Smoking Intake Research Articles

Investigating Diabetic Foot Pathophysiology and Amputation Prevention Strategies through Behavioral Modification

Diabetic foot complications stem from intricate interactions between macrovascular and microvascular changes, neuropathy, inflammation, immune responses, hyperglycemia, oxidative stress, and infection susceptibility. Macrovascular factors like atherosclerosis lead to tissue ischemia, while microvascular dysfunction worsens perfusion deficits. Neuropathy contributes significantly to such complications, causing sensory loss, motor problems, and autonomic dysfunction. This results in unnoticed injuries, muscle atrophy, deformities, and dry skin, elevating the risk of non-healing wounds and infections. Inflammation and immune responses amplify tissue damage and hinder healing. Chronic hyperglycemia generates advanced glycation end products, stiffening tissues, while oxidative stress exacerbates damage. Mitochondrial dysfunction further compromises cellular energy production, worsening tissue repair challenges. These multifaceted factors collectively contribute to diabetic foot complications. The impact of modifiable behavior factors such as smoking, heavy alcohol consumption, and exercise on the risk of lower extremity amputation (LEA) in diabetic patients is also not to be ignored. Substantial data had identified increased LEA risk from smoking and heavy alcohol intake and reduced risk from regular exercise. The cumulative impact of these behaviors underscores the significance of behavior modification in preventing LEA and enhancing the well-being of diabetic patients. Understanding these mechanisms is vital for developing effective preventive strategies, diagnostics, and treatments, addressing the impact of diabetic foot complications on individuals and healthcare systems.

Recurrent pregnancy loss: a male crucial factor-A systematic review and meta-analysis.

Recurrent pregnancy loss (RPL), defined as two or more failed clinical pregnancies, affects 1%-3% of couples trying to conceive. Nowadays up to 50% of cases remain idiopathic. In this context, paternal factors evaluation is still very limited. The aim is to address the topic of the male factor in RPL with a broad approach, analyzing collectively data on sperm DNA fragmentation (SDF) and semen parameters. We systematically searched in Pubmed/MEDLINE and Google Scholar from inception to February 2023. A protocol has been registered on PROSPERO (ID number CRD42022278616). PRISMA guidelines were followed. Pooled results from 20 studies revealed a higher DNA fragmentation rate in the RPL group compared to controls (mean difference [MD] 9.21, 95% CI 5.58-12.85, p<0.00001, I2 98%). Age, body mass index (BMI), smoking, and alcohol intake were not associated with DNA fragmentation. Subgroup analysis by different SDF assays (TUNEL and COMET at a neutral pH vs. indirect assessment with other assays) and ethnicity did not highlight different results (p = 0.25 and 0.44). Results pooled from 25 studies showed a significant difference comparing RPL and control groups regarding ejaculation volume (MD -0.24, 95% CI -0.43; -0.06, p 0.01, I2 66%), total sperm number (MD -10.03, 95% CI -14.65; -5.41, p<0.0001, I2 76%), total sperm motility (MD -11.20, 95% CI -16.15; -6.25, p<0.0001, I2 96%), progressive sperm motility (MD -7.34, 95% CI -10.87; -3.80, p<0.0001, I2 97%), and normal sperm morphology (MD -5.99, 95% CI -9.08; -2.90, p 0.0001, I2 98%). A sub-analysis revealed that Asian and Africans, but not white-European RPL men had lower progressive sperm motility compared to controls. In conclusion, current review and meta-analysis findings suggested that SDF and some specific semen parameters were associated with RPL in a multi-ethnic evaluation. This effort opens future direction on a growing awareness of, first, how the male factor plays a key role and, second, how appropriate would be to establish a direct dialogue between the gynecologist and the urologist. We performed a systematic review and meta-analysis on the male component of RPL. We found that sperm DNA fragmentation and some specific sperm parameters are significantly associated with RPL.

