Smoking Abuse Research Articles

Cancer and depression: a prospective study

Cancer diagnosis and treatment often produce psychologic stresses resulting from the actual symptoms of the disease, as well as from perceptions of the disease and its stigma. Depression is seen in many cancer patients. Depression occurs in approximately 25% of palliative care patients. It is widely recognised by clinicians that depression is a difficult symptom to identify amongst patients with advanced illness. The study is aimed for screening of depression among palliative care female patients. This study was local, prospective and cross-sectional. It was carried at Department of Clinical Oncology and Radiation Therapy of Charles University Hospital in Hradec Kralove, Czech Republic. Dates were obtained during year 2007 - 2008 in 64 palliative care female patients. The mean age for all 64 subjects was 60,5 years old (aged 29 - 88 years old). The Czech version of Zung self-rating depression scale was performed. The statistical evaluation presents that mean SDS (self-rating depression score) certifies the presence of signs of mildly depression among palliative care female patients (SDS range was 50-59). The mean SDS in all subjects was 56. The mean SDS in group of healthy females was 38,9 (normal range). The incidence of depression is 71,8% (46 of all 64 subjects). The relevance of depression is characterized: severely depressed was proved in 8 of all 46 subjects, the moderately depressed in 21 subjects of all 46 subjects and mildly depressed in 17 of all 46 subjects. The statistical evaluation not presents statistically significant dependence of SDS on smoking abuse, marital status, age, number of associated diseases and type of palliative care. The statistical evaluation presents that patients with cancer of lung, with cancer of endometrium, with cancer of gallbladder and with melanomas are moderately depressed (SDS 60-69), patients with cancer of ovary, with cancer of breast, with primary brain tumour, with cancer of ventricle, with cancer of pancreas head and with cancer of bucall cavity are mildly depressed (SDS 50-59). The results show that subsists clear association between oncological disease in palliative care and depression.

Precancerous conditions and carcinomas of the lower lip. Coincidence with leukoplakia and carcinomas of the oral cavity and larynx

In a prospective study of 102 patients with pre-neoplasia and/or manifest squamous-cell carcinoma of the lower lip the synchronous occurrence of intra-oral, pharyngeal or laryngeal leukoplakia and carcinoma was assessed. There was a coincidence rate of almost 15% leukoplakias, including individual carcinomas. This high coincidence is probably due to a combination of various "risk profiles" in patients with threatened or manifest lower-lip cancer. Chronic exposure to sunlight, especially in the presence of a genetic disposition, is the most important risk factor in lower-lip cancer and its preceding stages, while chronic alcoholism and smoking abuse have little etiological significance.

Pseudotumoral Neuroparacoccidioidomycosis: One Case Report

Neuroparacoccidioidomycosis is the central nervous system involvement by Paracoccidioides brasiliensis, a condition that may be underdiagnosed and has been scarcely reported. We describe a case of neuroparacoccidioidomycosis in a diabetic male with antecedent of heavy cigarette smoking and alcohol abuse. Thirty years before, he lived in the Amazon area and exerted rural activities in more recent years. The patient's main complaints were headache, visual deficit, hemiparesis, and weight loss. Imaging studies detected changes in the lungs and right adrenal gland, in addition to brain lesions. Paracoccidioides brasiliensis was found in tissue samples collected by the lung and brain biopsies. The patient is under ambulatory surveillance and in use of trimethoprim-sulfamethoxazole.

Child Abuse and Smoking Among Young Women: The Importance of Severity, Accumulation, and Timing

