High Smoking Rates Research Articles

Tips to Quit Smoking: Perspectives from Vietnamese Healthcare Providers, Community Leaders, and Past Tobacco Users in the United States.

This study focuses on smoking-cessation strategies for United States (US) Vietnamese individuals, a group with high smoking rates, particularly those with limited English proficiency (LEP). The researchers conducted 16 in-depth interviews with a diverse group of participants, including healthcare professionals, community leaders, and former tobacco users. Data were analyzed using the Phase-Based Model of smoking cessation, resulting in several helpful strategies across the four phases: Motivation, Preparation, Cessation, and Maintenance. Prominent advice for the Motivation Phase included having a strong determination to quit and a reason why, such as protecting loved ones. For the Preparation and Cessation Phases, participants recommended healthy coping mechanisms, avoiding triggers, changing habits, and gradually reducing the number of cigarettes smoked. In the Maintenance Phase, strategies included regular exercise and setting boundaries with other people who smoke. Participants also stressed the importance of social support throughout all four phases. These findings have implications for healthcare providers working with US Vietnamese who smoke, especially those with LEP. By understanding the unique challenges this group faces in accessing smoking-cessation resources, providers can offer tailored support and guidance. Ultimately, this study provides useful strategies for helping US Vietnamese quit smoking, improving their health outcomes and quality of life.

Prevalence of Modifiable Risk Factors in First-Presentation ST Elevation Myocardial Infarction Patients in Christchurch Hospital, New Zealand, Over a 5-Year Period in Māori and Non-Māori Populations

The prevalence of modifiable risk factors is known to be changing in some first-presentation ST elevation myocardial infarction cohorts worldwide. Many studies have noted an increase in patients without modifiable risk factors. This study aimed to assess the risk factors in first-presentation ST elevation myocardial infarction patients in Christchurch, New Zealand, over a 5-year period in Māori and Non-Māori populations. Data were extracted from the ANZACS-QI database from 1 January 2017 to 1 January 2023, for patients with ST elevation myocardial infarction presenting to Christchurch Hospital. Patients with prior cardiovascular disease were excluded. Prevalence of smoking, hypertension, dyslipidaemia, diabetes, and no modifiable risk factors were analysed using a two-proportion z-test. Of 1,138 patients, 66 were Māori. There was high prevalence of modifiable risk factors present with a disproportionately high rate of smoking among Māori (z=5.7; p<0.001). A total of 6.9% of the patients had no modifiable risk factors, with no significant difference found between Māori and Non-Māori (z=–0.29; p=0.2). Modifiable risk factors were still highly prevalent in this first ST elevation myocardial infarction population. Whilst risk factors such as smoking are declining in the general population, they remain highly prevalent in this group and disproportionally higher in Māori, likely contributing to health inequities. The proportion of patients who have no modifiable risk factors is relatively small.

