Smoking: health effects and control (1)

A comparison of quality of life between older adults living in high and low altitude areas

Background

High altitude is known to have a significant impact on human physiology and health, therefore, understanding its relationship with quality of life is an important research area. This study compared the quality of life (QOL) in older adults living in high and low altitude areas, and examined the independent correlates of QOL in those living in a high altitude area.

Methods

Older adults living in three public nursing homes in Xining (high altitude area) and one public nursing home in Guangzhou (low altitude area) were recruited. The WHOQOL-BREF was used to measure the QOL.

Results

644 older adults (male: 39.1%) were included, with 207 living in high altitude and 437 living in low altitude areas. After controlling for the covariates, older adults living in the high altitude area had higher QOL in terms of physical (P = 0.035) and social domains (P = 0.002), but had lower QOL in psychological (P = 0.009) domain compared to their counterparts living in the low altitude area. For older adults living in the high altitude area, smoking status was associated with higher social QOL (P = 0.021), good financial status was associated with higher physical QOL (P = 0.035), and fair or good health status was associated with higher physical (p < 0.001) and psychological QOL (P = 0.046), while more severe depressive symptoms were associated with lower QOL.

Conclusion

Appropriate interventions and support to improve depressive symptoms and both financial and health status should be developed for older adults living in high altitude areas to improve their QOL.

Tobacco Cessation Intervention for Young People

Most adolescent tobacco control programs focus on preventing consumption, but teen smoking persists. It is uncertain whether adult-specific therapies can assist adolescents in quitting smoking. The rising incidence of smoking in low and middle-socioeconomic countries and the challenges of conducting tobacco cessation programs in these settings (due to increasing population, poor lifestyle, lack of awareness and education, professional stress, and non-compliance) need an emphasis on the scope of trials to conduct tobacco cessation in these settings. In the 11th Five Year Plan, the Indian government introduced a new National Tobacco Control Program, which currently spans 108 districts in 31 states across the country. The objective is to review the randomized control trials of selected individuals held in India and assess and evaluate the effectiveness of the steps taken by the government to help people quit tobacco consumption. These programs are important because of the hazards and impact they have on the public health indices of the nation. The government has taken steps like prohibiting smoking in public areas and banning sources. Several programs, particularly those that employed group counselling, included a range of approaches that proved beneficial in helping young people quit smoking. The RCTs mentioned are psychosocially followed by behavioral and pharmacological therapies. The challenges faced are not having participatory health care, motivating tobacco users to quit even in the short-term, adequate coverage; barriers at a different level of implementation (at a regional, state, or national level); and interference by the tobacco industry should be eliminated. The currently functioning programs in India are the National Tobacco Control Program, the National and three Regional Quitlines and mCessation.

Maternal smoking during pregnancy and long-term ophthalmic morbidity of the offspring

OBJECTIVE

To examine whether smoking during pregnancy is correlated with long-term ophthalmic complications of the offspring.

STUDY DESIGN

A population-based cohort analysis was performed comparing all deliveries of mothers who reported smoking during pregnancy and non-smoking mothers between 1991 and 2014 at a single tertiary medical center. Hospitalizations of the offspring up to the age of 18 years involving ophthalmic morbidities were evaluated according to a predefined set of ICD-9 codes. A Kaplan-Meier curve was used to compare cumulative hospitalization rate in exposed and unexposed offspring and a Cox proportional hazards model was used to control for confounders.

RESULTS

During the study period, 243,680 deliveries met the inclusion criteria. Of them, 2965 (1.2%) were children of smoking mothers. Ophthalmic-related hospitalizations were significantly higher in children born to smoking mothers, as compared with the non-smoking group (1.4% vs. 0.1%, p < 0.01). Specifically, these hospitalizations were due to higher rates of visual disturbance rate and ophthalmic infections. The Kaplan-Meier curve demonstrated a significant higher cumulative incidence of ophthalmic-related hospitalizations in the smoking group (log rank p < 0.001). Using a Cox proportional hazards model, controlling for potential confounders, maternal tobacco use was found to be independently associated with long-term ophthalmic morbidity of the offspring (adjusted HR = 1.51, CI 1.11-2.04).

CONCLUSION

Maternal smoking during pregnancy is an independent risk factor for long-term ophthalmic morbidity of the offspring. These results are in line with many recent studies that strongly support maternal smoking cessation during pregnancy due to high offspring morbidity risk.

In Utero Exposure to Smoking and Alcohol, and Passive Smoking during Childhood: Effect on the Retinal Nerve Fibre Layer in Young Adulthood

PURPOSE

In utero exposure to cigarette smoke has been suggested to result in thinner retinal nerve fibre layer (RNFL). However, the potential cofounding effects of in utero alcohol exposure and passive smoking during childhood had not been considered. We explored RNFL thickness in young adults in relation to these early life factors.

METHODS

In 1989-1991, pregnant women completed questionnaires on their current smoking and alcohol drinking patterns. Following the birth of their offspring, information on household smokers was obtained between the 1- and 13-year follow-ups. At the 20-year follow-up, these offspring underwent an eye examination including optical coherence tomography imaging of the RNFL.

RESULTS

Participants (n = 1,287) were 19-22 years old at time of eye examination. Most participants (77%) had no in utero exposure to cigarette smoke; 1.3% were initially exposed but not after 18 weeks' gestation, while 21% had continual in utero smoking exposure. Half of the mothers never consumed alcohol or only consumed alcohol once during their pregnancies. After correcting for potential confounders, including in utero alcohel exposure and childhood passive smoking, participants who had continued in utero exposure to >10 cigarettes/day and ≤10 cigarettes/day had thinner RNFLs by 6.6 (95% confidence interval [CI] = 4.4-8.7) and 3.7 µm (95%[CI] = 2.3-5.5), respectively, than those with no exposure (p < .001). In utero alcohol exposure and childhood passive smoking were not significantly associated with RNFL thickness after accounting for in utero exposure to smoking.

CONCLUSIONS

In utero exposure to cigarette smoke is associated with thinner RFNL in young adulthood, independent of other early life environmental factors.

Evaluation of subclinical alterations in retinal layers and microvascular structures with OCT and OCTA in healthy young short-term smokers

PURPOSE

To detect the changes that can be determined with optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in young and short-term smokers.