Purpose We examined the association between severity, accumulation, and timing of abuse in childhood and adolescence and smoking status among young women. Methods Retrospective self-reported childhood abuse was ascertained with the modified Conflict Tactics Scale from 91,286 Nurses Health Study II participants in 2001 (68,505 returned; 75.0% response rate). Childhood abuse was categorized by severity (mile/moderate/severe), type (physical/sexual), and timing (childhood/adolescence). Smoking status during adolescence was reported at baseline (1989). Logistic regression was used to predict smoking initiation by age 14 and smoking status between the ages of 15 and 19. Results A graded association between severity of abuse and early initiation of smoking (by age 14 years) was demonstrated (odds ratio [OR] = 1.9, 95% confidence interval [CI] = 1.7–2.1 for severe physical violence). Young women with both physical and sexual abuse were two times more likely to start smoking by age 14 than were those reporting no abuse (OR = 2.0, 95% CI = 1.8–2.3). Although abuse during childhood increased risk for adolescent smoking (OR = 1.7, 95% CI = 1.8–2.1) for those with childhood physical and sexual abuse, inclusion of adolescent physical and sexual abuse (OR = 2.2, 95% CI 2.1–2.4) diminished the impact of childhood abuse (OR = 1.1, 95% CI 1.1–1.2). The degree of familial emotional support was protective against smoking, and reduced the impact of abuse by 40% among those with high emotional support versus those without ( p < .0001). Conclusions A strong and graded association was observed between both severity and accumulation of abuse and the risk of early initiation of smoking among girls. Smoking status during late adolescence was more strongly associated with adolescent abuse than childhood abuse. Early smoking onset is associated with both heightened risk for disease in adolescence but also increased morbidity and mortality in adulthood. Identifying and intervening in potentially modifiable risk factors for smoking onset in young women, such as early-life physical and sexual abuse, and building familial strengths, such as emotional support, may have significant public health implications.

Avaliação ultra-sonográfica, ecocardiográfica fetal e resultados perinatais em gestantes portadoras do HIV em uso de terapia anti-retroviral

PURPOSE: to evaluate fetal structural and/or functional abnormalities by ultrasound examination and fetal echocardiography, in pregnant women positive for human immunodeficiency virus (HIV). METHODS: we analyzed prospectively 109 HIV positive pregnant women under antiretroviral therapy (Study Group) and 200 low risk pregnant patients (Control Group). All of them were submitted to ultrasound scan and fetal and neonatal echocardiography once a month. The amniotic fluid volume, fetal growth, fetal structural and functional alteration and the perinatal outcome were evaluated. RESULTS: there were eight (7.3%) cases of fetal structural abnormality in the Study Group and two (1%) in the Control Group (p=0.616). There were four cases of congenital heart disease and four cases of hydronephrosis in the Study Group, with statistic significance (p=0.015) for the cardiac abnormalities. There were eight cases (7.3%) of oligohydramnios and 11 cases (10%) of polyhydramnios in the Study Group against two cases (1%) of oligohydramnios and none of polyhydramnios in the Control Group (p=0.004 and p<0.001). Eleven (10%) newborn babies were too small for their gestation age in the Study Group, against three (2.7%) in the Control Group (p=0,002). The incidence of preterm delivery was 8.7 and 2.5% in the Study and Control Groups respectively (p=0.041). It was observed six cases (5.5%) of fetal death in the Study Group and none in the Control Group (p=0.002). CONCLUSIONS: in the present study, we have observed higher prevalence of amniotic fluid volume and congenital heart abnormalities in the Study Group as compared to the Control Group. Statistical significance was found in both situations. The high fetal death rate found in the Study Group was probably due to fetal malformation, whereas the high prematurity rate and the prevalence of small size for the gestational age of the newborn babies were probably related to antiretroviral therapy, smoking and drug abuse.

Health-related quality of life in acute myeloid leukaemia and multiple myeloma survivors undergoing autologous progenitor stem cell transplantation: a retrospective analysis