Operationalization, characterization and validation of a healthy lifestyle index in 35 LMICs

Abstract Background For low- and middle-income countries (LMICs), there is no comprehensive and valid index reflecting overall lifestyle. This study aimed to operationalize, characterize, and validate a healthy lifestyle index (HLI), based on the World Health Organization (WHO) recommendations. Methods We used cross-sectional, complete-case data from individual-level, nationally representative surveys among non-pregnant adults in 35 LMICs, applying the WHO STEPwise approach to NCD risk factor surveillance (2009-2019; N = 125,607). The HLI was constructed based on WHO recommendations for fruit and vegetable intake, physical activity, smoking, and alcohol intake (unhealthiest = 0 points; healthiest = 16 points). We calculated the distributions of the HLI and its subcomponents across socio-demographic and geographic strata, accounting for the survey design and each country's World Bank population estimate. Partial Spearman correlations were calculated for the HLI with its subcomponents and cardio-metabolic risk markers. Results In this study (females: 51%, median age: 35.4 years), median HLI-score was 10.3 (interquartile range: 8.2-12.3), being highest in females (versus males) and low-income countries (versus middle-income countries). Twenty-two percent had at least five servings of fruits and vegetables per day (males: 20%, females: 24%); 82% exercised at least 600 MET-min/week (males: 87%, females: 78%); 69% never smoked (males: 40%, females: 97%); 64% were alcohol abstainers (males: 50%, females: 78%). Correlations of the HLI with its subcomponents were moderate and positive, ranging between r = 0.35 and r = 0.64; correlations with cardio-metabolic risk markers were weak, ranging between r = |0.02| and r =|0.12|. Conclusions The majority of adults in LMICs appear to live a healthy lifestyle, particularly women and individuals in low-income countries. Low fruit and vegetable intakes are a major concern. The HLI shows good content but poor construct validity. Key messages • There is an urgent need for interventions to promote fruit and vegetable consumption in LMICs. • The HLI is suitable to monitor lifestyles in LMICs on individual-, country- and WHO region-level.

Loneliness is associated with health behaviour: A Danish population study of 122.258 individuals

Abstract Background Loneliness is steadily being recognized as a public health concern due to its association with increased morbidity and mortality. Health behaviour has been proposed as a key mechanism that influences this association. The objective of the present study is to provide a comprehensive account of the relationship between loneliness and adverse health behaviour, including daily smoking, alcohol consumption, physical inactivity, unhealthy dietary habits and obesity. Methods We conducted a cross-sectional study using data from the 2017 Danish National Health Survey. Loneliness was assessed using a Danish version of the Three-Item Loneliness Scale. We analysed the association between loneliness and multiple forms of adverse health behaviour in 122.258 individuals aged 16 years and older using logistic regression models adjusting for sex, age, educational attainment, country of origin and cohabitation status. Stratified analyses was conducted to investigate potential differences by sex and age. Results Loneliness was associated with a greater risk of smoking (AOR=1.30; 95% CI: 1.21-1.40), physical inactivity (AOR=1.87; 95% CI: 1.75-1.99), unhealthy diet (AOR=1.58; 95% CI: 1.47-1.70), and obesity (AOR=1.60; 95% CI: 1.49-1.72). Conversely, loneliness was associated with a lower risk of weekly alcohol consumption (AOR=0.91; 95% CI: 0.83-0.98). Conclusions Our study provides evidence that loneliness is associated with an increased risk of adverse health behaviour, such as smoking, physical inactivity and unhealthy dietary intake, across the life span. These results suggest that adverse health behaviors may influence the association between loneliness and poor health. Longitudinal studies are needed to clarify causal relationships underlying these associations. Key messages • Loneliness is strongly associated with adverse health behaviour across the life span. • Our study supports the theory that health behaviour is a key mechanism on the relationship between loneliness and morbidity.

Association between nut consumption and low muscle strength among Korean adults.

Nuts are an important component of a healthy diet, but little has been known about their effects on muscle health. Therefore, this study examined the association between nut consumption and low muscle strength among Korean adults. This cross-sectional analysis was conducted using single 24-h recall and handgrip strength data from 3962 younger adults 19-39 years, 6921 middle-aged adults 40-64 years and 3961 older adults ≥65 years participated in the seventh cycle (2016-2018) of the Korea National Health and Nutrition Examination Survey. Low muscle strength was defined as handgrip strength <28 kg for men and <18 kg for women. Sex-specific OR were obtained for younger, middle-aged and older adults using multivariable logistic regression analyses. About one in four Korean adults were consuming nuts (using a culinary definition) with peanut being the most frequently consumed type. After adjustment for age, BMI, total energy intake, household income, alcohol consumption, smoking, resistance exercise, medical history and dietary protein intake, nut consumption was associated with the lower risk of low muscle strength among older adults ≥65 years (men: OR 0·55, 95 % CI (0·38, 0·79); women: OR 0·69, 95 % CI (0·51, 0·93)); however, this association was not observed among younger adults 19-39 years or middle-aged adults 40-64 years. Our results suggest that consuming nuts might be beneficial in lowering the risk of low muscle strength among Korean older adults.

