Concurrent Smoking Research Articles

PTU-092 Crohn’s disease: strictureplasty and risks for further surgery

Introduction Surgery plays an important role in the treatment of Crohn’s disease. Strictureplasty in particular is a practical and attractive treatment for Crohn’s disease, conserving bowel length. Only a few large surgical series have been published in the literature. We describe our own experience and factors that determine risk of reoperation or death over a ten year period. Method All the Crohn’s disease strictureplasties for a specialist IBD surgeon at St George’s Hospital from 1st January 2005 to 31st December 2014 were identified. Information was collected for weight, height, gender, smoking status as well as their medical and surgical management. Patients whose records were incomplete were contacted for further information. Results There were a total of 53 cases of strictureplasty, with just under 3,400 months of follow-up. 22 had concurrent bowel resection. 32 were male. Mean age of diagnosis was 24 years and 10 months. Mean time from diagnosis to first ever surgery was 6 years and 3 months. Mean number of prior surgeries was 1. Total number of further surgery in the follow-up period was 11, with mean time to reoperation 42 months. No patients died during in the follow-up period. 86.54% were non smokers. At the time of surgery 30.25% had a low BMI, 60.45% had a normal BMI and 9.3% had a high BMI. 72.55% were receiving treatment with the immunomodulators: azathioprine, 6-mercaptopurine or methotrexate. Kaplan Meier survival analysis was used to compare those that had strictureplasties and those that had strictureplasty and concurrent bowel resection, with further surgery or death up to 31st December 2014 as the endpoint. Log rank test for trend did not find that there was any significant difference between the two groups and probability of further surgery. Cox regression analysis was used to assess for risk for further surgery: age of diagnosis, number of previous surgeries, time from diagnosis to first ever surgery, treatment with immunomodulators, concurrent bowel resection, sex, BMI and smoking status. Significant risk for further surgery was found in those that had ever smoked (hazard ratio 4.775, p = 0.003) and those patients with a low BMI who had concurrent bowel resection as well as strictureplasty (hazard ratio 6.31, p = 0.002). Importantly previous surgery and age of diagnosis were not a risk factor for recurrent surgery (hazard ratios 1.016 and 1.198 respectively). Conclusion We review a decade of strictureplasties in the management of Crohn’s disease and have identified significant risks for further surgery of smoking and low BMI as well as concurrent bowel resection. We show that strictureplasty remains a viable and attractive management for stricturing Crohn’s disease with no deaths resulting from the surgery and a low number of reoperations. Disclosure of interest None Declared.

Concurrent alcohol and tobacco treatment: Effect on daily process measures of alcohol relapse risk.

The aim of this study was to compare the effects of alcohol treatment along with concurrent smoking treatment or delayed smoking treatment on process measures related to alcohol relapse risk. Alcohol dependent smokers (N = 151) who were enrolled in an intensive outpatient alcohol treatment program and were interested in smoking cessation were randomized to a concurrent smoking cessation (CSC) intervention or to a waiting list for delayed smoking cessation (DSC) intervention scheduled to begin 3 months later. Daily assessments of relapse process measures were obtained using an Interactive Voice Response (IVR) system for 12 weeks after the onset of smoking treatment in the CSC condition, and before beginning smoking treatment in the DSC condition. Smoking outcomes were assessed at 2 and 13 weeks after starting treatment. Seven-day carbon monoxide (CO) verified smoking abstinence in the CSC condition was 50.5% at 2 weeks and 19.0% at 13 weeks compared with 2.2% abstinence at 2 weeks and 0% abstinence at 13 weeks for those in the DSC condition. Drinking outcomes were not significantly different for CSC versus DSC treatment conditions. On daily IVR assessments, CSC participants had significantly lower positive alcohol outcome expectancies relative to DSC participants. Multilevel modeling (MLM) analyses of within-person effects across the 12 weeks of daily monitoring showed that daily smoking abstinence was significantly associated with same day reports of lower alcohol consumption, lower urge to drink, lower negative affect, lower positive alcohol outcome expectancies, greater alcohol abstinence self-efficacy, greater alcohol abstinence readiness to change, and greater perceived self-control demands. Analyses of process measures provide support for recommending smoking intervention concurrent with intensive outpatient alcohol treatment. (PsycINFO Database Record

Incident cancers attributable to alcohol consumption in Germany, 2010.

