Smoking Across the Menopausal Transition in a 10-Year Longitudinal Sample: The Role of Sex Hormones and Depressive Symptoms

INTRODUCTION

Current cigarette smoking rates among older women remain problematic, especially given that this population experiences increased smoking-related health consequences. Despite these increased health concerns, little research to date has explored smoking patterns across the menopausal transition (pre-, early-peri-, late-peri-, and postmenopausal) or the effect of unique factors such as sex hormones and depression during this transition.

METHODS

This study used 10 yearly waves of data from the Study of Women's Health Across the Nation, a longitudinal dataset. Data included 1397 women endorsing ever smoking regularly at baseline. Random-effects logistic regression models were used to examine smoking transitions.

RESULTS

Although there were no associations between menopausal transition stage and smoking behavior, increased estradiol was associated with an increased likelihood of quitting regular smoking (eg, transitioning from regular smoking to non-regular or no smoking; odds ratio [OR] = 1.28), whereas increased testosterone was associated with an increased likelihood of relapsing to regular smoking (eg, transitioning from former or nonregular smoking to regular smoking OR = 2.56). Depression was associated with increased likelihood of continued smoking (OR = 0.97) and relapse (OR = 1.03).

CONCLUSIONS

The results emphasize the need to develop interventions to target initiated or continued smoking among women across the menopausal transition and specifically highlight the importance of developing treatments that target depressive symptoms in this population. In addition, although singular hormone measures were associated with smoking behavior, there is a need for future study of dynamic changes in hormones, as well as the impact of progesterone on smoking behaviors across the menopausal transition.

IMPLICATIONS

To date, no studies have examined smoking behaviors across the menopausal transition. In this study, although menopausal transition status was not significantly related to transitions in smoking behavior, important relationships between sex hormones and depression were observed. Increased estradiol was associated with an increased likelihood of quitting regular smoking, whereas increased testosterone was associated with an increased likelihood of relapsing to regular smoking behavior. Higher depression scores were related to continued smoking and relapse to regular smoking behavior. These results highlight the need to develop interventions to target smoking cessation among women across the menopausal transition.

Intersection of E-Cigarette Use and Gender on Transitions in Cigarette Smoking Status: Findings Across Waves 1 and 2 of the Population Assessment of Tobacco and Health Study

INTRODUCTION

Cigarette smokers report using electronic cigarettes (e-cigarettes) to reduce or quit smoking, but findings are mixed regarding the benefit and risk of e-cigarettes in this population, and effects of gender are unknown.

METHODS

The Population Assessment of Tobacco and Health (PATH; waves 1 and 2; adult interviews) was used to evaluate relationships among wave 1 e-cigarette use (daily, nondaily, never) and gender and their association with transitions (quit vs. current; relapse vs. former) in cigarette smoking status across waves 1 and 2 of the PATH study.

RESULTS

Daily e-cigarette users had higher odds of quitting smoking (odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.12 to 2.18) compared with never e-cigarette users. Conversely, daily and nondaily e-cigarette users were at greater risk of smoking relapse (OR = 1.84, 95% CI = 1.15 to 2.94 and OR = 1.85, 95% CI = 0.99 to 3.46, respectively) compared with never e-cigarette users. Women were less likely to quit smoking compared with men independent of e-cigarette use (OR = 0.76, 95% CI = 0.59 to 0.99). In stratified analyses, daily or nondaily e-cigarette use did not increase the likelihood of quitting or relapse in women. In men, daily and nondaily e-cigarette users were at greater risk of smoking relapse (OR = 2.96, 95% CI = 1.49 to 5.86 and OR = 3.05, 95% CI = 1.29 to 7.17, respectively) compared with men who were never e-cigarette users.

CONCLUSIONS

Findings identify e-cigarettes as a potential aid for smoking cessation but also as a potential risk for smoking relapse in men only. Overall, women were less likely to quit smoking, and e-cigarette use did not impact their ability to quit or to stay quit.

IMPLICATIONS

Cigarette smokers report using e-cigarettes to reduce or quit smoking, but findings are mixed regarding the benefit and risk of e-cigarettes in this population. Using data from the newly available PATH (waves 1 and 2; adult interviews), our findings identify e-cigarettes as a potential aid for smoking cessation but also identify e-cigarettes as a potential risk for smoking relapse in men only. These findings may have implications for the regulation of e-cigarettes by the Food and Drug Administration and the benefit-cost ratio of e-cigarette use in smokers.