The determinants of fasting and post-load non-esterified fatty acids in older adults: The cardiovascular health study

AimNon-esterified fatty acids (NEFA) are potential targets for prevention of key cardiometabolic diseases of aging, but their population-level correlates remain uncertain. We sought to identify modifiable factors associated with fasting and post-load NEFA levels in older adults. MethodsWe used linear regression to determine the cross-sectional associations of demographic, anthropometric, and lifestyle characteristics and medication use with serum fasting and post-load NEFA concentrations amongst community-dwelling older adults enrolled in the Cardiovascular Health Study (n = 1924). ResultsFasting NEFA levels generally demonstrated a broader set of determinants, while post-load NEFA were more consistently associated with metabolic factors. Waist circumference and weight were associated with higher fasting and post-load NEFA. Cigarette smoking and caffeine intake were associated with lower levels of both species, and moderate alcohol intake was associated with higher fasting levels whereas greater consumption was associated with lower post-load levels. Unique factors associated with higher fasting NEFA included female sex, higher age, loop and thiazide diuretic use and calcium intake, while factors associated with lower fasting levels included higher educational attainment, beta-blocker use, and protein intake. Hours spent sleeping during the daytime were associated with higher post-load NEFA, while DASH score was associated with lower levels. ConclusionFasting and post-load NEFA have both common and unique modifiable risk factors, including sociodemographics, anthropometric, medications, and diet. Post-load NEFA were particularly sensitive to metabolic factors, while a broader range of determinants were associated with fasting levels. These factors warrant study as targets for lowering levels of NEFA in older adults.

Cigarette smoke uptake by different woven fabrics: Analysis of mechanical and colour properties

AbstractAlthough the impact of smoking tobacco on human health is well understood, less is known about the effects of tobacco smoke on cotton, viscose and polyamide fabrics. In this study, tobacco smoke was applied to fabric samples to investigate the effects of tobacco smoke on their mechanical and colour properties. For this purpose, tobacco smoke was pumped into a mechanism consisting of a glass box, in which cotton, viscose and polyamide fabrics were placed in a suspended position. The fabric samples were treated with tobacco smoke for 1 or 2 months. The samples were evaluated in terms of tensile and tear strength, elongation at break, as well as pilling and abrasion resistance values. A colour measurement test was used to investigate the withering effect of tobacco smoke, and Fourier Transfer–Infrared analysis was performed to examine the chemical changes. The tensile strength values in the warp direction were 419.34, 404.62 and 421.78 N without treatment and after 1 and 2 months of tobacco smoke treatment, respectively, for the cotton woven fabric. Furthermore, for woven cotton fabric, the L* value decreased from 93.8 to 78.7 after being treated with tobacco smoke for 2 months. As a result of this study, it was determined that tobacco smoke has no effect on the tensile strength properties of fabrics, causes changes to pilling and abrasion resistance values, and adversely affects the colour properties of fabrics.

Health behaviors according to the ability to understand health information in Korean adults.

This study aimed to verify the relationship between the level of understanding of health information and health behaviors among Korean adults. In total, 228 984 adults who participated in the 2021 Korea Community Health Survey were included. Participants were divided into three groups according to age (19-44, 45-64 and 65+). The ability to understand verbal and written health information was included, and its association with health behaviors, including smoking, alcohol consumption and preventive health service uptake, was assessed. Associations between the ability to understand health information and health behaviors were analyzed using chi-squared tests and multiple logistic regression analyses. Approximately 22.7% and 20% of the participants responded that verbal and written health information were easy to understand, respectively, with significant differences by age group. Compared to those with easy-to-understand verbal health information, those with difficulty in understanding had a higher risk of current cigarette smoking and monthly drinking and were less likely to engage in more than moderate physical activity, walking, influenza vaccination in 1 year, cancer examination in 2 years and medical examination in 2 years. Difficulty in understanding or no interest in written health information was also associated with unhealthy behaviors. A strong ability to understand health information is related to positive health behaviors. However, there are differences in the associations by age group, which should be considered when establishing a health literacy improvement strategy. These findings could promote health literacy and ultimately contribute to helping individuals make better choices for positive health behaviors.

