Hookah smoking and cancer: carcinoembryonic antigen (CEA) levels in exclusive/ever hookah smokers

<p>Abstract</p> <p>Background</p> <p>We have recently published some work on CEA levels in hookah (also called narghile, shisha elsewhere) and cigarette smokers. Hookah smokers had higher levels of CEA than non-smokers although mean levels were low compared to cigarette smokers. However some of them were also users of other tobacco products (cigarettes, bidis, etc.).</p> <p>Objectives</p> <p>To find serum CEA levels in ever/exclusive hookah smokers, i.e. those who smoked only hookah (no cigarettes, bidis, etc.), prepared between 1 and 4 times a day with a quantity of up to 120 g of a tobacco-molasses mixture each (i.e. the tobacco weight equivalent of up to 60 cigarettes of 1 g each) and consumed in 1 to 8 sessions.</p> <p>Methods</p> <p>Enhanced chemiluminescent immunometric technique was applied to measure CEA levels in serum samples from 59 exclusive male smokers with age ranging from 20–80 years (mean = 58.8 ± 14.7 years) and 8–65 years of smoking (mean = 37.7 ± 16.8). 36 non-smokers served as controls. Subjects were divided into 3 groups according to the number of preparations; the number of sessions and the total daily smoking time: Light (1; 1; ≤ 20 minutes); Medium (1–3; 1–3; >20 min to ≤ 2 hrs) and Heavy smokers (2–4; 3–8; >2 hrs to ≤ 6 hrs). Because of the nature of distribution of CEA levels among our individuals, Wilcoxon's rank sum two-sample test was applied to compare the variables.</p> <p>Results</p> <p>The overall CEA levels in exclusive hookah smokers (mean: 3.58 ± 2.61 ng/ml; n = 59) were not significantly different (p ≤ 0.0937) from the levels in non-smokers (2.35 ± 0.71 ng/ml). Mean levels in light, medium and heavy smokers were: 1.06 ± 0.492 ng/ml (n = 5); 2.52 ± 1.15 ng/ml (n = 28) and 5.11 ± 3.08 ng/ml (n = 26) respectively. The levels in medium smokers and non-smokers were also not significantly different (p ≤ 0.9138). In heavy smokers, the CEA levels were significantly higher than in non-smokers (p ≤ 0.0001567).</p> <p>Conclusion</p> <p>Overall CEA levels in exclusive hookah smokers were low compared to cigarette smokers. However, heavy hookah smoking substantially raises CEA levels. Low-nitrosamines smokeless tobacco of the SNUS Swedish type could be envisaged as an alternative to smoking for this category of users and also, in a broad harm reduction perspective, to the prevalent low-quality moist snuff called naswar.</p

English Background as the Predictors for Students’ Speaking Skills in Pakistan

This paper is based on the English background of the students as the predictors for students English speaking skills at the secondary level at province of Sindh, Pakistan. A questionnaire was designed for students of grade-11, which was used to collect data from 60 male students of the public institutes in district Hyderabad, Pakistan. There were three independent variables used in this study: (X1) either students attended English language institute, (X2) number of years students were educated in English medium schools, and (X3) last class’s English score. The dependent variable was English speaking score (Y). Students’ speaking skills were assessed by a standardized rubric designed by language experts. There were four research questions formulated. Data was analyzed using linear and multiple regression, and t-test in SAS 9.2 (Statistical Analysis System). With ?=0.05, the result indicates that there is a significant relationship between student last class’s English score (N=60, M=50.45, SD=9.00) and their speaking scores (N=60, M=11.77, SD=3.21), r = 0.73, p&lt;0.001. The number of years educated in English medium school (b = 0.22, t =2.05) and last class’s English score (b = 0.26, t = 8.26, p &lt;.0001) were found significant predictors at R2 =0.57, F(2,57) =37.20, p&lt;0.001. No statistical significance was indicated in students speaking score between those who attended English language institute (N=48, M= 12.04, SD= 3.43) and those who did not attend an English language institute (N=12, M= 10.67, SD= 1.83), t(58)= –1.34, p = 0.19. Interaction with students showed that most of the students do not speak English with fellow students because of shyness and lack of confidence. Keywords: English speaking, language, speaking skills, secondary schoo

English Background as the Predictors for Students’ Speaking Skills in Pakistan

This paper is based on the English background of the students as the predictors for students English speaking skills at the secondary level at province of Sindh, Pakistan. A questionnaire was designed for students of grade-11, which was used to collect data from 60 male students of the public institutes in district Hyderabad, Pakistan. There were three independent variables used in this study: (X1) either students attended English language institute, (X2) number of years students were educated in English medium schools, and (X3) last class’s English score. The dependent variable was English speaking score (Y). Students’ speaking skills were assessed by a standardized rubric designed by language experts. There were four research questions formulated. Data was analyzed using linear and multiple regression, and t-test in SAS 9.2 (Statistical Analysis System). With ?=0.05, the result indicates that there is a significant relationship between student last class’s English score (N=60, M=50.45, SD=9.00) and their speaking scores (N=60, M=11.77, SD=3.21), r = 0.73, p&lt;0.001. The number of years educated in English medium school (b = 0.22, t =2.05) and last class’s English score (b = 0.26, t = 8.26, p &lt;.0001) were found significant predictors at R2 =0.57, F(2,57) =37.20, p&lt;0.001. No statistical significance was indicated in students speaking score between those who attended English language institute (N=48, M= 12.04, SD= 3.43) and those who did not attend an English language institute (N=12, M= 10.67, SD= 1.83), t(58)= –1.34, p = 0.19. Interaction with students showed that most of the students do not speak English with fellow students because of shyness and lack of confidence. Keywords: English speaking, language, speaking skills, secondary school

