Passive smoking as well as active smoking increases the risk of acute stroke

Secondhand smoke exposure can increase the risk of first ischemic stroke: A 10.7-year prospective cohort study in China

INTRODUCTION

Passive smoking is considered a major public health issue in China. Prospective evidence regarding the link between secondhand smoke (SHS) and ischemic stroke in China is scarce.

METHODS

The China Kadoorie Biobank (CKB) study in Liuzhou City recruited 50,174 participants during 2004-2008. Of these 30,456 never-smokers were included in our study. The median follow-up period was 10.7 years. The incidence of ischemic stroke was obtained through the China Disease Surveillance Points (DSP) system and the Health Insurance (HI) database. Cox proportional risk models were used to evaluate the association between SHS exposure and ischemic stroke.

RESULTS

During 320,678 person-years of follow-up, there were 2059 patients with ischemic stroke observed and the incidence of ischemic stroke was 6.42 per thousand person-years. Participants exposed to SHS daily faced a 21 % higher risk of ischemic stroke (HR = 1.21, 95 %CI: 1.09-1.34) compared to those exposed to SHS less than once a week. Subgroup analyses revealed that daily SHS exposure was linked to heightened risk of ischemic stroke among women, non-employed, and non-weekly tea drinkers.

CONCLUSIONS

Daily SHS exposure was associated with higher risks of ischemic stroke. Proactive tobacco control strategies are necessary to decrease the risk of ischemic stroke in never smokers.

Health effects associated with exposure to secondhand smoke: a Burden of Proof study

Despite a gradual decline in smoking rates over time, exposure to secondhand smoke (SHS) continues to cause harm to nonsmokers, who are disproportionately children and women living in low- and middle-income countries. We comprehensively reviewed the literature published by July 2022 concerning the adverse impacts of SHS exposure on nine health outcomes. Following, we quantified each exposure-response association accounting for various sources of uncertainty and evaluated the strength of the evidence supporting our analyses using the Burden of Proof Risk Function methodology. We found all nine health outcomes to be associated with SHS exposure. We conservatively estimated that SHS increases the risk of ischemic heart disease, stroke, type 2 diabetes and lung cancer by at least around 8%, 5%, 1% and 1%, respectively, with the evidence supporting these harmful associations rated as weak (two stars). The evidence supporting the harmful associations between SHS and otitis media, asthma, lower respiratory infections, breast cancer and chronic obstructive pulmonary disease was weaker (one star). Despite the weak underlying evidence for these associations, our results reinforce the harmful effects of SHS on health and the need to prioritize advancing efforts to reduce active and passive smoking through a combination of public health policies and education initiatives.

Occupational Disease in New York State: An Update

An assessment of occupational disease in New York State was undertaken that partially replicated and expanded earlier work from 1987. Utilizing an expanded conception of occupational disease, the assessment used a variety of data sources and methods to provide estimates of mortality and morbidity of occupational disease; workers exposed to specific workplace hazards; disparities in occupational disease among racial/ethnic groups and gender; costs and distribution of costs of occupational disease; and accessible occupational medical resources. Examples of the pathways work may impact health in some of the major health issues of current import including stress-related health conditions; substance use; and overweight/obesity were included. The report contains recommendations for addressing the problem of occupational disease in New York State and advocates for the convening of a statewide group to develop an occupational disease prevention agenda.

In‐hospital outcomes of patients with a hypertensive emergency at a medical center, Ethiopia: A prospective observational study

Background

Hypertensive emergency is associated with substantial complications and loss of life across the world. Early identification and treatment of hypertensive emergency complications are critical to prevent or avoid any consequences. Despite this, in Ethiopia, studies addressing mortality rate and its predictors as well as complications of hypertensive emergency are limited.

Aims

This study aim to evaluate in‐hospital mortality of patients admitted with a hypertensive emergency at the emergency ward of Jimma Medical Center.

Methods

A consecutive sample of 140 adult (≥18 years of age) patients with a hypertensive emergency were recruited from September 1, 2020 to February 25, 2021 at Jimma Medical Center, Ethiopia and were followed up from admission to discharge/death. Patients who declined to participate and readmitted during the study period were excluded. To assess factors associated with in‐hospital mortality, bivariate and multivariate Cox regression analyses were performed. A p value of less than 0.05 was used to declare the statistical significance.

Results

Over three‐fourths of the study participants, that is, 108 (77.1%), were males with a mean (±standard deviation) age of 52.8 ± 13.6 years. Hemorrhagic stroke, 53 (38.0%), and acute kidney injury, 38 (27.1%), were the most common complications of hypertensive emergency. The average (±standard deviation) length of stay in the hospital was 8.53 ± 3.61 days. During in‐hospital follow‐up, 16 patients (11.4%, 95% confidence interval: 6.7–17.9) died. Multivariate Cox regression analysis showed that there was a significant relationship between patients not doing regular physical exercise before the current admission (adjusted hazard ratio = 4.629, 95% confidence interval: 1.171–18.294, p = 0.015) and in‐hospital mortality.

Conclusion

More than one‐tenth of patients with hypertensive emergency death was recorded at Jimma Medical Center. The frequent complications of hypertensive emergency were hemorrhagic stroke and acute renal injury. Not doing regular physical exercise before the current admission raises the likelihood of in‐hospital death. Therefore, strengthening and encouraging patients to perform regular physical exercise is imperative.

Brain Energy Metabolism in Ischemic Stroke: Effects of Smoking and Diabetes

Proper regulation of energy metabolism in the brain is crucial for maintaining brain activity in physiological and different pathophysiological conditions. Ischemic stroke has a complex pathophysiology which includes perturbations in the brain energy metabolism processes which can contribute to worsening of brain injury and stroke outcome. Smoking and diabetes are common risk factors and comorbid conditions for ischemic stroke which have also been associated with disruptions in brain energy metabolism. Simultaneous presence of these conditions may further alter energy metabolism in the brain leading to a poor clinical prognosis after an ischemic stroke event. In this review, we discuss the possible effects of smoking and/or diabetes on brain glucose utilization and mitochondrial energy metabolism which, when present concurrently, may exacerbate energy metabolism in the ischemic brain. More research is needed to investigate brain glucose utilization and mitochondrial oxidative metabolism in ischemic stroke in the presence of smoking and/or diabetes, which would provide further insights on the pathophysiology of these comorbid conditions and facilitate the development of therapeutic interventions.

Trend of passive smoking and associated factors in Iranian children and adolescents: the CASPIAN studies

Background

It is well documented that, similar to active smokers, passive smokers are also at an increased risk of developing non-communicable diseases, and it could impose high financial costs on the healthcare system. This study aimed to evaluate the trend of passive smoking and related determinants during the three phases of a school-based surveillance program.

Methods

This is a secondary study using the national data obtained from three phases of the surveillance program entitled The Childhood and Adolescence Surveillance and Prevention of Adult Noncommunicable Disease (CASPIAN) study, conducted from 2008 to 2014 on Iranian children and adolescents living in urban and rural areas of 30 provinces in Iran. Participants were selected by cluster multistage sampling method.

Results

Overall, the study participants consisted of 33,288 students (50.5% boys) with a mean (± SD) age of 12.8 ± 3.2 years. The passive smoking rate was significantly increased from 35.6% in 2008 to 43.2% in 2015 among children and adolescents. According to the multivariate logistic regression, father’s university education, mother’s employment, life satisfaction, and socioeconomic status had a protective role regarding second-hand smoke exposure. In contrast, the father’s self-employment had a positive role in increasing the rate of passive smoking.

Conclusion

Considering the increasing trend of passive smoking and its considerable adverse health effects, it is necessary to implement large-scale public interventions to reduce the rate and hazards of exposure to tobacco smoke.

Rates, Predictors, and Impact of Smoking Cessation after Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis

BACKGROUND

Smoking cessation after a first cardiovascular event reduces the risk of recurrent vascular events and mortality. This systematic review and meta-analysis aimed to summarize data on the rates, predictors, and the impact of smoking cessation in patients after a stroke or transient ischemic attack (TIA).