METHOD

In this cross-sectional, observational, and comparative study, 45 "healthy" smokers and 45 healthy non-smoker control participants were included. Those with a smoking history between 1 year to 5 years and an average of 10-30 cigarettes per day were included in the study. OCT and OCTA measurements were made at least 60 min after smoking and at least 8 h after caffeine-containing beverages in order to end the effect of nicotine on systemic and retinal blood flow in the smoking group.

RESULTS

The mean smoking period was 2.2 ± 0.13 years. Mean macular thickness(MMT), retinal nerve fiber layer(RNFL), and choroidal thickness(Cht) were significantly lower in the smoker group, while ganglion cell-inner plexiform layer(GC-IPL) thickness was higher. Vessel density(VD) values were similar between groups, while perfusion density(PD) values were significantly higher in the smoker group. There were significant correlations between MMT and outer VD, outer PD, foveal avascular zone(FAZ) perimeter and circularity index. FAZ area and central VD and PD were inversely correlated. Also, FAZ circularity index and subfoveal, nasal, and temporal ChTs were positively correlated.

CONCLUSION

Despite the short-term smoking, ischemic effects were observed in retinochoroidal and vascular structures.

Cigarette smoking and cognitive function among older adults living in the community

Background. The present study aimed to examine the long-term impact of CS on Executive Function (EF) and memory among older adults living in the community. Methods. Clock Drawing Test (CDT) and Delayed Word Recall Test (DWRT) were used to examine EF and memory, respectively, using four waves of National Health and Aging Trend Study. The respondents were asked whether they have ever smoked, length of smoking, and age of start and quit smoking. Results. CS can have a long-term impact on both EF and memory. However, current smoking can increase the risk of EF impairment compared to former smokers. Lung disease and current smoking can have a synergic effect of impairment in EF. Conclusion. In the long-term, smoking can negatively affect cognitive. Lung diseases and smoking can synergize their impacts on EF. The impact of smoking on cognition varies across ethnic groups; hence, educational programs targeting minorities can reduce discrepancies.

Association of smoking cessation after new-onset type 2 diabetes with overall and cause-specific mortality among Korean men: a nationwide population-based cohort study

INTRODUCTION

This study aimed to examine the association between smoking cessation after new-onset type 2 diabetes and overall and cause-specific mortality risks among Korean men.

RESEARCH DESIGN AND METHODS

The Korean National Health Insurance Service-National Health Screening Cohort database was searched, and 13 377 Korean men aged ≥40 years diagnosed with new-onset type 2 diabetes between 2004 and 2007 were included and followed up until 2013. We defined smoking status changes by comparing participants' answers in the last survey before diagnosis to those in the first survey after diagnosis. We estimated the adjusted HR (AHR) and 95% CI for mortality risk using multivariable Cox proportional hazards regression models.

RESULTS

We identified 1014 all-cause mortality events (cancer, n=406 and cardiovascular disease (CVD), n=184) during an average follow-up duration of 7.2 years. After adjustment for all confounding factors, the reduced risk of all-cause mortality was more significant among short-term quitters (AHR 0.78; 95% CI 0.64 to 0.95), long-term quitters (AHR 0.68; 95% CI 0.54 to 0.85), and never smokers (AHR 0.66; 95% CI 0.56 to 0.78) compared with current smokers (p for trend <0.001). The lower risk of mortality from cancer was significant among the short-term quitters (AHR 0.60; 95% CI 0.44 to 0.83), long-term quitters (AHR 0.67; 95% CI 0.46 to 0.90), and never smokers (AHR 0.50; 95% CI 0.39 to 0.65) compared with current smokers (p for trend <0.001). There was no significant association between changes in smoking status and death from CVD. Smoking cessation after diagnosis in non-obese individuals (AHR 0.73; 95% CI 0.58 to 0.92) and exercisers (AHR 0.54; 95% CI 0.38 to 0.76) was significantly associated with reduced mortality risk than current smoking.

CONCLUSIONS

Smoking cessation after new-onset type 2 diabetes was associated with reduced mortality risk.

Modifiable Cardiovascular Risk, Hematopoiesis, and Innate Immunity

Unhealthy diet, lack of exercise, psychosocial stress, and insufficient sleep are increasingly prevalent modifiable risk factors for cardiovascular disease. Accumulating evidence indicates that these risk factors may fuel chronic inflammatory processes that are active in atherosclerosis and lead to myocardial infarction and stroke. In concert with hyperlipidemia, maladaptive immune system activities can contribute to disease progression and increase the probability of adverse events. In this review, we discuss recent insight into how the above modifiable risk factors influence innate immunity. Specifically, we focus on pathways that raise systemic myeloid cell numbers and modulate immune cell phenotypes, reviewing hematopoiesis, leukocyte trafficking, and innate immune cell accumulation in cardiovascular organs. Often, relevant mechanisms that begin with lifestyle choices and lead to cardiovascular events span multiple organ systems, including the central nervous, endocrine, metabolic, hematopoietic, immune and, finally, the cardiovascular system. We argue that deciphering such pathways provides not only support for preventive interventions but also opportunities to develop biomimetic immunomodulatory therapeutics that mitigate cardiovascular inflammation.

The effect of smoking cessation on work disability risk: a longitudinal study analysing observational data as non-randomized nested pseudo-trials

BACKGROUND

Smoking increases disability risk, but the extent to which smoking cessation reduces the risk of work disability is unclear. We used non-randomized nested pseudo-trials to estimate the benefits of smoking cessation for preventing work disability.

METHODS

We analysed longitudinal data on smoking status and work disability [long-term sickness absence (≥90 days) or disability pension] from two independent prospective cohort studies-the Finnish Public Sector study (FPS) (n = 7393) and the Health and Social Support study (HeSSup) (n = 2701)-as 'nested pseudo-trials'. All the 10 094 participants were smokers at Time 1 and free of long-term work disability at Time 2. We compared the work disability risk after Time 2 of the participants who smoked at Time 1 and Time 2 with that of those who quit smoking between these times.