Sex Disparities in Infra-inguinal Vein Bypass for Peripheral Artery Disease

Although studies demonstrate sex-based differences in peripheral arterial disease (PAD), contemporary outcomes in surgically managed PAD remains largely under-characterized. We sought to discern the differences in perioperative outcomes between males and females with PAD who received infra-inguinal vein bypasses. The infra-inguinal bypass Vascular Quality Initiative (VQI) registry was queried between 2010 and 2020. We evaluated patients with infra-inguinal vein bypasses for occlusive disease, excluding non-occlusive disease, asymptomatic, acute limb ischemia, and emergent procedures. Baseline demographics, comorbidities, prior medical and surgical management, and perioperative outcomes were compared between men and women using the χ2 analysis and t test. Socioeconomic status was defined using Distressed Community Index (DCI). Bypass patency at 1 year was compared between single-segment vein bypasses of the same inflow and outflow targets, using Kaplan-Meier analysis. We identified 28,845 infra-inguinal vein bypasses; 30.6% of patients were female. Female patients were older and had a higher portion of black race, non-ambulatory status, and disadvantaged socioeconomic DCI (Table I). Males had higher rates of smoking, chronic obstructive pulmonary disease, cardiac disease, and coronary percutaneous/bypass interventions. More women were on more likely to be taking P2Y inhibitors, possibly related to a significantly higher rate of prior lower extremity endovascular interventions (P < .001). Alternatively, males had higher rates of prior ipsilateral bypass. Men presented with less clinical disease severity, with a higher proportion of claudication in men vs rest pain in women. Females had a higher rate of popliteal bypass targets suggestive of proximal disease, whereas more males had tibial bypass targets suggestive distal disease (Table II). Women had a higher utilization of non-reversed GSV compared with men (24.2% vs 22.6%; P < .001). No significant differences were seen in total procedure time, blood loss, or postoperative infection. More males underwent postoperative amputation. Fewer women returned home or were ambulatory on discharge. Males were also more likely to be on aspirin and statin both prior to intervention and on discharge (P < .001). There was no significant differences between men and women in 5-year survival (74.6% vs 74.2%; P = .98) or 1-year primary patency in femoral-above knee popliteal (58.6% vs 58.0%; P = .720), femoral-below knee popliteal (57.2% vs 56.7%; P = .816), femoral-tibial (56.5% vs 57.7%; P = .520), or popliteal-tibial (58.0% vs 55.7%; P = .950) bypass. Females present with a unique demographic, socioeconomic, and PAD disease pattern, with diminished perioperative medical management and advanced clinical disease. Acknowledgment of these differences should guide increasing attention to screening programs, medical optimization, and post intervention disposition planning. Although less women were discharged on optimal medical management, bypass patency was similar to men at 1 year.Table ICategorical variables for patients receiving infra-inguinal vein bypassMaleFemaleP-valueDemographics Age, years66 ± 1067 ± 12<.001 Body mass index, kg/m227.7 ± 5.728.0 ± 6.9.042 Race<.001White82.2%76.7%Black13.8%19.7%Others4.0%3.6% Ambulatory status<.001Ambulatory95.5%93.5%Non-ambulatory4.5%6.5% DCI<.001Prosperous23.1%20.8%Comfortable21.3%20.3%Mid-tier20.7%19.4%At-risk18.3%19.6%Distressed16.7%19.9% Smoking history87.0%76%<.001 Chronic obstructive pulmonary disease24.6%26.3%<.001 Hypertension87.8%89.6%<.001 Diabetes mellitus52.6%49.0%.008 Coronary disease31.2%27.1%<.001 Heart failure17.1%16.9%.018 Peripheral endovascular42.9%47.9%<.001 Peripheral bypass25.3%23.6%.015 Minor amputation10.7%8.6%<.001 Percutaneous coronary22.6%20.1%<.001 Coronary bypass19.1%16.9%<.001 Aspirin74.3%73%.071P2Y inhibitor28.9%32.9%<.001 Statin75.1%71.7%<.001 Claudication26.6%21.0%<.001 Rest pain24.3%28.6% Tissue loss49.2%50.4%DCI, Disadvantaged Community Index. Open table in a new tab Table IIPerioperative outcomes for patients receiving infra-inguinal vein bypassMale, %Female, %P-valueBypass category<.001 Femoral-above knee popliteal13.319.8 Femoral-below knee popliteal31.635.1 Femoral-tibial42.235.3 Popliteal-tibial12.89.8Perioperative antibiotics82.779.7<.001SSI3.03.9<.002Postoperative amputation12.111.9<.001Discharge medications Aspirin86.684.7<.001 P2Y inhibitor41.645.1<.001 Statin83.979.2<.001Discharge status<.001 Home72.364.6 Rehab16.019.8 Nursing home10.914.5 Other0.81.1Discharge graft patency.002 Primary95.093.5 Primary-assisted2.53.1 Secondary1.72.2 Occluded0.81.2SSI, Surgical site infection. Open table in a new tab

(206) Erectile Dysfunction and Hypogonadism in Men with Spina Bifida

Abstract Introduction Spina Bifida is a congenital neurological defect associated with genitourinary anomalies, requiring comprehensive urological care from pediatrics to adulthood. For men with spina bifida, a significant focus is on urinary tract surveillance to maintain continence, preserve kidney and bladder health, and optimize fertility and sexual function. While men with SB have an increasing interest in exploring their sexuality and sexual health, these concerns may be under-discussed and undertreated depending on their burden of illness. ED is associated with diminished body image and low self-confidence resulting in poor sexual health. Additionally, it creates barriers to maintaining intimate relationships. Current data tackling the prevalence of erectile dysfunction demonstrates variations in value, yet low quantifications of treatment for SB patients. Prior studies have shown a positive response to phosphodiesterase-5 (PDE5) inhibitor therapy (80%). Concurrently, the impact of hypogonadism on the SB is unknown. Hypogonadism is associated with increased insulin resistance in young males, hyperlipidemia, and other adverse vascular effects. These risk factors play a role in the vascular etiology of erectile dysfunction and can be a burden on sexual health. With a scarcity of men’s sexual health data focused on the adult SB male population, there is a need to illustrate the prevalence of ED and HG in men with SB while investigating treatment utilization. We hypothesize that men with SB will experience a higher rate of diagnosis of ED and HG compared to the general adult male population, and lower treatment utilization rates. Objective To calculate the estimated prevalence of erectile dysfunction and hypogonadism in adult men with spina bifida Methods This retrospective claims study used the MarketScan® databases from 2008 to 2017 to derive prevalence estimates for erectile dysfunction and hypogonadism in men with spina bifida, to compare these estimates to those in men without spina bifida, and to describe treatment patterns in this cohort. All men in aged 18 years and older with a diagnosis of SB were included for analysis. Patients with congenital hormonal disorders were excluded. To analyze treatment utilization, the National Drug Codes for pharmacotherapies for ED or HG and Current Procedural Terminology (CPT) codes for penile prosthesis were used. Results The estimated prevalence of erectile dysfunction and hypogonadism in men with spina bifida was 7.83% and 7.71%, respectively. Men with spina bifida in the sample exhibited high rates of smoking and metabolic comorbidities, but were diagnosed less frequently with erectile dysfunction when controlling for age and metabolic comorbidities than men without spina bifida. Most men with spina bifida and ED (66.6%) or hypogonadism (77.4%) do not receive treatment. However, a diagnosis of spina bifida did not appear to affect the likelihood of treatment for either condition on multivariate analysis. Conclusions Based on the results, claims data suggest that HG and ED are diagnosed less frequently than expected. While there are some limitations to the population being examined in this database, improving health care delivery of sexual health concerns during the surveillance of men with spina bifida will enhance their quality of life and optimize their sexual and metabolic function. Disclosure No

Reinstatement of nicotine conditioned place preference in a transgenerational model of drug abuse vulnerability in psychosis: Impact of BDNF on the saliency of drug associations.