Germany lacks an up-to-date assessment of the cancer burden attributable to alcohol. Therefore, cancer incidence attributable to this exposure was estimated for colorectal, liver, breast, and upper aerodigestive tract (UADT) cancer. Additionally, the impact of alcohol on UADT cancer was analyzed by smoking status, to account for synergistic interactions between these two risk factors. Alcohol consumption and smoking prevalence from a nationwide survey in Germany 2008-2011 were combined with relative risks of incident cancer from meta-analyses to obtain population attributable risks (PARs), indicating the proportion of cancers that could be avoided by eliminating a risk factor. Each PAR was multiplied with the respective cancer incidence for 2010 to calculate the absolute number of attributable cases. In Germany, for the year 2010, approximately 13,000 incident cancer cases could be attributed to alcohol consumption (3% of total cases). PAR was highest for esophageal cancer (men: 47.6% and women: 35.8%) and lowest for colorectal cancer in men (9.7%) and breast cancer in women (6.6%). Among women, moderate consumption levels account for the greatest PAR overall, whereas heavy drinking contributes considerably to overall PAR among men. Additionally, moderate-to-heavy drinking among smokers substantially contributes to the overall PAR of UADT cancers compared to drinking among non-smokers. In Germany, a substantial proportion of cases of common cancers can be attributed to alcohol consumption, even when consumed at moderate levels. Alcohol consumption with concurrent tobacco smoking is especially important for cancers of the UADT. These findings strengthen the rationale for prevention measures that address exposure at all levels.

Impact of Cannabis Use on Long-Term Remission in Bipolar I and Schizoaffective Disorder.

ObjectiveTo investigate the impact of regular cannabis use on long-term remission of mood symptoms in bipolar spectrum disorders.MethodsThe 24-month prospective observational study included patients (n=239) with bipolar I disorder and schizoaffective disorder, bipolar type. Participants were classified as regular cannabis users (three times or more per week) or non-users. The primary outcome measure was the achievement of remission on the evaluations during the 24 months.ResultsOf the 234 participants for whom data was available, 25 (10.7%) were regular cannabis users, and the group comprised significantly more males than females. In the total population, cannabis use was significantly associated with decreased likelihood of remission during the 24-month follow-up period. Subgroup analyses showed that cannabis use was significantly associated with lower remission rates on the Hamilton Depression Rating Scale in females (n=139) and patients prescribed mood stabilizers alone (n=151), whereas in males (n=95) and patients prescribed olanzapine and/or a mood stabilizer (n=83), cannabis use was significantly associated with lower remission rates on the Young Mania Rating Scale. Remission rates were lowest in the concurrent cannabis and tobacco smoking group (n=22) followed by the tobacco smoking only group (n=97), and the non-smoker group (n=116). The post-hoc analysis revealed that all remission rates were significantly lower in the concurrent cannabis and the tobacco smoking group compared to the non-smoker group.ConclusionCannabis use negatively affects the long-term clinical outcome in patients with bipolar spectrum disorders. A comprehensive assessment and integrated management of cannabis use are required to achieve better treatment outcomes for bipolar spectrum disorders.

