Smoking Abuse Research Articles

Transgenic over expression of nicotinic receptor alpha 5, alpha 3, and beta 4 subunit genes reduces ethanol intake in mice

Abuse of alcohol and smoking are extensively co-morbid. Some studies suggest partial commonality of action of alcohol and nicotine mediated through nicotinic acetylcholine receptors (nAChRs). We tested mice with transgenic over expression of the alpha 5, alpha 3, beta 4 receptor subunit genes, which lie in a cluster on human chromosome 15, that were previously shown to have increased nicotine self-administration, for several responses to ethanol. Transgenic and wild-type mice did not differ in sensitivity to several acute behavioral responses to ethanol. However, transgenic mice drank less ethanol than wild-type in a two-bottle (ethanol vs. water) preference test. These results suggest a complex role for this receptor subunit gene cluster in the modulation of ethanol's as well as nicotine's effects.

Abstract 3358: Sex Differences in Vascular Risk Factors in a Multi-ethnic, Medically Underserved Stroke Population

Background: Recent nationally representative studies of stroke patients have revealed that vascular risk factors are not as aggressively controlled in women compared to men. Medically underserved minority populations are at particularly high risk for poor control of vascular risk factors; however, little is known about sex differences in this population. Methods: Sex-specific vascular risk factors and admission medications were assessed for 440 consecutive ischemic stroke patients (39% female) admitted to a safety-net public hospital in Los Angeles County. Multivariate logistic regression was used to determine sex differences in vascular risk factors, adjusting for age and race. Results: The mean age was 58.9 (SE 10.6) years, 58% were Hispanic, 7% were white, 13% were black, 20% were Asian, and 1% were Native American. Stroke classification (using modified TOAST) revealed the following distribution: 35% small vessel, 20% large vessel, 7% cardioembolic, 23% cryptogenic, 13% >1 possible etiology, and 3% other mechanisms (e.g. drug use). Women had higher mean glycosylated hemoglobin levels than men (8.0% vs 7.4%, p<0.01) and were more likely than men to have a history of type 2 diabetes (49% vs. 40% male, p=0.04), systolic blood pressure > 140 mm Hg (72% vs. 62%, p=0.03), total cholesterol > 200 mg/dL (46% vs. 36%, p=0.04), and low HDL levels (<40 mg/dL for men and <50 mg/dL for women)(83% vs. 79%, p <0.01). Men were more likely than women to have a previous history of stroke (19% vs. 13%, p = 0.05), smoking (49% vs 19%, p<0.01), and alcohol abuse (28% vs. 7%, p<0.01). After adjustment for race and age, women were more likely than men to have total cholesterol > 200 mg/dL (OR 1.56, 95% CI 1.05-2.31), BMI ≥ 30 kg/m 2 (OR 1.55, 95% CI 1.03-2.34), systolic blood pressure >140 mm Hg (OR 1.46, 95% CI 0.96-2.22), low HDL (1.26, 95% CI 0.76-2.08), and triglyceride level > 150 mg/dL (OR 1.09, 95% CI 0.74-1.63); however, the latter 3 were not significant. After adjustment for race and age, men were more likely than women to have a history of smoking (OR 4.54, 95% CI 2.78-7.14) and alcohol abuse (OR 5.56, 95% CI 2.86-11.11). Conclusions: In this multi-ethnic population with inadequate access to care, women are more likely than men to have obesity, hypertension, and dyslipidemia while men are more likely than women to smoke or abuse alcohol. Larger studies are necessary to validate these findings. In the meantime, interventions aimed at reducing the incidence of metabolic syndrome components among women and smoking and alcohol abuse among men in underserved communities are likely warranted.