Psychotic disorders such as schizophrenia are often accompanied by high rates of cigarette smoking, reduced quit success, and high relapse rates, negatively affecting patient outcomes. However, the mechanisms underlying altered relapse-like behaviors in psychosis are poorly understood. The present study analyzed changes in extinction and reinstatement of nicotine conditioned place preference (CPP) and resulting changes in brain-derived neurotrophic factor (BDNF) in a novel heritable rodent model of psychosis, demonstrating increased dopamine D2 receptor sensitivity, to explore mechanisms contributing to changes in relapse-like behaviors. Male and female offspring of two neonatal quinpirole-treated (1mg/kg quinpirole from postnatal day (P)1-21; QQ) and two neonatal saline-treated (SS) Sprague-Dawley rats (F1 generation) were tested on an extended CPP paradigm to analyze extinction and nicotine-primed reinstatement. Brain tissue was analyzed 60min after the last nicotine injection for BDNF response in the ventral tegmental area (VTA), the infralimbic (IfL) and prelimbic (PrL) cortices. F1 generation QQ offspring demonstrated delayed extinction and more robust reinstatement compared to SS control animals. In addition, QQ animals demonstrated an enhanced BDNF response to nicotine in the VTA, IfL and Prl cortices compared to SS offspring. This study is the first to demonstrate altered relapse-like behavior in a heritable rodent model with relevance to comorbid drug abuse and psychosis. This altered pattern of behavior is hypothesized to be related to elevated activity-dependent BDNF in brain areas associated with drug reinforcement during conditioning that persists through the extinction phase, rendering aberrantly salient drug associations resistant to extinction and enhancing relapse vulnerability.

Acute effects of exercise among individuals with schizophrenia who smoke cigarettes

People with schizophrenia (SCZ) have a shorter life expectancy than those without psychiatric conditions. Of note, people with SCZ have high rates of cigarette smoking, physical inactivity, and obesity. These factors all coalesce to contribute to compromised health in this population, with smoking as a primary contributor. Therefore, it is paramount to develop effective smoking cessation strategies for this population. The purpose of this study was to investigate whether walking at a brisk pace, relative to engaging in passive activity, would reduce acute cigarette craving, nicotine withdrawal, and negative affect (NA) among people with SCZ who smoke cigarettes. Using a within-subjects design, twenty participants completed four laboratory sessions with condition sequence counterbalanced: 1) exposure to smoking cues + treadmill walking, 2) exposure to neutral cues + treadmill walking, 3) exposure to smoking cues + passive/sedentary activity, 4) exposure to neutral cues + passive/sedentary activity. Relative to sedentary activity, walking resulted in greater decreases in nicotine withdrawal but did not significantly affect craving or NA. These results did not vary as a function of cue type. These findings suggest that walking may be a helpful strategy to reduce acute nicotine withdrawal symptoms among people with SCZ. However, it should be used in conjunction with other strategies for smoking cessation.

Is peripheral blood immunophenotyping useful to understand the etiology of Idiopathic Granulomatous?

BackgroundThe etiology of idiopathic granulomatous mastitis (IGM) has not been clearly established. However, autoimmunity has recently become popular in etiopathogenesis. We aimed to investigate the immunophenotyping of immune cells to help clarify the etiopathogenesis of the disease. MethodsPatients with IGM and healthy volunteers were included in the study. Patients were divided into active and remission groups based on their disease status. The ratios of total T cells, helper T cells, cytotoxic T cells, natural killer cells, regulatory T cells, and monocyte subtypes were measured using flow cytometry. In addition, age, complete blood count for leukocyte, lymphocyte, neutrophil, and eosinophil counts, and the smoking status of all volunteers were evaluated. ResultsA total of 33 volunteers, including 11 patients with active IGM, 10 patients with remission IGM, and 12 healthy volunteers, were included in the study. The neutrophil, eosinophil, neutrophil/lymphocyte, and non-classical monocyte values were significantly higher in IGM patients than in healthy volunteers. Additionally, the CD4+ CD25+ CD127- regulatory T cell was significantly lower in IGM patients than in healthy volunteers. Furthermore, neutrophil, neutrophil/lymphocyte ratio, CD4+ CD25+ CD127- regulatory T cells, and non-classical monocytes showed significant differences when IGM patients were divided into active and remission groups. IGM patients had higher smoking rates, but this was not statistically significant. ConclusionThe changes in many cell types evaluated in our study were similar to the cell profiles of some autoimmune diseases. This could provide minor evidence to suggest that IGM is an autoimmune granulomatous disease with a local course.