Porphyromonas gingivalis lipopolysaccharide inhibits trophoblast invasion in the presence of nicotine

IntroductionPeriodontitis is a chronic infectious disease associated with Gram-negative subgingival microflora. In pregnant women, periodontitis is thought to be associated with adverse pregnancy outcomes, although the pathophysiology is unknown. Additionally, smoking is an established risk factor for adverse pregnancy outcomes. In the present study, we examined the direct effects of Porphyromonas gingivalis lipopolysaccharides (PGLPS) and nicotine on a trophoblast cell line. MethodsHTR-8/SVneo cells were plated on Matrigel chambers with or without PGLPS and nicotine. The invasive activity of the cells was directly evaluated using microscopy. ResultsPGLPS alone did not reduce the invasive activity of the HTR-8/SVneo cells. The co-administration of nicotine with PGLPS significantly reduced the invasive activity of the cells. DiscussionOur results suggest that although the direct pathogenic effects of P. gingivalis alone on trophoblast invasion may be limited, concurrent smoking reduces trophoblast invasion into the myometrium and inhibits maternal vascular reconstruction.

Development and evaluation of a mobile intervention for heavy drinking and smoking among college students.

Nearly all college student smokers also drink alcohol, and smoking and heavy episodic drinking (HED) commonly co-occur. However, few studies have examined the factors that concurrently influence smoking and HED among college students and, to date, no interventions have been developed that target both HED and smoking in this population. The objective of the current study was to develop and evaluate a mobile feedback intervention that targets HED and smoking. Participants (N = 94) were non-treatment-seeking college students (M(age) = 20.5 years, SD = 1.7) who engaged in at least a single HED episode in the past 2 weeks and reported concurrent smoking and drinking at least once a week. Participants were randomized to receive either the mobile intervention for 14 days, complete mobile assessments (without intervention) for 14 days, or complete minimal assessments (without intervention or mobile assessments). At a 1-month follow-up, compared with the minimal assessment condition, we observed significant reductions in the number of cigarettes per smoking day in both the mobile intervention (d = 0.55) and mobile assessment (d = 0.45) conditions. Among those randomized to the mobile intervention, receiving more modules of the intervention was significantly associated with a lower likelihood of any drinking during the 14-day assessment period and significant reductions in smoking at 1-month follow-up. The mobile intervention did not result in significant reductions in HED or concurrent smoking and drinking. Future research should continue to examine ways of using technology and the real-time environment to improve interventions for HED and smoking.

Effects of varenicline, nicotine or placebo on depressive symptoms in postmenopausal smokers.

Varenicline carries a black box warning for neuropsychiatric adverse events. We examined varenicline use and past history of major depressive disorder (MDD) on depressive symptoms during smoking cessation. This is a secondary analysis of two smoking cessation studies in 152 postmenopausal women who received placebo or nicotine patch, or 78 women who received varenicline with relaxation. Lifetime history of MDD (LH-MDD) was assessed at baseline and women with current MDD were excluded. Center for Epidemiologic Study Depression scale (CESD) measured depressive symptoms at baseline, 6 and 12 weeks. Baseline CESD scores were 5.3 + 4.4. Those with a LH-MDD reported higher CESD scores (p > .001). Those taking varenicline reported lower scores over all time periods compared to nicotine or placebo (p < .01). The differences between varenicline and the other treatments remained when controlling for LH-MDD, indicating an independent effect. CESD scores were associated with concurrent smoking status (p < .001), and with withdrawal symptoms (p < .001). CESD score were lower in those receiving varenicline, whether this is due to an anti-depressant effect, subject selection, use of relaxation or another cause is unknown. Varenicline does not increase depressive symptoms during smoking cessation in postmenopausal women without current MDD. Subjects with a LH-MDD are susceptible to developing depressive symptoms during smoking cessation, regardless of pharmacologic aid. Pharmacologic aids did not increase depression symptoms in this select population of postmenopausal women without current depression. Smoking cessation does increase depressive symptoms in those with LH-MDD, though the degree of increase was not clinically meaningful.