Electronic Cigarette Use and Risk of Harmful Alcohol Consumption in the U.S. Population

BACKGROUND

Electronic cigarette (e-cigarette) use is an increasingly common method of nicotine delivery in the general population. It is well-established that tobacco users are at increased risk to engage in hazardous drinking and meet criteria for alcohol use disorder (AUD) relative to nonusers. Less is known, however, about the risk of harmful alcohol use among people who use e-cigarettes. The current study reports on the association between e-cigarette and alcohol use in the U.S. population using a nationally representative sample.

METHODS

Data from 36,309 adults who participated in the National Epidemiologic Survey on Alcohol and Related Conditions-Wave III were included in the study. The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS) measured past-year e-cigarette and alcohol use outcomes. Based on past-year e-cigarette use, respondents were categorized as nonusers, nondaily users, or daily users. Alcohol use outcomes were drinking quantity/frequency, binge drinking frequency, AUD diagnostic status, and National Institute on Alcohol Abuse and Alcoholism-defined hazardous drinking status.

RESULTS

Controlling for demographic characteristics, daily and nondaily e-cigarette users showed increased risk of harmful alcohol use compared to e-cigarette nonusers, including hazardous drinking (adjusted odds ratios [AORs] = 1.69; 2.48), AUD (AORs = 1.89; 2.44), and binge drinking frequency (AORs = 1.30 to 3.30). Nondaily e-cigarette use was associated with higher levels of risk than was daily use. Secondary analyses examined alcohol use outcomes according to participants' patterns of dual tobacco cigarette/e-cigarette use. These analyses confirmed that e-cigarette use alongside tobacco cigarette use is associated with additive risk of harmful alcohol consumption, particularly among nondaily users.

CONCLUSIONS

E-cigarette users, particularly those who engage in nondaily and dual use, show elevated rates of harmful alcohol use. Heavy drinking may constitute a source of health risk among e-cigarette users.

Ludwig II, King of Bavaria: a royal medical history

OBJECTIVE

The case of Ludwig II, King of Bavaria, had soon become synonymous with paranoia, after he had drowned at the age of 40 together with the neuropsychiatrist Gudden.

METHOD

We were granted access to the Secret Archive of the House of Wittelsbach to study documents on Ludwig's medical history.

RESULTS

The documents underlying Gudden's expert opinion which led to Ludwig being deposed would be insufficient for a diagnosis of schizophrenia according to contemporary standards. The autopsy revealed prominent prefrontal brain atrophy.

CONCLUSION

The evidence is compatible with a diagnosis of schizotypal personality and suspected frontotemporal degeneration.

Ludwig II. von Bayern - schizotype Persönlichkeit und frontotemporale Degeneration?

Ludwig 2nd, dream-king of Bavaria, has been the subject of medical speculation even during his life and he still is today. Documents from the Secret Archive of the Bavarian State and more widely available information do not support a diagnosis of schizophrenia, but correspond with contemporary criteria for a schizotypal personality disorder. Ludwig's behavioural deterioration during the last months of his life and autopsy findings may indicate incipient frontotemporal degeneration.

First clinical experience with a mechanical valve with silver coating

BACKGROUND AND AIM OF THE STUDY

The interface between the annulus and sewing cuff is the infectious center of prosthetic valve endocarditis (PVE). To decrease the incidence of PVE, the sewing cuff of the St. Jude Medical (SJM) mechanical heart valve was permanently coated with elemental silver (Silzone coating). In vitro data have supported the antimicrobial efficacy of this coating.

METHODS

To study any adverse effects of the silver coating in humans, serum silver levels were determined (by graphite furnace atomic absorption spectrometry) before (baseline) and at five intervals after operation: day 1, day 3, discharge, one month, and two months. Between January and August 1997, 38 patients (71% males) underwent surgical implant of a SJM Masters Series valve with Silzone coating for the aortic valve (n = 29), mitral valve (n = 6), or both valves (n = 3). Five patients (13%) underwent concomitant procedures. Two patients (5%) presented with native active valve endocarditis.

RESULTS

There was no hospital mortality or valve-related hospital morbidity. Blood silver concentrations peaked shortly after surgery and then decreased during the postoperative period. Average levels were consistently below 4 parts per billion (ppb). Levels below 10 ppb are considered normal. Follow up was 95% complete. There were no recurrent or new cases of endocarditis.

CONCLUSION

These clinical data indicate that the SJM Masters Series valve with Silzone coating performs well. No adverse effects of the silver coating could be detected, and there were no valve-related complications.

