Waterpipe smoking in students: Prevalence, risk factors, symptoms of addiction, and smoke intake. Evidence from one British university

Background: Anecdotal reports suggest waterpipe smoking is becoming common in students in western countries. The aim was to examine prevalence, risk factors, symptoms of addiction, and smoke intake. Methods: This was a cross-sectional survey of students with subsidiary survey of regular waterpipe user and survey of exhaled carbon monoxide (CO) before and after waterpipe smoking in customers of a waterpipe café. 937 students of Birmingham University completed the initial survey with a follow up of 21 regular waterpipe smokers. 63 customers of a waterpipe café near the University completed the study of CO intake. Results: 355 (37.9%, 95% confidence intervals (CI) 34.8 to 41.1%) students had tried waterpipes,the prevalence of trying rising with duration at University. 75 (8.0%, 95%CI 6.4 to 10.0%) were regular smokers, similar to the prevalence of cigarette smoking (9.4%). Although cigarette smoking was the major risk factor for being a regular waterpipe smoker, odds ratio (95%CI) 2.77 (1.52 to 5.06), 65% of waterpipe smokers did not smoke cigarettes. Seven of 21 (33.3%) regular waterpipe smokers experienced cravings. Nearly all regular waterpipe users thought it less harmful than smoking cigarettes. The mean (standard deviation) rise in CO was 37.4 (25.8)ppm, nearly twice as high as a typical cigarette smoker seeking cessation treatment. Conclusion: Waterpipe smoking is a common part of student culture in one British university, as in the Middle East and in the United States. It poses a potential threat to public health, with evidence of dependence and high smoke intake

Is uncertainty in complex disease epidemiology resolvable?

The imposed limitations on what we can know about nature have been long recognized. Yet in the field of epidemiology a futile search for lifestyle-related risk factors for common chronic diseases continues unabated. This has led to the production of a growing body of evidence about potential lifestyle risk factors that tend to be marginal, contradictory, irreproducible, or hard to interpret. While epidemiologists are calling for a more refined methodology, I argue that our limitation in studying complex diseases is insurmountable. This is because the study of lifestyle-related small risks requires accurate measurement of multiple behaviors-exposures over a long period of time. It is also because in complex systems such as population?s health, the effect of rich interactions between its parts cannot be predicted based on traditional causal models of epidemiology. Within complex systems, understanding the interactions between system components can be more important than the contribution of each to disease risk

Factors Affecting Capture Rates of Insect Taxa by Retail Electrocutors and Eliminators in Northern Lower Michigan

We compare the abundance and types of insects captured at several locations, with and without a chemical attractant and in varying weather conditions using two different devices advertised to kill biting insects. Using both an insect electrocutor that uses ultraviolet light as an attractant, with and without octenol as an added attractant, and an insect eliminator that uses carbon dioxide, heat and octenol as attractants, more non-biting than biting insects were captured. Numerous harmless and beneficial insects were killed with electrocutors. Although eliminators were more target-specific, they captured fewer insects overall compared to electrocutors. The numbers and types of insects captured also varied by location and temperature conditions. More insects were killed by electrocutors located next to a lake compared to those located in an inland forested area and more were killed at lower compared to higher heights above the ground. More insects were also killed by electrocutors on warmer than on cooler nights. More non-biting insects were killed with electrocutors baited with octenol than without octenol

Estimating the beginning of the waterpipe epidemic in Syria

BACKGROUND: Waterpipe smoking is becoming a global public health problem, especially in the Eastern Mediterranean region (EMR). METHODS: We try in this study, which is a cross sectional survey among a representative sample of waterpipe smokers in cafes/restaurants in Aleppo-Syria, to assess the time period for the beginning of this new smoking hype. We recruited 268 waterpipe smokers (161 men, 107 women; mean age ± standard deviation (SD) 30.1 ± 10.2, response rate 95.3%). Participants were divided into 4 birth cohorts (≤ 1960, 1961–1970, 1971–1980, >1980) and year of initiation of waterpipe smoking and daily cigarette smoking were plotted according to these birth cohorts. RESULTS: Data indicate that unlike initiation of cigarette smoking, which shows a clear age-related pattern, the nineties was the starting point for most of waterpipe smoking implicating this time period for the beginning of the waterpipe epidemic in Syria. CONCLUSION: The introduction of new flavored and aromatic waterpipe tobacco (Maassel), and the proliferation of satellite and electronic media during the nineties may have helped spread the new hype all over the Arab World