METHODS

MEDLINE, EMBASE and Web of Science were searched to identify all published studies providing relevant data through May 20, 2021. Random-effects meta-analysis method was used to pool proportions. Some findings were summarized narratively.

RESULTS

Twenty-five studies were included. The pooled smoking cessation rates were 51.0% (8 studies, n = 1738) at 3 months, 44.4% (7 studies, n = 1920) at 6 months, 43.7% (12 studies, n = 1604) at 12 months, and 49.8% (8 studies, n = 2549) at 24 months or more of follow-up. Increased disability and intensive smoking cessation support programs were associated with a higher likelihood of smoking cessation, whereas alcohol consumption and depression had an inverse effect. Two studies showed that patients who quit smoking after a stroke or a TIA had substantially lower risk of recurrent stroke, death, and a composite of stroke, myocardial infarction, and death.

CONCLUSION

Smoking cessation in stroke survivors is associated with reduced recurrent vascular events and death. About half of smokers who experience a stroke or a TIA stop smoking afterwards. Those with low post-stroke disability, who consume alcohol, or have depression are less likely to quit. Intensive support programs can increase the likelihood of smoking cessation.

Stroke Prevention: Little-Known and Neglected Aspects

Combining available therapies has the potential to reduce the risk of stroke by 80% or more. A comprehensive review of all aspects of stroke prevention would be very lengthy; in this narrative review, we focus on some aspects of stroke prevention that are little-known and/or neglected. These include the following: (1) implementation of a Mediterranean diet; (2) B vitamins to lower homocysteine; (3) coordinated approaches to smoking cessation; (4) intensive lipid-lowering therapy; (5) lipid lowering in the elderly; (6) physiologically individualized therapy for hypertension based on renin/aldosterone phenotyping; (7) avoiding excessive blood pressure reduction in patients with stiff arteries; (8) treatment of insulin resistance with pioglitazone in stroke patients with prediabetes and diabetes; (9) impaired activation of clopidogrel in patients with variants of CYP2C19; (10) aspirin pseudoresistance due to enteric coating; (11) rationale for anticoagulation in patients with embolic stroke of unknown source; (12) pharmacologic properties of direct-acting oral anticoagulants that should be considered when choosing among them; (13) the identification of which patients with asymptomatic carotid stenosis are at a high enough risk to benefit from carotid endarterectomy or stenting; and (14) the importance of age in choosing between endarterectomy and stenting. Stroke prevention could be improved by better recognition of these issues and by implementation of the principles derived from them.

Preoperative Dependent Functional Status Is Associated With Poor Outcomes After Carotid Endarterectomy and Carotid Stenting in Both Symptomatic and Asymptomatic Patients

BACKGROUND

Both Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the most common procedures to treat patients with symptomatic, and asymptomatic high-grade carotid stenosis. Poor preoperative functional status (FS) is increasingly being recognized as predictor for postoperative outcomes. The purpose of this study is to determine the impact of preoperative functional status on the outcomes of patients who undergo CEA or CAS.

METHODS

Data was obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from the years 2011-2018. All patients in the database who underwent CEA or CAS during this time period were identified. Patients were then further divided into 2 subgroups: FS-Independent and FS-dependent. Bivariate and multivariate analyses was performed for pre, intra and post-operative variables with functional status. Outcomes for treatment of symptomatic carotid disease were compared to those with asymptomatic disease among the cohort of functionally dependent patients.

RESULTS

A total of 27,163 patients (61.2% Males, 38.8% Females) underwent CEA (n = 26,043) or CAS (n = 1,120) from 2011-2018. Overall, primary outcomes were as follows: mortality 0.77% (n = 210) and stroke 1.87% (n = 507).Risk adjusted multivariate analysis showed that FS-D patients undergoing CEA had higher mortality (AOR 3.06, CI 1.90-4.92, P < 0.001), longer operative times (AOR 1.36, CI 1.17-1.58, P< 0.001) higher incidence of unplanned reoperation (AOR 1.68, CI 1.19-2.37, P = 0.003), postoperative pneumonia (AOR 5.43, CI 1.62 - 18.11, P = 0.006) and ≥3 day LOS (AOR 3.05, CI 2.62-3.56, P < 0.001) as compared to FS-I patients. FS-D patients undergoing CAS had higher incidence of postoperative pneumonia (AOR 20.81, CI 1.66-261.54, P = 0.019) and higher incidence of LOS ≥3 days (AOR 2.18, CI 1.21-3.93, P < .01) as compared to FS-I patients. Survival analysis showed that the best 30-day survival was observed in FS-I patients undergoing CEA, followed by FS-I patients undergoing CAS, followed by FS-D patients undergoing CEA, followed by FS-D patients undergoing CAS. FS-D status increased mortality after CEA by 2.11%. When the outcomes of CAS and CEA were compared to each other for the cohort of FS-D patients, CAS was associated with higher incidence of stroke (AOR 3.46, CI 0.32-1.97, P= 0.046), shorter operative times (AOR 0.25, CI 0.12-0.52, P < 0.001) and higher incidence of pneumonia (AOR 11.29, CI 1.32-96.74, P = 0.027). Symptomatic patients undergoing CEA had higher LOS as compared to symptomatic patients undergoing CAS, and asymptomatic patients undergoing CEA or CAS.

CONCLUSIONS

FS-D patients, undergoing CEA have higher mortality as compared to FS-I patients undergoing CAS. FS-D patients undergoing CAS have higher incidence of postoperative pneumonia and longer LOS as compared to FS-I patients. For the cohort of FS-D patients undergoing either CEA or CAS, CAS was associated with higher risk of stroke and reduced operative times. Risk benefit ratio for any carotid intervention should be carefully assessed before offering it to FS-D patients. Preoperative Dependent Functional Status Is Associated with Poor Outcomes After Carotid Endarterectomy and Carotid Stenting in Both Symptomatic and Asymptomatic Patients.

Sex, Knowledge, and Attitude of Stroke Survivors Attending Bebe Herbal Center on Risk Factors before and after Stroke

Objective

The objective of this study was to investigate the extent stroke survivors who attended an herbal center knew of stroke risk factors and whether significant sex differences existed. Study Design. This was a cross-sectional study conducted from January to June 2018 at Bebe Herbal Center, and it involved two well-trained assistants who interviewed 149 first-time stroke survivors after consent and ethical approval were obtained. The survivors self-reported their knowledge, attitude, and beliefs on risk factors before and after stroke. Statistical Analyses. Means of continuous variables were compared using Student's unpaired t-test, while categorical variables between males and the females were analyzed using Pearson's chi-square test. P < 0.05 was taken as significant.

Results

Mean age of men (64.81 ± 1.24 yrs) was significantly higher than that of women (61.39 ± 1.42 yrs) (F = 0.096, t = 1.79, df = 147; P < 0.05). More men than women were 60 years and above while more women than men were below 60 years. Pearson's chi-square test showed significant association of sex with education (χ² = 12.31; df = 3, P < 0.006), occupation (χ² = 23.65; df = 4, P < 0.001), alcohol intake (χ² = 24.23; df = 1; P < 0.001), and smoking (χ² = 9.823; df = 1; P < 0.001). The commonest risk factor suffered was hypertension (73.1%), followed by alcohol intake (59.1%), smoking (31.5%), and diabetes mellitus (26.7%); these affected men more than women. Male survivors unaware of their hypertensive status were more likely to have stroke than females, and age had a significant effect on the likelihood of developing a stroke; the same was occupation.

Conclusions

These survivors suffered mainly from hypertension, triggered by psychosocial problems and diabetes mellitus; their stroke seemed fueled by unrecognized hypertension, unrecognized diabetes mellitus, ignorance of hyperlipidemia, and wide-scale belief in witchcraft as risk factor. Awareness programs in the third world should take these observations into consideration.