RESULTS

Of the participants in pseudo-trials, 2964 quit smoking between Times 1 and 2. During the mean follow-up of 4.8 to 8.6 years after Time 2, there were 2197 incident cases of work disability across the trials. Quitting smoking was associated with a reduced risk of any work disability [summary hazard ratio = 0.89, 95% confidence interval (CI) 0.81-0.98]. The hazard ratio for the association between quitting smoking and permanent disability pension (928 cases) was of similar magnitude, but less precisely estimated (0.91, 95% CI 0.81-1.02). Among the participants with high scores on the work disability risk score (top third), smoking cessation reduced the risk of disability pension by three percentage points. Among those with a low risk score (bottom third), smoking cessation reduced the risk by half a percentage point.

CONCLUSIONS

Our results suggest an approximately 10% hazard reduction of work disability as a result of quitting smoking.

The Effect of Smoking on Macular, Choroidal, and Retina Nerve Fiber Layer Thickness

Objectives

This study aimed to compare the thickness of the macula, choroid, and peripapillary retina nerve fiber layer (RNFL) in smokers with those of healthy, nonsmoking individuals using spectral domain optical coherence tomography (SD-OCT).

Materials and Methods

Sixty-eight healthy smokers with an average of 19.75 pack-years and 71 nonsmoker subjects (control group) were included in the study. Macular thickness, RNFL thickness, and choroidal thickness (CT) were measured by SD-OCT.

Results

The mean age of the smokers was 42.76±6.97 years and that of the control group was 41.15±11.61 years (p=0.32). Inferonasal and temporal RNFL thicknesses were 121.60±27.40 μm and 69.75±9.82 μm in the smokers group and 109.05±21.71 μm and 75.95±15.01 μm in the nonsmoker group, respectively. The differences were statistically significant (p=0.003, p=0.005, respectively). Central macular thickness (CMT) was 222.97±18.95 μm and subfoveal CT was 369.52±105.36 μm in the smoker group, while these values were 222.98±17.72 μm and 347.42±104.63 μm in the nonsmoker group, respectively. There were no significant differences in these comparisons (p=0.99, p=0.49, respectively). A significant negative correlation was found between smoking exposure and nasal and temporal CT.

Conclusion

The results of our study revealed that RNFL thickness was decreased but CMT and CT were not affected in healthy chronic smokers.

Mind over matter. The impact of subjective social status on health outcomes and health behaviors

Recent insights have shown subjective status to impact health and health behavior. It is however unclear how this exactly happens. In this study we explore two mechanisms: this of a direct, mediating effect of subjective status explaining the impact of material class on health outcomes and behavior and an indirect, moderating impact on the relationship between material class and health outcomes and behavior. To test this empirically we conduct two studies, focusing on Great-Britain, using survey-data from the English Longitudinal Study of Ageing (N: 2709-3448) and the Whitehall II-study (N: 6275-6467). Our linear and logistic regression analyses show subjective status has a mainly direct impact on health outcomes and has both a direct, mediating and indirect, moderating impact on health behavior. In the conclusion of our article we reflect on the theoretical reasons why subjective status has a direct impact in certain cases, while playing an indirect role in other cases.

Comparison of the Effects of Cigarette Smoking on Male and Female Vocal Folds

OBJECTIVE

To investigate effects of smoking cigarette on male and female larynges and compare them.

METHOD

Eighteen adult Wistar Albino rats were included to study; 9 were male and 9 female. The exposure groups each contained 6 rats, and the control groups 3 rats. Six male constituted group 1 and 6 female constituted group 2. Group 1 and 3 were exposed to smoke. Group 2 and 4 were composed of 3 males and 3 females, respectively. Smoke from 10 cigarettes was delivered in each of the morning and afternoon daily for 1 month. At the end of 4 weeks, all rats were sacrificed and their larynges were evaluated histopathologically.

RESULTS

Microscobic evaluation of epithelium of vocal folds revealed no significant difference between study groups. There was also no difference between study and control groups. Subepitelial tissue showed no difference between study groups but angiogenesis and inflammation were higher in study groups. Epithelial analysis of false vocal folds showed significant difference between study groups. Female epithelium showed more hyperplastic and metaplastic changes.

CONCLUSION

Cigarette smoke damaged both the vocal folds and false vocal folds. The female false vocal folds were more susceptible to damage than the males.

Effect of Active and Passive Smoking on Retinal Nerve Fibre Layer and Ganglion Cell Complex

Aim. To evaluate the possible structural and functional changes in the retinal nerve fibre layer (RNFL) and the ganglion cell complex (GCC) of chronic smokers and compare them with those of passive healthy smokers using spectral domain optical coherence tomography (SD-OCT) and pattern electroretinogram (PERG). Materials and Methods. We include 80 active chronic smokers and 80 age- and sex-matched healthy passive smokers. After a full ophthalmological examination, SD-OCT and PERG were tested for all participants. Urinary levels of cotinine and creatinine with subsequent calculation of the cotinine creatinine ratio (CCR). Results. Inferior and superior quadrants of RNFL were thinner in group I, but nasal and temporal quadrants did not show significant difference between the groups. There were no significant differences of GCC values between the two groups. There was no significant difference of PERG-P50 amplitude and latency; however, PERG-N95 showed significant difference between the two groups. Multiple regression analyses demonstrated that the number of cigarettes/day, urinary cotinine, and PERG-N95 amplitude are the most important determinants for both superior and inferior RNFL thicknesses. Conclusion. RNFL thickness decreases in chronic, healthy, heavy cigarette smokers, and this thinning is related to the number of cigarettes/day, urinary cotinine, and PERG-N95 latency and amplitude.

Breaking the Barriers: Strategies for a Comprehensive U.S. Tobacco Control Program

Given the health and social consequences of tobacco, a policy analysis strategy consisting of three approaches; legal, market, and health education is presented. A unifying feature of the strategy recommendations is that each addresses both prevention of the initiation of tobacco habits and encouragement of cessation. Overall, the strategies focus exclusively on policy alternative initiatives oriented toward reducing the toll of smoking within the United States. The manuscript addresses the conflict that public policy must resolve between the long-term negative health effects and the short-term positive economic interests of tobacco. The critical idea is that policy makers must think beyond local efforts and recognize that they can be a part of a larger network movement working in different ways, yet cooperating for better effectiveness and support to decrease and ultimately stop the use of tobacco products.

The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery

BACKGROUND

The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure.

METHODS

Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldrete's Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period.

