Tobacco Habits Research Articles

Well-armed is well started: A population-based study to assess risk stratification in potentially premalignant oral epithelial lesions.

Background:The association between potentially premalignant oral epithelial lesions (PPOEL), oral squamous cell carcinoma and its higher incidence in South-East Asian population due to the use of arecanut, pan, slaked lime and tobacco is well known. The study was carried out in urban and rural population of Bengaluru, Karnataka, to assess and correlate the pattern of habit, clinical presentation and cytological grading of PPOELs, attempting at identifying the main arms associated with risk of malignant transformation.Aims:Assessment of history, clinical presentation of PPOELs, co-relate with cytological grades and escalate to binary risk assessment.Materials and Methods:One hundred and fourteen cytological smears received at the Department from screening camps were stained with Papanicolaou and hematoxylin-eosin stains and correlated with the clinical data.Results/Statistics:Descriptive and inferential statistics were performed. 38% lie between 21 and 30 years, 76.3% males, 81 cases involved buccal mucosa with 51.1% Grade II cytosmear, 53.5% chewing tobacco habit, 10 cases involved multiple sites with 60% Grade II cytosmear and 6 cases showed Grade III cytosmear. Based on clinical risk factors and cytological grading, 15.3% were grouped under high risk lesions as against 5.4% when only cytological grading was considered.Conclusion:The incidence of PPOELs is increasing in young males with chewing tobacco mainly in buccal mucosa associated with habit. Biopsy and definitive treatment is necessary when the lesions are red, nonhomogeneous, seen in multiple sites and concomitant lesions with higher grades of dysplasia. The use of cytosmears in screening camps helps to assess, affirm and stress on biopsy on higher dysplasia grades as biopsy is not an acceptable norm in camps.

Effect of magnification and changes in tobacco pictorial warning on asceticism of tobacco use: An exploratory survey.

Background:Tobacco usage-related diseases pose serious threat for not only public health but also for country's economy and warning labels are considered as an effective strategy to spread more awareness on tobacco hazards.Aim:The aim of this hospital-based questionnaire survey was to assess the effect of magnified pictorial warning over tobacco products on asceticism of tobacco use and to measure the association of selected tobacco habits variables and asceticism of tobacco use.Materials and Methods:Present exploratory survey based on triangulation method of data collection was conducted among conveniently selected 1,008 tobacco users or smokers attending OPD services at tertiary care center during the year 2018–2019. Quantitative survey data was collected through structured questionnaire and two FGDs were conducted for qualitative information. Data was analyzed using descriptive and inferential statistics.Results:Magnification of health warnings over tobacco packets had impact on tobacco or cigarette consumption to some extent (415; 41.25%); but insisted only one third (383; 38.0%) participants to quit tobacco use. A significant association was observed between awareness about bad effect of tobacco use and attempt of quit tobacco uses (OR 0.29; CI 95%, 0.223–0.390; P = 0.001). Furthermore, significant effect of magnified warning over tobacco products was seen on reduction in tobacco use (OR 0.39; CI 95%, 0.300–0.531; P = 0.001) and quitting the tobacco (OR 0.38; CI 95%, 0.28620.513; P = 0.001).Conclusion:Study results concluded that magnification of pictorial warning is associated with the asceticism of tobacco use to some extent but alone it is not sufficient. Therefore, adjunct intervention of mass public education about bad effect of tobacco use is more essential to augment asceticism of tobacco use.

Effectiveness of cognitive-behavioral therapy compared with basic health education for tobacco cessation among smokers: A randomized controlled trial