Objective measures of smoking and caffeine intake and the risk of adverse pregnancy outcomes.

In pregnancy, women are encouraged to cease smoking and limit caffeine intake. We employed objective definitions of smoking and caffeine exposure to assess their association with adverse outcomes. We conducted a case cohort study within the Pregnancy Outcome Prediction study to analyse maternal serum metabolomics in samples from 12, 20, 28 and 36 weeks of gestational age. Objective smoking status was defined based on detectable cotinine levels at each time point and objective caffeine exposure was based on tertiles of paraxanthine levels at each time point. We used logistic and linear regression to examine the association between cotinine, paraxanthine and the risk of pre-eclampsia, spontaneous pre-term birth (sPTB), fetal growth restriction (FGR), gestational diabetes mellitus and birthweight. There were 914 and 915 women in the smoking and caffeine analyses, respectively. Compared with no exposure to smoking, consistent exposure to smoking was associated with an increased risk of sPTB [adjusted odds ratio (aOR) = 2.58, 95% CI: 1.14 to 5.85)] and FGR (aOR = 4.07, 95% CI: 2.14 to 7.74) and lower birthweight (β = -387 g, 95% CI: -622 g to -153 g). On univariate analysis, consistently high levels of paraxanthine were associated with an increased risk of FGR but that association attenuated when adjusting for maternal characteristics and objective-but not self-reported-smoking status. Based on objective data, consistent exposure to smoking throughout pregnancy was strongly associated with sPTB and FGR. High levels of paraxanthine were not independently associated with any of the studied outcomes and were confounded by smoking.

Therapeutic Management and New Upcoming Approaches for Age Related Macular Degeneration.

Age-related Macular Degeneration (AMD) is a severe eye illness that is going to lead in the race for incurable blindness globally among the elderly population. AMD is the third common reason responsible for affecting the quality of life globally. The macula and the retinal layers are adversely affected during AMD and are responsible for the loss of vision eventually. Numerous genetic variables, lipid metabolism, ageing and oxidative damage are the causative factors in the genesis of AMD. Lack of antioxidants, smoking and excessive alcohol intake contribute to increasing the risk of AMD. Management of dry AMD involves the use of nutritional supplements like zinc and antioxidants, along with conventional treatment, however, the use of nutritional supplements can only give minor benefits on the progression of dry AMD. Later stages of AMD need to be managed by cell-based interventions where the damaged or lost cells are replaced with fresh donor cells. A plethora of treatment methods are used in the management of AMD, such as nutrition, antibody-based treatments, stem cell management and nanotherapeutics. The available expensive treatments come with a number of adverse effects and future developments require the involvement of risk factor modification approaches, personalized therapy, targeting the disease specific pathways, exploring better anti-vascular endothelial growth factor (VEGF) inhibitors and many other regenerative approaches, that will broaden techniques to diagnose, control and treat AMD. This review provides an overview of the progression of AMD and the causative factors, with considerable emphasises on the current and potential prospects.

Effect of third-party components on emissions from a pod style electronic cigarette.

Electronic nicotine delivery systems (ENDS) have been associated with a dramatic increase in youth becoming addicted to nicotine following decades-long decline in cigarette smoking uptake. The United States Food and Drug Administration, Center for Tobacco Products (FDA/CTP) is responsible for regulating devices and consumable materials associated with ENDS. State and federal regulations regarding flavoring compounds in ENDS liquids (e-liquids) may be circumvented when vendors market refillable reservoirs side-by-side with noncompliant e-liquids. This study investigated the effect of third-party refillable versus manufacturer-supplied single-use reservoirs on total particulate matter (TPM) and nicotine emissions. The maximum TPM yield per puff was 5.6 times higher for the third-party (Blankz) reservoir (12.4 mg/puff) in comparison with the manufacturer's (JUUL) reservoir (2.2 mg/puff), whereas the maximum TPM concentration was over 7 times higher for third party (0.200 mg/ml) versus manufacturer (0.028 mg/ml) pod. The third-party pod was tested with nicotine concentrations ranging from 0% to 4%. The mass ratio of nicotine present in the aerosol (mg Nic/mg TPM) was found to be approximately the same as the mass ratio of the e-liquid (mg Nic/mg e-liquid) for both pods and all 3 nicotine laden e-liquids tested. Toxicant exposure may increase when consumers use third-party pods with ENDS devices. Refillable reservoirs are a significant barrier to regulatory restrictions on potentially toxic additives to e-liquids. It is recommended FDA/CTP require emissions characterization of third-party reservoirs used with each ENDS they are compatible with and should be required to demonstrate no increased potential toxicant exposure in comparison with manufacturer-provided reservoirs.