Addressing Tobacco Use in Underserved Communities Outside of Primary Care: The Need to Tailor Tobacco Cessation Training for Community Health Workers.

Individuals from communities with a low socioeconomic status have the highest rates of tobacco use but are less likely to receive assistance with quitting. Community health workers (CHWs) are well-positioned to engage these communities; however, CHWs face barriers in receiving relevant tobacco cessation training. The objective of this study was to conduct a mixed methods needs assessment to describe tobacco practices and the desire for training among CHWs. After incorporating CHW feedback, we developed a needs assessment survey to understand knowledge, practices, and attitudes about tobacco cessation in Chicago, IL. CHWs (N = 23) recruited from local community-based organizations completed the survey online or in-person. We then conducted a focus group with CHWs (N = 6) to expand upon the survey and used the Framework Method to analyze the qualitative data. CHWs reported that their clients had low incomes, low literacy levels, and high smoking rates (e.g., "99%" of patients). About 73.3% reported discussing tobacco use during visits, but fewer reported that they had provided cessation advice (43%) or intervened directly (9%). CHWs described high variability in their work environments (e.g., location, duration, content of visits, etc.) and greater continuity of care. CHWs discussed that existing training on how to conduct tobacco interventions is ineffective, because of its stand-alone design. Our findings illustrate how CHWs adapt to their clients' needs, and that the currently available "gold-standard" cessation curricula are incompatible with the training needs and flexible care delivery model of CHWs. A curriculum tailored to the CHW experience is needed to maximize the strengths of the CHW care model by training CHWs to adaptively intervene regarding tobacco use in their highly burdened patients.

Expanding population-level interventions to help more low-income smokers quit: Study protocol for a randomized controlled trial

BackgroundLow-income Americans have higher rates of smoking and a greater burden of smoking-related disease. In the United States, smokers in every state can access evidence-based telephone counseling through free tobacco quitlines. However, quitlines target smokers who are ready to quit in the next 30 days, which can exclude many low-income smokers. A smoke-free homes intervention may help engage smokers in tobacco control services who are not yet ready to quit. Previous research in low-income populations suggests that receiving a smoke-free homes intervention is associated with higher quit rates. This study tests whether, at a population level, expanding on quitlines to include a smoke-free homes intervention for smokers not ready to quit could engage more low-income smokers and increase long-term cessation rates. MethodsIn a Hybrid Type 2 design, participants are recruited from 211 helplines in 9 states and randomly assigned to standard quitline or quitline plus smoke-free homes intervention arms. Participants in both arms are initially offered quitline services. In the quitline plus smoke-free homes condition, participants who decline the quitline are then offered a smoke-free homes intervention. Participants complete a baseline and follow-up surveys at 3 and 6 months. Those who have not yet quit at the 3-month follow-up are re-offered the interventions, which differ by study arm. The primary study outcome is self-reported 7-day point prevalence abstinence from smoking at 6-month follow-up. ConclusionThis real-world cessation trial involving 9 state tobacco quitlines will help inform whether offering smoke-free homes as an alternative intervention could engage more low-income smokers with evidence-based interventions and increase overall cessation rates.This study has been registered at ClinicalTrials.gov (Study Identifier: NCT04311983).

The impact of depression on opioid withdrawal symptoms among smokers with opioid use disorder receiving medication-assisted opioid detoxification.

Individuals with opioid use disorder (OUD) endorse high rates of combustible smoking (Zale et al., 2015) which is associated with poorer outcomes (e.g., opioid craving and lower detoxification completion rates) among individuals receiving medications for opioid use disorder (MOUD; Mannelli et al., 2013) and lower smoking cessation rates (Okoli et al., 2010). The complex pharmacological relationship between opioids and nicotine may help explain these findings (Kohut, 2017); however, little is known about psychosocial variables that influence MOUD processes among combustible smokers with OUD. The present study sought to expand upon prior work (Mannelli et al., 2013) by examining the impact of psychological factors and smoking-related variables on opioid withdrawal symptoms among smokers with OUD receiving Suboxone at an inpatient substance use treatment facility. Current smokers with OUD (N = 64) completed a battery of psychological measures examining depression, anxiety, and smoking constructs. The present study tested the influence of daily smoking rate, nicotine dependence, smoking urges, anxiety, and depression on opioid withdrawal symptoms through a hierarchical multiple regression. Findings revealed that smoking urges (p = .003) predicted severity of opioid withdrawal symptoms while controlling for race, daily smoking rate, and nicotine dependence. Depression (p = .000), however, explained variance in severity of opioid withdrawal symptoms above and beyond all smoking-related variables and anxiety. Results highlight the importance of considering psychological factors, specifically depression, which impact treatment processes among smokers with OUD to help inform the development of effective treatment interventions for both OUD and smoking cessation among individuals with OUD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