Background: Tobacco is a risk factor for oral cancer, adult periodontal diseases, and cleft lip and palate in children. Tobacco cessation counseling has been shown to improve the likelihood of achieving success for quitting the habits. Aim: This study aimed to assess the effectiveness of cognitive-behavioral therapy (CBT) compared with basic health education (BHE) for tobacco cessation among smokers in Bengaluru city. Materials and Methods: A randomized controlled trial was conducted over a period of 6 months among smokers attending a tobacco cessation center in a dental college in Bengaluru city. The participants were assigned to either CBT or BHE groups with 1:1 allocation sequence ratio. Randomization and allocation concealment were done by an investigator who had no clinical involvement in the trial. Nicotine dependence was assessed using the Fagerstrom's Addiction Scale for smokers, while motivational levels were assessed using Transtheoretical model. The groups were followed up for 4 and 12 weeks. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS 22.0, IBM, Armonk, NY, USA). Paired and unpaired “t“-tests, Chi-square test, Fisher's exact test, and analysis of variance test were applied. Statistical significance was considered atP < 0.05. Results: Majority of the study participants started smoking at an early age and had long duration and cigarette smoking years. Among CBT group, the mean Fagerstrom's addiction score at baseline (4.8 ± 7.3) significantly reduced (3.8 ± 3.1) at the 1st follow-up and at the 2nd follow-up (3.5 ± 8.9) (P < 0.001). The proportion of smokers with frequency more than ten cigarettes per day reduced from baseline (P = 0.16) to the 2nd follow-up (P = 0.07) in CBT group compared to BHE group. Conclusion: CBT is effective in reducing tobacco habits and addiction levels when compared to BHE among smokers. Tobacco cessation counseling using CBT has been found to reduce smoking habits, thereby improving the possibility of quitting the habits.

Prevalence and Epidemiological Variation of Oral Squamous Cell Carcinoma among Population of Central Nepal

Background: Squamous cell carcinoma (SCC) is the most common malignant neoplasm of the oral cavity and represents about 90% of all oral malignancies. Oral squamous cell carcinoma (OSCC) is an important cause of morbidity and mortality worldwide with an incidence rate that varies widely by geographic location. The purpose of this study was to identify any trends in prevalence at specific anatomic sites or within specific age or sex groups of OSCCs in Chitwan population of Nepal. &#x0D; Methods: The study covers the period between January 2016 and October 2018. OSCC cases were retrospectively analysed for site, age, gender and habits and the findings were formulated to chart the trends in Chitwan population.&#x0D; Results: The study revealed a male to female ratio of 2.45:1 with the largest number of OSCCs developing in the fourth and fifth decades of life. Most commonly affected site was the buccal mucosa (66.06%), followed by retromolar area (19%), floor of the mouth (10.41%), lateral border of the tongue (1.81%), labial mucosa (2.26%), and palate (0.45%). Smokeless tobacco habit was more prevalent than smoking tobacco in both men as well as women. Chi Square test was done to show association between different variables i.e. between gender to site and gender to habit and gender to different grades of cancer, which were found to be non-significant.&#x0D; Conclusions: Oral cancer is an important cause of morbidity and mortality worldwide with an incidence rate that varies widely by geographic location. Even within one geographical location, the variations are seen among groups categorized by age, sex, site or habit.&#x0D;

CLINICAL AND MORPHOLOGIC PROFILE OF ORAL TONGUE SQUAMOUS CELL CARCINOMA: A RETROSPECTIVE STUDY

Objectives Oral tongue squamous cell carcinoma (OTSCC) is a malignant neoplasm that is quite aggressive with a poor prognosis. Therefore, this study described clinicopathologic characteristics of a series of cases of OTSCC. Study Design Observational and cross-sectional research. Sample consisted of 76 cases of OTSCC diagnosed in an oncology referral hospital, within a 16-year period (2000 to 2016). Clinical characteristics of patients (age, sex, and tobacco or alcohol habits, treatment, and survival) and lesions (tumor size, locoregional metastasis, distant metastasis, clinical stage, and recurrence) were obtained from medical records. Morphologic analysis was based on the World Health Organization (2017). Statistical analysis was descriptive. Results Mean age of patients was 57.24 years. OTSCC was more frequent in males (n = 53; 69.73%), associated with tobacco or alcohol habits (n = 54; 71.05%), and tumor size T3/T4 (n = 42; 55.26%). The most recommended treatment was surgery associated radiotherapy and chemotherapy (n = 37; 48.68%). Local and distant metastasis occurred in 56.57% (n = 43) and 10.52% (n = 8), respectively. Advanced clinical stages III/IV (n = 54; 71.05%) were predominant. OTSCC without recurrence was higher (n = 61; 80.26%). Overall survival was ± 51.47 months. Conclusions The results showed that OTSCC is more common in smokers and drinkers of the male sex, and the latter diagnosis can be responsible for lower survival of these patients.