Metabolic syndrome and smoking may justify earlier colorectal cancer screening in men

Gender, smoking, and metabolic syndrome (MetS) are important risk factors of colorectal neoplasm. Whether presence of these factors may warrant earlier screening remains unclear. To compare age- and gender-specific risk of colorectal neoplasms in association with smoking and MetS under endoscopic or stool-based screening. Cross-sectional observational study. Screening center in a university hospital in Taiwan. A cohort of 10,884 average-risk individuals who received concurrent screening colonoscopy and fecal immunochemical testing (FIT). First, the prevalence of colorectal neoplasms and positive predictive value of FIT relative to age, gender, smoking, and MetS. Second, the number of colonoscopies needed to detect 1 advanced neoplasm with different strategies. Male smokers aged 40 to 49 years had a significantly higher prevalence of advanced neoplasms and positive predictive value of stool tests than nonsmoking counterparts. The prevalence of advanced neoplasms in concurrent MetS and smoking (6.2%) or smoking alone (3.8%) men aged 40 to 49 years was higher than that of average-risk women aged 50 to 59 years (2.1%) (P = .03 and .04, respectively). The number of colonoscopies needed to detect 1 advanced neoplasm in men aged 40 to 49 years with concurrent MetS and smoking, smoking, MetS, and women aged 50 to 59 years was, respectively, 14.6, 24.8, 39.8, and 47.4 in the colonoscopy scenario and 1.7, 4.6, 5.7, and 8.3 in the FIT scenario. Self-selective bias may exist for subjects voluntarily submitted to health check-ups. MetS and smoking significantly impact both the prevalence of colorectal neoplasms and the diagnostic yields of screening tests in men aged 40 to 49 years. Whether our findings justify earlier screening in this subgroup requires further study.

A case of clozapine intoxication presenting with atypical NMS symptoms

Clozapine is an antipsychotic drug indicated for treatment-resistant schizophrenia. Clozapine at toxic doses may cause hyperthermia, alterations in consciousness, seizures, cardiac arrhythmias, excessive mucus production in bronchi, hypersalivation, miosis, blood dyscrasias, pancreatitis and hepatitis (Sartorius et al., 2002). Clozapine blood levels are influenced by age, gender, ethnicity, physical illnesses like liver failure, changes in the activity of the cytochrome oxidase enzymes due to genetic variability, concurrent medication use, smoking or caffeine consumption (Greenwood-Smith et al., 2003). Generally, plasma levels of over 1000 ng/ml are associated with central nervous system adverse effects (Varma et al., 2011). One potentially lethal side effect of antipsychotics including clozapine is neuroleptic malignant syndrome (NMS). Neuroleptic malignant syndrome is typically characterized by fever, altered mental status, leukocytosis, autonomic dysfunction and rigidity. Atypical antipsychotics including clozapine are associated less with NMS than typical antipsychotics, and when NMS occurs during treatment with atypical antipsychotics, associated symptoms are less typical (Trollor et al., 2012). In this case report, we present a patient using clozapine for treatment of schizophrenia who was admitted to the Emergency Room with NMS-like symptoms. We present a 53 yr old, female patient diagnosed with schizophrenia, who was on clozapine 500 mg/d for the past 3 yr. She had hyperlipidemia and chronic obstructive pulmonary disease (COPD) and was using rosuvastatin 20 mg/d. She was admitted to the Emergency Room (ER) with acute onset-confusion, shivering, meaningless talk and urinary incontinence. Her body temperature was 39.2°C, blood pressure 90/50 mmHg, pulse rate 117/min, RR: 17/min, SaO2:%96. Electrocardiogram (ECG) was normal. Her Glasgow Coma Score was 15. Blood tests showed hyponatremia (133.2 mEq/l), increased levels of creatinine (1.52 mg/dl), BUN (23.68 mg/dl), uric acid (7.07 mg/dl) and decreased levels of phosphorus (2.50 mg/dl). Liver and thyroid function tests and potassium, chloride and calcium levels were within normal range. Complete …

Smoking aggravates the impaired pulmonary function of officially acknowledged female victims of air pollution of 40 years ago.