How Do Adolescent Smoking Prevention Interventions Work in Different Contextual Settings? A Qualitative Comparative Study Between the UK and Colombia

BackgroundAdolescent smoking is associated with significant health and social risks. Previous research has demonstrated the effectiveness of interventions based on behavior change theories in preventing adolescent smoking uptake. However, evidence from the theory-based perspective of evaluation is limited, especially for how such complex interventions work, and how they work when implemented in different contextual settings.MethodA comparative qualitative analysis was conducted to explore various influences on behavior change among participants taking part in two smoking prevention interventions in Northern Ireland and Bogotá. Twenty-seven focus groups were conducted in 12 schools (6 in Northern Ireland and 6 in Bogota, n = 195 pupils participated; aged 11–15 years). The Theoretical Domains Framework guided a content analysis of the data.ResultsWe found similarities across settings in terms of knowledge, skills, and beliefs related to smoking or vaping behavior change, as well as differences in contextual resources and social influence. Different environmental resources included availability to purchase tobacco products in the neighborhoods and previous information about tobacco risk. Participants in both interventions perceived behavioral change outcomes related to personal skills and intention to not smoke or vape.ConclusionThese findings have highlighted how both individual factors and contextual resources influence behavior change for smoking prevention in practice. Local contextual factors and social influences affecting pupils should be taken into account in the implementation and evaluation of health behavior change interventions. In particular, this study supports using social and contextual influence strategies in interventions to reduce the onset of adolescent smoking and vaping.

Prevalence and determinants of resistant hypertension in the delta region of Egypt: A prospective observational study.

Hypertension (HTN) is a leading cause of morbidity and mortality affecting about 30%-40% of the adult population in developed countries. Fewer data were published about the prevalence, sociodemographics, and clinical characteristics of the resistant hypertensive population in Egypt. Hence, our aim is to focus the attention on these determinantsespecially in the delta region of Egypt. Data belonging to patients visiting our HTN clinic in the Cardiovascular Department, Tanta University Hospital, Gharbeyah Governorate, Egypt, were collected over 12 months, between January 1, 2022, and 31 December 31, 2022, and then carefully analyzed. We found that the prevalence of resistant hypertension (RHTN) in the delta region of Egypt was 18%. We noted more RHTN cases in older age, that is, mean ± Std. was 51.5 ± 13.24 and 62.1 ± 7.56 for non-RHTN and RHTN, respectively. Also, the prevalence was higher in women representing about 54.4% of cases. Sixty-two percentof the patients with RH were obese (mean ± Std. of body mass indexwas 30.7 ± 5.36 in HTNand 47.7 ± 30.3 in RHTNgroups with p value <0.001). We found a significant relationship between chronic kidney disease, diabetes, and RHTN. Control of HTN among the Egyptian population in the delta region was unsatisfactory and higher than rates published globally. RH was more obvious in women, elderly, obese population, and diabetic and chronic kidney disease patients. Excessive use of nonsteroidal anti-inflammatory drugs, smoking, and high salt intake were clearly observed.

Impact of Nicotine Replacement Therapy on Breast Surgery Outcomes.