Late gestational maternal serum cortisol is inversely associated with fetal brain growth

To analyze the association between fetal brain growth and late gestational blood serum cortisol in normal pregnancy.Blood total cortisol was quantified at delivery in 432 Chinese mother/child pairs. Key inclusion criteria of the cohort were: no structural anomalies of the newborn, singleton pregnancy, no alcohol abuse, no drug abuse or history of smoking no hypertensive disorders and no impairment of glucose tolerance and no use of steroid medication during pregnancy. Differential ultrasound examination of the fetal body was done in early (gestational day 89.95±7.31), middle (gestational day 160.17±16.12) and late pregnancy (gestational day 268.89±12.42). Newborn's cortisol was not correlated with any of the ultrasound measurements during pregnancy nor with birth weight. Multivariable regression analysis, considering timing of the ultrasound examination, the child's sex, maternal BMI, maternal age, maternal body weight at delivery, the timing of cortisol measurement and maternal uterine contraction states, revealed that maternal serum total cortisol was significantly negative correlated with ultrasound parameters describing the fetal brain: late biparietal diameter (R2=0.512, p=0.009), late head circumference (R2=0.498, p=0.001), middle biparietal diameter (R2=0.819, p=0.013), middle cerebellum transverse diameter R2=0.76, p=0.014) and early biparietal diameter(R2=0.819, p=0.013). The same analysis revealed that birth weight as well as ultrasound parameters such as abdominal circumference and femur length were not correlated to maternal cortisol levels.In conclusion, our study demonstrates that maternal cortisol secretion within physiological ranges may be inversely correlated to fetal brain growth but not to birth weight. It remains to be demonstrated whether maternal cortisol secretion negatively influencing fetal brain growth translates to adverse neurological outcomes in later life.

Abstract P118: Changes in Patient Predictors of Use of Drug-Eluting Coronary Stents After FDA Warnings in Early 2007

Objective: Use of drug-eluting stents (DES) in PCI began to decline in late 2006 after release of scientific findings of higher risk of late stent thrombosis with DES. An emergency meeting of the FDA advisory panel cautioned about complications resulting from off-label use of DES. In this study, we compared early 2006 (pre-controversy) with late 2007 (post-controversy) patient predictors of use of DES vs. BMS for STEMI, NSTEMI, and stable CHD. Methods: We compared pre-controversy vs. post-controversy predictors of DES vs. BMS for STEMI (n= 9,341), NSTEMI (n=21,410) and stable CHD (n=23,495) through multivariate logistic regression analysis of hospital discharge data for Florida. Results: Throughout the study period, we observed reduced rates of DES implantation in patients with CHF (NSTEMI), cardiomyopathy (STEMI), Medicaid (STEMI and CHD), smoking (NSTEMI and CHD), medication noncompliance (STEMI, NSTEMI and CHD), and drug abuse (STEMI). Compared to the pre-controversy era, new deterrents to DES use post-controversy for STEMI patients were age >75 years, atrial fibrillation (AF), anticoagulation medication (AM), and smoking; while for NSTEMI new deterrents to DES were age >85 years, AF, AM, alcohol abuse and drug abuse. For stable CHD, in the pre-controversy era, patients aged 45-54 years were more likely to get DES, while those with diabetes mellitus were less likely to get DES. In the post-controversy era, new deterrents to DES use were age > 75 years, CHF, AF, peripheral vascular disease, AM, chronic kidney disease, alcohol abuse, or a history of medication noncompliance. Blacks with NSTEMI were more likely to get DES (OR 1.4; 95% CI 1.03-2.01; p=0.03) in the pre-controversy era, but less likely (OR 0.7; 95% CI 0.59-0.83; p<0.0001) in the post-controversy era. In contrast, the likelihood of DES implantation for blacks was significantly lower (OR 0.61; 95% CI 0.43-0.87; p=0.006) for STEMI in the pre-controversy era only and not different for stable CHD. Conclusions: In the state of Florida, the reduction in DES use post-controversy is related to older age, presence of co-morbidities like atrial fibrillation requiring additional anticoagulants and patient markers of potential non-compliance with thienopyridines (e.g. alcohol and drug abuse).