Air pollution due to industrial waste and tobacco smoke is detrimental to pulmonary function. However, the combined effects of air pollution and smoking on pulmonary function have not been investigated. We examined the combined effect of air pollution of 40 years ago and concurrent smoking on the pulmonary function of officially acknowledged female victims in Japan, because females are more susceptible to the adverse effects of both irritants than males. The subjects comprised 655 female victims living in one of two areas with air pollution of 40 years ago and 572 females living in an area without air pollution. All victims have been prescribed standard respiratory medications. Pulmonary function was measured in 2000 for air-pollution groups (130 smokers and 525 non-smokers; mean age, 68.4 years) and during the period of 2004 to 2013 for non-air-pollution groups (113 smokers and 459 non-smokers; mean age, 69.0 years). The smokers included both current smokers and ex-smokers. The victims with a history of smoking had significantly lower forced expiratory volume in 1 second (FEV1 % predicted) (mean, 74%) and significantly lower FEV1/forced vital capacity (FVC) (mean, 70%) than the other groups (P<0.001). Thus, smoking aggravates the pulmonary function in officially acknowledged female victims, despite the improved air pollution and the continuous medical care provided by the government. In conclusion, exposure to air pollution of 40 years ago and cigarette smoking are associated with reduced pulmonary function. These results highlight the importance of measures aimed at smoking cessation and limiting air pollution.

The Magnitude of Tobacco Smoking-Betel Quid Chewing-Alcohol Drinking Interaction Effect on Oral Cancer in South-East Asia. A Meta-Analysis of Observational Studies

Tobacco smoking, betel quid chewing and alcohol drinking are oral cancer risk factors. Observational studies unanimously report that oral cancer risk in smoking-drinking-chewing exposed subjects is exceptionally high. However, none of them assessed the fractions of this risk attributable to the three individual risk factors and to the smoking-drinking-chewing interaction. The present study sought to assess the magnitude of the smoking-drinking-chewing interaction effect on oral cancer. A meta-analysis of observational South-East Asian studies which reported oral cancer odds ratios (ORs) stratified for smoking-drinking-chewing exposures was performed. The pooled ORs were estimated and controlled for quality, heterogeneity, publication bias and inclusion criteria. The smoking-drinking-chewing interaction effect was estimated through the pooled Relative Excess Risk due to Interaction (RERI, excess risk in smoking-drinking-chewing exposed individuals with respect to the risk expected from the addition of the three individual risks of smoking, drinking and chewing). Fourteen studies were included with low between-study heterogeneity. The pooled ORs for smoking, drinking, chewing, smoking-drinking-chewing, respectively were 3.6 (95% confidence interval −95% CI, 1.9–7.0), 2.2 (95% CI, 1.6–3.0), 7.9 (95% CI, 6.7–9.3), 40.1 (95% CI, 35.1–45.8). The pooled RERI was 28.4 (95% CI, 22.9–33.7). Among smoking-drinking-chewing subjects, the individual effects accounted for 6.7% (smoking), 3.1% (drinking), 17.7% (chewing) of the risk, while the interaction effect accounted for the remaining 72.6%. These data suggest that 44,200 oral cancer cases in South-East Asia annually occur among smoking-drinking-chewing exposed subjects and 40,400 of these are exclusively associated with the interaction effect. Effective oral cancer control policies must consider concurrent tobacco smoking, alcohol drinking, betel quid chewing usages as a unique unhealthy lifestyle.

Drug resistance profiles of Mycobacterium tuberculosis complex and factors associated with drug resistance in the Northwest and Southwest Regions of Cameroon.