RESULTS

A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay.

CONCLUSION

Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients.

Prevalence of Smoking and Attitude toward Smoking Cessation among Community Pharmacists, Saudi Arabia

Background:

Although the percentage of the population that smokes has declined in the US and other countries, it is increasing in Third World countries. In Saudi Arabia, despite warnings on every packet of cigarettes indicating health hazards related to smoking, this habit is increasing rapidly, particularly among the younger population.

Objective:

To assess the prevalence and risk factors of smoking among community pharmacists and explore their attitudes toward issues related to smoking cessation.

Methods:

A survey was conducted in November 2003 in community pharmacies in Riyadh City, Saudi Arabia. Community pharmacies were randomly selected from the Ministry of Health Registers List. A self-administered questionnaire was used for data collection.

Results:

The survey revealed a 19.9% prevalence rate of cigarette smoking among community pharmacists. Lung diseases, including cancer, and cardiovascular diseases were mentioned as the main risk factors of cigarette smoking. The majority of the surveyed pharmacists agreed with banning smoking in common places, and they are willing to support patients who want to quit smoking. They also believe that the pharmacist can play a positive role in smoking cessation.

Conclusions:

Although pharmacists who participated in this survey were fully aware of the health hazards related to smoking, we found that their activities in promotion of smoking cessation were far from exemplary. Based on these findings, there is a need to put more emphasis on pharmacists to devote time for anti-smoking counseling.

[The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery]

BACKGROUND

The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure.

METHODS

Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldrete's Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period.

RESULTS

A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay.

CONCLUSION

Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients.

Integrating lifestyle-focused approaches into psoriasis care: improving patient outcomes?

Psoriasis is one of the most well described cutaneous disorders, with a large body of literature devoted to describing its pathogenesis and treatment. In recent years, attention has turned toward the mechanisms by which lifestyle can impact psoriatic disease, and how lifestyle interventions may help to alleviate cutaneous, rheumatological, and comorbid disease in the setting of psoriasis. The following review explores our current understanding of the interaction between lifestyle factors and psoriasis and describes outcomes of interventions meant to target these factors.

Oxidative stress as a mechanism of added sugar-induced cardiovascular disease

Added sugars comprising of table sugar, brown sugar, corn syrup, maple syrup, honey, molasses, and other sweeteners in the prepared processed foods and beverages have been implicated in the pathophysiology of cardiovascular diseases. This article deals with the reactive oxygen species (ROS) as a mechanism of sugar-induced cardiovascular diseases. There is an association between the consumption of high levels of serum glucose with cardiovascular diseases. Various sources of sugar-induced generation of ROS, including mitochondria, nicotinamide adenine dinucleotide phosphate-oxidase, advanced glycation end products, insulin, and uric acid have been discussed. The mechanism by which ROS induce the development of atherosclerosis, hypertension, peripheral vascular disease, coronary artery disease, cardiomyopathy, heart failure, and cardiac arrhythmias have been discussed in detail. In conclusion, the data suggest that added sugars induce atherosclerosis, hypertension, peripheral vascular disease, coronary artery disease, cardiomyopathy, heart failure, and cardiac arrhythmias and that these effects of added sugars are mediated through ROS.

Psoriasis and smoking: a systematic review and meta-analysis

Psoriasis is an inflammatory skin disease associated with increased cardiovascular comorbidity. Smoking is associated with an increased risk of cardiovascular disease, and prior studies have suggested that patients with psoriasis are more likely to be active smokers. Smoking may also be a risk factor in the development of psoriasis. We conducted a systematic review and meta-analysis to assess the prevalence of smoking among patients with psoriasis, and we reviewed the contribution of smoking to the incidence of psoriasis. A total of 25 prevalence and three incidence studies were identified. The meta-analysis of prevalence studies included a total of 146 934 patients with psoriasis and 529 111 patients without psoriasis. Random effects meta-analysis found an association between psoriasis and current smoking [pooled odds ratio (OR) 1·78, 95% confidence interval (CI) 1·52-2·06], as well as between psoriasis and former smoking (pooled OR 1·62, 95% CI 1·33-1·99). Meta-regression analysis did not reveal any sources of study heterogeneity, but a funnel plot suggested possible publication bias. A subset of studies also examined the association between moderate-to-severe psoriasis and smoking, with a pooled OR of 1·72 (95% CI 1·33-2·22) for prevalent smoking. The three incidence studies found an association between smoking and incidence of psoriasis, with a possible dose-effect of smoking intensity and duration on psoriasis incidence. These findings suggest that smoking is an independent risk factor for the development of psoriasis, and that patients with established psoriasis continue to smoke more than patients without psoriasis.

Effects of cigarette smoking on choroidal and retinal thickness and ocular pulse amplitude

BACKGROUND

In our study, we aimed to show the effects of smoking on choroidal thickness and ocular pulse amplitude. It is known that the anatomy and physiologic functions of the choroid is important in ocular diseases like glaucoma and age-related macular degeneration. Choroidal thickness is measured by the spectral domain optical coherence tomography (SD-OCT). The ocular pulse amplitude (OPA) is the difference between the systolic and diastolic intraocular pressure (IOP) and it is an index of choroidal perfusion.

DESIGN

This was a cross-sectional prospective observational study at the Turgut Ozal University Hospital setting.

PARTICIPANTS

The test subjects were divided into two groups: the smokers group which consisted in 24 participants (20 male, 4 female) and the control group with 22 participants (16 male, 6 female).

METHODS

The participants underwent full ophthalmological examination including best-corrected visual acuity (BCVA), spherical equivalent (SE) values of refractive errors, intraocular pressure (IOP), ocular pulse amplitude (OPA), central corneal thickness (CCT), axial length (AL) and choroidal thickness. The IOP and the OPA were measured with the dynamic contour tonometer. The CCT and the AL were measured with the Nidek AL-Scan (Nidek Co., Ltd., Gamagori, Japan). The choroidal thickness was measured by the Cirrus high-definition optical coherence tomography (Cirrus Version 6.0; Carl Zeiss Meditec, Dublin, CA).