NIH-DC Initiative to Reduce Infant Mortality in Minority Populations in Washington, DC: History and Lessons Learned

In the years leading up to implementation of the NIH-DC Initiative, the infant mortality rate among blacks was at least twice as high as among whites. National data (Table 1) demonstrate that while infant mortality rates were decreasing for both white and black infants, the discrepancy between the rates increased. Table 2 provides the infant mortality rate among white and black infants In Washington, DC, as well as the rate ratio. During this period, the rate for blacks in Washington, DC was higher than observed nationally for blacks and the discrepancy in rates between whites and blacks was also higher [1–3]. Similar disparities existed between the rates for blacks and whites for other birth outcomes related to infant mortality, such as low birth weight [4] (Tables 3, 4) and preterm delivery. Data on low and very low birth weight showed a similar pattern: the actual rates and the discrepancy in rates comparing whites and blacks were higher in Washington, DC than nationally. In response to this problem, the United States Senate and House [5] urged the National Institutes of Health to close the health gap between minority and majority Americans by addressing issues such as infant mortality and health behaviors in adolescent and young adult minorities. To address these issues in Washington, DC, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and what is now the National Institute on Minority Health and Health Disparities (formerly the NIH Office of Research on Minority Health) established the NIH-DC Initiative to Reduce Infant Mortality. This was a collaborative research network between the NICHD, a data coordinating center, and various primary collaborating sites in the District of Columbia. There are multiple known risk factors for poor perinatal outcome, including perceived racial discrimination, young maternal age, low level of maternal education, poverty, inadequate housing, lack of social support, being unmarried, late or no prenatal care, unintended childbearing, adverse health behaviors during pregnancy like smoking, drinking and drug abuse. Additionally there are a number of medical risk factors, including preeclampsia, premature rupture of the membranes, urinary tract and vaginal infections. To address these health discrepancies, the overarching goals of the NIH-DC Initiative were to develop projects with the objectives of understanding the determinants of risk factors for the high rates of infant mortality, understanding risk factors for low birth weight among minorities in DC, and developing interventions that help reduce those risk factors. Phase I began in 1992 and included diverse projects that: evaluated an educational program for new mothers who had inadequate or no prenatal care; studied the characteristics of neonatal intensive care units within Washington DC; addressed immunization rates for DC children; evaluated a program to prevent adolescent pregnancy; described the barriers, motivators and facilitators of prenatal care utilization; surveyed childhood injuries; and assessed alcohol consumption during pregnancy. These studies produced many relevant results. Three key results: First, that mothers randomized to an intervention for women with M. Kiely (&) M. Davis Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development/NIH/DHHS, 6100 Executive Blvd, Rockville, MD 20852-7510, USA e-mail: kielym@nih.gov

Riabilitazione dopo intervento di osteosintesi o protesi di spalla in frattura

A proximal humerus fracture is a relatively common event. Humeral anatomy must be preserved as much as possible by performing a correct osteosynthesis, if feasible. Shoulder hemiarthroplasty is a correct indication in older patients with a poor bone stock. A poor functional outcome is known to be related with older age, comorbidities, obesity, poor pre-op range of motion, smoke and alcohol abuse. Patients will have better pain relief and a quicker return to normal activity after implant of an inverted prosthesis, while a better long-term functional outcome is associated to an anatomical prosthesis. There is a strong relation between rehabilitative exercise and functional outcome both in osteosynthesis and hemiarthroplasty. Patients that undergo osteosynthesis can be classified in two groups: good bone stock and good synthesis: rehabilitation program can be accelerated; poor bone stock and poor synthesis: the rehabilitation program should be implemented slowly. Post-operative immobilization time is relevant to the range of motion final outcome; 4 weeks’ immobilisation time is necessary after osteosynthesis. Different types of fracture, potential instability of the fracture and the presence of osteoporosis should be borne in mind and the rehabilitation program should be modified accordingly. Active movements need to be encouraged with a correct planning of mobilization and strength rehabilitation exercise. It is also very important to consider long-term biologic changes in periarticular tissues and rehabilitative exercises need to be focused on this. Stability of the tuberosities after the implant of an anatomical shoulder prosthesis in fracture is very important in the rehabilitation program. An inverted prosthesis in fracture may offer good and rapid active movements in absence of osteoporosis. In patients with osteoporosis range of motion exercises should start after 1 month post-op. Strengthening exercises will start after achievement of a satisfying shoulder range of motion.

Effects of antihypertensive treatments on incidence of diabetes: a case-control study.