Childhood trauma and glucose metabolism in patients with first-episode psychosis

Although the associations between first-episode psychosis (FEP) and metabolic abnormalities on one side, and childhood trauma (CT) and risk of developing psychosis on the other are both well established, evidence on the relationship between CT and metabolic dysregulation in terms of abnormal glucose metabolism is very limited. We tested whether, already at illness onset, FEP patients with a history of CT show dysregulation of a broad range of glucose metabolism markers.In particular, in 148 FEP patients we evaluated serum concentrations of c-peptide, insulin, plasminogen-activator-inhibitor–1 (PAI-1), resistin, visfatin, glucagon, glucagon-like peptide-1 (GLP-1), gastric-inhibitor-peptide (GIP), leptin, and ghrelin. We also assessed CT with the Childhood Experience of Care and Abuse Questionnaire, and stressful life events (SLEs) with a semi-structured interview. Psychopathology, cannabis and tobacco habits, Body Mass Index (BMI) were recorded. Serum concentrations of markers were analyzed from peripheral blood.Ninety-five patients (56 % males, mean age 29.5) reported CT. Multivariate models showed that CT is associated only with the concentrations of c-peptide and insulin after adjusting for age, sex, BMI and SLEs. FEP patients who had experienced CT showed higher c-peptide and insulin serum concentrations.Our study reports that CT might be associated with the metabolic abnormalities in the first stage of psychosis, suggesting that a thorough anamnestic evaluation at psychosis onset that would include the history of CT could be helpful for clinicians in order to implement early programmes of healthy lifestyle education and to guide choice of therapeutic interventions for trauma.

The Prevalence of Potentially Malignant Disorder (Leukoplakia) among Tobacco Users

Introduction: Leukoplakia is the most common premalignant or potentially malignant lesion of the oral mucosa. The annual percentage of malignant transformation varies as a result of differences in tobacco and dietary habits. For both genders, cancer of the mouth and pharynx ranks sixth overall in the world. In industrialized countries, men are affected two to three times as often as women, largely due to higher use of alcohol and tobacco. Methodology: Archives from the past 2 years (2017-2018) were accessed from Saveetha Dental College. The inclusion criteria was the type of leukoplakia, site affected, age and sex of the patient. The exclusion criteria were the non-tobacco users. The data was collected and statistically analysed. Results: There exists a male predilection to the occurrence of leukoplakia among the screened population. A correlation between gender and leukoplakia had a positive correlation for the male gender and types 1,4 leukoplakia and had a slight positive correlation. Conclusion: The incidence of leukoplakia among tobacco users is high as compared to the non tobacco users. The male population is at a higher risk. More incidences of homogenous and speckled leukoplakia has been reported within the 2 years.

Negative Alcohol and Tobacco Consumption Behaviors in an Australian Army Combat Brigade

Abstract Introduction Western militaries have consumption rates of alcohol and tobacco which are higher than the associated civilian populations, and are concerned about the negative effects on health, wellbeing, and military performance that such high rates may have. Materials and Methods A survey questionnaire which collected nonidentifiable data was distributed to all accessible members of an Australian Army Combat Brigade over the annual induction training and prefield exercise period between January and March 2019. The survey was composed of personal and demographic questions, followed by questions concerning the personal consumption habits of alcohol and tobacco. 1,606 complete and valid surveys were returned, representing 55.3% of the Brigade’s posted strength. Ethical clearance for this project was provided by the Australian Defence Force Joint Health Command Low Risk Ethics Panel (18-012). Results Almost one quarter of the Combat Brigade exceeded the Australian daily risk guideline for alcohol consumption, and over three quarters exceeded the occasion risk guideline; with 6.1% of soldiers drinking alcohol daily. 24.3% identified as tobacco smokers, with 15.9% smoking daily. Smoking rates and volumes were higher when deployed on field training exercises and on international training and operational deployments; as was the consumption of roll-your-own cigarettes. Overall, the main determinants of the negative consumption behaviors were gender (male) and age (under 25). Conclusions This study confirmed that the members of an Australian Army Combat Brigade have higher negative health consumption behaviors concerning alcohol and tobacco than the general civilian population. The results also identified a cohort of Senior Non-Commissioned Officers and Warrant Officers (E5–E9) between the ages of 35 and 44 who had high negative consumption behaviors which could result in poor health outcomes. This could be a suitable cohort for a targeted campaign to reduce tobacco and alcohol consumption and to assist to make healthy life changes.

Does iQOS harvest personal data from users and manipulate their tobacco habits?: A review of current evidence

Does iQOS harvest personal data from users and manipulate their tobacco habits?: A review of current evidence

P1.04-61 Neutrophil-Lymphocyte Ratio: A Predictive Biomarker of Immunotherapy in Lung Cancer?