Summary Background Haematopoietic stem cell transplantation (HSCT) is a specific therapeutic method used for biomodulation antitumour therapy of haematological malignancies and of solid tumours. It is also used for the therapy of non-tumour and hereditary diseases. Aim To analyse the selected psychosocial, health and demographic aspects of quality of life (QoL) in acute myeloid leukaemia (AML) and multiple myeloma (MM) survivors undergoing autologous progenitor stem cell transplantation (PSCT). Materials/Methods The total number of AML survivors was 12 (7 male, 5 female). The total number of MM survivors was 32 (18 male, 14 female). The average age of AML survivors was 47.5 years old. Average age of MM survivors was 60 years old. The Czech version of the international generic European Quality of Life Questionnaire, Version EQ-5D, was used. The effect of selected psychosocial, health and demographic aspects of QoL was determined by means of analysis of variance. The descriptive analysis was used for evaluation of QoL questionnaires. Results The above-mentioned aspects proved statistically significant dependence of QoL (EQ-5D score and EQ-5D VAS) on age in both cohorts (p Conclusions Low QoL correlates with increasing age of survivors treated with autologous PSCT. QoL in survivors who underwent autologous PSCT and believed in God was higher than in survivors who were non-believers. Low QoL correlates with smoking abuse. In both cohorts of survivors we proved lower QoL in smokers in comparison with non-smokers or former smokers. Low QoL in AML survivors with low level of education, meaning survivors with elementary and apprentice level education, has been proved. Low QoL correlates with increasing number of associated diseases in both cohorts of survivors.

Asians and Native Hawaiian or Other Pacific Islanders Midlife Lesbians' Health

SUMMARY The purpose of this pilot study was to determine actual and potential health issues of midlife lesbians who were Asian American, Native Hawaiian, or other Pacific Islanders (A-NHOPI). We explored the health status (body composition, “outness,” smoking, alcohol, and abuse) of 29 A-NHOPI lesbians; 34.5% were totally disclosed to family, co-workers, and health-care providers. They reported high rates of quitting smoking, and low rates of smoking and alcohol abuse. Childhood physical abuse was reported by 34.7% and childhood sexual abuse was reported by 28.6% of these women. Findings from this study will assist therapists with some of the issues affecting A-NHOPI midlife lesbians.

Maternal nutrition in pregnancy: of importance in The Netherlands?

The importance of maternal nutrition during pregnancy is increasingly emphasized and several recommendations are given to pregnant women. This article will review the evidence on which such recommendations are based, with a particular focus on The Netherlands. In well-nourished populations, the evidence is generally insufficient and results are relatively poor. Aside from the benefits of stopping smoking, alcohol and substance abuse, the only evidence-based nutritional recommendation in The Netherlands is the periconceptional use of folic acid for the prevention of fetal neural tube defects. However, only approximately a third of all pregnant Dutch women actually do take folic acid. This implies that other strategies need to be explored in order to reach more of these women. In addition, there is a need for more high-quality research on the benefits of good nutrition during pregnancy in well-nourished populations, both for mother and child. In developing countries, the health benefits of supplementing the...

Quality of life in patients with multiple myeloma and malignant lymphoma undergoing autologous progenitor stem cell transplantation: The effect of selected psychosocial and health aspects on quality of life: A retrospective analysis

Summary Background Quality of life (QoL) is defined as “a patient's subjective evaluation of his life situation”. QoL evaluation is carried out by means of generic and specific questionnaires. Generic QoL questionnaires generally evaluate a patient's overall condition regardless of his disease. Specific QoL questionnaires are designed to evaluate a patient's overall condition for a particular type of disease. Aim The study analyses the effect of selected psychosocial and health aspects on quality of life in patients with multiple myeloma and malignant lymphoma undergoing autologous progenitor stem cell transplantation. Materials/Methods The total number of respondents undergoing transplantation between 2001 and 2003 was 56:32 respondents (18 male and 14 female) with multiple myeloma, and 24 respondents (11 male and 13 female) with malignant lymphoma. The average age of patients with multiple myeloma was 60 years and the average age of patients with malignant lymphoma was 44.5 years. The Czech version of the international generic European Quality of Life Questionnaire, Version EQ-5D, was used. The effect of selected psychosocial and health aspects (age, sex, level of education, marital status, number of associated diseases, smoking abuse, religion, type of disease and time since the transplantation) on quality of life in patients was determined by means of analysis of variance. Results The above-mentioned aspects proved statistically significant dependence of quality of life on age, smoking abuse in patients with multiple myeloma and on type of disease. EQ-5D score (dimensions of quality of life) and EQ-5D VAS (subjective health condition) significantly decrease with increasing age in both groups of patients and with smoking abuse in patients with multiple myeloma, and are significantly higher in patients with malignant lymphoma. The effect of other aspects on quality of life was not proven as statistically significant. The quality of life in patients with multiple myeloma undergoing autologous progenitor stem cell transplantation is at a lower level (mean EQ-5D score 68.9%, mean EQ-5D VAS 66.6%) than in patients with malignant lymphoma after the transplantation (mean EQ-5D score 82.7%, mean EQ-5D VAS 76.7%) at the Department of Clinical Haematology of the Department of Medicine of Charles University Hospital in Hradec Kralove, Czech Republic. Conclusion The global quality of life in our patients with multiple myeloma and malignant lymphoma undergoing autologous progenitor stem cell transplantation is at a good level.