Multiple self-care behaviors and associated factors in community-dwelling patients with hypertension in Myanmar

This study aimed to identify the prevalence of self-care behaviors and the associated factors among hypertensive patients in primary care in Myanmar. This cross-sectional study was conducted from April to May 2019 among 410 hypertensive patients in Myitkyina Township, Kachin State, Myanmar. Hypertensive patients aged 30–70 years old and being registered at the community health centers in Myitkyina Township were selected using multi-stage cluster random sampling. Self-care behaviors were measured by Hypertensive Self-Care Activity Level Effect (H-SCALE). Chi-square test and multiple logistic regression analysis were used to explore the associated factors. Prevalence of adherence to multiple self-care behaviors were low: avoidance of tobacco use at 50.2%, followed by physical activity at 24.9%, medication at 24.1%, weight management at 9.5%, and healthy diet at 2.7%, while abstinence from harmful alcohol drinking was high at 97.8%. Multiple logistic regression analysis indicated that younger patients, low family income, inadequate knowledge, and no comorbidity were associated with non-adherence to medication. Living in rural area and having poor self-efficacy were associated with non-adherence to weight management, while being younger, female and having poor self-efficacy were also associated with non-adherence to physical activity. Compared with Kachin, other ethnics were more likely to be non-adherent to avoidance of tobacco use. Although a majority of respondents were not harmful drinkers, adherence to medication, healthy diet, physical activity, weight management and avoidance of tobacco use were very low. Health practitioners should provide education programs for hypertensive patients to direct them towards practical techniques in managing their blood pressure.

Stroke, Smoking and Vaping: The No-Good, the Bad and the Ugly

Both stroke and smoking continue to be major public health crises in the United States, with stroke being the third and fourth leading cause of death among women and men, respectively. The goal of this review will be to provide clinicians a succinct overview regarding the epidemiology, economics, and biology of stroke in the setting of smoking and electronic cigarette use. Special attention will be given to the escalating public health crisis of electronic cigarette use, emphasizing mechanistic relationships of stroke and lung injury. Readers will be made aware of the need for continued scientific advancement and study regarding these relationships, as well as the need for improved governmental and public health efforts to curb these ongoing public health crises.

Management of asymptomatic carotid stenosis

Patients with asymptomatic carotid stenosis (ACS) are at very high risk of coronary events, so they should all receive intensive medical therapy. What is often accepted as “best medical therapy” is usually suboptimal. Truly intensive medical therapy includes lifestyle modification, particularly smoking cessation and a Mediterranean diet. All patients with ACS should receive intensive lipid-lowering therapy, should have their blood pressure well controlled, and should receive B vitamins for lowering of plasma total homocysteine (tHcy) if levels are high; a commonly missed cause of elevated tHcy is metabolic B12 deficiency, which should be diagnosed and treated. Most patients with ACS would be better treated with intensive medical therapy than with either carotid endarterectomy (CEA) or stenting (CAS). A process called “treating arteries instead of treating risk factors” markedly reduced the risk of ACS in an observational study; a randomized trial vs. usual care should be carried out. The few patients with ACS who could benefit (~15%, or perhaps more if recent evidence regarding the risk of intraplaque hemorrhage is borne out) can be identified by a number of features. These include microemboli on transcranial Doppler, intraplaque hemorrhage, reduced cerebrovascular reserve, and echolucency of plaques, particularly “juxtaluminal black plaque”. No patient should be subjected to CAS or CEA without evidence of high-risk features, because in most cases the 1-year risk of stroke or death with intervention is higher with either CEA (~2%) or CAS (~4%) than with intensive medical therapy (~0.5%). Most patients, particularly the elderly, would be better treated with CEA than CAS. Most strokes can be prevented in patients with ACS, but truly intensive medical therapy is required.

Acute effects of electronic cigarettes on arterial pressure and peripheral sympathetic activity in young nonsmokers

Electronic cigarettes (e-cigarettes) are marketed as an alternative to smoking for those who want to decrease the health risks of tobacco. Tobacco cigarettes increase heart rate (HR) and arterial pressure, while reducing muscle sympathetic nerve activity (MSNA) through sympathetic baroreflex inhibition. The acute effects of e-cigarettes on arterial pressure and MSNA have not been reported: our purpose was to clarify this issue. Using a randomized crossover design, participants inhaled on a JUUL e-cigarette containing nicotine (59 mg/mL) and a similar placebo e-cigarette (0 mg/mL). Experiments were separated by ∼1 mo. We recorded baseline ECG, finger arterial pressure (n = 15), and MSNA (n = 10). Subjects rested for 10 min (BASE) and then inhaled once every 30 s on an e-cigarette that contained nicotine or placebo (VAPE) for 10 min followed by a 10-min recovery (REC). Data were expressed as Δ means ± SE from BASE. Heart rate increased in the nicotine condition during VAPE and returned to BASE values in REC (5.0 ± 1.3 beats/min nicotine vs. 0.1 ± 0.8 beats/min placebo, during VAPE; P < 0.01). Mean arterial pressure increased in the nicotine condition during VAPE and remained elevated during REC (6.5 ± 1.6 mmHg nicotine vs. 2.6 ± 1 mmHg placebo, during VAPE and 4.6.0 ± 1.7 mmHg nicotine vs. 1.4 ± 1.4 mmHg placebo, during REC; P < 0.05). MSNA decreased from BASE to VAPE and did not restore during REC (-7.1 ± 1.6 bursts/min nicotine vs. 2.6 ± 2 bursts/min placebo, during VAPE and -5.8 ± 1.7 bursts/min nicotine vs. 0.5 ± 1.4 bursts/min placebo, during REC; P < 0.05). Our results show that acute e-cigarette usage increases mean arterial pressure leading to a baroreflex-mediated inhibition of MSNA.NEW & NOTEWORTHY The JUUL e-cigarette is the most popular e-cigarette in the market. In the present study, inhaling on a JUUL e-cigarette increased mean arterial pressure and heart rate, and decreased muscle sympathetic nerve activity (MSNA). In contrast, inhaling on a placebo e-cigarette without nicotine elicited no sympathomimetic effects. Although previous tobacco cigarette studies have demonstrated increased mean arterial pressure and MSNA inhibition, ours is the first study to report similar responses while inhaling on an e-cigarette. Listen to this article's corresponding podcast at @ https://ajpheart.podbean.com/e/aerosolized-nicotine-and-cardiovascular-control/.

Association between secondhand smoke exposure and hypertension: nearly as large as smoking

: Active smoking is a widely accepted risk factor for cardiovascular disease and is recognized as a major public health problem. Passive smoking, also known as secondhand smoke exposure (SHSE), is thought to have similar cardiovascular consequences and the risk has been postulated to be equivalent to that of active smoking. A major component of this risk involves the connection with chronic hypertension. There are several population-based observational studies investigating the relationship between SHSE and chronic hypertension, all of which demonstrate a positive association. Given that SHSE appears to be a risk factor for chronic hypertension, SHSE should also be a risk factor for hypertensive end-organ disease. Many studies have sought to investigate this relationship, but this has yet to be fully elucidated. In this review, we focus on the current evidence regarding the association between SHSE and hypertension as well as exploration of the links between SHSE and hypertensive end-organ damage.

Cigarette Smoking and Incident Stroke in Blacks of the Jackson Heart Study

Background Blacks are disproportionately affected by stroke compared with whites; however, less is known about the relationship between stroke and cigarette smoking in blacks. Therefore, we evaluated the relationship between cigarette smoking and all incident stroke in the JHS (Jackson Heart Study). Methods and Results JHS participants without a history of stroke (n=4410) were classified by self-reported baseline smoking status into current, past (smoked at least 400 cigarettes/life), or never smokers at baseline (2000-2004). Current smokers were further classified by smoking intensity (number of cigarettes smoked per day [1-19 and ≥20]) and followed up for incident stroke (through 2015). Hazard ratios (HRs) for incident stroke for current and past smoking compared with never smoking were estimated with adjusted Cox proportional hazard regression models. After adjusting for cardiovascular risk factors, the risk for stroke in current smokers was significantly higher compared with never smokers (HR, 2.48; 95% CI, 1.60-3.83) but there was no significant difference between past smokers and never smokers (HR, 1.10; 95% CI, 0.74-1.64). There was a dose-dependent increased risk of stroke with smoking intensity (HR, 2.28 [95% CI, 1.38-3.86] and HR, 2.78 [95% CI, 1.47-5.28] for current smokers smoking 1-19 and ≥20 cigarettes/day, respectively). Conclusions In a large cohort of blacks, current cigarette smoking was associated with a dose-dependent higher risk of all stroke. In addition, past smokers did not have a significantly increased risk of all stroke compared with never smokers, which suggests that smoking cessation may have potential benefits in reducing the incidence of stroke in blacks.