Papillary muscle shortening for mitral valve reconstruction in patients with ischaemic mitral insufficiency

AIMS

To evaluate the feasibility of papillary muscle shortening in a specific group of high risk patients with ischaemic mitral regurgitation undergoing mitral valve reconstruction.

BACKGROUND

From January 1996 to December 1997, 712 (10.1%) out of a total of 7042 open heart patients underwent mitral valve surgery in our hospital. Mitral valve reconstruction was performed in 408 of these patients (57.3%) and valve replacement had to be performed in 304 patients (42.7%).

METHODS

A specific technique of papillary muscle reconstruction was performed in 32 patients undergoing valve reconstruction (7.8%). These cases had degenerated and had developed fibrotic elongated papillary muscles, which resulted in prolapses of one or more parts of the mitral valve leaflets. The aetiology in this group of patients was ischaemic, requiring concomitant myocardial revascularization in 28 patients (87.5%) with a mean of 2.7 grafts/patient. All patients underwent papillary muscle shortening using a pericardium pledget-reinforced Polytetrafluoroethylene suture and annuloplasty with a Carpentier-Edwards Physio Annuloplasty Ring. Of these 32 patients, 17 (53.1%) were male, the mean age was 67.1+/-9.7 years (range 41 to 81 years) and all but one were in pre-operative NYHA class III or IV.

RESULTS

There were two hospital deaths (6.2%). Postoperative Doppler echocardiography indicated satisfactory mitral valve function in all patients. Within the short mean follow-up period of 9.6+/-5.4 months (3 to 26 months) there was one non-cardiac-related death (3.1%). There was no need for reoperation, and no cases of thromboembolic and bleeding complications in the postoperative period. All patients were in NYHA functional class I or II at the time of follow-up.

CONCLUSION

Our results indicate that mitral valve repair is a safe treatment for this group of high risk patients, and that papillary muscle shortening is a valuable tool in these patients with ischaemic mitral regurgitation undergoing surgery.

[Isolated prolapse of the posterior leaflet of the mitral valve. Results of reconstructive surgery]

Out of 522 patients undergoing mitral valve reconstruction for mitral regurgitation between 1988 and June 1994, the authors studied 159 cases of isolated mitral regurgitation by prolapse of the posterior mitral leaflet. There were 98 men (62%) and 61 women (38%), with an average age of 58.4 +/- 10.4 years. The functional class and ejection fraction were 2.8 +/- 0.11 and 0.66 +/- 0.2 respectively. In 155 patients, surgery consisted in quadrangular resection of the prolapsed tissue, followed in 83 cases by sliding posterior valvuloplasty and in 72 cases by plicature of the annulus. In 4 cases, the prolapse was treated by implantation of artificial chordae tendinae. A Carpentier-Edwards ring was inserted in all cases. There were no hospital deaths. Echocardiography was performed before discharge from hospital and showed satisfactory mitral valve function in 98% of cases: slight systolic anterior motion (SAM) was observed in one case. All patients were followed up for an average of 3.67 +/- 0.10 years. At six years, survival was 93 +/- 7%; moreover, 93 +/- 7% and 97 +/- 3% of patients had no thromboembolic or haemorrhagic complications. Six patients were reoperated, three of them in the first year of follow-up. At six years, 95 +/- 5% of patients were free of reoperation and 81 +/- 11% were free of all complications. The authors conclude that the excellent medium term survival and the low rate of complications are evidence in favour of conservative surgery for treatment of mitral regurgitation due to prolapse of the posterior mitral leaflet.

[Simultaneous enucleation of a pulmonary melanoma metastasis and myocardial revascularization]

BACKGROUND

The incidence of late, recurrence of malignant melanoma, is a well known, but very rare clinical experience.

CASE REPORT

We report a case of simultaneous myocardial revascularisation and resection of pulmonary melanoma metastasis. In 1963 an enucleation of the right eye was necessary due to an ocular melanoma. In 1993 the patient suffered acute left heart failure and a 3-vessel disease with severe reduced left ventricular function was diagnosed. Chest X-ray examination revealed a singular pulmonary lesion in the right lower lobe with a diameter of 5.5 cm. Myocardial revascularisation and resection of the pulmonary focus was performed simultaneously without complication. The histological examination documented a pulmonary late recurrence of malignant melanoma. Up to this time (3 years later) the patient is free of cardiac symptoms and there is no evidence of further late recurrence of malignant melanoma.