RESULTS

Gender did not differ significantly between the groups (p = 0.12). The age, SE, IOP, OPA, CCT and AL did not differ significantly in smokers and control groups (p = 0.12, p = 0.37, p = 0.54, p = 0.80, p = 0.56 and p = 0.82, respectively). The nasal, temporal, central retinal (p = 021, p = 021, p = 0.11) and nasal, temporal, central choroidal thicknesses (p = 0.80, p = 0.39, p = 0.75) did not differ significantly between smokers and control groups.

CONCLUSIONS

We could not find a significant difference in OPA, retinal and choroidal thicknesses between smokers and non smokers. Further studies including histopathological changes in larger groups are needed to show the effect of smoking on choroidal thickness especially in patients with ocular diseases like age-related macular degeneration.

Dental patient's knowledge and perceptions about the effects of smoking and role of dentists in smoking cessation activities

OBJECTIVES

The objective of the following study is to assess the knowledge of patients about the consequences of smoking on the general and oral health, to analyze the patient's perceptions about the role of dentists in smoking prevention, counseling and cessation and to analyze the willingness of smokers to quit smoking following dentist's advice.

MATERIALS AND METHODS

A descriptive study was conducted in a sample of 486 dental patients visiting Vokkaligara Sangha Dental College and Hospital, Bengaluruin the month of August 2011 using a self-administered questionnaire. Descriptive statistics and Chi-square test was performed to analyze data.

RESULTS

The patients had good knowledge about the effects of smoking on general and oral health. Statistically significant difference was observed in the knowledge of smokers and non-smokers about the effects of smoking on ageing (P = 0.008) and oral cancer (P = 0.0012). Patients had a positive perception about the role of dentists in smoking cessation activities. Smokers exhibited a willingness to quit if suggested by the dentist.

CONCLUSION

Patients perceive that dentists can play an important part in smoking cessation activities. Hence, dentists should not hesitate to give smoking cessation advice to their patients and grasp this opportunity to improve the general and oral health of the community.

The Characteristics of False Respondents on a Self-reported Smoking Survey of Korean Women: Korean National Health and Nutrition Examination Survey, 2008

Background

Previous studies have shown that self-reports tend to underestimate smoking status, especially among women in Korea. We therefore assessed the characteristics of Korean women smokers who falsely described themselves as non-smokers.

Methods

The subjects were 4,135 adult women aged ≥19 years who participated in the 2008 Korean National Health and Nutrition Examination Survey. Of these, 3,151 subjects answered questions about their smoking status on self-reported questionnaires and underwent assays of urinary cotinine concentration. Subgroups of false respondents (n = 131) and true respondents (n = 198) regarding smoking were determined by comparing their responses on questionnaires with their urinary cotinine levels.

Results

Among adult Korean women, the self-reported smoking rate was 7.4% (95% confidence interval [CI], 6.4% to 8.4%); however, using urinary cotinine >100 ng/mL as a marker of smoking, the smoking rate was 11.8% (95% CI, 10.5% to 13.3%). In multivariate analysis, after adjusting for type of household, family income, and suicidal ideation, the odds ratios (ORs) of false respondents were 3.49 (95% CI, 1.41 to 8.63) for college-educated women and 2.47 (95% CI, 1.22 to 5.01) for women with high school education, relative to women with elementary school education. Married women with living spouses (OR, 2.80; 95% CI, 1.33 to 5.90) were more likely to respond falsely than unmarried women. Women who reported trying to reduce weight within 1 year (OR, 2.70; 95% CI, 1.47 to 4.93) and those who reported being less stressed (OR, 1.82; 95% CI, 1.08 to 3.07) were more likely to be false respondents.

Conclusion

The smoking rate determined using urinary cotinine concentration was higher than the self-reported rate among Korean women. Among smokers, those who were more educated, married, living with a husband, trying to reduce weight, and less stressed tended to describe themselves falsely as non-smokers.

Does smoking cessation improve health-related quality-of-life?

This article examines whether smokers who enrolled in a community-based smoking cessation program and were successful in quitting for a six-month period had better health-related quality-of-life at six months relative to those who relapsed. An observational, longitudinal design was used; the sample included 350 participants 18-65 years of age. Health-related quality-of-life was measured using a broad array of indicators of physical and mental health. Six-month outcomes were compared between successful quitters and relapsers using analysis of covariance. Those who quit for six months had better psychological well-being, cognitivefunctioning, energy/fatigue, sleep adequacy, selfesteem, sense of mastery, and worse role functioning at six months than those who continued to smoke (p values > .05). No differences were observed in physical and social functioning, pain, or current health perceptions. There were no significant differences at enrollment in health-relatedquality-of-life between those who quit subsequently and those who relapsed, thus quality-of-life measures did not predict smoking status. We conclude that smokers who quit can possibly anticipate improvements in a range of mental health outcomes within six months, which could become an additional incentive to quit. Subsequent smoking cessation studies should include health-related quality-of-life measures to determine the generalizability of these findings.

Effects of smoking on visual acuity of central serous chorioretinopathy patients

BACKGROUND

The aim of this study was to evaluate the differences, in terms of visual outcome and treatment needs, between smokers and non-smokers central serous chorioretinopathy (CSCR) patients.

METHODS

The files of 252 patients diagnosed with CSCR who had presented to the Retina Unit of the Ophthalmology Clinic at Dicle University Medical School in Turkey were retrospectively evaluated. Eighty-four smokers, with a known history of smoking of at least one pack-year, and 133 non-smokers were included, whereas 35 patients with additional pathologies were excluded from the study.

RESULTS

Of the patients, 192 (88.5%) were male and 25 (11.5%) were female. The mean patient age was 38.8 ± 8.1 years (range: 20-68 years). Visual acuity (VA) of the smoker and non-smoker groups was measured as 0.45 ± 0.35 and 0.24 ± 0.28 logarithm of the minimum angle of resolution (logMar), respectively, at the first visit; 0.19 ± 0.29 and 0.06 ± 0.14 logMar at the sixth month; and 0.07 ± 0.14 and 0.02 ± 0.05 logMar at the ninth month. VA measurements at presentation and during all examinations (1th, 6th and 9th month) were significantly different for the two groups. VA was lower in the smoker group. In 27 patients (12.4%), an additional treatment modality was needed. Of the 27 patients, only 8 (6%) were non-smokers, whereas 19 (22.6%) were smokers. There was no difference between groups in the recurrence rate during follow-up (p = 0.907); 14 (16.7%) smokers and 8 (19.0%) non-smokers experienced a recurrence.