Smoking cessation therapy, including nicotine replacement therapy (NRT), is used perioperatively to assist patients to reduce their tobacco smoke intake and consequently decrease their risk of smoking-associated complications. There are, however, theoretical concerns that nicotine-induced peripheral vasoconstriction could impair wound healing. This study investigated the effect of NRT on postoperative outcomes in patients undergoing breast surgery. A retrospective chart review of patients undergoing breast surgery within the Yale New Haven Health System from the years 2014 to 2020 was performed. Documented smoking status within 6 months before surgery, use or prescription of NRT, type of surgery, and surgical complications of infection, wound dehiscence, tissue necrosis, hematoma, seroma, fat necrosis, and return to operating room within 30 days were recorded. Demographic and complication data were compared between patients with NRT usage and those without using t-tests and chi-square analyses. Multivariable logistic regression models were created to predict the effect of NRT usage on the occurrence of any complication. A total of 613 breast procedures met inclusion criteria, of which 105 (17.2%) had documented NRT use. The NRT cohort and the non-NRT cohort were well balanced with respect to demographics and procedural variables. Upon multivariable modeling for risk of any surgical complication, NRT was not a significant predictor (odds ratio [OR]: 1.199, p = 0.607 and OR: 0.974, p = 0.912, respectively), whereas procedure type, increased body mass index, and increased age were. NRT use was not associated with an increased risk of postoperative complications compared with not using NRT as part of smoking cessation therapy prior to operation.

Black Seed (&lt;i&gt;Nigella sativa&lt;/i&gt;) oil restores smoke or nicotine-induced vascular impairment via improvement in endothelium-dependent relaxation: role of nitric oxide synthase and voltage-sensitive potassium channels

Background: Despite the overwhelming evidence linking smoking and nicotine intake with vascular function impairments, the mechanisms involved and the possible ameliorative effect of black seed (Nigella sativa (NS)) oil administration are not clearly understood. This study sought to determine the involvement of nitric oxide synthase and voltage-sensitive potassium channels in the modulation of vascular reactivity in cigarette or nicotine-exposed rats treated with NS oil.&#x0D; Methods: Thirty male Sprague-Dawley rats were divided into 6 groups comprising vehicle control (Control), NS oil only (NS), Smoke only (SMK), Smoke + NS oil (SMKNS), Nicotine only (NCT) and Nicotine + NS oil (NCTNS). Animals were either passively exposed to cigarette smoke or nicotine vapour for 12 weeks, however, NS oil treatment commenced from 9th-12th week orally. At the end of the 12-week experimental period, vascular reactivity to norepinephrine (NE), acetylcholine (ACh) and sodium nitroprusside (SNP) were assessed with or without the presence of L-nitro-arginine (LNA) or 4-Amino-pyridine (4AP).&#x0D; Results: Percent contractile response to NE was higher (p &lt; 0.01) while relaxation response to ACh was lower in the SMK and NCT (p &lt; 0.05) groups. LNA-induced inhibition to ACh was significantly reduced in both SMK and NCT groups. 4AP-induced inhibition to ACh was significantly increased only in the NCT group. 4AP-induced inhibition to SNP was increased in SMK group. NS oil reduced only contractile response to NE in NCT group. It also significantly improved relaxation response to ACh as well as restored LNA-induced inhibition to ACh in the SMK and NCT groups. Interestingly, while NS oil reduced 4AP-induced inhibition in the NCT group, it reduced 4AP-induced inhibition to SNP in the SMK group.&#x0D; Conclusion: NS oil ameliorates vascular dysfunction by reducing contractile response in rats exposed to nicotine vapour while increasing endothelium-dependent relaxation as well as restoring differentially both LNA- and 4AP-induced inhibition in rats exposed to cigarette smoke and nicotine vapour.

Circulating Copper Is Associated with Inflammatory Biomarkers in Greek Older Adults with Osteoarthritis.

Osteoarthritis (OA) is the most common form of arthritis, that causes a significant decrease in the quality of life of the afflicted and constitutes a great burden for the socioeconomic system. Trace elements and heavy metals are implicated in the pathophysiology of OA, exacerbating inflammatory and oxidative stress responses. The aim of this cross-sectional study was to quantify metals in plasma samples of Greek OA patients and explore their link with disease related parameters, health status or quality of life, as well as epigenetic OA markers. This is the first study on plasma metal levels in Greek kneeOA patients. To achieve precision in plasma metal and miRNA measurements, high-quality samples were selected from a subset of 34 participants (NCT04783792). Demographic, quality of life, clinical, biochemical, inflammation, oxidative stress, and anthropometric parameters, as well as microRNA levels were assessed. Significant correlations were found between circulating metals with OA related parameters or with measured microRNAs. Also, significant positive associations between plasma copper (Cu) levels and CRP (p = 0.033) or IL-6 (p = 0.001) occurred when adjusting for age, gender, BMI, physical activity level, smoking, disease severity, total arthroplasty, and dietary intake of the respective metal. Cu's role in OA is bidirectional, and this study confirms the findings that in OA, Cu is positively associated with inflammation. Such relationships between lifestyle, environment and OA enhance our understanding and encourage further study on metals related to OA inflammation.