Identifying predictive biomarkers of immunotherapy in advanced non-small cell lung cancer (NSCLC) is essential to select the patients that could benefit more from this revolutionary therapy. Besides PD-L1 expression, neutrophil-lymphocyte ratio (NLR) has been explored as a potential predictor of clinically meaningful outcomes. Aim: Assess if NLR is an independent predictor of response to immunotherapy in advanced NSCLC. Retrospective study of patients with locally advanced or metastatic NSCLC treated with immunotherapy in the second or further lines setting in a Multidisciplinary Thoracic Tumor Unit between 2015 and 2018. Pre-treatment NLR was calculated from baseline peripheral blood cell counts. NLR was categorized as a binary variable: “low” (<5) or “high” (≥5). Cox regression models were used for overall survival (OS) and progression-free survival (PFS) analysis. From a total of 63 patients, 49 were treated with nivolumab and 14 with pembrolizumab. At the beginning of immunotherapy, baseline patient characteristics were: men: 79.4%; median age (IQR): 62 (56-70) years; ever smokers: 82.5%; ECOG PS 0-1: 82.5%; adenocarcinoma: 63.5%; squamous cell carcinoma: 31.7% and NSCLC-NOS: 4.8%; stage IV: 76.2%; PD-L1 expression <1%: 47.6%. Twenty-three patients (36.5%) received immunotherapy in the third or further lines of treatment. Median PFS and OS were 5 months (2-10) and 8 months (4-13), respectively. After adjusting for gender, age, tobacco habits, ECOG PS, histology and PD-L1 expression, "high" NLR was an independent predictive factor of worse PFS (HR 2.22; 95% CI 1.06-4.66; p 0.035) and OS (HR 2.74; 95% CI 1.19-6.30; p 0.017). In our cohort, patients with NLR≥5 had a higher risk of disease progression and death compared to those with NLR<5. NLR is an inexpensive and affordable biomarker that could help to predict response to immunotherapy. Further large prospective studies are needed to validate this biomarker and to establish the optimal cut-off level.

Intergenerational Transfer of Tobacco Use Behaviour from Parent to Child: A Case Control Study.

Background:Parental influence may be a strong modifiable risk factor in the initiation of Tobacco habits among young adults. Parenting style may modify the risk of initiation of Tobacco use.Objective:To examine the intergenerational transfer of Tobacco habits amongst the urban and tribal populations in Kerala. Methodology:A hospital based unmatched case control study was undertaken in urban and tribal health centres in Kerala, India. 239 cases (19-30 years of age using any form of Tobacco, 64.10% males) and 256 controls (35.90% males) were enrolled. Parental Tobacco exposure ascertainment was done by conducting in depth interviews using a validated structured questionnaire, parent bonding instrument and life grid technique. Multiple logistic regressions were performed.Results:The odds of a case initiating the habit of Tobacco use was nearly four times more when the parent was a Tobacco user [adjusted OR 4.26 (95% CI 2.39 – 7.58)] as opposed to controls. Among other covariates examined, low parental bonding with subject (especially father- warmth/care) was a strong risk factor for Tobacco usage [OR 2.17 (95% 1.11 – 4.23)]. The cases had nearly four times the probability of Tobacco uptake compared to controls if the mothers had no formal schooling [adjusted OR of 3.93 (95% CI, 2.12 – 7.26)]. Conclusion:Parental use of Tobacco influences the uptake of Tobacco habits in their children, with the father’s parenting (low paternal warmth) being a strong risk factor.

Prevalence of Mandibular Fractures in a Government Medical College at Ranchi

Context: The unique position, shape and structure of the lower jaw lead to its high incidence of fracture. The mandible is a membranous long bone bent to a horse shoe shape. Even though it is very strong, its prominent position on the face makes it vulnerable to fracture. The fracture can occur in different parts of the bone, sometimes at multiple sites too, depending upon the nature of the impact. Aim and Setting and Design: The purpose of this study is to determine the etiology, pattern and distribution of mandibular fractures in a Government Medical College at Ranchi, Jharkhand. Methods and Materials: The study was carried out in the dental OPD of a Government Medical College at Ranchi, Jharkhand from June 2013 to November 2014. All patients who were clinically and radio graphically confirmed fracture mandible were examined and all demographic variables (age, gender, place, education, occupation, tobacco habit and duration of habit) were recorded. The pattern and cause of mandibular fracture were included and sites were classified accordingly as ramus, condyle, symphysis, body, parasymphysis and angle. Statistical Analysis: Simple descriptive statistics were employed for the analysis. Results and Conclusion: The present study concluded Road Traffic Accidents as the most common cause for mandibular fractures. Also, parasymphyseal fracture was the commonest unilateral and parasymphysis and condyle as commonest combined fracture of the mandible..