Aim of this case-control study is the assessment of the relationship between antihypertensive treatment and incidence of diabetes in an unselected cohort of subjects participating in a screening program for diabetes. A case-control study nested within a cohort of nondiabetic subjects with a mean follow-up of 27.7 ± 11.3 months was performed, comparing 40 cases of incident diabetes and 160 controls matched for age, sex, body mass index, fasting plasma glucose, 2-h post-load glycemia, smoking and alcohol abuse. When considering antihypertensive treatment at enrolment, a lower proportion of cases was exposed to ACE-inhibitors/angiotensin receptor blockers (ACE-i/ARB) in comparison with controls. A non-significant trend toward a higher exposure to diuretics, which were mainly represented by thiazide diuretics, was observed in cases. In a multivariate analysis, including both ACE-i/ARB and diuretics, a protective effect of ACEi/ARB, and an increased risk with diuretics were observed. Similar results were obtained in alternative models, after adjusting for systolic and diastolic blood pressure at enrolment, diagnosis of hypertension, concurrent treatment with β-blockers or calcium-channel blockers, and number of antihypertensive medications. Diuretics seem to be associated with a higher incidence of diabetes, whereas treatment with ACEi/ARB could have a protective effect.

P03-248 - Prevalence of cigarette smoking in schizophrenic patients compared to other hospital admitted psychiatric patients

Introduction & aimsEstimate the prevalence of cigarette smoking and some of the related factors among schizophrenic and other hospitalized psychiatric patients.MethodsThis was a cross-sectional study on 120 patients hospitalized in Shahid Beheshti hospital in Kerman in 2005. Patients were equally devided in two groups of schizophrenia and other psychiatric disorders. Sampling was based on statistical census and data were collected using a questionnaire including 27 questions on demographic data, psychiatric disorder, smoking cigarettes and other substances, and Fagerstrom test. Data were analyzed by Chi-square and ANOVA tests using SPSS software.ResultsPrevalence and severity of cigarette smoking was 71.6% and 6.47% among schizophrenic and 51.6% and 6.40% among other psychiatric patients, respectively and the difference was not significant. History of withdrawal was 25.6% and 58.1% in the schizophrenia and other disorders respectively and the difference was significant (P < 0.05). Addiction to other substances was 51.6% in schizophrenic and 45% in the other patients and the most prevalent substances in both groups were opium and alcohol. The severity of smoking cigarettes was 6.9 along with other drug abuses and 5.1 in cases with just smoking based on Fagerstrom test and the difference was significant (P < 0.05).ConclusionsThe prevalence of cigarette smoking in both schizophrenia and other psychiatric patients is higher than normal population, but there is no significant difference between these two groups. Schizophrenic patients need persistent supportive and supervising programs for cigarette smoking abuse treatment because of their cognitive, motivate and social problems.

Teaching Motivational Interviewing Skills to Third-Year Psychiatry Clerkship Students

despite a large percentage of health care costs being related to smoking, obesity, and substance abuse, most physicians are not confident in motivating patients to change health behaviors. Motivational interviewing (MI) is a directive, patient-centered approach for eliciting behavior change. The purpose of this study was to teach students MI skills and assess their confidence and knowledge during the psychiatry clerkship using smoking cessation as the target behavior. using a pretest/posttest design, 98 students were given a 10-item questionnaire during the psychiatry clerkship to assess their knowledge and confidence in health behavior change. Students received a 3-hour presentation on the principles of MI and practiced skills through role play. Students were encouraged to utilize these skills with patients. paired t tests results showed significant differences pre- and postclerkship for nine of the 10 items, including the student's confidence in working with patients in the area of smoking cessation. students can gain basic knowledge and increased confidence in working with patients for promoting behavioral change, even with a brief session, taught by nonexperts in motivational interviewing theory.

Drug Abuse Pattern and High Risk Behaviors among Addicts in Shahroud County of Semnan Province, Northeast Iran in 2009.