E-cigarette use and other risk factors associated with tobacco smoking susceptibility among Australian adolescents

ObjectiveTo explore risk factors for smoking susceptibility among Australian adolescents to inform prevention policies and programs. MethodsCross-sectional survey of students aged 12–17 years who reported having never smoked (n=4,171). Bivariate associations between smoking susceptibility and a range of factors previously linked to youth smoking and smoking susceptibility were initially examined, with significant factors (p<0.05) included in a final multivariable logistic regression model. ResultsEleven percent of adolescents who had never smoked were susceptible to smoking. Smoking susceptibility was independently associated with ever use of e-cigarettes (adjusted odds ratio [AOR]=3.26, 95% confidence interval [CI]: 1.83-5.81), perceiving those who smoke to be more popular (AOR=2.87, 95% CI: 1.62-5.10), having a close friend/s who smokes (AOR=2.66, 95% CI: 1.61-4.40), not perceiving smoking one or two cigarettes occasionally as personally dangerous (AOR=2.56, 95% CI: 1.61-4.09), and having symptoms of depression (AOR=1.59, 95% CI: 1.06-2.38). ConclusionsThe strongest smoking-initiation risk factor identified was ever use of e-cigarettes, with social norms, harm misperceptions around low-rate tobacco use and mental health also linked to smoking susceptibility. Implications for Public HealthStronger e-cigarette regulations that reduce promotion to and access by youth, as well as interventions addressing the other identified risk factors, may help prevent future smoking uptake among Australian adolescents.

Effectiveness of Self-Instructional Module (SIM) on Knowledge Regarding Breast Cancer among Women

Women are blessed with a kind heart, a sea of love, and a bundle of affection. They are, undoubtedly, a symbol of love and a pillar of strength. They are always there, like a beacon in the night. A woman is not only beautiful, but, a woman is a companion to a man, family and society given by God Almighty. Yes, women are indeed God’s most beautiful creation. Every woman should know this, and should live up to it. Women should respect themselves. Today, sadly, things have changed. Many women have no sense of their health and their wellness. Cancer has become one of the ten leading causes of death in India. According to Indian Council of Medical Research there are nearly 1.5-2 million cancer cases at any given point of time. Over 7 lakh new cases of cancer and 3 lakh deaths occur annually due to cancer. Nearly 15 lakh patients require facilities for diagnosis, treatment and follow up at a given time.3 The incidence of breast cancer is rising in every country of the world especially in developing countries such as India. This is because more and more women in India are beginning to work outside their homes which allow the various risk factors of breast cancer to come into play. These include late age at first childbirth, fewer children and shorter duration of breast-feeding.4 Breast cancer has increased incidence of among women residing in metropolitan cities. Statistically, breast cancer is supposed to be more common among unmarried women; those who are married, but have not had children; and those who have had children, but did not breast feed their babies. It is also related with smoking, alcohol drinking and high fat intake to the causation of breast cancer and this probably explains its etiological relationship to a modern lifestyle and environment.5 Materials and Methods: Descriptive survey design is selected using convenient sampling and 60 working women were selected as sample. A structured questionnaire is used to assess the knowledge of the working women regarding breast cancer. The questionnaire consisted of two parts: Part –A to collect the demographic data, Part-B consisting of questions regarding the various aspects of knowledge about breast cancer. Results: Major findings of the study revealed that the majority of 50%women belonged to the age group of 41-50 yrs, 75% women are married 50% are graduate, majority (40%) of women had two children and 40 never breast fed majority of women (40%) had a family monthly income of Rs. 20001-30000, and had no history of breast cancer running in the family. The mean knowledge score was 5.7 (SD  2.47) and 22% of the study population had poor knowledge regarding breast cancer. Demographic variables like age, marital status educational status, duration of breast feeding and family history were associated with the level of knowledge. A self-instructional module was prepared for use as a teaching aid and found effective with‘t’ value 17.77 at p&lt;0.01 level. Conclusion: After the detailed analysis of the study findings showed that the earlier studies done on the knowledge of women regarding breast cancer. There is lack of knowledge even in the educated women regarding breast cancer. It is the responsibility of all the nursing educators, administrators and policy makers to find out the barriers in the gain of knowledge and should try to remove them and to develop strategies which can make emphasis on prevention and early detection of diseases