Education as gender equalizer: overcoming youth unemployment in Pakistan

Resistance to a positive change brings no change in a society unless its members do not work for it. In many parts of Pakistan female employment is a sensitive cultural issue. In this country the female population is more than 90 million, and quarter of it is youth, but majority of female youth are not master of their own soul because of the low female literacy rate in the country.  This study presents an in-depth outlook of female education, unemployment and its consequences for female gender. A detailed description of the factors and forces which are resisting a positive change in the society has also been presented. This paper presents practicable solutions to make female youth economically active, productive and more independent in male dominant society. Keywords: Education, Female youth, unemploymen

Heterogeneous malaria transmission in long-term Afghan refugee populations: a cross-sectional study in five refugee camps in northern Pakistan.

BACKGROUND: Afghan refugees in northern Pakistan have been resident for over 30 years and current information on malaria in this population is sparse. Understanding malaria risk and distribution in refugee camps is important for effective management both in camps and on return to Afghanistan. METHODS: Cross-sectional malariometric surveys were conducted in five Afghan refugee camps to determine infection and exposure to both Plasmodium falciparum and Plasmodium vivax. Factors associated with malaria infection and exposure were analysed using logistic regression, and spatial heterogeneity within camps was investigated with SatScan. RESULTS: In this low-transmission setting, prevalence of infection in the five camps ranged from 0-0.2 to 0.4-9 % by rapid diagnostic test and 0-1.39 and 5-15 % by polymerase chain reaction for P. falciparum and P. vivax, respectively. Prevalence of anti-malarial antibodies to P. falciparum antigens was 3-11 and 17-45 % for P. vivax antigens. Significant foci of P. vivax infection and exposure were detected in three of the five camps. Hotspots of P. falciparum were also detected in three camps, only one of which also showed evidence of P. vivax hotspots. CONCLUSIONS: There is low and spatially heterogeneous malaria transmission in the refugee camps in northern Pakistan. Understanding malaria risk in refugee camps is important so the malaria risk faced by these populations in the camps and upon their return to Afghanistan can be effectively managed

A critique of the WHO TobReg's "Advisory Note" report entitled: "Waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators"

BACKGROUND AND AIM: The World Health Organisation Study Group on Tobacco Product Regulation (TobReg) has issued in 2005 an "Advisory Note" entitled: "Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators". "Waterpipe" smoking is now considered a global public health threat and the corresponding artefact is actually known in the world under three main terms: hookah, narghile and shisha. This important report, the first ever prepared by WHO on the subject, poses two major problems. On one hand, its bibliographical references dismiss world chief relevant studies. On the other, it contains a certain number of errors of many orders: biomedical, sociological, anthropological and historical. The purpose of the present study is to highlight, one by one, where these weaknesses and errors lie and show how this official report can be considerably improved. RESULTS: We realise that widely advertised early anthropological studies were not taken into consideration whereas they shed a substantial light on this peculiar form of smoking and help understanding its high complexity. As for concrete errors to be found in this report, they deal with the chemistry of smoke, health-related effects, smoking patterns, description and history of the artefact and its use, gender and underage use aspects, prevention and research needs in this field. CONCLUSION: The scientific credibility of an international expert report may be at stake if its recommendations do not rely on sound objective research findings and a comprehensive review of the existing literature. The critical comments in this study will certainly help improve the present WHO report

Hookah (Shisha, Narghile) Smoking and Environmental Tobacco Smoke (ETS). A Critical Review of the Relevant Literature and the Public Health Consequences

Hookah (narghile, shisha, “water-pipe”) smoking is now seen by public health officials as a global tobacco epidemic. Cigarette Environmental Tobacco Smoke (ETS) is classically understood as a combination of Side-Stream Smoke (SSS) and Exhaled Main-Stream Smoke (EMSS), both diluted and aged. Some of the corresponding cigarette studies have served as the scientific basis for stringent legislation on indoor smoking across the world. Interestingly, one of the distinctive traits of the hookah device is that it generates almost no SSS. Indeed, its ETS is made up almost exclusively by the smoke exhaled by the smoker (EMSS), i.e. which has been filtered by the hookah at the level of the bowl, inside the water, along the hose and then by the smoker’s respiratory tract itself. The present paper reviews the sparse and scattered scientific evidence available about hookah EMSS and the corresponding inferences that can be drawn from the composition of cigarette EMSS. The reviewed literature shows that most of hookah ETS is made up of EMSS and that the latter qualitatively differs from MSS. Keeping in mind that the first victim of passive smoking is the active smoker her/himself, the toxicity of hookah ETS for non-smokers should not be overestimated and hyped in an unscientific way

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe