. There is evidence of accelerated cognitive decline and increased risk of dementia in elderly patients with SCZ. Investigating β-amyloid (Aβ), we conducted a systematic review focusing on Aβ in patients with SCZ. An OVID literature search using PsychINFO, Medline, and Embase databases was conducted, looking for studies that compared Aβ levels between patients with SCZ and either elderly control subjects, patients with Alzheimer disease (AD), or patients with other psychiatric illnesses. Among 14 identified studies, 11 compared Aβ between SCZ and elderly control subjects, 7 between SCZ and AD, and 3 between SCZ and other psychiatric illnesses. As a result, no evidence was found suggesting that Aβ levels differ in patients with SCZ from elderly control subjects or patients with other psychiatric illnesses. All seven studies reported lower cortical Aβ in patients with SCZ than patients with AD. Furthermore, three of the four studies, which investigated the relationship between Aβ and cognitive impairment in SCZ, observed no association between two factors. The limitations of the included studies are small sample sizes, the inclusion of cerebrospinal fluid Aβ or postmortem plaques rather than cortical Aβ assessment in vivo, and the investigation of different brain regions. In conclusion, Aβ deposition is not associated with cognitive decline in late-life SCZ. Future studies should investigate other neurodegenerative indicators in SCZ to better understand the pathophysiologic mechanisms underlying this illness.
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Affiliation(s)
- Jun Ku Chung
- Institute of Medical Science, Faculty of Medicine, University of Toronto,Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Shinichiro Nakajima
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Canada,Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan,Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Eric Plitman
- Institute of Medical Science, Faculty of Medicine, University of Toronto,Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada,Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Danielle Uy
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Canada,Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Fernando Caravaggio
- Institute of Medical Science, Faculty of Medicine, University of Toronto,Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - M. Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health Institute, McGill University, Montreal, Quebec, Canada,Department of Psychiatry and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Ariel Graff-Guerrero
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Multimodal Imaging Group-Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.
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Zollinger TW, Saywell RM, Overgaard AD, Jay SJ, Holloway AM, Cummings SF. Estimating the Economic Impact of Secondhand Smoke on the Health of a Community. Am J Health Promot 2016; 18:232-8. [PMID: 14748313 DOI: 10.4278/0890-1171-18.3.232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. This study provides a model to estimate the health-related costs of secondhand smoke exposure at a community level. Model Development. Costs of secondhand smoke–related mortality and morbidity were estimated using national attributable risk values for diseases that are causally related to secondhand smoke exposure for adults and children. Estimated costs included ambulatory care costs, hospital inpatient costs, and loss of life costs based on vital statistics, hospital discharge data, and census data. Application of the Model. The model was used to estimate health-related costs estimates of secondhand smoke exposure for Marion County, Indiana. Attributable risk values were applied to the number of deaths and hospital discharges to determine the number of individuals impacted by secondhand smoke exposure. Results. The overall cost of health care and premature loss of life attributed to secondhand smoke for the study county was estimated to be $53.9 million in 2000—$10.5 million in health care costs and $20.3 million in loss of life for children compared with $6.2 million in health care costs and $16.9 million in loss of life for adults. This amounted to $62.68 per capita. Conclusions. This method may be replicated in other counties to provide data needed to educate the public and community leaders about the health effects and costs of secondhand smoke exposure.