Female vulnerability to the effects of smoking on health outcomes in older people

Cigarette smoking is among the leading risk factors for mortality and morbidity. While men have a higher smoking prevalence, mechanistic experiments suggest that women are at higher risk for health problems due to smoking. Moreover, the comparison of smoking effects on multiple conditions and mortality for men and women has not yet been done in a population-based group with race/ethnic diversity. We used proportional hazards models and restricted mean survival time to assess differences in smoking effects by sex for multiple health outcomes using data from the U.S. Health and Retirement Study (HRS), a population-representative cohort of individuals aged 50+ (n = 22,708, 1992-2014). Men had experienced more smoking pack-years than women (22.0 vs 15.6 average pack-years). Age of death, onset of lung disorders, heart disease, stroke, and cancer showed dose-dependent effects of smoking for both sexes. Among heavy smokers (>28 pack-years) women had higher risk of earlier age of death (HR = 1.3, 95%CI:1.03-1.65) and stroke (HR = 1.37, 95%CI:1.02-1.83). Risk of cancer and heart disease did not differ by sex for smokers. Women had earlier age of onset for lung disorders (HR = 2.83, 95%CI:1.74-4.6), but men risk due to smoking were higher (Smoking-Sex interaction P<0.02) than women. Passive smoke exposure increased risk of earlier heart disease (HR = 1.33, 95%CI:1.07-1.65) and stroke (HR:1.54, 95%CI:1.07-2.22) for non-smokers, mainly in men. Smoking cessation after 15 years partially attenuated the deleterious smoking effects for all health outcomes. In sum, our results suggest that women are more vulnerable to ever smoking for earlier death and risk of stroke, but less vulnerable for lung disorders. From an epidemiological perspective, sex differences in smoking effects are important considerations that could underlie sex differences in health outcomes. These findings also encourage future mechanistic experiments to resolve potential mechanisms of sex-specific cigarette smoke toxicity.

Secondhand cigarette smoke induces increased expression of contractile endothelin receptors in rat coronary arteries via a MEK1/2 sensitive mechanism

OBJECTIVES

Cigarette smoke, a strong risk factor for cardiovascular diseases, upregulates contractile endothelin (ET) receptors in coronary arteries. The present study examined the effects of second hand cigarette smoke exposure on the contractile endothelin receptors and the role of the MEK1/2 pathway in rat coronary arteries. Design: Rats were exposed to secondhand smoke (SHS) for 8 weeks followed by intraperitoneal injection of a MEK1/2 inhibitor, U0126 daily for another 4 weeks. Contractile responses of isolated coronary arteries were recorded by a sensitive wire myograph. The receptor protein expression levels were examined by Western blotting. Results: The results showed that SHS in vivo caused increased expression of ET receptors ET_A and ET_B, and that the MEK1/2 blocker U0126 significantly reversed SHS exposure-increased ET_A-mediated contractile responses and protein levels. Similar alterations were observed in ET_B receptors. U0126 showed dose-dependent effects on SHS-induced response on contractile property and protein levels of the ET_B receptor. However, only the higher dose U0126 (15 mg/kg) had inhibitory effects on the ET_A receptor. Conclusions: Taken together, our data show that SHS increases contractile ET receptors and MEK1/2 pathway inhibitor offsets SHS exposure-induced ET_A and ET_B receptor upregulation in rat coronary arteries.

Improved treatment capacity and quality of care: the effectiveness of the stroke prevention and treatment system in Shanghai, China from 2012-2017

Because of the high mortality, recurrence, and rate of disability of stroke, a stroke prevention and treatment system was instituted in Shanghai in 2012; this system includes 11 municipal hospitals, 25 district hospitals, and 240 community health centers. Community health centers focus on early screening in the community, health management of high-risk individuals, and secondary prevention and rehabilitation of stroke patients. Residents' health profiles are utilized by community health centers to proactively identify the population at higher risk. District hospitals are responsible for screening for vascular lesions in high-risk individuals, including carotid artery and intracranial artery screening, and standardized treatment of stroke patients. Municipal hospitals concentrate on complex and emergency care for acute onset stroke. The system specifies care for all stages of stroke management. The development of the system has improved the capacity of and quality of care for stroke patients. The rate at which patients undergo intravenous thrombolysis and the percentage of patients with a door-to-needle time of less than 60 minutes have increased significantly. However, the primary and secondary prevention of stroke is insufficient, the stroke rehabilitation system is incomplete, and the quality of care in primary healthcare facilities is limited. An evaluation system and payment mechanisms are needed to incentivize healthcare personnel to fulfill their responsibilities and to ensure the system's operation.

[Primary Prevention of Acute Stroke]

Primary Prevention of Acute Stroke Abstract. Strokes are frequent. Vascular risk factors are increasing the stroke risk. Most vascular risk factors are treatable. Their therapy is important in the primary prevention of stroke. According to the INTERSTROKE study, arterial hypertension, inactivity, overweight, dyslipidemia, smoking, unhealthy diet, cardiac pathologies such as major arrhythmia, diabetes mellitus, stress/depression and overconsumption of alcohol are the most important treatable vascular risk factors. In this article, we will also report on at present less well known treatable vascular risk factors such as sleep apnea, atheromatosis of the aortic arch and of arteries supplying the brain, migraine with aura and chronic inflammatory disorders and infections.

Association of secondhand tobacco smoke exposure during childhood on adult cardiovascular disease risk among never-smokers

PURPOSE

Adult secondhand tobacco smoke (SHS) exposure is related to stroke and coronary heart disease (CHD) risk, but long-term effects are less clear. We evaluated whether childhood SHS exposure affects subsequent stroke or CHD risk among adult black and white never-smokers followed for stroke and CHD.

METHODS

In this prospective cohort study, inverse probability weights were calculated to correct for bias due to attrition and survey nonresponse. Cox proportional hazards models were used to assess hazard ratios and 95% confidence intervals for stroke or CHD, separately, by number of childhood household smokers.

RESULTS

Of 13,142 eligible participants, 6136 had childhood SHS exposure assessed. Baseline mean (SD) age was 63.5 (9.0), 65% were female, 30% black, 46% reported 0 childhood household smokers, 36% reported 1, and 18% reported 2+. In 60,649 person-years, 174 strokes were observed (2.9% of participants), and in 45,195 person-years, 114 CHD events were observed (2.1% of participants). The weighted and adjusted hazard ratios (95% confidence intervals) of stroke for 2+ versus 0 childhood household smokers was 1.66 (1.29-2.13) and was 1.15 (0.82-1.59) for CHD.

CONCLUSIONS

We observed a significant association between childhood SHS exposure and stroke, but not CHD, after age 45 years and adjusting for missing information.

Cardiovascular risk factors of hypertension, smoking and obesity: Emerging concerns among Pathan and Persian young adults?

Background: Hypertension was considered as a disease of the elderly but due to unhealthy dietary and lifestyle changes its incidence has increased in younger population. Smoking and obesity are emerging concerns the world is facing globally in younger age groups. This study is therefore aimed to identify these cardiovascular risk factors among Pathan and Persian young adults.

Methods: It was a cross-sectional study carried out at multiple undergraduate, postgraduate educational institutes and hospitals using non-probability convenient sampling among young adults aged between 15 to 40 years for a period of six months from Apr 1st, 2017 to Sep 30th, 2017. Mean±SD was calculated for continuous variables and categorical variables were expressed as frequencies. Chi-square test and Fisher exact test were used for statistical analysis.