CONCLUSION

The appreciable number of patients who, after a disease-free interval of 10 to 20 years, develop a late recurrence of a malignant melanoma, and in particular-as in the present case-a choroidal melanoma, is powerful evidence for a need to keep these patients under lifelong surveillance.

Valve repair for mitral regurgitation caused by isolated prolapse of the posterior leaflet

BACKGROUND

Although prolapse of the posterior leaflet is the most common abnormality of the mitral valve causing dysfunction, the long-term results of mitral valve repair for this condition are seldom reported.

METHODS

From October 1988 to June 1994, 208 patients (mean age, 59.4 years) with mitral regurgitation caused by isolated prolapse of the posterior leaflet underwent mitral valve repair alone or combined with myocardial revascularization (n = 30). The surgical techniques were quadrangular resection (n = 199) followed by annulus plication (n = 101) or sliding leaflet plasty (n = 98), use of artificial chordae (n = 5), or papillary muscle shortening (n = 4). All patients had an annuloplasty with a Carpentier ring. Mean follow-up was 3.4 +/- 0.1 years and total follow-up, 656 patient-years.

RESULTS

There were six operative deaths (2.9%). Postoperative Doppler echocardiography found two cases of systolic anterior motion (1%), and echocardiographic studies at follow-up showed satisfactory mitral valve function in 97% of 112 patients. At 6 years, the actuarial survival rate was 87% +/- 7%, and freedom from thromboembolic complications, bleeding complications, and reoperation was 93% +/- 7%, 95% +/- 3%, and 95% +/- 4%, respectively.

CONCLUSIONS

Mitral valve repair for regurgitation caused by prolapse of the posterior leaflet provides excellent survival at 6 years and should be considered the method of choice for its surgical treatment.

[Clinical experiences with mitral valve reconstruction]

Between October 1988 and December 1993, 433 patients with mitral valve insufficiency underwent mitral valve repair. Patient's age ranged from 13 to 82 years (mean age 59.5 years). Mitral valve insufficiency was due to degenerative disease in 192 patients (44%), ischemic disease in 102 (23%), rheumatic disease in 76 (18%) and other causes in 63 patients (15%). Most of the patients (337) were in functional class III or IV. The patients were divided into 3 functional groups: type I (normal leaflet motion) 141 patients (33%), type II (leaflet prolapse) 265 patients (61%) and type III (restricted leaflet motion) 27 patients (6%). Two patients were lost to follow-up for a total follow-up of 761 patients per year. The operative mortality was 2.5% for the total group, 0.4% for the group with isolated mitral valve insufficiency, 7.5% for the group with mitral valve repair associated with coronary artery bypass grafting and 2.9% for the group associated with tricuspid valve repair. At the time of the discharge, 71% of the patient at Doppler echocardiography showed no mitral regurgitation, 25.5%, 3% and 0.5% showed a mitral regurgitation grade 1,2 or 3 respectively. The 5-year actuarial survival was 84%. At 5 years, 96% of the patients were free from reoperation, 96% free from thromboembolism and 93% free from bleeding complications. Among the survivors 93% of the patients were in functional class I or II.

A scale for identifying "Stockholm syndrome" reactions in young dating women: factor structure, reliability, and validity

The factor structure, reliability, and validity of a 49-item scale designed to measure Stockholm Syndrome (also referred to as "traumatic bonding" and "terror bonding"), that is, bonding with an abusive partner, were assessed for college women in heterosexual dating relationships. Factor analysis identified three major factors: Core Stockholm Syndrome, characterized by cognitive distortions and other strategies for coping with abuse; Psychological Damage, marked by depression, low self-esteem, and loss of sense of self; and Love-Dependence, typified by the feeling that one cannot survive without one's partner's love. The scale and factors had excellent internal consistency and good test-retest reliabilities. They correlated negatively with the Marlowe-Crowne Social Desirability scale and positively with Horowitz, Wilner, & Alvarez' (1979) Impact of Event Scale, Hyler and Rieder's (1987) Borderline Personality Disorder Scale, Hatfield and Sprecher's (1986) Passionate Love Scale, and Straus' (1979) Verbal Aggression and Violence scales of the Conflict Tactics Scales.

[Pericardial lipoma as the cause of extensive mediastinal space-occupying lesion]

Lipomas of the heart are benign neoplasias and have rarely been described. Due to the fact that they normally cause no symptoms, diagnosis is often purely accidental. In the current report, the case of a 55-year-old patient is described in whom serial chest x-rays showed massive, progressive cardiac enlargement. Echocardiography and NMR showed a large pericardial mass confirmed by subsequent surgery which revealed a giant pericardial lipoma.