Comparison of patterns of use, beliefs, and attitudes related to waterpipe between beginning and established smokers

BACKGROUND: To compare patterns of use, beliefs, and attitudes related to waterpipe smoking between university students (beginning smokers) and café customers (established smokers) in Aleppo Syria, in order to explore the evolution of this smoking method. METHODS: Two cross-sectional surveys were conducted among representative samples of university students (total 587, 48.4% men, mean age 22 years), and waterpipe users among cafe' customers (total 268, 60% men, mean age 30 years) in Aleppo, Syria. We used interviewer-administered questionnaire inquiring about pattern of waterpipe smoking (initiation, frequency), situational characteristics of use (partner, place, sharing), beliefs related to waterpipe smoking (harmful/addictive properties of waterpipe), attitudes related to waterpipe smoking (confidence in quitting, will to quit, motivation for quitting, past year quit attempt), and cigarette smoking. RESULTS: Daily and regular patterns of smoking become more prevalent with increased duration of smoking, but intermittent smoking remains the predominant pattern of waterpipe use. Women seem to be drawn later to the habit, which seem to escape the usual taboo against women's cigarette smoking. Patterns and context of waterpipe use tend to change with progress of the practice affecting frequency, setting, and sharing of waterpipe. Unlike beginners, established waterpipe smokers seem more smoking-method oriented, more hooked on the habit, less willing to quit, and less likely to foresee challenges to quitting. CONCLUSION: Use patterns and attitudes related to waterpipe smoking evolve to accommodate the change in dependence and life circumstances of the smoker. Most of use features, beliefs, attitudes, as well as time-course seem unique to this smoking method requiring novel approach to intervention

The Gateway Effect of E-cigarettes: Reflections on Main Criticisms

The recent spread of e-cigarette use has spurred not only enthusiasm about their harm reduction and smoking cessation potential but also concerns about possible risks from long-term use, and stalled cessation through dual use.1 Another main concern is that e-cigarette use is increasing among tobacco-naive youth2 than among only adult smokers who are using them for cessation and expectation of risk reduction.1 With youth smoking at all-time lows in several nations with advanced tobacco control programs,3–5 there are therefore concerns that e-cigarettes may stall or reverse these declines as youth who were likely to never use any form of nicotine become familiar with it, and start experimenting with other forms of nicotine delivery. These concerns were strengthened by the recent publication of a meta-analysis of longitudinal studies showing that e-cigarettes can serve as a gateway to later cigarette smoking among nicotine-naive youth.6 They were also emphasized by the 2018 report of the National Academies of Sciences, Engineering, and Medicine (NASEM),7 which concluded that such studies “provided “strong evidence of plausibility and specificity of a possible causal effect of e-cigarette use on smoking…” with the Committee “consider[ing] the overall body of evidence of a causal effect of e-cigarette use on risk of transition from never to ever smoking to be substantial” (pp. 16–32). By contrast, Public Health England concluded, “Despite some experimentation with these devices among never smokers, e-cigarettes are attracting very few young people who have never smoked into regular use”.8 Given the importance of putative gateway or “catalyst”9 effects in assessing the population impact of e-cigarettes, proponents of e-cigarettes were quick to criticize such evidence and their underlying gateway hypothesis.10–13 In the context of this debate, the gateway hypothesis is adapted to denote the use of less harmful forms of nicotine delivery (eg, e-cigarettes), leading to the use of more harmful ones (eg, combustible cigarettes).7,10–13 We here present and respond to three major criticisms that have been made of e-cigarettes’ gateway potential based on currently available evidence