Results: A total of 708 subjects were included. Mean±SD age was 26.12±3.7 years. Out of 708, 300(42.37%) were smokers with 209 (29.52%) active and 91 (12.85%) passive smokers. Among smokers, 216 (30.5%) were males while 84 (11.87%) were females. A total of 432 (61.02%) subjects were not doing any exercise, and 636 (89.83%) were consuming junk food. A total of 165 (23.3%) subjects were overweight, and 15 (2.1%) were obese. Stage-1 hypertension was present in 72 (10.2%), while 16 (2.25%) subjects had stage-2 hypertension.

Conclusion: There is an increased prevalence of cardiovascular risk factors which includes hypertension, smoking, and obesity among Pathan and Persian young adults.

Exposure to second-hand smoke among secondary school-going adolescents: Findings from the Malaysian Adolescent Health Risk Behaviour (MyAHRB) study

Background:

Exposure to second-hand smoke (SHS) is one of the main causes of morbidity and it has been proven to be associated with an increased likelihood of smoking initiation among adolescents. Nonetheless, evidence on SHS exposure among Malaysian adolescents is scarce. Therefore, this article aims to demonstrate the magnitude and factors associated with SHS exposure among school-going adolescents in selected secondary schools in Peninsular Malaysia.

Methods:

Data were derived from the Malaysian Adolescent Health Risk Behaviour (MyAHRB) study conducted in 2013. A total of 2599 adolescent were recruited into the study using a two-stage proportionate-to-size sampling method. Data were obtained from self-administered questionnaires. Descriptive analysis and multivariable logistic regression were performed to determine the risk factors/predictors associated with SHS.

Results:

More than half of the respondents had been exposed to SHS during the last one week (56.4%), and SHS exposure was significantly higher among respondents who smoked (94.0% vs. 49.9%, p <0.001). Multivariable analysis revealed that the likelihood of exposure to SHS was higher among those who smoked (adjusted odds ratio (aOR) 12.90, 95% confidence interval (CI): 8.01–20.4), had at least one parent/guardian who smoked (aOR 5.49, 95% CI: 4.41–6.94) and adolescents of Malay descent (aOR 2.10, 95% CI: 1.68–2.63).

Conclusion:

Our findings suggested that the effectiveness of anti-smoking measures implemented in recent years to protect adolescents from the health risks of passive smoking were less evident. Therefore, educational and awareness programmes that emphasize the negative health impacts of SHS exposure on Malaysian adolescents, particularly when among smoking adults, should be intensified to help in preventing adoption of smoking behaviours among adolescents.

The relationship between smoking and stroke: A meta-analysis

BACKGROUND

Stroke is one of the leading causes of death and disability for adult men and women worldwide, and a number of studies have explored the influences of smoking on stroke. However, few studies have discussed the relationship between stroke and smoking with consideration of the following factors: sex, the number of cigarettes smoked per day, stroke subtype, and the follow-up duration. Consequently, we aimed to extend previous work by using a systematic review to explore the relationship between stroke and cigarette smoking in reference to the above factors.

METHODS

A systematic review was conducted using the PubMed, Embase, and Cochrane Central Register databases and the following search criteria: ["stroke" (MeSH) and "smoking" (MeSH)]. All analyses were conducted with Stata, and funnel plots and Egger regression asymmetry tests were used to assess publication bias.

RESULTS

The meta-analysis included 14 studies involving 303134 subjects. According to the meta-analysis, smokers had an overall increased risk of stroke compared with nonsmokers, with a pooled odds ratio (OR) of 1.61 (95% confidence interval [CI]: 1.34-1.93, P < .001). A subgroup analysis conducted based on smoking status revealed ORs of 1.92 (95% CI: 1.49-2.48) for current smokers and 1.30 (95% CI: 0.93-1.81) for former smokers. In addition, the relationship between stroke of any type and smoking status was also statistically significant; current smokers had an increased risk of stoke compared with nonsmokers (OR: 1.46, 95% CI: 1.04-2.07, P < .001), which was influenced by sex (men: OR: 1.54, 95% CI: 1.11-2.13, P = .002; women: OR: 1.88, 95% CI: 1.45-2.44, P < .023). From the analysis, we also observed that passive smoking increased the overall risk of stroke by 45% (OR: 1.45, 95% CI: 1.0-2.11, P < .05). Based on the dose-response meta-analysis, the risk of stroke increased by 12% for each increment of 5 cigarettes per day.

Association of exposure level to passive smoking with hypertension among lifetime nonsmokers in Japan: a cross-sectional study

Brief exposure to passive smoking immediately elevates blood pressure. However, little is known about the association between exposure to passive smoking and chronic hypertension. We aimed to examine this association in a cross-sectional study, after controlling multiple potential confounders.Participants included 32,098 lifetime nonsmokers (7,216 men and 24,882 women) enrolled in the Japan Multi-Institutional Collaborative Cohort Study. Passive smoking was assessed using a self-administered questionnaire. The single question about exposure to passive smoking had five response options: "sometimes or almost never," "almost every day, 2 hours/day or less," "almost every day, 2 to 4 hours/day," "almost every day, 4 to 6 hours/day," and "almost every day, 6 hours/day or longer." Hypertension was defined as any of the following: systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or use of antihypertensive medication. Multivariate-adjusted odds ratio (OR) and 95% confidence interval (CI) for hypertension were estimated by exposure level to passive smoking using unconditional logistic regression models.The multivariate-adjusted OR for hypertension in those exposed almost every day was 1.11 (95% CI: 1.03-1.20) compared with those exposed sometimes or almost never. The OR for a 1-hour per day increase in exposure was 1.03 (95% CI: 1.01-1.06, Pfor trend = .006). This association was stronger in men than in women; the ORs were 1.08 (95% CI: 1.01-1.15, Pfor trend = .036) and 1.03 (95% CI: 1.00-1.05, Pfor trend = .055), respectively.Our findings suggest importance of tobacco smoke control for preventing hypertension.

Thyroid nodules in centenarians: prevalence and relationship to lifestyle characteristics and dietary habits

Background

Thyroid nodules (TNs) are common thyroid lesions in older population. Few studies have focused on the prevalence of TNs and their relationship to lifestyle characteristics and dietary habits in centenarians. The current study aimed at determining the prevalence of TNs in Chinese centenarians by using high-resolution ultrasound (US) equipment and at investigating its relationship to lifestyle characteristics and dietary habits.

Participants and methods

The current study was part of the China Hainan Centenarian Cohort Study that was conducted in Hainan, an iodine-sufficient region in People’s Republic of China. A total of 874 permanent residents aged ≥100 years (mean age =102.8±2.8 years) without any missing data were included in the analysis.

Results

Among the participants, 649 of them were detected at least one TN under the US examinations. The overall prevalence rate of TNs was 74.3%. The prevalence of TNs was higher in participants who were women, had hypertension, had diabetes, and were underweight compared with their counterparts. Multivariate logistic regression analyses showed that being female, hypertensive, and diabetic; betel quid consumption; and red meat consumption were independent risk factors, while being underweight and nut consumption were independent protective factors for TNs.

Conclusion

Our findings indicate that the presence of TNs was highly prevalent in Chinese centenarians, particularly in women. In addition to gender, having hypertension, having diabetes, and being underweight, the presence of TNs was independently associated with betel quid, red meat, and nut consumption. Further prospective studies are warranted to verify these associations in populations from different age strata, races, cultures, and iodine supplementation.

Exposure to tobacco secondhand smoke and its associated factors among non-smoking adults in smoking-restricted and non-restricted areas: findings from a nationwide study in Malaysia

OBJECTIVES

Secondhand smoke (SHS) has been associated with increased morbidity and mortality. Therefore, the aims of the paper are to assess SHS exposure among non-smoking adults in Malaysia attending various smoking-restricted and non-restricted public areas according to the Control of Tobacco Product Regulations (CTPR) as well as its relationship with various sociodemographic variables.

DESIGN

Data were extracted from a cross-sectional study, the Global Adults Tobacco Survey (GATS) 2011 which involved 3269 non-smokers in Malaysia. Data was obtained through face-to-face interviews using a validated pre-tested questionnaire. Factors associated with exposure to SHS were identified via multivariable analysis.