This study aimed at determining the drug abuse pattern and the frequency of high-risk behaviors among the clients of Methadone Maintenance Treatment Centers and Drop-in Centers in Shahroud County of Semnan Province. In this cross-sectional study, the data collection tool was a questionnaire including 10 general and 32 specific items about drug abuse pattern and high-risk behaviors. The data were collected via interview. The mean age of the subjects was 34.8 year. The patterns of opium consumption among the subjects before coming to treatment center were inhalation (44.4%), ingestion (25.7%), and injection (12.7%). The subjects abused different types of opium before referring to the treatment centers including opium 88.42%, opium extract 65.5%, crack 48.0%, alcohol 30.3%, cannabis 19.8%, heroin 16.7%, and other substances 6.5%. Almost 42.4% of subjects had positive family history of drug abuse. There was not statistically significant correlation between the form of substance abuse and gender, education level, occupation and marital status. However the correlation between form of substance abuse and place of residence (P=0.014), income (P=0.03) and tobacco smoking (P=0.001) was statistically significant. The most prevalent pattern of drug consumption was inhalation. Opium and crack were the most frequent kind of drugs among study subjects. These results need serious attention in providing services through Methadone Maintenance Treatment Centers as well as Drop-in Centers. In addition, due to highly positive family history among addicts, family participation will play an important role in prevention.

Nudge, nudge…

The government plans to ring-fence around £4 billion and shift the responsibility for the nation's public health from the NHS to local authorities, which will work with a new quango, Public Health England, to tackle issues such as smoking, obesity and alcohol abuse, overseeing national screening programmes and coordinating the response to flu pandemics and other outbreaks.

Priapus is Happier with Venus than with Bacchus

The relationship between alcohol consumption and erectile function is still not completely clarified. Aims of the present study are to explore a number of biological and clinical correlates of alcohol consumption in a sample of men consulting for sexual dysfunction, and to verify possible associations with the incidence of major adverse cardiovascular events (MACEs). A consecutive series of 1956 (mean age 55 ± 11.9 years old) attending our outpatient clinic for sexual dysfunction was retrospectively studied. A subset of the previous sample (N = 1687) was enrolled in a longitudinal study. Different clinical, biochemical, instrumental (penile Doppler ultrasound [PCDU]), and intrapsychic (Middlesex Hospital Questionnaire [MHQ]) were evaluated. We considered alcohol abuse more than three drinks per day. Among the patients studied 81% reported no or mild (<4 drinks/day) alcohol consumption whereas 14.3% and 3.9% declared a moderate (4-6 drinks/day) or severe (>6 drinks/day) alcohol abuse, respectively. After adjustment for confounders, both moderate or severe alcohol abuse was associated with low perceived partner's sexual desire, worse couple relationship, and smoking abuse. Furthermore, moderate and severe alcohol abuse was associated with low prolactin and thyroid-stimulating hormone levels, as well as an increase in triglycerides and total cholesterol levels. Penile blood flow was reduced in moderate and severe alcohol drinkers even after adjustment for confounders. In the longitudinal study, after adjusting for confounding factors, any kind of alcohol abuse was independently associated with a higher incidence of MACE (hazard ratio = 2.043 [1.059-3.943]; P < 0.0001). Our findings demonstrate that, in subjects consulting for erectile dysfunction, severe alcohol consumption is associated with a worse sexual function and a higher incidence of MACE.

Health Technology Assessment, ricerca e sanità pubblica

The relationship between research, health technology assessment (HTA) and public health has been recognized as fundamental in recent years in Italy, both at the national and regional levels. Sometimes the HTA process could be seen as an opportunity to conduct primary research, and this process is well established in some Countries. Nevertheless, the research for HTA purposes several times suffers from lack of evidence in terms of availability of clinical trials, economic evaluations, legal, ethical and social assessments. The research as a HTA tool could be of great interest in the field of public health, not only for well established issues, such as vaccination, but also for alcohol, smoking and drug abuse, for dietary habits, home and traffic injuries, physical and psychiatric disability.