Massive hiatus hernia: Evaluation and surgical management

AbstractObjective: Paraesophageal hernias represent advanced degrees of sliding hiatus hernia with intrathoracic displacement of the intraesophageal junction. Gastroesophageal reflux disease occurs in most cases, resulting in acquired short esophagus, which should influence the type of repair selected. Methods: Between 1960 and 1996, 94 patients with massive, incarcerated paraesophageal hiatus hernia were operated on at the Toronto General Hospital. The mean age was 64 years (39 to 85 years), with a female to male ratio of 1.8:1. Organoaxial volvulus was present in 50% of cases. Clinical presentation in these patients included postprandial pain in 56%, dysphagia in 48%, chronic iron deficiency anemia in 38%, and aspiration in 29%. Symptomatic reflux, either present or remote, was recorded in 83% of cases. All patients underwent endoscopy by the operating surgeon. In 91 of 94 patients, the esophagogastric junction was found to be above the diaphragmatic hiatus, denoting a sliding type of hiatus hernia. Gross, endoscopic peptic esophagitis was observed in 36% of patients: ulcerative esophagitis in 22% and peptic esophagitis with stricture in 14%. A complete preoperative esophageal motility study was obtained for 41 patients. The lower sphincter was hypotensive in 21 patients (51%), and the amplitude of peristalsis in the distal esophagus was diminished in 24 patients (59%). These abnormalities are both features of significant gastroesophageal reflux disease. In 13 recent, consecutive patients with paraesophageal hernia, the distance between the upper and lower esophageal sphincters was measured during manometry. The average distance was 15.4 ± 2.33 cm (11 to 20 cm), which is consistent with acquired short esophagus. The normal distance is 20.4 cm ± 1.9 (p < 0.0001). Results: All 94 patients were treated surgically: 97% had a transthoracic repair with fundoplication. A gastroplasty was added in 75 cases (80%) because of clearly defined or presumed short esophagus. There were two operative deaths, and two patients were never followed up. Among the 90 available patients, the mean follow-up was 94 months; median follow-up was 72 months. Seventy-two patients (80%) are free of symptoms (excellent result); 13 (13%) have inconsequential symptoms requiring no therapy (good result); and three patients (4%) are improved but have symptoms requiring medical therapy or interval dilatation (fair result). Two patients had poor results because of recurrent hernia and severe reflux. Both were successfully treated by reoperation with the addition of gastroplasty because of acquired shortening, which was not recognized at the first operation. Conclusions: Most of these 94 patients had symptoms or endoscopic, manometric, and operative findings that were consistent with a sliding hiatus hernia. There was a high incidence of endoscopic reflux esophagitis and of acquired short esophagus. True paraesophageal hernia, with the esophagogastric junction in a normal abdominal location, appears rare. Our observations were supported by measurements obtained at preoperative endoscopy and manometry, and by findings at the time of surgical repair. These observations support the choice of a transthoracic approach for repair in most patients. (J Thorac Cardiovasc Surg 1997;115:53-62

Missing the elephant in the vaping transition room.

We respond to a paper by Coleman B et al Transitions in electronic cigarette use among adults in the Population Assessment of Tobacco and Health (PATH) Study, Waves 1 and 2 (2013-2105). Tobacco Control 2018; doi:10.1136/tobaccocontrol-2017-054174 which reports on the vaping and smoking status of 2932 adult e-cigarette users followed for 12 months in a national, stratified US study. For every person vaping at Wave 1 who benefited across 12 months by quitting smoking, there are 2.1 who either relapsed to smoking to or took-up smoking. Most disturbingly, in this adult cohort nearly one in four of those who had never been established smokers took up smoking after first using EC. Concern about putative gateway effects of ECs to smoking have been dominated by concerns about youth. These data showing transitions from EC to smoking in nearly a quarter of exclusive adult EC users with no histories of established smoking should widen this debate to consider adult gateway effects too

A needs assessment of the formal and informal support systems among a sample of elderly in LaSalle, Ontario Canada.

The study was undertaken to explore the informal and formal support systems of the elderly who reside in the Town of LaSalle in southwestern Ontario. An extensive review of the literature provided information on social support networks, demographic implications and its ramification on social policy documents. As well as, various needs assessment studies of the elderly in Windsor-Essex County. Informal and formal support systems and three theoretical perspectives were examined. Data was collected from sixty-five participants utilizing a systematic random sampling procedure. The major findings of the study showed that the primary informal supports of the elderly were their spouse and adult daughters. The data revealed that the elderly visited with their adult children on a weekly basis and reciprocal exchange of assistance was present. Currently, the utilization of formal support services by the elderly in LaSalle is extremely low. The current formal support service needs are in the areas of outdoor home maintenance, letter carriers alert and foot care services. The future perceived formal support needs are similar to the present needs with the addition of transportation and shopping services. The data showed that the elderly preferred to remain in the Town of LaSalle and future preferred dwelling was a private home, senior\u27s apartment and apartment. Thus, the elderly wish to remain independent and autonomous. Paper copy at Leddy Library: Theses & Major Papers - Basement, West Bldg. / Call Number: Thesis1996 .M396. Source: Masters Abstracts International, Volume: 37-01, page: 0130. Adviser: Rosemary Cassano. Thesis (M.S.W.)--University of Windsor (Canada), 1996