RESULTS

The study revealed that almost two-thirds of respondents were exposed to SHS in at least one public area in the past 1 month, with a significantly higher exposure among males (70.6%), those with higher educational attainment (81.4%) and higher income (quintile 1%-73.9%). Besides, the exposure to SHS was almost four times higher in non-restricted areas compared with restricted areas under the CTPR (81.9% vs 22.9). Multivariable analysis revealed that males and younger adults at non-restricted areas were more likely to be exposed to SHS while no significant associated factors of SHS exposure was observed in restricted areas.

CONCLUSIONS

The study revealed the prevalence of SHS exposure was higher among Malaysian adults. Although smoke-free laws offer protection to non-smokers from exposure to SHS, enforcement activities in restricted areas should be enhanced to ensure strict public abidance. In addition, legislation of restricted areas should also be extended to greatly reduce the SHS exposure among non-smokers in Malaysia.

Awareness of health effects of exposure to secondhand smoke from cigarettes: A cross-sectional study of never-smoked adult primary care patients in Eastern Nigeria

Background:

Cigarette smoking whether actively or passively is a growing public health problem. Despite the wealth of information on the hazards of active cigarette smoking, awareness of the health effects of passive smoking on human population is often neglected in Nigeria.

Aim:

The study was aimed at describing the awareness of health effects of exposure to secondhand smoke from cigarettes among never-smoked adult primary care patients in Eastern Nigeria.

Materials and Methods:

A hospital-based study carried out on a cross-section of 500 adult patients in a primary care clinic in Nigeria. Data were collected using pretested, structured, and interviewer-administered questionnaire. Exposure to secondhand smoke was defined as exposure to cigarette smoke in a never-smoked adult patient in the previous 1 year. Data were analyzed using Statistical Package for Social Sciences version 21 for the calculation of percentages for categorical variables. Bivariate analysis involving Chi-square test was used to test for significance of association between categorical variables at P < 0.05.

Results:

The age of the respondents ranged from 18 to 74 years, with a mean age of 36 ± 12.4 years. There were 180 (36.0%) males with 320 (64%) females, with a sex ratio of 1.8. Awareness of general health effects of secondhand smoke on adults, children, and pregnant women was 95.6%, 92.8%, and 65.2%, respectively. The most common specific health effects the respondents were aware for adults, children, and obstetric population were lung cancer (95.6%), precipitation of asthmatic condition (92.8%), and delivery of small babies (65.2%), respectively. The predominant source of awareness of information was radio (93.6%). Awareness of general health effects of exposure to secondhand smoke on adults (P = 0.041), children (P = 0.031), and obstetrics population (P = 0.02) was significantly associated with exposure status.

Conclusion:

The most common health effects of secondhand smoke the respondents had highest awareness were lung cancer, precipitation of asthmatic attacks, and delivery of small babies in adults, children, and obstetric population, respectively. Awareness of general health effects on adults, children, and obstetrics population was significantly associated with exposure status. The current level of awareness should be improved while effort should be intensified to address identified areas of low level of awareness.

Relationship between Stroke Events during Pachinko Play and Prognosis

BACKGROUND

This study investigated whether pachinko play influences the outcome of stroke events, and identified the significant variables affecting outcomes.

METHODS

We reviewed the medical and imaging records of 2075 consecutive patients with stroke from January 2003 through June 2012. The remaining patients were divided into 2 groups, the pachinko players group (PP) and the non-pachinko players group (NPP). Background factors were recorded on admission. Multivariate logistic regression analysis was used to identify the factors significantly correlated with Glasgow Outcome Scale (GOS) score and risk of death at the time of discharge.

RESULTS

The PP group exhibited higher prevalence of hypertension and current smoking compared with the NPP group. However, no difference was found in outcomes between the PP and NPP groups. Multivariate analysis identified the dependent predictive variables for GOS as age (adjusted β = -.18, 95% confidence interval [CI]: -.22 to -.14, P <.001), Glasgow Coma Scale (GCS) score on admission (adjusted β = .64, 95% CI: .60 to .68, P <.001), and history of hypertension (adjusted β = -.06, 95% CI: -.10 to -.02, P = .007). Logistic regression analysis showed that age (odds ratio = 1.02, 95% CI: 1.01 to 1.04, P <.001) and GCS score on admission (odds ratio = .72, 95% CI: .69 to .75, P <.001) were significantly associated with death at the time of discharge.

CONCLUSIONS

Patients with stroke during playing pachinko have higher prevalence of hypertension and higher smoking rate, but pachinko play itself was not a critical factor determining the outcome of patients with stroke in our emergency center.

Doppler sonographic assessment of carotid arteries in Sudanese stroke patients

BACKGROUND:

Hypertension, diabetes, and smoking were considered to be associated with several public health problems.

OBJECTIVE:

the study aims to explore the hemodynamic of carotid arteries in association with hypertension, diabetes, and smoking in Sudanese stroke patients.

MATERIALS AND METHODS:

In a quantitative descriptive study, fifty patients with stroke were scanned by B-mode and Doppler sonography. Carotid arteries were investigated with a 7-MHz linear transducer by a standard carotid sonography protocol.

RESULTS:

The average Doppler resistive index (RI) was 0.71 ± 0.084 and intima-media thickness was 1.39 ± 0.78 mm. The end diastolic velocities (EDVs) and peak systolic velocities (PSVs) of common carotid arteries were significantly changed in smokers and hypertensive (P < 0.05). The elevation of RI in right and left CCAs were significantly correlated with smokers (P = 0.017 and 0.010 respectively). Hemorrhagic stroke was most prevalent in hypertensive rather than diabetic and smokers. The carotid hemodynamics changed significantly in hypertensive and smokers more than diabetics.

CONCLUSION:

EDV and PSV were significantly correlated with hypertension and tobacco smoking rather than diabetes. Hypertension, diabetes, and smoking have an association with stroke and hand significant effect on carotid artery hemodynamic and atherosclerotic disease. The Doppler RIs were significantly correlated with smokers. Patients with risk factors of stroke should be scanned with Doppler sonography as early as possible.

Chemical and Physical Exposures in the Emerging US Green-Collar Workforce

OBJECTIVE

"Green collar" workers serve in occupations that directly improve environmental quality and sustainability. This study estimates and compares the prevalence of select physical and chemical exposures among green versus non-green U.S. workers.

METHODS

Data from the U.S. 2010 National Health Interview Survey (NHIS) Occupational Health Supplement were linked to the Occupational Information Network (ONET) Database. We examined four main exposures: 1) vapors, gas, dust, fumes (VGDF); 2) secondhand tobacco smoke; 3) skin hazards; 4) outdoor work.

RESULTS

Green-collar workers were significantly more likely to report exposure to VGDF and outdoor work than nongreen-collar workers [adjusted odds ratio (AOR) = 1.25; 95% CI = 1.11 to 1.40; AOR = 1.44 (1.26 to 1.63), respectively]. Green-collar workers were less likely to be exposed to chemicals (AOR = 0.80; 0.69 to 0.92).

CONCLUSIONS

Green-collar workers appear to be at a greater risk for select workplace exposures. As the green industry continues to grow, it is important to identify these occupational hazards in order to maximize worker health.

Passive smoking and stroke in men and women: a national population-based case-control study in China

An association between passive smoking and stroke is unclear in China, particularly the association with hemorrhagic stroke. This study included 16205 deaths due to stroke aged ≥30 years and 16205 non-stroke controls randomly selected and frequency-matched to cases on gender and age. Smoking of spouses, defined as ≥1 cigarette per day for up to 1 year, was taken as a measure of exposure to passive smoking of subjects that was retrospectively ascertained by interviewing surviving spouses. After adjustment for variables, passive smoking increased the risk of death by 10% (odds ratio (OR), 1.10; 95% confidence interval (CI), 1.05-1.16) for all strokes, by 10% (OR, 1.10; 95% CI, 1.04-1.16) for hemorrhagic stroke, and by 12% (OR, 1.12; 95% CI, 1.03-1.23) for ischemic stroke, compared with non-exposure. This finding was highly consistent in men or women and in smokers or non-smokers, and was generally consistent among zones of China despite geographic diversity. The risk significantly increased with exposure-years and quantity of cigarettes smoked daily by spouses. This study indicated that passive smoking is associated with deaths from all-type strokes. It is highly advisable for the government to promote strong tobacco prevention and cessation programs and smoke-free environments.