Care of head and neck cancer patients with swallowing difficulties

Cancers of the head and neck include oral cavity, oropharynx, hypopharynx, nasopharynx, larynx, nasal fossa, paranasal sinuses, thyroid, salivary glands and vermilion surfaces (Parker et al, 2004). Incidence of these cancers has risen in the past 30 years, particularly in people under the age of 65 years. Risk factors include cigarette smoking and excessive alcohol abuse. At time of diagnosis patients often present with swallowing difficulties due to tumour location and size. Further oncological treatments such as surgery and radiotherapy can exacerbate these difficulties and cause major nutritional problems. Dietary management in relation to texture modification and nutritional content of meals needs to be addressed as well as feeding strategies recommended by the speech and language therapist. Good communication between all members of the multidisciplinary team is paramount in ensuring that patients have the necessary support, education and quality of life they need.

Fertile Grounds of Inquiry: Environmental Effects on Human Reproduction

In a world whose population exceeds 6.5 billion, declining human fertility might not seem to be a critical problem. After all, overpopulation has been a global concern for decades. Declining fertility rates in more advanced nations largely reflect the changing role of women and their rapidly growing presence in the workplace—fertility declines may stem at least in part from the modern tendency to delay child-bearing until later in life, when fertility naturally declines. But this doesn’t explain the fact that, according to a December 2005 report of the CDC’s National Survey on Family Growth (NSFG), the fastest-growing segment of U.S. women with impaired fecundity (the capacity to conceive and carry a child to term) is those under 25. The rising incidence of fertility-impairing health factors such as obesity also likely plays an important role. Clues from environmental exposure assessments, wildlife studies, and animal and human studies hint at additional factors: exposure to low-level environmental contaminants such as phthalates, polychlorinated biphenyls (PCBs), dioxins, pesticides, and other chemicals may be subtly undermining our ability to reproduce. As recognized by the American Society of Reproductive Medicine, infertility is a biological disease that impairs a couple’s ability to achieve a viable pregnancy. It can be caused by hormonal, ovarian, uterine, urological, and other medical factors. Known risk factors include advanced age, being over-or underweight, lack of exercise, smoking, alcohol and substance abuse, sexually transmitted diseases, and poor nutrition. According to the American Society of Reproductive Medicine, a medical infertility cause can be identified, or perhaps only indefinitely suggested, in approximately 90% of cases and may be multifactorial in 25% of cases. Male factors include low sperm count and sperm abnormalities, such as altered morphology and low motility. Female factors stem from ovulation problems such as premature ovarian failure (early menopause), thyroid irregularities, polycystic ovarian syndrome, and fallopian tube obstruction. Up to 10% of infertility cannot be explained medically. Fertility transcends the reproductive system, notes Louis Guillette, a professor of zoology at the University of Florida in Gainesville. “When you talk about infertility, you literally are talking about probably almost every system in the body—infertility is an integrated signal of all these different systems,” he explains. “Trying to tease out which system, or more than likely what multiple systems have been altered, leading to that phenomenon, is very tough work.” Infertility is generally defined as occurring when a couple cannot become pregnant after trying to conceive for at least one year (or six months if the woman is over age 35). According to the 2001 WHO report Current Practices and Controversies in Assisted Reproduction, at least 80 million people worldwide are estimated to be affected by infertility. Infertility rates range from less than 5% to greater than 30% depending on location and how infertility is defined, with higher rates associated with lack of medical care access. Based on the 2005 NSFG report, approximately 12% of American couples experienced impaired fecundity in 2002. This is a 20% increase from the 6.1 million couples who reported an inability to have children in 1995. Determining whether infertility is actually increasing is more complicated than these numbers imply, however. In a paper published in the September 2006 issue of Fertility and Sterility, David Guzick and Shanna Swan of the University of Rochester School of Medicine and Dentistry noted that “impaired fecundity” as defined by the NSFG implies a decrease in fertility, but the same study also showed that fertility, defined there as a married woman unable to become pregnant within 12 months, has increased. The absence of definitive information can frustrate couples experiencing fertility problems as well as experts. “There seems to be more to it than can be explained from traditional understanding about impacts,” says Joseph Isaacs, president and CEO of RESOLVE: The National Infertility Association. “As a patient advocacy group, we believe more research into environmental impacts is needed. We fear that future generations may be at risk because of exposures to toxic substances as early as in utero.”