CONCLUSION

This study has shown that patients selected and who are current smokers have poorer vision and need longer treatment.

Epidemiology of lung cancer

Incidence and mortality attributed to lung cancer has risen steadily since the 1930s. Efforts to improve outcomes have not only led to a greater understanding of the etiology of lung cancer, but also the histologic and molecular characteristics of individual lung tumors. This article describes this evolution by discussing the extent of the current lung cancer epidemic including contemporary incidence and mortality trends, the risk factors for development of lung cancer, and details of promising molecular targets for treatment.

Serum mineral status of long-term cigarette smokers

This study was carried out to investigate comparatively some serum mineral levels of cigarette smokers. A total of 25 nonsmokers (control group) and 50 long-term cigarette smokers (smoking for at least 15 years; smoker group) were participated in the study. Subjects were between 25 and 40 years old. Control and smoker groups were matched for age, sex and body mass index status. The blood samples were taken from smokers and nonsmokers after 12 h of fasting period. The levels of zinc (Zn), copper (Cu), iron (Fe), magnesium (Mg), calcium (Ca), potassium (K), chlorine (Cl), sodium (Na) and phosphorus (P) were measured by autoanalyzer using commercial kits. Student’s t test was used to compare the control and smoker groups, and p < 0.05 indicated a significant difference. Pearson’s correlation coefficient was used to demonstrate the relationship among parameters in smoker and control groups. Although there was no statistical difference ( p > 0.05) between the groups regarding the levels of K, P, Mg, Na, Cl, Zn, Fe, Ca and Cu, some positive correlations were observed in controls but not in smokers. Therefore, it was concluded that smoking does not affect the serum mineral levels. However, it may negatively affect some important positive correlations among minerals observed in healthy individuals.

Could spatial heterogeneity in human vocal fold elastic properties improve the quality of phonation?

The physical mechanisms leading to the acoustic and perceptual qualities of voice are not well understood. This study examines the spatial distribution of biomechanical properties in human vocal folds and explores the consequences of these properties on phonation. Vocal fold lamina propria specimens isolated from nine excised human male larynges were tested in uniaxial tension (six from non-smokers, three from smokers). An optical method was employed to determine the local stretch, from which the elastic modulus of three segments in the anterior-posterior direction was calculated. Several specimens exhibited a significant heterogeneity in the modulus with the middle segment stiffer than the other segments. It was concluded that such modulus gradients are stronger in specimens from non-smokers than smokers. To understand the functional implications of a modulus gradient, the first eigenmode of vibration was calculated with a finite element model. With a modulus gradient, the vocal fold's eigenmode deflection was spread along the anterior-posterior length, whereas for a homogeneous modulus distribution, the deflection was more focused around the mid-coronal plane. Consequently, the strong modulus gradient may enable more complete glottal closure, which is important for normal phonation, while a more homogeneous modulus may be responsible for poor glottal closure and a perceived "breathy" voice.

Medical and psychological risk factors for incident hypertension in type 1 diabetic african-americans

Objective. To determine risk factors for the development of hypertension among African-Americans living with type 1 diabetes. Methods. African-Americans with type 1 diabetes (n = 483) participated in a 6-year followup. At both baseline and followup blood pressure was measured twice in both sitting and standing positions using a standard protocol. Patients had a structured clinical interview, ocular examination, retinal photographs, and blood and urine assays and completed the Hostility and Direction of Hostility Questionnaire (HDHQ) and the Beck Depression Inventory (BDI). Results. Of the 280 diabetic patients with no hypertension at baseline, 82 (29.3%) subsequently developed hypertension over the 6-year followup. Baseline older age, longer duration of diabetes, family history of hypertension, greater mean arterial blood pressure, overt proteinuria, increasing retinopathy severity, peripheral neuropathy, smoking, and higher hostility scores were significantly associated with the development of hypertension. Multivariate analyses showed that higher hostility scores and overt proteinuria were significantly and independently associated with the development of hypertension in this population. Conclusions. The development of hypertension in African-Americans living with type 1 diabetes appears to be multifactorial and includes both medical (overt proteinuria) as well as psychological (high hostility) risk factors.

The effect of smoking on survival and bone loss of implants with a fluoride-modified surface: a 2-year retrospective analysis of 1106 implants placed in daily practice

AIM

To compare the survival and peri-implant bone loss of implants with a fluoride-modified surface in smokers and nonsmokers.

MATERIALS AND METHODS

Patient files of all patients referred for implant treatment from November 2004 to 2007 were scrutinized. All implants were placed by the same experienced surgeon (B. C.). The only inclusion criterion was a follow-up time of at least 2 years. Implant survival and bone loss were assessed by an external calibrated examiner (S. V.) comparing digital peri-apical radiographs taken during recall visits with the post-operative ones. Implant success was determined according to the international success criteria (Albrektsson et al. 1986). Survival of implants installed in smokers and nonsmokers was compared using the log-rank test. Both nonparametric tests and fixed model analysis were adopted to evaluate bone loss in smokers and nonsmokers.

RESULTS

One-thousand one-hundred and six implants in 300 patients (186 females; 114 males) with a mean follow-up of 31 months (SD 7.15; range 24-58) were included. Nineteen implants in 17 patients failed, resulting in an overall survival rate of 98.3% at the implant level and 94.6% at the patient level. After a follow-up period of 2 years, the cumulative survival rates was 96.7% and 99.1% with the patient and implant as the statistical unit, respectively. Implant survival was significantly higher for nonsmokers compared with smokers (implant level P=0.025; patient level P=0.017). The overall mean bone loss was 0.34 mm (n=1076; SD 0.65; range 0-7.1). Smokers lost significantly more bone compared with nonsmokers in the maxilla (0.74 mm; SD 1.07 vs. 0.33 mm; SD 0.65; P<0.001), but not in the mandible (0.25 mm; SD 0.65 vs. 0.22 mm; SD 0.5; P=0.298).

CONCLUSION

The present study is the first to compare peri-implant bone loss in smokers and nonsmokers from the time of implant insertion (baseline) to at least 2 years of follow-up. Implants with a fluoride-modified surface demonstrated a high survival rate and limited bone loss. However, smokers are at a higher risk of experiencing implant failure and more prone to show peri-implant bone loss in the maxilla. Whether this bone loss is predicting future biological complications remains to be evaluated.