The effect of nurse-led care on stability time in therapeutic range of INR in ischemic stroke patients receiving warfarin

PURPOSE

The current study is designed in order to investigate the effect of nurse-led care (the supportive and educational measurements by nurses) on stability time in therapeutic range of INR in ischemic stroke patients receiving Warfarin.

METHOD

In this quasi-experimental study, 80 ischemic stroke patients were investigated, 40 patients in experimental group and 40 in the control group referred to the nurse-based warfarin clinics affiliated to Shiraz University of Medical Sciences. The mean±SD duration of the intervention was 144±84days. The patients based on the percentage stability time in the therapeutic range of INR were classified into 3 groups of good control (>75%), medium control (60-75%), and poor control groups (<60%). The results were analyzed using qui-square and independent t-test according to these categories.

RESULTS

38 patients in the experimental group and 39 in the control group had the therapeutic range of INR 2-3. The percentage of the stability time in the therapeutic range of INR (mean±SD) in the experimental group was 64.08%±18.7 and in the control group it was 44.58%±25.12 (P<0.001). The percentage of total INRs within the therapeutic range was 52.5% in the experimental group and 40.6% in the control group (P=0.001).

CONCLUSIONS

In conclusion, using the stroke prevention guidelines, thrombotic therapy protocols and familiarity with patients' diagnosis and risk factors in the experimental group led to more patients' stability time (The time that patients could remain stable within the INR therapeutic range) in their therapeutic range of INR as the best indicator of clinical performance.

Monitoring an outdoor smoking area by means of PM2.5 measurement and vegetal biomonitoring

The extension of pollutant accumulation in plant leaves associated with its genotoxicity is a common approach to predict the quality of outdoor environments. However, this approach has not been used to evaluate the environmental quality of outdoor smoking areas. This study aims to evaluate the effects of environmental tobacco smoke (ETS) by assessing particulate matter 2.5 μm (PM_2.5) levels, the pollen abortion assay, and trace elements accumulated in plant leaves in an outdoor smoking area of a hospital. For this, PM_2.5 was measured by active monitoring with a real time aerosol monitor for 10 days. Eugenia uniflora trees were used for pollen abortion and accumulated element assays. Accumulated elements were also assessed in Tradescantia pallida leaves. The median concentration of PM_2.5 in the smoking area in all days of monitoring was 66 versus 34 μg/m³ in the control area (P < 0.001). In addition, the elements Al, Cd, Cu, Ni, Pb, Rb, Sb, Se, and V in Tradescantia pallida and Al, Ba, Cr, Cu, Fe, Mg, Pb, and Zn in Eugenia uniflora were in higher concentration in the smoking area when compared to control area. Smoking area also showed higher rate of aborted grains (26.1 ± 10.7 %) compared with control (17.6 ± 4.5 %) (P = 0.003). Under the study conditions, vegetal biomonitoring proved to be an effective tool for assessing ETS exposure in outdoor areas. Therefore, vegetal biomonitoring of ETS could be a complement to conventional analyses and also proved to be a cheap and easy-handling tool to assess the risk of ETS exposure in outdoor areas.

Environmental Tobacco Smoke Exposure and Risk of Stroke in Never Smokers: An Updated Review with Meta-Analysis

OBJECTIVES

The study aimed to review the epidemiological evidence relating environmental tobacco smoke exposure to stroke in never smokers.

METHODS

The study is similar to our review in 2006, with searches extended to March 2016.

RESULTS

Twelve further studies were identified. A total of 28 studies varied considerably in design, exposure indices used, and disease definition. Based on 39 sex-specific estimates and the exposure index current spousal exposure (or nearest equivalent), the meta-analysis gave an overall fixed-effect relative risk estimate of 1.23 (95% confidence interval: 1.16-1.31), with significant (P < .05) heterogeneity. There was no significant heterogeneity by sex, continent, fatality, disease end point, or degree of adjustment for potential confounding factors. Relative risks were less elevated in prospective studies (1.15, 1.06-1.24) than in case-control studies (1.44, 1.22-1.60) or cross-sectional studies (1.40, 1.21-1.61). They also varied by publication year, but with no trend. A significant increase was not seen in studies that excluded smokers of any tobacco (1.07, .97-1.17), but was seen for studies that included pipe- or cigar-only smokers, occasional smokers, or long-term former smokers. No elevation was seen for hemorrhagic stroke. Relative risk estimates were similar using ever rather than current exposure, or total rather than spousal exposure. Eleven studies provided dose-response estimates, the combined relative risk for the highest exposure level being 1.56 (1.37-1.79). Many studies have evident weaknesses, recall bias, and particularly publication bias being major concerns.

CONCLUSIONS

Although other reviewers inferred a causal relationship, we consider the evidence does not conclusively demonstrate this. We repeat our call for publication of data from existing large prospective studies.

Β-Amyloid Burden is Not Associated with Cognitive Impairment in Schizophrenia: A Systematic Review

Current literature suggests that the pathology of schizophrenia (SCZ) has developmental origins. However, the neurodevelopmental theory of SCZ cannot solely explain progressive neurodegenerative processes in the illness. There is evidence of accelerated cognitive decline and increased risk of dementia in elderly patients with SCZ. Investigating β-amyloid (Aβ), we conducted a systematic review focusing on Aβ in patients with SCZ. An OVID literature search using PsychINFO, Medline, and Embase databases was conducted, looking for studies that compared Aβ levels between patients with SCZ and either elderly control subjects, patients with Alzheimer disease (AD), or patients with other psychiatric illnesses. Among 14 identified studies, 11 compared Aβ between SCZ and elderly control subjects, 7 between SCZ and AD, and 3 between SCZ and other psychiatric illnesses. As a result, no evidence was found suggesting that Aβ levels differ in patients with SCZ from elderly control subjects or patients with other psychiatric illnesses. All seven studies reported lower cortical Aβ in patients with SCZ than patients with AD. Furthermore, three of the four studies, which investigated the relationship between Aβ and cognitive impairment in SCZ, observed no association between two factors. The limitations of the included studies are small sample sizes, the inclusion of cerebrospinal fluid Aβ or postmortem plaques rather than cortical Aβ assessment in vivo, and the investigation of different brain regions. In conclusion, Aβ deposition is not associated with cognitive decline in late-life SCZ. Future studies should investigate other neurodegenerative indicators in SCZ to better understand the pathophysiologic mechanisms underlying this illness.

Estimating the Economic Impact of Secondhand Smoke on the Health of a Community

Purpose.

This study provides a model to estimate the health-related costs of secondhand smoke exposure at a community level.

Model Development.

Costs of secondhand smoke–related mortality and morbidity were estimated using national attributable risk values for diseases that are causally related to secondhand smoke exposure for adults and children. Estimated costs included ambulatory care costs, hospital inpatient costs, and loss of life costs based on vital statistics, hospital discharge data, and census data.

Application of the Model.

The model was used to estimate health-related costs estimates of secondhand smoke exposure for Marion County, Indiana. Attributable risk values were applied to the number of deaths and hospital discharges to determine the number of individuals impacted by secondhand smoke exposure.

Results.

The overall cost of health care and premature loss of life attributed to secondhand smoke for the study county was estimated to be $53.9 million in 2000—$10.5 million in health care costs and $20.3 million in loss of life for children compared with $6.2 million in health care costs and $16.9 million in loss of life for adults. This amounted to $62.68 per capita.

Conclusions.

This method may be replicated in other counties to provide data needed to educate the public and community leaders about the health effects and costs of secondhand smoke exposure.