Psychobiological Correlates of Women's Sexual Interest as Perceived by Patients with Erectile Dysfunction

We have recently reported that the perceived loss of a partner's sexual desire is independently associated with an increased incidence of major cardiovascular events in patients with erectile dysfunction (ED). No study has ever evaluated the specific impact of men's perception of women's sexual desire on male sexual function and lifestyle attitudes in ED subjects. To evaluate the clinical correlates of the perception of a partner's sexual desire [hypoactive sexual desire (HSD)] in a consecutive series of subjects seeking medical care for ED. A consecutive series of 2,303 heterosexual male patients (mean age 58.1 ± 10.5) was studied. Patients were interviewed with the Structured Interview on Erectile Dysfunction (SIEDY) structured interview. They also completed the Middlesex Hospital Questionnaire, a brief questionnaire for the screening of the symptoms of mental disorders. Among the patients studied, 458 (19.9%) reported a mild loss of their partner's desire, 302 (13.1%) a moderate reduction of libido, while 118 (5.1%) complained of a complete absence of sexual interest on the part of their partner. After adjustment for confounding factors, the perceived women's HSD was associated with different sexual, lifestyle, and relational factors. In particular, more extra-marital affairs, a longer and more hostile couple relationship, as well as a stressful job and both alcohol and smoking abuse were all significantly associated with perceived women's HSD. In addition, the perceived women's moderate to severe HSD was significantly associated with severe ED and less frequent sexual intercourse. Finally, partner HSD was significantly associated with a stepwise increase of free-floating anxiety and depressive symptoms (adj. r = 0.081, P < 0.05 and 0.158, P < 0.0001, respectively). Perceived sexual interest (éros) on the part of the woman can be seen for men not only as a fun and enjoyable behavior, but also a safe strategy for improving a man's overall health and life expectancy.

Environmental and genetic factors in age related hearing impairment

The etiology of age related hearing loss (ARHI), or presbycusis, is multifactorial and includes both genetic and environmental influences. Much research effort has been put into elucidation of the environmental factors and nowadays a huge amount of data are available regarding the effects of noise exposure, ototoxic medication, exposure to chemicals, chronic medical conditions, malnutrition, tobacco smoking and alcohol abuse, although some of these factors remain still controversial [1] On the other hand, little is known about the role of genetic factors, despite the fact that the number of genetic studies on presbycusis is increasing at a surprising rate in the last few years. The hypothesis that genetic factors could play a significant role in AHRI was proposed as early as the ‘70s, based on the observation of several families whose members were affected by a presbycusis which manifested very early, occasionally before the age of 45, and the consideration that either the time of onset or the rate of progression of presbycusis vary greatly between individuals. In the ‘90s, heritability estimates have shown that approximately half of the variance in ARHI is due to heritable factors. An important contribution to the study of genetic factors in ARHI derives from laboratory research on inbred mice. Some of these strains present an early presbycusis and have in common the defective Cdh23 ahl allele of the gene encoding cadherin23, a protein localized in the stereocilia of the hair cells, which hold the cilia together. Lack or absence of otocadherins increases the vulnerability of hair cells either to aging, or to noise exposure. Experimental data obtained in mice has been found and confirmed in humans. Two genomewide linkage studies and a few association studies based upon candidate genes approaches for AHRI have been published in the last years. AHRI has been correlated with several single nucleotide polymorphisms (SNPs) in a region of KCNQ4; with a SNP in N-acetyltransferase 2 (confirming the role of oxidative stress in presbycusis); with a highly significant SNP in the GRHL2 gene; with a significant SNP at the GRM7 locus (indicating the possible effect of glutamate excitotoxicity in AHRI). These findings are important for both the management and possible future therapeutic intervention into presbyacusis.

Indian psychiatry and research in Pakistan.

In Asian culture, there is much stigmatization attached on having mental health problems and seeking help from a mental health expert. It is therefore, not surprising, that this stigmatization results in the refutation of the subsistence of a psychiatric problem in an individual and his family but also produces obstruction to help-seeking desires. To get a clear picture of the existence of psychiatric issues in the population, various research projects addressing psychiatric issues in children, women, and elderly are conducted both in Pakistan and India. A significant input has been taken from research conducted in India combating disaster management. In addition, public awareness programs are organized to provide information about common psychiatric disorders in children, adults, women, and the elderly.-Furthermore, psychiatric patients and their families are educated for the management of mental heath problems related to marriage, pregnancy, birth and hazards of smoking & substance abuse in young adults. Keeping in view the similarity in cultural background, treatment models, family structure, and psychosocial factors, collaborative research studies should be encouraged leading to improvement in psychiatric care of the patients both in India and Pakistan.