MP45-07 ERECTILE DYSFUNCTION AND HYPOGONADISM ARE UNDERREPORTED IN MEN WITH SPINA BIFIDA

You have accessJournal of UrologyCME1 Apr 2023MP45-07 ERECTILE DYSFUNCTION AND HYPOGONADISM ARE UNDERREPORTED IN MEN WITH SPINA BIFIDA Nyemkuna Fortingo, Garrick Greear, Tung-Chin Hsieh, Rupam Das, Joshua Horns, James Hotaling, and Yahir Santiago-Lastra Nyemkuna FortingoNyemkuna Fortingo More articles by this author , Garrick GreearGarrick Greear More articles by this author , Tung-Chin HsiehTung-Chin Hsieh More articles by this author , Rupam DasRupam Das More articles by this author , Joshua HornsJoshua Horns More articles by this author , James HotalingJames Hotaling More articles by this author , and Yahir Santiago-LastraYahir Santiago-Lastra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Spina Bifida is a congenital neurological defect associated with genitourinary anomalies, requiring comprehensive urological care from pediatrics to adulthood. For men with spina bifida, a significant focus is on urinary tract surveillance to maintain continence, preserve kidney and bladder health, and optimize fertility and sexual function. While men with SB have an increasing interest in exploring their sexuality and sexual health, these concerns may be under-discussed and undertreated depending on their burden of illness. Concurrently, the impact of hypogonadism on the SB is unknown. Hypogonadism is associated with increased insulin resistance in young males, hyperlipidemia, and other adverse vascular effects. These risk factors play a role in the vascular etiology of erectile dysfunction and can be a burden on sexual health. Our objective was to calculate the estimated prevalence of erectile dysfunction and hypogonadism in adult men with spina bifida. METHODS: This retrospective claims study used the MarketScan® databases from 2008 to 2017 to derive prevalence estimates for erectile dysfunction and hypogonadism in men with spina bifida, to compare these estimates to those in men without spina bifida, and to describe treatment patterns in this cohort. RESULTS: The estimated prevalence of erectile dysfunction and hypogonadism in men with spina bifida was 7.83% and 7.71%, respectively. Men with spina bifida in the sample exhibited high rates of smoking and metabolic comorbidities, but were diagnosed less frequently with erectile dysfunction when controlling for age and metabolic comorbidities than men without spina bifida. CONCLUSIONS: Based on the results, claims data suggest that HG and ED are diagnosed less frequently than expected. While there are some limitations to the population being examined in this database, improving health care delivery of sexual health concerns during the surveillance of men with spina bifida will enhance their quality of life and optimize their sexual and metabolic function. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e623 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nyemkuna Fortingo More articles by this author Garrick Greear More articles by this author Tung-Chin Hsieh More articles by this author Rupam Das More articles by this author Joshua Horns More articles by this author James Hotaling More articles by this author Yahir Santiago-Lastra More articles by this author Expand All Advertisement PDF downloadLoading ...

Untreated major depression in healthcare workers: Results from the nationwide AMADEUS survey.

Recent studies have suggested increased rates of depression in healthcare workers (HCWs), with direct impact on care quality and productivity. The objective was to determine the proportion of HCWs adequately treated for their major depression in a nationwide survey, the proportion of lifestyle risk factors for depression, and to determine if working in psychiatry department or professional status may modulate these outcomes. The method followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement guidelines. A survey comprising the Center for Epidemiologic Studies-Depression Scale was sent to public and private national healthcare facilities. Overall, 10,325 participants were recruited; 3438 (33.3%) [95% confidence interval 32.4-34.2] met likely diagnostic criteria for clinical depression. Almost 80% of them declared that they had a history of major depressive episode. However, only approximately 23% of them were treated with antidepressants and approximately 13% had a psychiatric follow-up. Depressed HCWs working in psychiatry departments received slightly better care for their depression, but they also consumed more anxiolytics and hypnotics and had more risk factors for depression (including smoking and hazardous drinking). We found specificities according to professions, physicians reported higher rates of hazardous drinking while nurses, nurse assistants, and health executives had higher rates of smoking and twice as much obesity as physicians. Disseminating tools to detect major depression, programs destigmatizing depression and antidepressants, promoting physical activity, weight loss, tobacco cessation and reduced alcohol consumption are promising strategies to improve the care of major depression in HCWs. Reducing depression in healthcare workers is necessary to improve the quality of care, to limit burnout, medical errors, absenteeism and turn-over and globally to improve the wellbeing at work.