BackgroundAnti-tuberculosis drug resistance continues to be a major obstacle to tuberculosis (TB) control programmes with HIV being a major risk factor in developing TB. We investigated anti-TB drug resistance profiles and the impact of socioeconomic as well as behavioural factors on the prevalence of TB and drug resistance in two regions of Cameroon with such data paucity.MethodsThis was a hospital-based study in which 1706 participants, comprising 1133 females and 573 males consecutively enrolled from selected TB and HIV treatment centres of the Northwest and Southwest regions. Demographic, clinical and self-reported risk behaviours and socioeconomic data were obtained with the consent of participants using questionnaires. Culture and drug resistance testing were performed according to standard procedures.ResultsThe prevalence of resistance to at least one anti-TB drug was 27.7% and multi-drug resistance was 5.9%. Smoking, concurrent alcohol consumption and smoking, being on antiretroviral therapy for ≤ 12 months and previous household contact with TB patient were independently associated with tuberculosis prevalence, while only previous tuberculosis infection was associated with drug resistance in a univariate analysis.ConclusionThe study showed a high prevalence of drug resistance TB in the study population with only previous TB infection associated with drug resistance in a univariate analysis. It also provides evidence in our context, of the role of alcohol and smoking in increasing the risk of developing TB, which is more likely in people living with HIV/AIDS. Therefore, it is important for public health authorities to integrate and intensify alcohol/smoking abstention interventions in TB and HIV control programs in Cameroon.

Renal vein thrombosis associated with oral contraception and smoking: a case report from Japan, with literature review.

Renal vein thrombosis, one of the common thrombotic complications of nephrotic syndrome or renal cell carcinoma, is reportedly a rare complication of hormonal contraception. Solitary renal vein thrombosis in the Japanese population is thought to be very rare because the incidence of venous thromboembolism is comparatively very low in Asian populations. We report a 38-year-old Japanese female with left renal vein thrombosis associated with oral contraception and concurrent smoking as the first Japanese case of solitary renal vein thrombosis associated with oral contraceptives, with a review of the literature. Seven cases were previously reported. The results revealed that all patients complained of acute onset of pain around the involved kidney without urinary symptoms or fever, and were effectively treated with anticoagulants. Other remarkable facts include that nausea and vomiting were frequently seen, and that the renal outcome was benign, despite various initial urine abnormalities. This report may alert clinicians to the importance of these risk factors as an etiology of renal vein thrombosis even in Asian populations. Clinicians should regard renal vein thrombosis as one of the differential diagnoses for acute flank pain in patients using oral contraceptives. A detailed history taking that reveals oral contraception, smoking, and other thrombophilic predispositions as well as timely computed tomographic scans would be the keys to diagnosis. Smoking cessation should be strongly recommended to oral contraceptive users, especially women over 35 years of age, regardless of dosage.

Flow Dynamics and Contaminant Transport in Industrial-Type Enclosing Exhaust Hoods

The present study concerns the flow dynamics and associated contaminant transport in the near wake of a worker using an industrial-type benchtop enclosing hood. The primary focus is on evaluating the effects on the dynamics of the wake flow and the exposure level of various extraneous factors, such as the strength and direction of cross-drafts and the worker's body heat and shape. Three-dimensional Unsteady Reynolds-Averaged Navier-Stokes simulations were carried out for a model of a simple mannequin and a model of an anthropometric mannequin. Estimated flow patterns and concentrations near the simple mannequin were compared with the observations from concurrent smoke visualization experiments and with the experimental concentration measurements, respectively. Results for both visualizations indicated that the flow in front of the worker is dominated by dynamic vortical structures and that body heat may have negative effects on the exposure level, especially at low flow rates. Using simple rounded shapes to simulate the human form was a fair approximation from the viewpoint of flow structures and exposure trends, which agreed well with the experimental measurements and observations. However, the quantitative values of the predicted concentrations in the breathing zone were sensitive to the mesh resolution. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplementary resource: Figures S1–S11.]

Letter From the Editor in Chief, Renee Bittoun

Smoking cessation has been the primary goal for those of us working in tobacco treatment for many decades. However, we have all noticed that in countries where there is a strong anti-smoking climate, there seems to be an increasing percentage of smokers, willing and motivated to quit, who, despite all efforts on our part, find it very difficult to achieve this. ‘Harm reduction’ or ‘harm minimisation’ strategies have become part of our agenda and is now offered routinely to smokers in these circumstances. As these strategies invariably incorporate concurrent smoking with nicotine-containing products, there is the dilemma of on-going nicotine usage, or ‘therapeutic/medicinal nicotine’ for extended periods of time (though evidently better and safer than smoking alone).