Preventing fractures in the elderly in GP practice

Osteoporosis is a common bone disorder that increases the risk of a fragility fracture. The elderly are prone to the development of osteoporosis and have an increased propensity to fall thereby increasing their risk of fractures. Fractures (especially hip fractures) in the elderly are associated with a high morbidity and mortality, and are also costly, accounting for large portions of health budgets. To prevent fractures it is therefore prudent to identify those with or at risk of osteoporosis and those at risk of falling. Although there is a lack of consensus on which individuals gain most benefit from Dual Energy X-ray Absorptiometry (DEXA) screening, the majority would concur that individuals with known risk factors for osteoporosis and those at risk of sustaining a fracture should undergo DEXA screening. After a diagnosis of osteoporosis, secondary causes should be excluded and appropriate therapy initiated. Therapy may include treatment of a secondary cause, non-pharmacologic and pharmacologic measures. Pharmacologic therapy has been shown to significantly decrease the risk of both vertebral and nonvertebral fractures. Individuals not diagnosed with osteoporosis but at increased risk of falls have been shown to derive some benefit from calcium and vitamin D supplementation, a weight-bearing exercise regimen, and refraining from smoking and alcohol abuse.

641. Retargeting Adenoviruses to Surface Expressed Antigens on Oral Mucosa

Head and neck squamous cell carcinomas (HNSCC) comprise 5% of all newly diagnosed cancers in the world today. Risk factors for development of HNSCC are smoking and alcohol abuse, infection with viruses, and genetic predisposition. HNSCC is preceded by preneoplastic lesions of genetically altered cells. When tumors arise in these lesions, the large preneoplastic lesions often remain behind after surgical treatment, causing secondary cancers. Although the preneoplastic lesions can be diagnosed using genetic markers in both treated patients and other risk populations, the treatment options are very limited and the only intervention at present is increased surveillance.

“My Nurse Taught Me How to Have a Healthy Baby and Be a Good Mother:” Nurse Home Visiting with Pregnant Women 1888 to 2005

Nurse home visiting with pregnant women and new mothers in the early decades of the twentieth century was designed to improve birth and newborn outcomes, hasten Americanization of immigrant mothers, and improve their parenting skills. Today the Nurse Family Partnership home visitation program improves newborn and child outcomes by positively influencing maternal role attainment and significantly decreasing maternal smoking and other substance abuse, child abuse and neglect, and children's emergency room visits. It also improves life possibilities for vulnerable young women by decreasing the interval and frequency of subsequent pregnancies and reduces dependence on welfare by increasing workforce participation. This article reviews the history of home visits by nurses to pregnant women and demonstrates the benefits achieved by these programs today.