Addressing the common pathway underlying hypertension and diabetes in people who are obese by maximizing health: the ultimate knowledge translation gap

In accordance with the WHO definition of health, this article examines the alarming discord between the epidemiology of hypertension, type 2 diabetes mellitus (T2DM), and obesity and the low profile of noninvasive (nondrug) compared with invasive (drug) interventions with respect to their prevention, reversal and management. Herein lies the ultimate knowledge translation gap and challenge in 21st century health care. Although lifestyle modification has long appeared in guidelines for medically managing these conditions, this evidence-based strategy is seldom implemented as rigorously as drug prescription. Biomedicine focuses largely on reducing signs and symptoms; the effects of the problem rather than the problem. This article highlights the evidence-based rationale supporting prioritizing the underlying causes and contributing factors for hypertension and T2DM, and, in turn, obesity. We argue that a primary focus on maximizing health could eliminate all three conditions, at best, or, at worst, minimize their severity, complications, and medication needs. To enable such knowledge translation and maximizing health outcome, the health care community needs to practice as an integrated team, and address barriers to effecting maximal health in all patients. Addressing the ultimate knowledge translation gap, by aligning the health care paradigm to 21st century needs, would constitute a major advance.

The effect of smoking on early bone remodeling on surface modified Southern Implants®

INTRODUCTION

Smoking affects the survival of turned titanium implants. Although smoking has less impact on the failure rate of rough surface implants, the effect on bone loss on rough surface implants has not been studied yet and may be an important factor in biological stability.

AIM

To determine the effect of smoking on early implant failures and bone remodeling around moderately rough implants (Southern Implants®, Southern Implants, Irene, South Africa).

MATERIALS AND METHODS

Three hundred twenty-nine patient records, containing information on 712 installed implants, were scrutinized retrospectively and periapical radiographs were analyzed for interproximal bone level. Mann-Whitney U-test and Fisher's exact test were performed to compare bone level and implant survival in smokers and nonsmokers. Only implants with at least 6 months of function time were analyzed for bone level changes.

RESULTS

The overall survival rate was 98.3%. Implants in smokers had a threefold higher failure rate compared with nonsmokers (5/104 = 4.8% vs 7/608 = 1.2%). This was statistically significant on implant level (p = .007) but not on patient level (1/41 vs 7/288, p = .997). Readable radiographs from 363 implants in 169 patients were available with a mean follow-up of 12 months (SD 5.11; range 6-28). The mean interproximal bone level was 1.36 mm (n = 363; SD 0.41; range 0.48-3.70). Bone levels were independent of jaw location. Sixty implants from 21 smokers lost statistically significantly (p = .001) more bone (mean 1.56; SD 0.53; range 0.75-3.22) than the 303 implants in 148 nonsmokers (mean 1.32 mm; SD 0.38; range 0.48-3.7). The maxilla is especially prone to bone loss compared with the mandible (1.70 mm vs 1.26 mm, p < .001).

CONCLUSION

The Southern Implants® system demonstrated a high absolute survival rate. Although smokers are not more prone to implant loss, more pronounced peri-implant bone loss was observed, especially in the maxilla. Whether this affects future biological complications remains to be investigated in prospective long-term studies.

Detrimental effects of cigarette smoke constituents on physiological development of extraocular and intraocular structures

No investigation has yet been accomplished to screen the detrimental effects of cigarette smoke condensate (CSC) and total particular matter solution (TPMS) on embryonic development of extraocular and intraocular structures. In this report, chicken embryo assay was utilized to undermine diverse ocular pathologies produced by exposure of CSC and TPM. Extraocular anomalies triggered after exposure of CSC and TPMS include degeneration of optic chiasma, medial rectus muscle, and inflammatory lesions in forebrain. Histological investigations of CSC and TPMS-treated embryos also exposed delayed differentiation of photoreceptor layer, degeneration of retinal ganglion and nerve cell layer. In addition, corneal thickness, deterioration and complete loss of hyaloid vasculature were observed. Extraocular and intraocular regions of TPMS-treated embryos also revealed widespread hemorrhages in the entire cephalic, optic disc, ganglion cell layer and vitreous humor area. The findings of our experiment demonstrate, for the first time, that exposure to CSC and TPMS is hazardous for developing embryos and it has potential detrimental effects on several underlying events of ocular development. Moreover, it was also intriguing that toxicity profile of TMP was much more higher than CSC with more profound detrimental effects on ocular development.

Impact and interactions between smoking and traditional prognostic factors in lung cancer progression

BACKGROUND

Cigarette smoking is a well-known risk factor of lung carcinogenesis. The clinical impact of smoking on lung cancer metastases and survival remains unclear. We sought to investigate the effect of smoking intensity on lung cancer treatment failure (represented by overall survival), and the interactions between smoking and clinicopathological factors in lung cancer progression.

METHODS

Clinical information was obtained from four non-small cell lung cancer patient cohorts (n=347). Twenty patients were excluded from the analysis because their smoking history was not available. The distribution of smoking intensity on patient age (> or =60 years or <60 years), gender, tumor differentiation (poor, moderate and well differentiated), and clinical stage (1, 2, or 3) was assessed with Kruskal-Wallis rank sum tests. The effect of smoking on cause-specific lung cancer mortality was estimated by using Cox proportional hazard models and Kaplan-Meier analysis. The interactions between clinicopathological factors and smoking intensity with regard to lung cancer overall survival were evaluated with analysis of variance (ANOVA) for Cox modeling.

RESULTS

Greater smoking intensity at diagnosis was found in older patients (> or =60 years; p=0.022), male (p=1.35e-7), poorly differentiated tumors (p=8.51e-5), patients with tumor stage 2 (p=0.031), and squamous cell lung cancer patients (p=2.2e-16). Patients who smoked more than 61 packs/year had an increased risk for lung cancer recurrence (hazard ratio=1.41, 95% CI: [1.03, 1.94], log-rank p=0.032) and shorter overall survival period (log-rank p=0.033, Kaplan-Meier analysis) than those who smoked less than 61 packs/year. ANOVA analysis showed that smoking intensity (p=0.03) and tumor stage (p=1.2e-6) are the only significant prognostic factors of lung cancer, whereas patient age, gender, and tumor differentiation were not significant in lung cancer prognostication. There were significant interactions between smoking and clinical stage (p=0.02) as well as patient age and tumor differentiation (p=0.03) in lung cancer progression.