Peripheral artery disease and extracorporeal membrane oxygenation: Examining a high-risk cohort over time.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a resource-intensive approach for the management of refractory cardiogenic shock. Within this population exists a substantial cohort of patients with peripheral artery disease (PAD), which independently increases the risk of complications and all-cause mortality. We studied 10-year national trends of the impact of PAD among VA-ECMO recipients to better understand the prevalence of PAD and implications on outcomes in this vulnerable population. This 10-year retrospective, propensity score-matched study identified all adult patients (≥18) who underwent VA-ECMO between 2009 and 2018, from a large US database (National Inpatient Sample). Patients with an ICD diagnosis of PAD were identified. The primary endpoints of in-hospital mortality, bleeding complications and major limb loss (above- or below-knee amputation) were compared between patients with PAD to those without. A total of 6768 patients were identified, of which 342 (5.3%) had PAD. The median age at admission was significantly higher in PAD patients [64years vs. 55years; p < .01], as was male gender [71% vs. 64%; p < .01]. Patients with PAD had higher rates of smoking (38.9% vs. 23.3%), hypertension (71.1% vs. 50%), diabetes (37.4% vs. 27.0%), chronic kidney disease (30.1% vs. 18.0%), coronary artery disease (76.0% vs. 35.0%) and dyslipidemia (76.0% vs. 35.0); all p < .01. After propensity-matching 2:1 for comorbidities, PAD patients were found to have significantly greater overall complications, including in-hospital mortality, bleeding, surgical wound infections, pseudoaneurysms, and major adverse limb events [71.9% vs. 63.9%; p < .01]. Subgroup analysis revealed greater in-hospital mortality [62.2% vs. 55.3%; p < .05], major amputations [4.1% vs. 0.3%; p < .01] and blood transfusions [32.2% vs. 26.2%; p < .05] in PAD patients. Over 2014-2018, the non-PAD group demonstrated statistically discernable trends in a 51.1% decrease in overall complications and a 28.1% increase in survival to discharge (all p < .01). Over the same time period the PAD cohort experienced a modest, nonsignificant, decrease in complications [7.0%, p = .40] and a decrease in those surviving to discharge [47.1% vs. 40.5%, p = .91]. Patients with PAD on VA-ECMO are sicker at baseline and experience significantly greater major amputations and higher in-hospital mortality. They have not benefitted from the considerable decrease in complication rates and increase in survival to discharge over time as compared to their non-PAD counterparts. These findings demonstrate the substantial frailty of the PAD population within an already high-risk cohort, and highlight the need for better procedural approaches and innovative technologies.

Incidence trends of oral cavity, oropharyngeal, hypopharyngeal and laryngeal cancers among males in Taiwan, 1980–2019: a population-based cancer registry study

In a country with a high prevalence of cigarette smoking, betel chewing, and alcohol drinking, cancers of the oral cavity, nasopharynx, and larynx were the fourth, twelfth and seventeenth leading causes of cancer death, respectively, for men in 2020. We analyzed patients with head and neck cancer from 1980 to 2019 from the Taiwan Cancer Registration Database and discussed the annual average percent change, average percent change, age period, and birth cohort. Obvious period effects and birth effects are seen in oral, oropharyngeal, and hypopharyngeal cancer; however, the most significant period effect was seen between 1990 and 2009, which mainly reflects the consumption of betel nuts per capita. In addition, the period effect lessens after 2010 in oral cancer and hypopharyngeal cancers, while oropharyngeal cancers remain an obvious period effect, which results from the rising prevalence of HPV. Due to the high prevalence rate of betel quid chewing and cigarette smoking in the 1990s, the government executed several acts. As a result, the age-adjusted incidence rates of oral, oropharyngeal, and hypopharyngeal cancers have flattened since 2010, which can be explained by the declining cigarette smoking rate. The strict policy indeed shows an obvious effect on the head and neck cancer incidence rates, and we expect to see a further decline in the future.

Artificial neural network machine learning prediction of the smoking behavior and health risks perception of Indonesian health professionals.

Health professionals (HPs) can play an important role in influencing the smoking behavior of their patients and the implementation of smoke-free workplace policies. In some countries physicians and dentists may not have a no-smoking policy in place. Breathing in other people's tobacco smoke (second-hand smokers) increase the risk of smoking related diseases. Environmental Tobacco smoke ETS causes a similar range of diseases to active smoking, including various cancers, heart disease, stroke, and respiratory diseases. Little is known about the smoking-related attitudes and clinical practices of HPs in Indonesia. Evidence suggests that high smoking rates remain among male HPs; however, the risk perceptions and attitudes to smoking among Indonesian HPs have not been investigated using prediction model artificial neural networks. For this reason, we developed and validated an artificial neural network (ANN) to identify HPs with smoking behavior. The study population consisted of 240 HPs, including 108 (45%) physicians, and 132 (55%) dentists, with more female (n=159) than male participants (n=81) for both professions. Participants were randomly divided into two sets, the training (192) and test (48) sets. The input variables included gender, profession (doctor or dentist), knowledge regarding smoking-related diseases and awareness of smoking provided to their patients, smoke-free policy in place at their workplace, and smoking status. ANN was constructed with data from the training and selection sets and validated in the test set. The performance of ANN was simultaneously evaluated by discrimination and calibration. After the training, we completed the process using the test dataset with a multilayer perceptron network, determined by 36 input variables. Our results suggested that our final ANN concurrently had good precision (89%), accuracy (81%), sensitivity (85%), and area under the curve (AUC; 70%). ANN can be used as a promising tool for the prediction of smoking status based on health risk perceptions of HPs in Indonesia.