Alarming development of dual snus and cigarette usage among young Finnish males

BackgroundThe consumption of tobacco products has evolved to include more complex combinations of different products. We investigated the tobacco habits of a representative population of young Finnish male conscripts in order to evaluate the prevalence of dual use of cigarettes and snus as well as the transition from one tobacco product to another. In addition, we evaluated the correlation between the level of education and the use of cigarettes and snus.MethodsA questionnaire-based survey was carried out in three out of 17 garrisons among conscripts during their first week of service in 2014. A total of 1971 male conscripts were selected by simple random sampling of the 9013 males in the selected garrisons. Of them 1916 participated and filled in the questionnaire. The response rate was 97.2%. The questionnaire consisted of 25 questions including age, gender, basic education, use of tobacco products as well as questions assessing nicotine dependency.ResultsThe amount of dual users of cigarettes and snus was 21%. There was a higher probability of dual use of cigarettes and snus among smokers compared to snus users (p < 0.001). One third (35%) of former smokers reported daily snus use and over 40% of the former snus users smoked daily. One third (34%) of the participants reported snus usage and 14% of the study subjects used snus daily. 40% of the study population were smokers and over 25% smoked daily. Of the participants with basic educational background 57% smoked daily (p < 0.001), however, no association between snus and level of education was found (p = 0.69).ConclusionsThis study provides better understanding of the complex tobacco habits of young adult males. The simultaneous usage of multiple tobacco products as well as the high tendency to transition from one tobacco product to another should be taken into consideration when planning cessation interventions in health care settings and tobacco control policies at societal levels.

Prevalence of human papillomavirus type 16 in persistent oral lesions arising in patients with tobacco, areca nut, and alcohol habits

AbstractBackground and purposeHuman papillomavirus (HPV) has been shown to be associated with oral malignancies. The purpose of this study was to detect HPV and a high‐risk type HPV16 viral DNA in 24 cases with oral squamous cell carcinoma (OSCC) and 15 cases with non‐OSCC persistent oral lesions (POL) residing in North India. The diagnosis was determined by the histopathological characteristics of the oral biopsy.ResultsAll oral lesions were HPV‐DNA positive, and the HPV16‐positive ratios of OSCC and non‐OSCC POLs were 50% and 53%, respectively. Approximately 62% of moderately differentiated OSCC and 36% of well‐differentiated OSCC were HPV16 positive. Evaluated odds and prevalence ratios &gt;1 indicated a higher prevalence of HPV16 infection in patients with tobacco, areca nut, and/or alcohol habits, compared with nonaddicts. The obtained P‐values were higher than 0.05, indicating that the relationship is statistically insignificant, which may be due to lower number of POL cases. This study could not conclude that HPV16 infection plays an essential role in malignant transformation of the oral mucosa, raising a need for further experimental endeavors.ConclusionsThis study indicates that HPV16 infection in OSCC and non‐OSCC POLs frequently occurred in people with tobacco smoking, tobacco‐areca nut chewing, and alcohol intake. These fallacious habits may increase HPV16 infection in the oral cavity.

Association of oral pre-malignant lesions with the consumption of tobacco

Background: Tobacco consumption in the form of chewing and smoking is one of the biggest addictions. It causes various oral pre-malignant lesions which mainly include oral sub-mucous fibrosis (OSMF) caused by betel nut consumption and tobacco quid lesion, leukoplakia, erythroplakia and smoker's palate caused by chewing and smoking tobacco.Methods: The data about the past and present consumption of tobacco was collected from 909 individuals. Based on the tobacco habits, the oral cavity findings were assessed and the statistical analysis was carried out to find the significance of associations observed between tobacco consumption and lesions.Results: Out of 909 subjects, 537 were consuming tobacco, out of which 284 were chewers, 65 were smokers and 76 were consuming in both forms. Out of the 284 tobacco chewers, 43% had oral lesions (19.4% had OSMF and 21.5% had tobacco quid) as compared to just 1% of workers having oral lesions (OSMF) amongst those who had no addiction. There was a high prevalence of lesion in tobacco chewers (p&lt;0.005). Out of total smokers, 15.8% had smoker's palate whereas no lesion was seen in the non-addicted workers. The odds of developing oral pre-malignant lesion are 43.62 times higher in exposed individuals.Conclusions: The tobacco consumption in any form is hazardous. Betel nut exposure causes more harmful effect which goes unnoticed. Awareness should be created about various lesions caused by tobacco as well as betel nut and special steps should be taken for early diagnosis and its treatment.