Internal fixation of the odontoid: a newer approach to an old problem

A surgical approach to cervical spine instability associated with odontoid fracture is described. Internal fixation of the odontoid (IFO) has advantages over traditional posterior surgical treatments currently employed. This approach to the odontoid process is easier for the surgeon comfortable with anterior discectomy to perform than other techniques described in the spine literature.

Therapy of giant intracranial aneurysms in the elderly

A series of 13 elderly patients (eight female, five male) with giant intracranial aneurysms is presented. The mean age was 67.8 years, with a range of 57-81 years. The paper presents the significant medical problems associated with operating on elderly individuals. Surgical intervention was attempted in all cases. Following surgical treatment, eight patients (62%) are alive and functional. Three patients (23%) are alive but partially disabled. Two patients (15%) died during the perioperative period. This compares favorably with other series which include younger patients indicating surgery for giant intracranial aneurysms can be carried out in elderly patients with an acceptable morbidity and mortality.

[Heart surgery in a female patient with blood group Oh (Bombay phenotype)]

A 62-year-old woman with stenosing coronary artery disease had the rare blood group Oh (Bombay phenotype). After prophylactic deep-freeze conservation of autologous blood, direct myocardial revascularization was successfully accomplished under extracorporeal circulation. Three deep-freeze units of erythrocyte concentrates were used. Both operation and postoperative wound healing progressed without complication.

[Bypass operations in coronary heart disease--status in 1982]

Coronary artery bypass surgery is the method of choice in treating coronary heart disease. A hospital mortality of about 1% is followed by nearly full life-expectancy and quality. Early diagnosis and division in groups, either for medical or surgical treatment, and early reconstruction before irreversible damage of myocardium would save many coronary patients from early retirement. 87.8% our patients felt symptomatically better, 66.1% were without symptoms. Five years after bypass surgery 93.6% of patients survived, but only 52.1% of patients with similar extend of disease survived after medical treatment. Only 45% of patients returned to work after the operation, though 53% of these had no complaints - indicating that coronary heart disease is also a sociopolitical problem.

[Microparticles in heart operations with extracorporal circulation (author's transl)]

Disturbances of the microcirculation during extracorporal circulation are not yet clearly understood. Many authors think that microembolism is reposible. In two groups of patients with different perfusion techniques we were looking for microparticles with a new constant pressure filtration method using the Agglometer r apparatus. During the by-pass no particles were found. Yet, we found particles in the priming when blood was used, in the suction blood and in special blood samples after contact with the pericardium. In these cases it was always possible to eliminate the particles with special filters. The particles in the suction blood seemed to originate from the extracardial blood portion coming from the pericardium. This portion seemed to be responsible for postoperative complications such as hemolysis and petechia. These complications could not be seen when extracardiac suction blood was eliminated or filtrated.

A quantitative evaluation of Landsat imagery of Australian rangelands

The capability of multidate, multispectral ERTS-1 imagery of three different rangeland areas within Australia was evaluated for its usefulness in preparing inventories of rangeland types, assessing on a broad scale range condition within these rangeland types, and assessing the response of rangelands to rainfall events over large areas. For the three divergent rangeland test areas, centered on Broken W, Alice Springs and Kalgoorlie, detailed interpretation of the imagery only partially satisfied the information requirements set. It was most useful in the Broken Hill area where fenceline contrasts in range condition were readily visible. At this and the other sites an overstorey of trees made interpretation difficult. Whilst the low resolution characteristics and the lack of stereoscopic coverage hindered interpretation it was felt that this type of imagery with its vast coverage, present low cost and potential for repeated sampling is a useful addition to conventional aerial photography for all rangeland types.

[Life expectancy in acquired vitium cordis after operative treatment (author's transl)]

Indications and results of operative treatment of acquired heart diseases are presented with reference to our experience with over 1500 operations on the heart valves and over 800 coronary surgical operations. The risk in timely operation for prosthetic substitution of aortic and mitral defects is less than 5%. An essential condition is, however, that no irreversible changes have developed and that the defect could be completely corrected. Surgical treatment of coronary heart disease is superior to conservative therapy and carries a risk of under 2% on strict indication. Timely operation on segmental stenoses before the ischemic myocardium is fibrosed is an essential. 70% of patients operated on can count on freedom from complaint for the time being after these palliative operations.