CONCLUSION

Smoking intensity at diagnosis is an independent, significant prognostic factor of non-small cell lung cancer. This factor could be used in patient selection for chemoprevention of tumor metastases and relapse. Additionally, the information may be used for clinically relevant tobacco prevention and intervention messages.

How free of tobacco smoke are 'smoke-free' homes?

The risks of exposure to environmental tobacco smoke (ETS) are well established and 'harm reduction' strategies such as smoking outside to protect infants and children from exposure to ETS have been advocated for some time. The aim of this study was to assess the validity of self-reported smoking levels in residential settings. The participants were families (n = 92) randomly selected from lower socioeconomic areas of Perth, Western Australia. Each household was monitored for vapor phase nicotine and particulates with an aerodynamic diameter of < or = 10 microm (PM(10)). Of the 42% (39) households who reported that someone smoked cigarettes at home, only four (4%) said that smoking occurred inside the house. There was a 'moderate' agreement between parental-reported tobacco smoking and levels of nicotine (kappa = 0.55, P < 0.01). There were significant differences in the median levels of air nicotine (P < 0.01) and PM(10) (P < 0.05) between households in which smoking was reported as only occurring outside, and the smoke-free households.

PRACTICAL IMPLICATIONS

The study outcome suggests that a strategy based on the separation of children and smoking activity is inadequate to protect the former from ETS at home, and that health professionals should give parents unambiguous advice to give up smoking in order to make their homes a completely smoke-free environment.

Adherence to a healthful life attenuates lipid parameters among a healthy Italian population

BACKGROUND AND AIM

During the last 5 years, an increasing body of evidence on the association between adherence to the Mediterranean diet (MD), calculated through specific diet scores, and health status have been accumulated, but limited data are available regarding the association between MD scores and biomarkers. Similarly, many studies have demonstrated a significant protection against chronic diseases from a global healthy lifestyle (HL) pattern which includes not only dietary habits but also physical activity and abstinence from smoking, whereas few data regarding the influence of a HL pattern on circulating biomarkers are available. Using the framework of an epidemiological study conducted in Florence, Italy between 2002 and 2004 we evaluated the association between two different scores (a score of adherence to the MD and a score of adherence to a healthful life which includes abstinence from smoking and a moderate-to-high physical activity level) and some circulating parameters linked to chronic diseases.

METHODS AND RESULTS

Dietary habits and anthropometric and biochemical profiles were studied in 932 individuals (365 M; 567 F) with a median age of 47.5 years. Subjects who reported a greater adherence to the MD were found more frequently to be male, married and over 45 years of age. A general linear model dividing the study population into quartiles of scores was used. After adjustment for age, gender, educational status, body mass index and total energy intake, we observed no influence of adherence to the MD on circulating levels of biomarkers. On the other hand, an inverse association between circulating levels of lipid parameters (namely total cholesterol, LDL-cholesterol and triglycerides) and higher scores of adherence to a HL, was reported. In addition, a significant difference between the highest and the lowest quartiles of HL scores for homocysteine plasma levels was observed (p=0.04).

CONCLUSION

A high adherence to a HL, which includes not only a high adherence to the MD but also to other lifestyle factors (i.e. abstinence from smoking, and increasing physical activity during leisure time), is able to lower lipid parameters and homocysteine in a clinically healthy Italian population.

Smoking interferes with the prognosis of dental implant treatment: a systematic review and meta-analysis

AIM

This systematic literature review was performed to investigate if smoking interferes with the prognosis of implants with and without accompanying augmentation procedures compared with non-smokers.

METHODS

A systematic electronic and handsearch (articles published between 1989 and 2005; English and German language; search terms "dental or oral implants and smoking"; "dental or oral implants and tobacco") was performed to identify publications providing numbers of failed implants, related to the numbers of smokers and non-smokers for meta-analysis. Publications providing statistically examined data of implant failures or biologic complications among smokers compared with non-smokers were included for systematic review.

RESULTS

Of 139 publications identified, 29 were considered for meta-analysis and 35 for systematic review. Meta-analysis revealed a significantly enhanced risk for implant failure among smokers [implant-related odds ratio (OR) 2.25, confidence interval (CI(95%)) 1.96-2.59; patient-related OR 2.64; CI(95%) 1.70-4.09] compared with non-smokers, and for smokers receiving implants with accompanying augmentation procedures (OR 3.61; CI(95%) 2.26-5.77, implant related). The systematic review indicated significantly enhanced risks of biologic complications among smokers. Five studies revealed no significant impact of smoking on prognosis of implants with particle-blasted, acid-etched or anodic oxidized surfaces.

CONCLUSION

Smoking is a significant risk factor for dental implant therapy and augmentation procedures accompanying implantations.

Intima-media thickness of the common carotid artery in highway toll collectors

PURPOSE

To assess the effects of exposure to exhaust particles on intima-media thickness of the common carotid artery in highway toll collectors.

METHODS

Sixty-one highway toll collectors (HTCs) between 24 and 56 years of age (mean, 36.2 +/- 7.3) and 48 controls between 24 and 64 years of age (mean, 42.6 +/- 10.6) were evaluated with gray-scale sonography to measure intima-media thickness (IMT) of the common carotid artery (CCA). Subgroups were categorized according to duration of exhaust exposure and further divided according to tobacco use.

RESULTS

CCA IMT was higher (0.8 +/- 0.2 mm) in HTCs than in the control group (0.6 +/- 0.1 mm; p < 0.001) and remained higher when subgroups with similar smoking habits were compared. In HTCs, IMT was greater when the number of years working in tollbooths was greater (p = 0.023). IMT was lower in HTCs with an exposure duration of < 10 years compared with a duration of 10-20 years (p = 0.017) or > 20 years (p value not significant).

CONCLUSION

Air pollution has a widely acknowledged negative effect on humans. This study confirms that exposure to exhaust particles might cause wall thickening of carotid arteries.