Exclusive waterpipe smoking and the risk of nasopharynx cancer in Vietnamese men, a prospective cohort study

Tobacco smoking is carcinogenic to humans. Besides cigarettes, the most common form of tobacco smoking, there was sparse evidence of waterpipe’s carcinogenicity-induced nasopharyngeal cancer (NPC). This study investigated the association between waterpipe smoking and NPC mortality. Our study followed up with 20,144 eligible man participants from nine northern Vietnam communes between 2007 and 2019. Face-to-face interviews were conducted to gather data on exclusive waterpipe and cigarette smoking and dietary intake using structured semi-quantitative food frequency and lifestyle questionnaires. Nasopharyngeal cancer was determined by accessing the medical records at the state health facilities. We estimated the Cox proportional hazard ratio and 95% confidence intervals, HR (95% CI). The proportion of never smokers, exclusive waterpipe, exclusive cigarette, and dual waterpipe and cigarette smokers was 55.8%, 14.5%, 16.6%, and 13.1%, respectively. Exclusively waterpipe smokers increased the risk of NPC death compared to exclusively cigarette smokers, HR (95% CI): 4.51 (1.25, 16.31), p = 0.022. A dose-dependent positive relationship between NPC and exclusive waterpipe smoking was significantly seen for higher intensity HR (95% CI): 1.35 (1.07, 1.71), earlier age of smoking initiation HR (95% CI): 1.26 (1.06, 1.50), longer duration HR (95% CI): 1.31 (1.04, 1.66), and the cumulative number of a smoke lifetime HR (95% CI): 1.37 (1.08, 1.74). We observed a significant positive association between exclusive waterpipe smoking and NPC in men. The findings suggested that waterpipe smoking is likely more harmful than cigarettes in developing this cancer. A firm tobacco control against waterpipe smoking is highly recommended.

Adverse health consequences of undiagnosed hearing loss at middle age: A prospective cohort study with the UK Biobank.

Hearing impairment is common in the middle-aged population but remains largely undiagnosed and untreated. The knowledge about to what extent and how hearing impairment matters for health is currently lacking. Thus, we aimed to comprehensively examine the adverse health consequences as well as the comorbidity patterns of undiagnosed hearing loss. Based on the prospective cohort of the UK Biobank, we included 14,620 individuals (median age 61years) with audiometry-determined (i.e., speech-in-noise test) objective hearing loss and 38,479 individuals with subjective hearing loss (i.e., tested negative but with self-reported hearing problems; median age 58years) at recruitment (2006-2010), together with 29,240 and 38,479 matched unexposed individuals respectively. Cox regression was used to determine the associations of both hearing-loss exposures with the risk of 499 medical conditions and 14 cause-specific deaths, adjusting for ethnicity, annual household income, smoking and alcohol intake, exposure to working noise, and BMI. Comorbidity patterns following both exposures were visualized by comorbidity modules (i.e., sets of connected diseases) identified in the comorbidity network analyses. During a median follow-up of 9years, 28 medical conditions and mortality related to nervous system disease showed significant associations with prior objective hearing loss. Subsequently, the comorbidity network identified four comorbidity modules (i.e., neurodegenerative, respiratory, psychiatric, and cardiometabolic diseases), with the most pronounced association noted for the module related to neurodegenerative diseases (meta-hazard ratio [HR]=2.00, 95%confidence interval [CI] 1.67-2.39). For subjective hearing loss, we found 57 associated medical conditions, which were partitioned into four modules (i.e., diseases related to the digestive, psychiatric, inflammatory, and cardiometabolic systems), with meta-HRs varying from 1.17 to 1.25. Undiagnosed hearing loss captured by screening could identify individuals with at greater risk of multiple adverse health consequences, highlighting the importance of screening for speech-in-noise hearing impairment in the middle-aged population, for potential early diagnosis and intervention.