The Relationship of Tobacco, Alcohol, and Betel Quid with the Formation of Oral Potentially Malignant Disorders: A Community-Based Study from Northeastern Thailand

The association between betel quid use and oral potentially malignant and malignant disorders in Southeast Asian and Pacific regions: a systematic review and meta-analysis with GRADE evidence profile

Background

Betel quid (BQ) chewing is a prevalent habit in the Asian and Pacific regions. It is deeply intertwined within cultural customs, and has been reported to result in oral potentially malignant disorders (OPMDs) and malignant disorders (MDs).

Objective

We aim to present a summative and broad overview of the burden that BQ chewing has imposed on the residents of the Southeast Asian, Pacific, and Australasian regions, allowing us to quantify the level of impact it is currently causing on the risk of people developing oral cancer.

Methods

This scoping review and meta-analysis screened databases such as PubMed, MEDLINE, and Google Scholar for publications that investigated the association between BQ and OPMDs and MDs. The search strategy involved MeSH headings relating to BQ, OPMDs, and MDs, and a search for results during the period between January 2010 and June 2023 within the set geographical boundaries of the Southeast Asian and Pacific regions. This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for Scoping Reviews (PRISMA-ScR). R software was used to screen outliers. The included studies were further analysed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

Results

Nine articles (n = 19,312 participants) presented odds ratio outcomes from 11 regionally different study groups. We indicated a strong correlation between BQ chewing and the increased risk of OMPDs and MDs. The risk was quantified through meta-analyses with an odds ratio (OR) of 8.18 (5.27-12.72) and an increased OR of 9.93 (7.36-13.39) when the outlier was removed. BQ chewing was further identified within various Australian communities and discovered to be produced locally in North Queensland.

Discussion

A meta-analysis of two outcomes revealed substantial heterogeneity and minor evidence of publication bias, thus the association effect was included with and without these articles. The overall GRADE quality of evidence ranged from moderate to very high and highlighted five studies with a high level of imprecision.

Conclusion

The lingering high prevalence of BQ in the Southeast Asia and Pacific regions, as well as its rising acceptance among non-ethnic Australians, is alarming and requires prompt and rigorous intervention to prevent the risk of oral cancer.

Systematic Review Registration

PROSPERO (CRD42023429694).

The Effect of High Nicotine Dose on Maximum Anaerobic Performance and Perceived Pain in Healthy Non-Smoking Athletes: Crossover Pilot Study

Background: In recent years, there has been intensive discussion about the positive effect of nicotine usage on enhancing sports performance. It is frequently applied through a non-burned tobacco form before physical activity. Nicotine is under the World Anti-Doping Agency (WADA) 2021 monitoring program. Therefore, study results that reveal either positive or negative effects are expected. This is the pilot study that reports the effect of 8 mg dose of nicotine on performance and perceived pain. Material and Methods: This research aimed to explore the oral intake effect of a high-nicotine dose (8 mg) on the maximum anaerobic performance and other selected physical performance parameters in healthy, well-trained adult athletes (n = 15, age 30.7 ± 3.6, BMI 25.3 ± 1.7). The cross-sectional study protocol included the oral administration of either sublingual nicotine or placebo tablets before the anaerobic load assessed by a standardized 30 s Wingate test of the lower limbs. Afterward, the Borg subjective perception of pain (CR 10) and Borg rating of perceived exertion (RPE) were evaluated. Wilcoxon signed-rank test was used for the analysis of data with a 0.05 level of significance. Results: The results revealed that oral administration of an 8 mg nicotine dose does not significantly improve any of the physical performance parameters monitored. We only reported the statistically significant positive effect in RPE (p = 0.03). Conclusion: Lower perception of pain intensity that we reported after nicotine application might be an important factor that affects performance. However, we did not report any improvement in physical performance parameters.

Association Analysis of GSTP1-rs1695 Polymorphism with the Risk of Oral Cancer: A Literature Review, an Updated Meta- Analysis, and a Structural Assessment

BACKGROUND

This study aimed to investigate the association of rs1695 polymorphism in glutathione S-transferase P1 (GSTP1) with risk of oral cancer in a meta-analysis which was followed by a bioinformatics approach.