A 50-Year-Old Man With Clubbing Has Seizures After a Dental Procedure

A 50-year-old white man presented to the emergency department with right-sided focal seizures with secondary generalization. The first episode was 3 h prior to hospital admission; his daughter, who called an ambulance, witnessed the second episode. The patient worked as an engineer and denied any history of smoking or alcohol abuse. His medical history was unremarkable, with specifically no known convulsive or respiratory disorders. He was not taking any medications. He had no previous surgical history other than an uneventful root canal procedure 4 weeks prior. He was known to have clubbing, and abnormal chest radiograph findings since childhood, which had never been investigated. On further questioning, he reported recurrent spontaneous epistaxis and a long history of shortness of breath and chest pain with exertion, although he remained active.

076 Sex and gender différences in tobacco smoking among adolescents in France

Introduction There is a well-recognized relationship between smoking trends and psychosocial differences and other personal characteristics. This study aims to examine smoking patterns in boys and girls and to identify genetic/biological (sex) and environ-mental/cultural (gender) risk factors associated with adolescent tobacco smoking. Methods The National Adolescent Health Survey (NAHS) pro-vided a representative sample of 11,582 students in French secon-dary public schools from eight metropolitan districts, who completed a self-administered standardized questionnaire. The questionnaire consisted of socio-demographic items and various adolescent risk behaviors. Variables were classified as sex-specific (puberty, menstrual cycle, hormone intake), gender-specific (envi-ronmental tobacco smoking, alcohol consumption, drug abuse) and sex/gender influenced factors (sexual intercourse, contraceptive use, body mass index (BMI), physical activity). Results The overall prevalence of active smoking was 15.6% and there was no statistically significant difference between girls (15.8%) and boys (15.4%). Boys and girls differed considerably regarding smoking behavior and factors that were socially influenced or mediated: puberty (adjusted odds-ratio for being regular smoker compared to non smokers (OR) = 4.7 [95% CI: 3.5, 6.5] in boys vs. 18.0 [9.6,32.0] in girls), exposure to passive smoking (OR=3.3 [2.3,4.8] vs. 4.8 [3.2,7.2]), alcohol consumption (OR=2.9 [2.1,3.9] vs. 4.6 [2.7,7.9]) and drug abuse (OR=15.0 [12.0,20.0] vs. 12.0 [8.8,16.0]). Girls using birth control pill had an increased tobacco consumption (OR=2.5 [1.8, 3.6]). No other statistically significant differences were observed between sexes. The only protective factor for both boys and girls was living with parents (OR= 0.61 and 0.62 respectively). Conclusions The prevention of unfavorable health behavior like smoking among adolescents is linked to understanding the interactions of various individual characteristics and therefore the determination of sex-related and gender-specific or sex/gender influenced factors of risk is indispensable.

Nutritional state of HCV-infected individuals examined and treated in outpatient clinic

Hepatitis C affects more than 170 million people in the world. It is considered a severe health problem with 70 to 80% of the cases showing a chronic evolution. The hepatic lesion caused by the C virus (HCV) can interfere in the patients’ nutritional state and contribute to the progress of the hepatic disease to cirrhosis (20% of the cases). From the eighty-two adult individuals clinically examined, 76.8% were men, with mean age of 37.2 years. They were subdivided into 4 groups: Control Group (CG), with 26 healthy individuals; Group 1 (G1), with 30 HCV-infected individuals that did not need drug treatment; Group 2 (G2), with 14 HCV-infected individuals in treatment; and Group 3 (G3), with 12 individuals infected by HCV 12 months after the end of the treatment. All groups were investigated according to clinical-epidemic factors (transmission mechanism, social and economical condition, sedentary life, smoking, and alcohol abuse); laboratory characteristics; family history; eating habits; drug treatment; and anthropometric measures, such as body weight, body mass index (BMI), and evaluation of corporeal fat and thin mass. These last two parameters were eutrophic for values between 10 and 90%. The epidemiological factors (alcoholism and sedentary life) did not present statistical difference between groups, only smoking showed a significant difference in G1. The actual weight of all individuals was higher than the expected according to sex, age and hepatic disease. The BMI showed slight obesity according to the World Health Organization (WHO), 1998. The HCV-infected individuals presented an increased percentage of body fatness (24.6% ± 8.7, 27.2% ± 9.7, and 29.1% ± 9.8, respectively). Therefore, the anthropometric indicators of adipose mass showed that the reserves were preserved, possibly being associated to smoking and sedentary habits, which lead to coronary diseases, hyperlipidemia and arteriosclerosis. According to the thin mass evaluation, most of the HCV-infected individuals were eutrophic, not showing nutritional risk. The analysis of the diet’s macronutrients showed that the energetic and proteic consumes were made according to the specific recommendation to individuals with hepatitis C. On the other hand, the quantity of lipids in the diet was 10 to 15% higher than the recommended to the individuals of Group 1. The percentage of saturated fat was high in the three groups studied. In view of the obtained results, a nutritional evaluation shows to be necessary in HCV-infected individuals, for posterior intervention and prevention of nutritional problems.