Clinical and biochemical parameters associated with substance-induced psychotic disorder: which differences between alcohol, cannabis and psychostimulants

IntroductionAccording to DSM V, substance-induced psychotic disorder is a mental health condition in which the onset of psychotic symptoms can be traced to the use of a psychotropic substance. The pathogenesis of this disease is still poorly understood; current literature traces its causes back to genetic predisposition and early traumatic events (i.e. child abuse).ObjectivesThe present study aims to identify specific clinical features and biochemical markers which could be addressed as predictors for the long-term prognosis of this disease. Moreover, we aim to identify specific correlations between the clinical phenotype and the underlying substance abuse, in order to allow the early start of a tailored treatment.MethodsBetween 2020 and 2022 we recruited 218 patients referring to the Policlinico Hospital in Milan and the San Gerardo Hospital in Monza, Italy. All the patients were diagnosed with substance induced psychotic disorder: 31 reported alcohol abuse (14,2%), 71 psichostimulants (32,6%), 116 cannabis, (53,2%). For each patients, we collected demographic data, medical records and a comprehensive psychometric assessment (GAF, PANSS, BPRS, Modified Sad Person Scale-MOAS). Furthermore, we collected a blood sample for dosing Na+, K+, Na+/K+, hemogram with formula and platelets, glucose , urea, creatinine, uric acid, transaminases, γGT, bilirubin, plasma proteins, albumin, LDH, CPK, PCHE, cholesterol, HDL, LDL, Tg, TSH.ResultsChi squared test (χ²) has been used to compare qualitative variables between the 3 subgrous (alcohol-, psychostimulants- and cannabis-induced psychotic syndromes) (fig.1). One way ANOVA test has been used to compare quantitative variables between the same 3 subgroups (fig.2). After removing one of the subgropus (alcohol-induced psychotic symptoms), the same analysis have been repeated. Significant variables have been included in a binary logistic regression model in order to confirm their validity as predictors for cannabis- and psychostimulants-induced psychotic disorders (fig 3). Finally we performed Omnibus test and Hosmer-Lemeshow test in order to verify the validity of these regression models.Image:Image 2:Image 3:ConclusionsFor each considered subgroups, we indentified the following features. Alcohol induced psychotic syndrome: higher age of onset and age of hospital admission, higher cholesterol and hurea levels, , high comorbidity with medical conditions anxiety/depression, low social functioning, higher suicidal risk;, higher hospitalization rate. Cannabis induced psychotic syndrome: higher hemoglobin and albumin levels, more severe psychiatric symtoms (BPRS), higher smoking rates. Psychostimulants induced psychotic syndrome: higher multi-drug abuse risk. We could assume that according to this consideration the treatment protocols for each of these subgroups should be tailored according to their specific features.Disclosure of InterestNone Declared

Naltrexone plus bupropion reduces cigarette smoking in individuals with methamphetamine use disorder: A secondary analysis from the CTN ADAPT-2 trial

IntroductionMethamphetamine (MA) use is marked by high rates of comorbid tobacco smoking, which is associated with more severe drug use and worse clinical outcomes compared to single use of either drug. Research has shown the combination of naltrexone plus oral bupropion (NTX-BUP) improves smoking cessation outcomes in non-MA-using populations. In the Accelerated Development of Additive Pharmacotherapy Treatment (ADAPT-2) study, NTX-BUP successfully reduced MA use. Our aim in this secondary data analysis was to examine changes in cigarette smoking among the subgroup of participants reporting comorbid tobacco use in the ADAPT-2 trial. MethodsThe multi-site ADAPT-2 study used a randomized, double blind, sequential parallel comparison design to evaluate treatment with extended-release injectable NTX (380 mg every 3 weeks) combined with once-daily oral extended-release BUP (450 mg/day) vs matching injectable and oral placebo in outpatients with moderate or severe MA use disorder. The study assessed smoking outcomes, based on self-reported timeline followback (TLFB) data, twice/week for 13 weeks. ResultsOf the 403 participants in the ADAPT-2 trial, 290 reported being current cigarette smokers (71.9 %). The study found significant differences (p's < 0.0001) for each smoking outcome indicating greater change in the proportion of nonsmoking days, number of cigarettes smoked per week, and consecutive nonsmoking days, all favoring the group receiving NTX-BUP versus placebo. ConclusionsNTX-BUP was associated with significant reductions in self-reported cigarette smoking in the context of concurrent treatment for MA use disorder. These off-target medication effects warrant prospective investigation using biochemically confirmed measures of smoking abstinence. The development of NTX-BUP as a co-addiction treatment strategy has a potential for high public health impact.