Head and Neck Squamous Cell Carcinoma in Young Adults: A Hospital‑Based Study

Abstract Background: Head and neck cancers (HNCs) account for 30% of all cancers in India. In north eastern India, tobacco-related cancers are very common because of the widespread use of tobacco. The paucity of any study from this region in young head and neck patients has prompted us to take up this study. Methodology: A retrospective study was conducted at Dr. B Borooah Cancer Institute, Guwahati during January 2015–December 2015. Data regarding tumor site, age, sex, education, habit of tobacco (smokeless and smoke), and betel nut consumption were analyzed using IBM SPSS version 19. P &lt; 0.05 was considered as statistically significant. Results: About 75.1% patients were males. Among patients ≤39 years, 83.7% were tobacco chewers, 50.5% were smokers, and 83.7% betel nut chewers, and among &gt;39 years, these proportions were 83.7%, 56.2%, and 78.7%, respectively. The most common site among ≤39 years and &gt;39 were mouth (40.8%) and hypopharynx (36.8%). Among tobacco and betel nut chewers and smokers, the most common sites were mouth (40.3%, 42.5%) and hypopharynx (41.5%). The site of head and neck squamous cell carcinoma was highly associated with chewing and smoking habit (P &lt; 0.05). Among illiterate patients, proportions of tobacco and betel nut chewers and smokers were 65.3%, 61.6%, and 67.9%, respectively. Conclusion: A positive association between tobacco use, male gender, and low education levels were found. The younger generation should be made aware about the adverse health consequences of tobacco use to reduce the preventable risk factors of HNC.

Does Socioeconomic Status Influence the Risk of Subclinical Atherosclerosis?: A Mediation Model

BackgroundSocioeconomic status (SES)—education, income level, and occupation—is associated with cardiovascular risk. ObjectivesThis study aimed to investigate the association between SES and subclinical atherosclerosis and the potential mechanisms involved. MethodsSES, lifestyle habits (smoking, dietary patterns, physical activity, and hours of sleep), traditional risk factors, and subclinical atherosclerosis extent were prospectively assessed in 4,025 individuals aged 40 to 54 years without known cardiovascular disease enrolled in the PESA (Progression of Early Subclinical Atherosclerosis) study. After factors associated with atherosclerosis were identified, a multiple mediation model was created to quantify the effect of SES on subclinical atherosclerosis as explained by lifestyle behaviors. ResultsAlthough education level was significantly associated with the presence of atherosclerosis, no differences were found according to income level in this population. Participants with lower education presented with a higher risk of generalized atherosclerosis than those with higher education (odds ratio: 1.46; 95% confidence interval: 1.15 to 1.85; p = 0.002). Lifestyle behaviors associated with both education level and atherosclerosis extent were: smoking status, number of cigarettes/day, and dietary pattern, which explained 70.5% of the effect of SES on atherosclerosis. Of these, tobacco habit (smoking status 35% and number of cigarettes/day 32%) accounted for most of the explained differences between groups, whereas dietary pattern did not remain a significant mediator in the multiple mediation model. ConclusionsDespite the relative economic homogeneity of the cohort, lower education level is associated with increased subclinical atherosclerosis, mainly mediated by the higher and more frequent tobacco consumption. Smoking cessation programs are still needed, particularly in populations with lower education level.

Lifestyle and Exercise Intervention Reduces Blood Pressure: A Multiethnic Control Trial