Einflussfaktoren auf das Outcome nach Stabilisierung akuter hochgradiger Acromioclaviculargelenksinstabilitäten

Akromioclaviculargelenks(ACG-)instabilitäten stellen eine häufige Verletzung junger, sportlich aktiver Menschen dar. Zur Bestimmung deren Schweregrades hat sich die Klassifikation nach Rockwood durchgesetzt, die sechs Grade unterscheidet. Anhand dieser Klassfikation kann ein Therapiealgorithmus abgleitet werden. Demnach werden hochgradige, bidirektionale ACG-Instabilitäten vom Typ V in der Regel operativ versorgt. In der aktuellen Literatur werden zahlreiche operative Verfahren beschrieben, wobei sich bislang keine der erläuterten Techniken als ‚Goldstandard‘ durchsetzen konnte. Sowohl für offene als auch für minimal-invasive Verfahren wurden gute klinische und radiologische Ergebnisse publiziert. Letztere werden als technisch anspruchsvoller erachtet, bieten jedoch zahlreiche Vorteile. Neben kosmetischen Vorzügen können durch die geringere Invasivität der postoperative Wundschmerz sowie das Infektionsrisiko reduziert werden. Des Weiteren handelt es sich um ein einzeitiges Verfahren, das zudem die Detektion glenohumeraler Begleitverletzungen oder pathologien ermöglicht. Wodurch das Heilungspotenzial der das Schultereckgelenk stabilisierenden Strukturen nach der operativen Versorgung beeinflusst wird, wurde bislang noch nicht ausreichend geklärt. Neben der Art der operativen Versorgung werden zahlreiche weitere Einflussfaktoren diskutiert. Ebenso ist nicht bekannt, wodurch fortdauernde Beschwerden nach einer operativen Versorgung dieser Verletzungen bedingt werden. Die vorliegende Dissertation befasst sich mit prognostischen Faktoren radiologischer Ergebnisse nach arthroskopisch-assistierter Stabilisierung hochgradiger Schultereckgelenksprengungen sowie mit Zusammenhängen klinischer und radiologischer Resultate. Die vorgenommenen Untersuchungen zeigten, dass das radiologische Outcome überwiegend durch die initiale Reposition des Gelenks und die Stabilisierungstechnik beeinflusst wird. Eine initiale Überreposition und die zusätzliche acromioclaviculäre(AC-) Stabilisierung scheinen Repositionsverlusten entgegenzuwirken. Zudem erwies sich das Alter der Patienten als prognostisch relevant. Weiterhin konnte ein Zusammenhang zwischen Repositionsverlusten und persistierenden Beschwerden im Sinne von Schmerzen detektiert werden.Acromioclavicular (AC) joint dislocations are common among young and active people. The Rockwoods classification of those injuries is has been widely employed, allowing medical professionals to distributed, distinguish six degrees of instability and determine preferred methods of treatment. According to widely accepted recommendations, high-grade type V AC separations are usually treated surgically, whereby numerous open and arthroscopically assisted techniques can be applied. Even so, none of these techniques has been accepted as a standard procedure. Good clinical and radiographic results have been published for both open as well as arthroscopically assisted techniques. On the one hand, minimally invasive stabilization of AC injuries is considered to be more technically demanding. On the other, such minimally invasive procedures offer numerous advantages, including reduced postoperative pain and risk of infection. Arthroscopically assisted techniques also offer the opportunity to detect concomitant glenohumeral lesions or pathologies, which can also be addressed during the procedure. The factors that influence postoperative ligament healing and by extension radiographic results remain under-investigated. Numerous potential determinants have been discussed in the literature so far. Associations between radiographic and clinical results are likewise under investigated. This thesis deals with factors influencing radiographic results after arthroscopically assisted AC joint reconstruction and associations between clinical and radiographic results. The studies performed demonstrated that the radiological outcome is predominantly influenced by the initial reduction of the joint and the stabilization technique. Initial overreduction and additional AC stabilization seem to counteract loss of reduction. In addition, the age of the patients have proven to be prognostically relevant. Finally, a correlation between loss of reduction and persistent complaints in terms of pain has been detected