Diagnosis and Treatment of a Neck Node Swelling Suspicious for a Malignancy: An Algorithmic Approach

Aim. To present an up-to-date algorithm incorporating recent advances regarding its diagnosis and treatment. Method. A Medline/Pubmed search was performed to identify relevant studies published in English from 1990 until 2008. Only clinical studies were identified and were used as basis for the diagnostic algorithm. Results. The eligible literature provided only observational evidence. The vast majority of neck nodes from occult primaries (>90%) represent SCC with a high incidence among middle aged man. Smoking and alcohol abuse are important risk factors. Asiatic and North African patients with neck node metastases are at risk of harbouring an occult nasopharyngeal carcinoma. The remainder are adenocarcinoma, undifferentiated carcinoma, melanoma, thyroid carcinoma and Merkel cell carcinoma. Fine needle aspiration cytology (FNAC) reaches sensitivity and specificity percentages of 81% and 100%, respectively and plays an important role as the second diagnostic step after routine ENT mirror and/or endoscopic examination. FDG-PET/CT has proven to be helpful in identifying occult primary carcinomas of the head and neck, especially when applied as a guiding tool prior to panendoscopy, and may induce treatment related clinical decisions in up to 60% of cases. Conclusion. Although reports on the diagnostic process offer mainly descriptive studies, current information seems sufficient to formulate a diagnostic algorithm to contribute to a more systematic diagnostic approach preventing unnecessary steps.

Establishment of a Low Birth Weight Registry and Initial Outcomes

The study was conducted to evaluate a regional, prospective database of information on mothers of low birth weight (LBW) infants. The database informs on unidentified or under-reported modifiable risk factors from which evidence-based, targeted community intervention strategies could be designed to lower the rate of low birth weight in the region. The LBW Registry is based on informed consent, a semi-structured face-to-face (FTF) interview with the mother of the newborn LBW infant, medical record review, and birth certificate worksheet data collection. Descriptive statistics were used to summarize data from the registry. High rates of modifiable risk factors among mothers of low birth weight infants (October 2007-October 2008) include smoking (44%), alcohol consumption (16%), and drug abuse (14%). Preconception vitamin use was low (34%). The reported use of fertility drugs in FTF interviews was notably higher than information reported on the birth certificate worksheets by the same set of interviewed mothers (5.4 vs. 1.5%), as was alcohol use during pregnancy (16 vs. 1.3%). More than half (52%) of the mothers of low birth weight infants reported a vaginal or urinary tract infection during pregnancy. Additionally there were higher than average rates of unmarried mothers (62%), unintended pregnancies (67%), and Medicaid beneficiaries (57%). Mothers repeatedly expressed excessive demands in their lives, straining their coping abilities and resources. The LBW Registry provides expanded local data on potentially modifiable risk factors to aid in designing targeted prevention and intervention strategies.

Inhalation injury associated with smoking, alcohol and drug abuse: An increasing problem

This study investigated the association of inhalation injury (IHI) with smoking, alcohol and drug abuse in patients admitted to the Welsh Centre for Burns between 1995 and 2006. Common characteristics of these individuals were identified and contrasted with inhalation injury not associated with these social factors. Two hundred and fourteen patients were identified with inhalation injury. Ninety-two of these were associated with smoking, alcohol abuse and/or drug abuse. The proportion of IHI cases associated with smoking remained stable but IHI associated with alcohol and drug abuse increased dramatically over the course of the study and if current trends continue will increase further in future years. This study also showed that IHI associated with smoking alcohol and drug abuse were found to be largely caused by housefires and deliberate self-harm, and occurred between 22:00 and 05:59 h. These results were in sharp contrast with IHI not associated with these factors.

Introduction to the Theme Issue on Smoking and Substance Abuse

Introduction to the Theme Issue on Smoking and Substance Abuse