Leber's hereditary optic neuropathy: case report and literature review

Leber's hereditary optic neuropathy is an important cause of progressive painless visual loss among young male patients. To report on a case of a young patient with a clinical and neurophysiological condition suggestive of Leber's hereditary optic neuropathy, confirmed by genetic testing. We describe a 17-year-old male with progressive bilateral visual loss. Two maternal uncles had had similar patterns of visual loss. The patient had a history of smoking and alcohol abuse. Neuro-ophthalmological examination revealed visual acuity of 20/800 in both eyes, with decreased direct and consensual pupillary light reflexes. Fundus examination demonstrated pale optic discs. The visual evoked potential test showed signs of conduction disturbances in both optic nerves and campimetric study showed complete visual loss in all fields of both eyes. A diagnosis of bilateral optic neuropathy with a clinical suspicion of Leber's hereditary optic neuropathy was made. A blood sample was submitted to genetic analysis in relation to the principal mutations of this disorder, and homoplasmic mutation in 11778 was detected, thereby confirming the diagnosis of Leber's hereditary optic neuropathy.

Sacred tobacco use in Ojibwe communities.

A sacred relationship exists between tobacco and American Indian ceremonial activities and beliefs. This ancient connection continues to play an important role in American Indian communities including the Anishinabe (Ojibwe). Six Ojibwe traditional healers and spiritual leaders described the sacred use of tobacco during interviews. The research provides information on key-informant smoking behaviors, influence of tobacco-industry media, and 3 essential themes: the origin of sacred traditional tobacco; contemporary use and abuse of tobacco; and cultural strengths and meaning of tobacco in Anishinabe (Ojibwe) communities. Health professionals must recognize, be amenable to learn, and understand that sacred tobacco use and smoking commercial cigarette tobacco have separate purposes and functions. The challenge for health professionals, including nurses, is to retain the cultural use and value of tobacco while addressing the abuse and chronic effects of cigarette smoking when providing health care to American Indian clients.

Risk factors for smoking abuse after heart transplantation

Patients (n = 103) were studied before heart transplantation with regard to smoking habits by means of a clinical interview, and 81 were submitted to Minnesota Multiphasic Personality Inventory (MMPI). After a mean time of 50.8 ± 24.2 months from transplant, they were once again interviewed to ascertain their smoking habits after intervention. Nonsmokers (35 of 103) were still nonabusers. Of the remaining 68 patients who ceased smoking before heart transplant, 12 (17.6%) had returned to tobacco abuse. Dividing these 68 patients into two groups based upon the length of smoking cessation before heart transplant (less than 1 year: short term [ST] more than 1 year: long term [LT]), we noticed that the ST group showed a much greater rate of reabuse (8 of 20, 40%) than the LT group (4 of 48, 8.3%, P = .006). Analyzing six scales of MMPI, we found a statistically different score for self-control ability (scale K) in ST and LT smokers compared to nonsmokers (45.5 and 45.5 vs 51.2, P = .026), and for difficult adaptation (scale Ma) in ST compared both to LT smokers and nonsmokers (ST 57, LT 50.5, NS 47.6; P = .042 LT vs ST, P = .0005 ST vs NS). We concluded that patients who have recently decided to stop smoking and show after MMPI compilation a score of >50 for K and <50 for Ma scale have a higher risk of reabuse and need a greater effort by the transplant team to reinforce their will to stop smoking.