Results of Arthroscopic Repair of Partial- or Full-Thickness Longitudinal Medial Meniscal Tears by Single or Double Vertical Sutures Using the Inside-Out Technique

Background: Although numerous studies have assessed arthroscopic repair of meniscal tears, no study has described the repair of partial- or full-thickness longitudinal medial meniscal tears using single or double vertical sutures. Purpose: To present the intermediate-term results of medial meniscal tears repaired with single or double vertical sutures. Study Design: Case series; Level of evidence, 4. Methods: The authors evaluated the results of 112 longitudinal medial meniscal tears treated with inside-out single or double vertical sutures, with or without anterior cruciate ligament (ACL) reconstruction, based on the clinical resolution of symptoms, the Lysholm knee scoring scale, and the Tegner activity scale. Re-examination was also performed by magnetic resonance imaging after the repair. The length of the tears was evaluated arthroscopically. Eighty-five tears of 112 were >2 cm in length, and 27 were tears ≤2 cm. Eighty-nine (79.4%) of the 112 repairs were performed in conjunction with ACL reconstructions, and the remaining 23 (20.6%) repairs were performed in ACL-intact knees. The tear type of the menisci in our study was full thickness in 66 (58.9%) cases and partial thickness in 46 (41.1%) cases. Double vertical sutures were used for full-thickness tears, and single vertical sutures were used for partial-thickness tears. Results: The cases were evaluated after a mean follow-up duration of 49.3 months (range, 12-88 months). Clinical and radiological examination results determined that 99 (88.4%) meniscal repairs had healed, and the remaining 13 cases (10.6%) were considered to be failures. The healing rate of the full-thickness group was 80.3%, while in the partial-thickness group, the rate was 100%. The mean Lysholm score improved significantly from a preoperative value of 63.8 to a postoperative value of 89.5 (P < .001). The mean Tegner activity score was 3.3 preoperatively and 6.7 postoperatively (P < .001). Logistic regression analysis found that concurrent ACL reconstruction, tear length, and smoking as factors had a significant effect on meniscal healing. Conclusion: Single or double vertical sutures using the inside-out technique provide a high rate of healing in longitudinal medial meniscal tears.

Advances in pediatric asthma in 2012: Moving toward asthma prevention

Last year's "Advances in pediatric asthma: moving forward" concluded the following: "Now is also the time to utilize information recorded in electronic medical records to develop innovative disease management plans that will track asthma over time and enable timely decisions on interventions in order to maintain control that can lead to disease remission and prevention." This year's summary will focus on recent advances in pediatric asthma on modifying disease activity, preventing asthma exacerbations, managing severe asthma, and risk factors for predicting and managing early asthma, as indicated in Journal of Allergy and Clinical Immunology publications in 2012. Recent reports continue to shed light on methods to improve asthma management through steps to assess disease activity, tools to standardize outcome measures in asthma, genetic markers that predict risk for asthma and appropriate treatment, and interventions that alter the early presentation of asthma to prevent progression. We are well on our way to creating a pathway around wellness in asthma care and also to use new tools to predict the risk for asthma and take steps to not only prevent asthma exacerbations but also to prevent the early manifestations of the disease and thus prevent its evolution to severe asthma.