Behavioral Health, Nursing Home Workforce, And More

From the Editor-In-Chief Health AffairsVol. 42, No. 2: Behavioral Health, Nursing Home Workforce & More Behavioral Health, Nursing Home Workforce, And MoreAlan R. WeilPUBLISHED:February 2023Free Accesshttps://doi.org/10.1377/hlthaff.2023.00023AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSBehavioral health careNursing homesWorkforce issuesEmergency departmentsTelehealthHealth equityThe February issue of Health Affairs covers behavioral health, including mental health and substance use; the nursing home workforce; and health equity issues such as racial and ethnic disparities in ambulance transportation destinations and adverse birth outcomes.Behavioral HealthIn the midst of a mental health provider shortage, Lisa Rotenstein and coauthors find an almost 50 percent increase in the share of primary care physician visits that address a mental health concern, with growth from 10.7 percent of visits in 2006–07 to 15.9 percent in 2016 and 2018. Black patients and Hispanic patients are 40 percent less likely than White patients and non-Hispanic patients, respectively, to have a mental health concern addressed during a primary care visit.K. John McConnell and colleagues use newly available national Medicaid claims data from 2018 to examine emergency department (ED) visits for mental health conditions among Medicaid beneficiaries. They report substantial state-to-state variation “both in ED visits for mental health conditions and in outpatient mental health visits, with these measures positively correlated.”Lori Uscher-Pines and coauthors explore recent trends in the use of telemedicine to address opioid use disorder (OUD). More than three-quarters of clinicians treating OUD report the use of one or more digital equity strategies designed to address barriers patients may have to using telemedicine, with about one-third offering real-time technical assistance and more than 15 percent supplying patients with electronic devices if they do not have them.Brendan Saloner and coauthors investigate smoking rates among people involved in the criminal legal system—a group of people with relatively high rates of smoking and substance use disorder (SUD). Using data from the period 2010–19, the authors find that “overall smoking rates among people with SUD decreased by 9.4 percentage points…during the study period, but they remained effectively unchanged in the subgroup of people with SUD who had criminal legal involvement.”Nursing Home WorkforceUsing a novel database of real estate investment trust (REIT) investments in US nursing homes and Medicare cost data from the period 2013–19, Robert Tyler Braun and coauthors determine that REIT investment in a nursing home increased licensed practical nurse and certified nursing assistant staffing hours per resident day by 2.15 percent and 1.55 percent, respectively, while decreasing registered nurse staffing in years 2 and 3 after investment.Elizabeth White and coauthors explore the relationship between nursing home staff shift times and COVID-19 testing and vaccination status. They find that day-shift staff had the highest testing rates and odds of vaccination, whereas night-shift staff had the lowest.Adequate staffing is central to ensuring high nursing home quality. To help illuminate the implications of various policy recommendations, John Bowblis and coauthors analyze nursing home staff expenditures and determine that “any specific threshold for nursing staff expenditures…would have a varying degree of effectiveness in ensuring that any given nursing home was adequately staffed.” Ultimately, the authors argue, increased expenditures on staff do not necessarily translate to an increase in staffing levels.EquityChristine Pack and coauthors investigate ambulance destinations for patients transported in 2020 from the same ZIP code and find meaningful differences by race and ethnicity. “In half of the studied ZIP codes, at least 8 percent of White patients would have had to be transported to different hospitals to achieve evenness in the transport destinations of White and non-White patients,” the authors report.Clare Brown and coauthors examine disparities in rates of preterm birth and low birthweight across racial and ethnic subcategories. They find sizable variation in adverse birth outcomes within racial and ethnic groups, demonstrating that broad racial and ethnic categorizations can conceal important intragroup differences.Eunhae Grace Oh and coauthors analyze dialysis facility networks for Medicare Advantage (MA) plans in 2020, one year before changes that significantly increased MA enrollment among patients with end-stage renal disease (ESRD). Nearly one-quarter of dialysis networks were narrow, which the authors define as including 25 percent or less of the dialysis facilities within the plan’s service area. Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native beneficiaries with ESRD were more likely than White beneficiaries to be enrolled in narrow-network MA plans.Examining COVID-19 booster rates at the end of the first Omicron wave in 462 Massachusetts communities, Adam Gaffney and coauthors find lower rates in communities with higher uninsurance rates and lower prevalence of medical checkups, after controlling for demographic factors. They call for “innovative vaccination outreach efforts to communities with a high prevalence of chronic illness…to mitigate the inequitable burden of COVID-19.” Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 6 February 2023 Information© 2023 Project HOPE—The People-to-People Health Foundation, Inc.PDF download

A Widening Divide: Cigarette Smoking Trends Among People With Substance Use Disorder And Criminal Legal Involvement.

People with substance use disorder (SUD) smoke cigarettes at a rate more than twice that of the general population. Policies and programs have focused on promoting smoking cessation among people with SUD, yet it is unclear whether interventions have adequately reached the subgroup involved in the criminal legal system, who have among the highest smoking rates. Drawing on repeated cross-sections of the National Survey on Drug Use and Health, we found that smoking rates declined by 9.4percentage points overall among people with SUD from 2010 to 2019, but rates remained virtually unchanged among the subgroup with criminal legal involvement. In regression analyses focused on people with SUD, three-quarters of the excess smoking burden for those with criminal legal involvement at baseline (2010-13) was accounted for by controlling for sociodemographics, substance use type, health insurance, and recent SUD treatment. However, even after we controlled for these same factors, the disparity in smoking prevalence among people with SUD between those with and without criminal legal involvement remained constant over time. These findings underscore the need for smoking cessation interventions focused on the criminal legal system, including correctional facilities and SUD treatment programs that serve people in this population.

The impact of cigarette prices on smoking onset and cessation: evidence from Vietnam

BackgroundVietnam is a country with very high smoking rates among men. According to a Global Adult Tobacco Survey (GATS) conducted in 2015, the daily smoking prevalence among Vietnamese men was...