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Affiliation(s)
- Terrell W Zollinger
- Indiana University, Bowen Research Center, Long Hospital 245, 1110 West Michigan Street, Indianapolis, IN 46202, USA
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Spence JD, Song H, Cheng G. Appropriate management of asymptomatic carotid stenosis. Stroke Vasc Neurol 2016; 1:64-71. [PMID: 28959466 PMCID: PMC5435189 DOI: 10.1136/svn-2016-000016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/09/2016] [Accepted: 04/12/2016] [Indexed: 01/06/2023] Open
Abstract
With modern intensive medical therapy, the annual risk of ipsilateral stroke in patients with asymptomatic carotid stenosis (ACS) is now down to ∼0.5%. Despite this, there is a widespread practice of routine intervention in ACS with carotid endarterectomy (CEA) and stenting (CAS). This is being justified on the basis of much higher risks with medical therapy in trials conducted decades ago, compared with lower risks of intervention in recent trials with no medical arm. Such extrapolations are invalid. Although recent trials have shown that after subtracting periprocedural risks the outcomes with CEA and CAS are now comparable to medical therapy, the periprocedural risks still far outweigh the risks with medical therapy. In the asymptomatic carotid trial (ACT) 1 trial, the 30-day risk of stroke or death was 2.9% with CAS and 1.7% with CEA. In the CREST trial, the 30-day risk of stroke or death among asymptomatic patients was 2.5% for stenting and 1.4% for endarterectomy. Thus, intensive medical therapy is much safer than either CAS or CEA. The only patients with ACS who should receive intervention are those who can be identified as being at high risk. The best validated method is transcranial Doppler embolus detection. Other approaches in development for identifying vulnerable plaques include intraplaque haemorrhage on MRI, ulceration and plaque lucency on ultrasound, and plaque inflammation on positron emission tomography/CT. Intensive medical therapy for ACS includes smoking cessation, a Mediterranean diet, effective blood pressure control, antiplatelet therapy, intensive lipid-lowering therapy and treatment with B vitamins (with methylcobalamin instead of cyanocobalamin), particularly in patients with metabolic B12 deficiency. A new strategy called 'treating arteries instead of risk factors', based on measurement of carotid plaque volume, is promising but requires validation in randomised trials.
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Affiliation(s)
- J David Spence
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Hongsong Song
- Peking University Third Hospital, Beijing, The People's Republic of China
| | - Guanliang Cheng
- Huai'an First People's Hospital, Nanjing Medical University, Huai'an, The People's Republic of China
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Cao L, Ping NN, Cao YX, Li W, Cai Y, Warfvinge K, Edvinsson L. The effects of MEK1/2 inhibition on cigarette smoke exposure-induced ET receptor upregulation in rat cerebral arteries. Toxicol Appl Pharmacol 2016; 304:70-8. [PMID: 27212444 DOI: 10.1016/j.taap.2016.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 05/11/2016] [Accepted: 05/18/2016] [Indexed: 10/24/2022]
Abstract
Cigarette smoking, a major stroke risk factor, upregulates endothelin receptors in cerebral arteries. The present study examined the effects of MEK1/2 pathway inhibition on cigarette smoke exposure-induced ET receptor upregulation. Rats were exposed to the secondhand smoke (SHS) for 8weeks followed by intraperitoneal injection of MEK1/2 inhibitor, U0126 for another 4weeks. The urine cotinine levels were assessed with high-performance liquid chromatography. Contractile responses of isolated cerebral arteries were recorded by a sensitive wire myograph. The mRNA and protein expression levels of receptor and MEK/ERK1/2 pathway molecules were examined by real-time PCR and Western blotting, respectively. Cerebral artery receptor localization was determined with immunohistochemistry. The results showed the urine cotinine levels from SHS exposure group were significantly higher than those from the fresh group. In addition, the MEK1/2 inhibitor, U0126 significantly reduced SHS exposure-increased ETA receptor mRNA and protein levels as well as contractile responses mediated by ETA receptors. The immunoreactivity of increased ETA receptor expression was primarily cytoplasmic in smooth muscle cells. In contrast, ETB receptor was noted in endothelial cells. However, the SHS-induced decrease in endothelium-dependent relaxation was unchanged after U0126 treatment. Furthermore, SHS increased the phosphorylation of MEK1/2 and ERK1/2 protein in cerebral arteries. By using U0126 could inhibit the phosphorylated ERK1/2 protein but not MEK1/2. Taken together, our data show that treatment with MEK1/2 pathway inhibitor offsets SHS exposure-induced ETA receptor upregulation in rat cerebral arteries.