Factors Associated With Smoking Relapse in the Postpartum Period: An Analysis of the Child Health Surveillance System Data in Southeast England

There is increasing evidence that a high proportion (47%-63%) of women who quit smoking during pregnancy relapse during the postpartum period. The purpose of this population-based study was to examine the association between selected sociodemographic factors and smoking relapse in the early postpartum period (within the first 6 weeks) in women who had successfully quit smoking during the pregnancy. The study included 512 women resident in East Sussex, United Kingdom, who had quit smoking during the pregnancy. Information on the prevalence of smoking and selected sociodemographic factors and breast feeding at the 6-weeks postpartum review by health visitor was obtained from the Child Health Surveillance System, which records and monitors the health and development of children from birth until school entry. Of the 512 women who had quit smoking during the pregnancy, 238 (46.5%) relapsed in the early postpartum period. In the bivariate analysis, there was an association between deprivation and smoking relapse in the early postpartum period (OR = 5.3, 95% CI: 2.5-11.4), with a significant trend in increasing risk of relapse with increasing level of deprivation (p < .01). Stepwise logistic regression analysis showed that women who lived in deprived urban areas (OR = 2.3, 95% CI: 1.2-4.2), had ≥3 children (OR = 3.8, 95% CI: 2.2-6.4), and had other smokers in the household (OR = 5.6, 95% CI: 3.6-8.8) were significantly more likely to relapse in the early postpartum period. On the other hand, women who were breast feeding were significantly less likely to relapse (OR = 0.6, 95% CI: 0.4-0.9). Factors associated with early postpartum smoking relapse identified in this study, particularly breast feeding, high parity, and concurrent smoking by partner/other household member(s), may contribute to the development of effective and targeted interventions to maintain smoking cessation in women and their household.

Laryngeal pathologies in older Korean adults and their association with smoking and alcohol consumption

This study's objectives were to assess the prevalence rate of laryngeal pathologies in the Korean elderly, and to examine the association of smoking and alcohol consumption with laryngeal diseases. Cross-sectional study. Data were from the 2008 Korea National Health and Nutritional Examination Survey. Subjects were 663 elderly persons (261 men and 402 women) between the ages of 65 and 84 years who completed the laryngoscopic examination. Weighted prevalence of laryngeal pathologies was compared by demographic characteristics, smoking, alcohol drinking, body mass index, and self-reported voice problems. Multiple logistic regression analyses were conducted to examine the independent as well as combined influence of smoking and alcohol consumption on laryngeal lesions. The prevalence of laryngeal pathologies in the Korean elderly between the ages of 65 and 84 years was 8.1%. The prevalence of laryngeal lesions increased with age and was higher among men, middle school and high school graduates, manual workers, current smokers, current alcohol drinkers, and those with self-reported voice problems. Adjusting for covariates, current smokers, compared with nonsmokers, were more likely to have laryngeal pathologies (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.01-4.67). Current alcohol drinking was not independently associated with laryngeal diseases. Concurrent smoking and alcohol drinking, however, were associated with a significantly higher risk of laryngeal pathologies (OR, 3.29; 95% CI, 1.22-8.88). Smoking and alcohol consumption may increase the risk of laryngeal diseases in later life.

Concurrent drinking and smoking among college students: An event-level analysis.

Cigarette smoking and drinking commonly co-occur among college students, a population that is at high risk for developing alcohol and nicotine use disorders. Several studies have been conducted that have examined predictors of drinking or smoking to gain a better understanding of the antecedents of engaging in these behaviors. Yet, few studies have examined specific factors that influence concurrent smoking and drinking in this population. The current study used data from a 21-day electronic diary-based study of college students (n=86) who engaged in concurrent drinking and smoking to examine event-level associations between alcohol use and cigarette smoking in the student's natural environment. We specifically focused on within-person analyses of contexts in which students reported smoking and drinking simultaneously in comparison to contexts in which students reporting drinking without smoking. Situational contexts included environmental setting, whether s/he was alone or with others, and changes in stress and urges to smoke before initiating drinking. Results indicated that students drank more while smoking and smoked three times as many cigarettes, on average, during drinking episodes. Being with others at a party or a bar was associated with increased odds of smoking while drinking. Likewise, increased stress since the prior assessment predicted a greater likelihood of smoking while drinking. Based on the findings from the present study, it is important for future prevention and intervention efforts to consider social settings and heightened stress among students as potential risk factors for engaging in concurrent drinking and smoking.