MATERIALS AND METHODS

Related articles were collected through a systematic search in PubMed, Google Scholar, and EMBASE databases up to June 2022 and then screened. Finally, seven studies, including 1249 cases of oral cancer and 1861 healthy individuals, were included in our meta-analysis. Seven different genetic models including G vs. A, GG+GA vs. AA, GG vs. GA+AA, GA vs. GG+AA, GG vs. GA, GG vs. AA, and GA vs. AA were used for the calculation of odds ratio and 95% confidence interval in order to assess the association between GSTP1-rs1695 polymorphism and oral cancer risk. Also, the ethnicity-based stratified analyses were performed using the seven mentioned models. Some bioinformatics software was used to investigate the effect of rs1695 polymorphism on the primary, secondary, and three-dimensional structure of GSTP1.

RESULTS

Our results showed that rs1695 polymorphism was not associated with the risk of oral cancer in any seven genetic models (G vs. A: OR= 0.9331, 95%CI= 0.6339-1.3737, P= 0.726; GG vs. GA+AA: OR= 0.9112 , 95%CI= 0.6865-1.2093, P= 0.520; GG+GA vs. AA: OR= 0.9006, 95%CI= 0.5522-1.4690, P= 0.675; GA vs. GG+AA: OR= 0.8732, 95%CI= 0.5763-1.3230, P= 0.522; GG vs. AA: OR= 0.9516, 95%CI= 0.5503-1.6456, P= 0.859; GG vs. GA: OR= 1.0645, 95%CI= 0.7891-1.4359, P= 0.683; GA vs. AA: OR= 0.8825, 95%CI= 0.5499-1.4162, P= 0.604). Also, we did not observe any significant associations in ethnicity-based stratified analyses. But bioinformatics studies have shown that this polymorphism can alter the physicochemical properties and secondary structure of the protein.

CONCLUSIONS

Based on results, the rs1695 polymorphism could not be considered a risk factor for oral cancer.

Predicting Hazardous Alcohol Drinking Behaviors in Family Members of Hazardous Alcohol-Drinker Patients

Family members of hazardous or harmful alcohol drinkers suffer many consequences of their relative’s alcohol-drinking behaviors and risk developing their own hazardous alcohol drinking behaviors. Studies of alcohol-related healthcare problems have mainly focused on patients, with few studies on their family members. This cross-sectional study explored factors predicting hazardous alcohol drinking behaviors in family members of hazardous alcohol-drinker patients. Participants were recruited from four randomly chosen hospitals in Taiwan. Data were collected using self-report questionnaires on family members’ alcohol use, perceived stress, coping mechanisms, social support, health, quality of life, protective factors against hazardous alcohol drinking, facilitative factors for hazardous alcohol drinking, and demographics. The 318 family members who participated in this study were divided by their Chinese-version Alcohol Use Disorders Identification Test scores into two groups: hazardous alcohol drinkers (score ≥ 8) and non-hazardous alcohol drinkers (score < 8). Significant factors predicting hazardous alcohol drinking behaviors were found by logistic regression to be the frequency of using general coping mechanisms (OR = 1.29, p < 0.01), the frequency of using strategies to cope with patients’ drinking-related behaviors (OR = 0.89, p < 0.01), factors protecting against hazardous alcohol drinking (OR = 0.76, p < 0.01) and factors facilitating hazardous alcohol drinking (OR = 1.52, p < 0.01). Interventions should be designed for family members of hazardous alcohol drinkers to address these four significant predictors.

Pilot Model for Community Based Oral Cancer Screening Program: Outcome from 4 Northeastern Provinces in Thailand

Management of advanced-stage oral cancer adds a great burden to individuals and health care systems. Community-based oral cancer screening can be beneficial in early detection and treatment. In this study, a novel oral cancer screening program was conducted utilizing an existing network of health care personnel, facilities, and digital database management for efficient coverage of a large population. The screening program considered 392,396 individuals aged ≥40 from four northeastern provinces in Thailand. Three levels of screening were performed: S1 by village healthcare volunteers to identify risk groups, S2 by dental auxiliaries to visually identify abnormal oral lesions, and S3 by dentists for final diagnosis and management. A total of 349,318 individuals were interviewed for S1, and 192,688 were identified as a risk group. For S2, 88,201 individuals appeared, and 2969 were further referred. Out of 1779 individuals who appeared for S3, oral potentially malignant disorders (OPMDs) were identified in 544, non-OPMDs in 1047, doubtful lesions in 52, and no results in 136 individuals. Final treatment was carried out in 704 individuals that included biopsies of 504 lesions, exhibiting 25 cancerous lesions and 298 OPMDs. This study is so far one of the largest oral cancer screening programs conducted in Thailand and showed effective implementation of community-based oral cancer screening.