The effect of ethnicity and medication on blood pressure (BP) have been widely described; however, less is known about the interaction between ethnicity, BP medication and regular exercise on hypertensive patients. PURPOSE: This study was aimed to determine the effectiveness of an exercise training and healthy lifestyle education program to reduce BP levels and improve adherence to pharmacological therapy on a multiethnic group of hypertensive patients. METHODS: An 8-month quasi-experimental longitudinal intervention with an exercise group (EG) and control group (CG) was designed. Five hundred and sixty-eight hypertensive patients (67.4±8.8 years; BMI, 26.4±3.1 kg/m2; systolic BP (SBP), 146±9 mmHg and diastolic BP (DBP), 95±7 mmHg; 18% Indigenous, 23% Colombian-African and 59% Hispanic) finalized the study (EG, n= 307 and CG, n= 261). EG participated in 3 weekly exercise training sessions (30 to 60 minutes of concurrent training), which were complemented by medication and lifestyle education. The average of three repeated measures of BP performed with an electronic sphygmomanometer was utilized as primary outcome. Health status, medication adherence, salt consumption, tobacco and alcoholic habits were recorded by questionnaires during clinic history assessment. Non-parametric tests were carried out to compare differences between EG and CG. Several logistic regression models were used to find independent variables predicting two levels (-3 or - 5 mmHg) of reduction in systolic (SBP) or diastolic blood pressures (DBP). RESULTS: We found significant reductions both SBP and DBP in EG (-5.92 mmHg and -5.0 mmHg, respectively, P<0.001 for both) but not in the CG. Also, prevalence of medication adherence was significantly improved in 28.7% (P<0.001) in the EG. In the logistic regression, all models confirmed the EG as the main explanatory variable of a 3 or 5 mmHg BP reduction, independently of other lifestyle risk factors and medication adherence. CONCLUSIONS: In accordance with other studies patients in EG showed more diminution in SBP and DBP than CG, which was independent of other risks factors. However, the main findings were that either ethnic or medication adherence did not influence statistically the reduction in BP associated with our exercise/lifestyle intervention.

Care of adolescents and young adults with cancer in Asia: results of an ESMO/SIOPE/SIOP Asia survey

BackgroundAdolescents and young adults (AYAs) with cancer require dedicated management encompassing both adult and paediatric cancer services. Following a European survey, the European Society for Medical Oncology, the European Society for Paediatric Oncology and the Asian continental branch of International Society of Paediatric Oncology undertook a similar survey to assess AYA cancer care across Asia.MethodsA link to the online survey was sent to healthcare professionals (HCPs) in Asia interested in AYA cancer care. Questions covered the demographics and training of HCPs, their understanding of AYA definition, availability and access to specialised AYA services, the support and advice offered during and after treatment, and factors of treatment non-compliance.ResultsWe received 268 responses from 22 Asian countries. There was a striking variation in the definition of AYA (median lower age 15 years, median higher age 29 years). The majority of the respondents (78%) did not have access to specialised cancer services and 73% were not aware of any research initiatives for AYA. Over two-thirds (69%) had the option to refer their patients for psychological and/or nutritional support and most advised their patients on a healthy lifestyle. Even so, 46% did not ask about smokeless tobacco habits and only half referred smokers to a smoking cessation service. Furthermore, 29% did not promote human papillomavirus vaccination for girls and 17% did not promote hepatitis B virus vaccination for high-risk individuals. In terms of funding, 69% reported governmental insurance coverage, although 65% reported that patients self-paid, at least partially. Almost half (47%) reported treatment non-compliance or abandonment as an issue, attributed to financial and family problems (72%), loss of follow-up (74%) and seeking of alternative treatments (77%).ConclusionsLack of access to and suboptimal delivery of AYA-specialised cancer care services across Asia pose major challenges and require specific interventions.

Oral cancer on the gingiva in patients with proliferative leukoplakia: A study of 30 cases.

Proliferative verrucous leukoplakia, recently coined as proliferative leukoplakia (PL), is associated with a strong tendency to recur after treatment and an elevated rate of malignant transformation. We compared the clinical characteristics of patients with gingival PL with and without progression to oral squamous cell carcinoma. The patients were divided into two groups: group 1 included 33 patients with gingival PL that did not progress to cancer, and group 2 included 30 patients with PL who developed malignant transformation during follow-up. We compared age, sex, tobacco habit, clinical characteristics of gingival PL lesions, and location, tumor-node-metastasis (TNM) stage, and clinical characteristics of gingival malignancy between groups. Female sex was predominant in the group with gingival cancer, and simultaneous involvement of the buccal mucosa, tongue, and palate was more common in this group than in the group without cancer. PL lesions were also largest in the group of patients with cancer. Most gingival cancer occurred in areas with teeth and took the form of oral ulceration. TNM stage I was most common. The simultaneous presence of lesions on the buccal mucosa, grade of lesion extension, and presence of ulcerative lesion were significantly associated with gingival cancer in patients with PL.