Appropriate management of asymptomatic carotid stenosis

With modern intensive medical therapy, the annual risk of ipsilateral stroke in patients with asymptomatic carotid stenosis (ACS) is now down to ∼0.5%. Despite this, there is a widespread practice of routine intervention in ACS with carotid endarterectomy (CEA) and stenting (CAS). This is being justified on the basis of much higher risks with medical therapy in trials conducted decades ago, compared with lower risks of intervention in recent trials with no medical arm. Such extrapolations are invalid. Although recent trials have shown that after subtracting periprocedural risks the outcomes with CEA and CAS are now comparable to medical therapy, the periprocedural risks still far outweigh the risks with medical therapy. In the asymptomatic carotid trial (ACT) 1 trial, the 30-day risk of stroke or death was 2.9% with CAS and 1.7% with CEA. In the CREST trial, the 30-day risk of stroke or death among asymptomatic patients was 2.5% for stenting and 1.4% for endarterectomy. Thus, intensive medical therapy is much safer than either CAS or CEA. The only patients with ACS who should receive intervention are those who can be identified as being at high risk. The best validated method is transcranial Doppler embolus detection. Other approaches in development for identifying vulnerable plaques include intraplaque haemorrhage on MRI, ulceration and plaque lucency on ultrasound, and plaque inflammation on positron emission tomography/CT. Intensive medical therapy for ACS includes smoking cessation, a Mediterranean diet, effective blood pressure control, antiplatelet therapy, intensive lipid-lowering therapy and treatment with B vitamins (with methylcobalamin instead of cyanocobalamin), particularly in patients with metabolic B12 deficiency. A new strategy called 'treating arteries instead of risk factors', based on measurement of carotid plaque volume, is promising but requires validation in randomised trials.

The effects of MEK1/2 inhibition on cigarette smoke exposure-induced ET receptor upregulation in rat cerebral arteries

Cigarette smoking, a major stroke risk factor, upregulates endothelin receptors in cerebral arteries. The present study examined the effects of MEK1/2 pathway inhibition on cigarette smoke exposure-induced ET receptor upregulation. Rats were exposed to the secondhand smoke (SHS) for 8weeks followed by intraperitoneal injection of MEK1/2 inhibitor, U0126 for another 4weeks. The urine cotinine levels were assessed with high-performance liquid chromatography. Contractile responses of isolated cerebral arteries were recorded by a sensitive wire myograph. The mRNA and protein expression levels of receptor and MEK/ERK1/2 pathway molecules were examined by real-time PCR and Western blotting, respectively. Cerebral artery receptor localization was determined with immunohistochemistry. The results showed the urine cotinine levels from SHS exposure group were significantly higher than those from the fresh group. In addition, the MEK1/2 inhibitor, U0126 significantly reduced SHS exposure-increased ETA receptor mRNA and protein levels as well as contractile responses mediated by ETA receptors. The immunoreactivity of increased ETA receptor expression was primarily cytoplasmic in smooth muscle cells. In contrast, ETB receptor was noted in endothelial cells. However, the SHS-induced decrease in endothelium-dependent relaxation was unchanged after U0126 treatment. Furthermore, SHS increased the phosphorylation of MEK1/2 and ERK1/2 protein in cerebral arteries. By using U0126 could inhibit the phosphorylated ERK1/2 protein but not MEK1/2. Taken together, our data show that treatment with MEK1/2 pathway inhibitor offsets SHS exposure-induced ETA receptor upregulation in rat cerebral arteries.

Exogenous Neural Stem Cells Transplantation as a Potential Therapy for Photothrombotic Ischemia Stroke in Kunming Mice Model

Stroke is considered as the second leading cause of death worldwide. The survivors of stroke experience different levels of impairment in brain function resulting in debilitating disabilities. Current therapies for stroke are primarily palliative and may be effective in only a small population of stroke patients. In this study, we explore the transplantation of exogenous neural stem cells (NSCs) as the potential therapy for the photothrombotic ischemia stroke in a Kunming mice model. After stroke, mice receiving NSC transplantation demonstrated a better recovery of brain function during the neurobehavioral tests. Histology analysis of the brain samples from NSC transplanted mice demonstrated a reduction of brain damage caused by stroke. Moreover, immunofluorescence assay for biomarkers in brain sections confirmed that transplanted NSCs indeed differentiated to neurons and astrocytes, consistent with the improved brain function after stroke. Taken together, our data suggested that exogenous NSC transplantation could be a promising therapy for stroke.

Knowledge, attitudes and perceptions of stroke: a cross-sectional survey in rural and urban Uganda

BACKGROUND

Information regarding the increasing burden of non-communicable diseases such as stroke is largely unknown among the vulnerable communities. This analysis, which is part of a larger U.S. National Institute of Heath-funded Medical Education Partnership Initiative neurological disorder survey, assessed community knowledge and attitudes on stroke and stroke risk factors.

METHODS

A population cross-sectional survey was conducted in urban and rural Mukono, district, central Uganda. Through the systematic sampling method, data were gathered from 377 adult participants who were interviewed about selected aspects of stroke knowledge, attitudes and perception using a pretested structured questionnaire.

RESULTS

A total of 377 participants were enrolled (47% urban). The leading risk factors identified by the participants were stress (36.6%) and hypertension (28.9%) respectively. None of the study participants identified cigarette smoking as a stroke risk factor. Seventy six percent of the participants did not recognize stroke as a disease of the brain.

CONCLUSION

Stroke knowledge is poor in both rural and urban Uganda. Tailored public health approaches that improve stroke awareness, knowledge and self management approaches are urgently needed to develop effective preventive measures and community response to stroke.

Meta-analysis of the association between second-hand smoke exposure and ischaemic heart diseases, COPD and stroke

Background

Second-hand smoke (SHS) is the most important contaminant of indoor air in first world countries. The risks associated with SHS exposure are highly relevant, because many people are regularly, and usually involuntarily, exposed to SHS. This study aims to quantify the effects of SHS exposure. Therefore, its impact on ischaemic heart diseases (IHD), chronic obstructive pulmonary diseases (COPD) and stroke will be considered.

Methods

A systematic literature review was conducted to identify articles dealing with the association between SHS and the three outcomes IHD, COPD and stroke. Overall, 24 articles were included in a meta-analysis using a random effects model. Effect sizes stratified for sex and for both sexes combined were calculated.

Results

The synthesis of primary studies revealed significant effect sizes for the association between SHS exposure and all three outcomes. The highest RR for both sexes combined was found for COPD (RR = 1.66, 95 % CI: 1.38–2.00). The RR for both sexes combined was 1.35 (95 % CI: 1.22–1.50) for stroke and 1.27 (95 % CI: 1.10–1.48) for IHD. The risks were higher in women than in men for all three outcomes.

Conclusions

This is the first study to calculate effect sizes for the association between SHS exposure and the disease outcomes IHD, COPD, and stroke at once. Overall, the effect sizes are comparable with previous findings in meta-analyses and therefore assumed to be reliable. The results indicate the high relevance of public health campaigns and legislation to protect non-smokers from the adverse health effects attributable to SHS exposure.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2489-4) contains supplementary material, which is available to authorized users.

Secondhand Smoke Exposure and Stroke: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

INTRODUCTION

Stroke is a major public health concern worldwide given the associated morbidity and mortality. Smoking is a risk factor for stroke, but the relationship between secondhand smoke (SHS) exposure and stroke has been inconsistent to date. The aim of the current study was to examine the association of SHS exposure and risk of stroke and its subtypes (ischemic and hemorrhagic stroke) among nonsmokers.

METHODS

Demographic and clinical characteristics were compared by SHS exposure status for African American and white nonsmokers aged ≥45 years in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study in 2014. Hazard ratios (HRs) and corresponding 95% CIs were calculated by Cox proportional hazards models to assess the relationship between SHS exposure and stroke risk.

RESULTS

Of the 21,743 participants (38% African American, 45% male), SHS exposure in the past year was reported by 23%. Compared with those without SHS exposure, exposed participants were more likely to be female, white, younger, and reside with a smoker (all p<0.001). A total of 428 incident strokes were observed from April 2003 to March 2012 during a mean follow-up of 5.6 years. The risk of overall stroke was increased 30% among those with SHS exposure after adjustment for other stroke risk factors (95% CI=2%, 67%). This relationship appeared to be driven by ischemic strokes.

CONCLUSIONS

SHS exposure is independently associated with an increased risk of stroke. Future studies are needed to confirm these findings and examine the role of long-term effects of SHS exposure on stroke outcomes.