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Affiliation(s)
- Lei Cao
- Division of Experimental Vascular Research, Institute of Clinical Sciences in Lund, Lund University, Sweden; Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Na-Na Ping
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Yong-Xiao Cao
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Wei Li
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Yan Cai
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Karin Warfvinge
- Division of Experimental Vascular Research, Institute of Clinical Sciences in Lund, Lund University, Sweden
| | - Lars Edvinsson
- Division of Experimental Vascular Research, Institute of Clinical Sciences in Lund, Lund University, Sweden
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Hou B, Ma J, Guo X, Ju F, Gao J, Wang D, Liu J, Li X, Zhang S, Ren H. Exogenous Neural Stem Cells Transplantation as a Potential Therapy for Photothrombotic Ischemia Stroke in Kunming Mice Model. Mol Neurobiol 2016; 54:1254-1262. [PMID: 26820680 DOI: 10.1007/s12035-016-9740-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/20/2016] [Indexed: 12/26/2022]
Abstract
Stroke is considered as the second leading cause of death worldwide. The survivors of stroke experience different levels of impairment in brain function resulting in debilitating disabilities. Current therapies for stroke are primarily palliative and may be effective in only a small population of stroke patients. In this study, we explore the transplantation of exogenous neural stem cells (NSCs) as the potential therapy for the photothrombotic ischemia stroke in a Kunming mice model. After stroke, mice receiving NSC transplantation demonstrated a better recovery of brain function during the neurobehavioral tests. Histology analysis of the brain samples from NSC transplanted mice demonstrated a reduction of brain damage caused by stroke. Moreover, immunofluorescence assay for biomarkers in brain sections confirmed that transplanted NSCs indeed differentiated to neurons and astrocytes, consistent with the improved brain function after stroke. Taken together, our data suggested that exogenous NSC transplantation could be a promising therapy for stroke.
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Affiliation(s)
- Boru Hou
- School of Life Sciences, Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730000, Gansu, China.,Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu, China
| | - Junning Ma
- School of Life Sciences, Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730000, Gansu, China.,Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu, China
| | - Xiumei Guo
- School of Life Sciences, Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730000, Gansu, China.,Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu, China
| | - Furong Ju
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu, China
| | - Junwei Gao
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu, China
| | - Dengfeng Wang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu, China
| | - Jixing Liu
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu, China
| | - Xiaohui Li
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu, China
| | - Shengxiang Zhang
- School of Life Sciences, Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730000, Gansu, China.
| | - Haijun Ren
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu, China.
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Kaddumukasa M, Kayima J, Kaddumukasa MN, Ddumba E, Mugenyi L, Pundik S, Furlan AJ, Sajatovic M, Katabira E. Knowledge, attitudes and perceptions of stroke: a cross-sectional survey in rural and urban Uganda. BMC Res Notes 2015; 8:819. [PMID: 26708348 PMCID: PMC4691295 DOI: 10.1186/s13104-015-1820-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 12/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Information regarding the increasing burden of non-communicable diseases such as stroke is largely unknown among the vulnerable communities. This analysis, which is part of a larger U.S. National Institute of Heath-funded Medical Education Partnership Initiative neurological disorder survey, assessed community knowledge and attitudes on stroke and stroke risk factors. METHODS A population cross-sectional survey was conducted in urban and rural Mukono, district, central Uganda. Through the systematic sampling method, data were gathered from 377 adult participants who were interviewed about selected aspects of stroke knowledge, attitudes and perception using a pretested structured questionnaire. RESULTS A total of 377 participants were enrolled (47% urban). The leading risk factors identified by the participants were stress (36.6%) and hypertension (28.9%) respectively. None of the study participants identified cigarette smoking as a stroke risk factor. Seventy six percent of the participants did not recognize stroke as a disease of the brain. CONCLUSION Stroke knowledge is poor in both rural and urban Uganda. Tailored public health approaches that improve stroke awareness, knowledge and self management approaches are urgently needed to develop effective preventive measures and community response to stroke.
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Affiliation(s)
- Mark Kaddumukasa
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - James Kayima
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Martin N Kaddumukasa
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Edward Ddumba
- Department of Medicine, St Raphael of St Francis Nsambya Hospital, Nkozi University, P.O. Box 7146, Kampala, Uganda.
| | - Levi Mugenyi
- Infectious Diseases Research Collaboration, Mulago Hill Road, MUJHU3 Building, P.O. Box 7475, Kampala, Uganda.
| | - Svetlana Pundik
- University Hospitals Case Medical Center, Neurological Institute Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Anthony J Furlan
- University Hospitals Case Medical Center, Neurological Institute Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Elly Katabira
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
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