吸烟对冠心病患者血浆同型半胱氨酸的影响

目的探讨吸烟对冠心病患者血浆同型半胱氨酸（HCY）的影响,为冠心病患者早期治疗提供依据。方法将所有研究对象分为4组：①冠心病吸烟组74例;②冠心痛不吸烟组46例;③健康吸烟组42例;④健康不吸烟组26例。又根据吸烟指数将所有入选的吸烟者分成3组：重度吸烟组40例、中度吸烟组44例和轻度吸烟组32例。采用酶联免疫吸附测定（ELISA）法检测血浆HCY水平。结果血浆HCY水平在冠心病吸烟组、冠心病不吸烟组、健康吸烟组、健康不吸烟组中依次降低（15．79±4．18）μmol／L、（12．12±2．43）μmol／L、（10．85±3．78）μmol／L、（7．26±3．15）μmol／L（P〈0．01）,在健康不吸烟组、轻度吸烟组、中度吸烟组、重度吸烟组血浆HCY水平依次增高（7．26±3．15）μmol／L、（9．58±4．06）μmol／L、（13．32±3．26）μmol／L、（15．43±3．18）μmol／L（P〈0．01）。结论吸烟使冠心病患者和健康者血浆HCY水平升高,HCY水平随吸烟指数的增加而升高。     

The effect of smoking on bone metabolism: maternal and cord blood bone marker levels

BACKGROUND: To clarify the effect of smoking on bone metabolism in the fetus, we measured osteocalcin (OC), bone isoenzyme of alkaline phosphatase (BALP), procollagen type 1 C-terminal propeptide (PICP) in maternal serum and umbilical cord blood. METHODS: 15 active smoker, 14 passive smoker, 15 nonsmoker women and their newborn were included in this study. OC, BALP, PICP were determined by enzyme immunoassay. RESULTS: Of the bone markers tested only OC was different in the serum of the three groups of women. Infants of smoker women have significantly lower umbilical cord blood OC levels than those of infants from both passive smoker and nonsmoker women.(25.6 +/- 6.6, 35.8 +/- 10.4, 37.2 +/- 16.1 ng/mL respectively, p < 0.05). Infants of smoker women have significantly lower umbilical cord blood BALP levels than those of infants from nonsmoker women. (46 +/- 12, 57 +/- 15 U/L p < 0.05). All bone markers except total ALP were significantly higher in umbilical cord blood as compared to maternal blood levels (p < 0.001 for all). CONCLUSION: High umbilical cord blood bone marker levels may reflect the altered bone metabolism of fetus. Moreover, chronic hypoxia due to smoking may cause the suppression of bone matrix synthesis or placental synthesis as reflected by low OC and BALP levels in umbilical cord blood of infants from smoker women.     

Stories from the streets: people's experiences of homelessness

This study explores how people speak about their experiences of homelessness, and how these experiences have affected their identity claims and their mental health. The mental health of the homeless population is a growing concern for the UK government and non-governmental agencies. There is however, little research looking at the mental health needs of homeless people and their experiences. For this study, a qualitative, narrative approach was used. Eight people were interviewed who described themselves as homeless. The subsequent data were analysed through a narrative analysis process paying particular attention to how people construct their identities. Although each participant is homeless, they speak about their experiences very differently. People's identities have been affected by their experiences, and because of the trauma and indignity of homelessness, their identities have had to be reshaped. While it might be considered normal for people's identities to relate to families and occupation, homeless people construct identities around illness, drugs and exclusion. Experiences of homelessness negatively affect people's sense of identity to destructive proportions. Nevertheless, participants demonstrate a way of coping by forming strong opinions about policy and service provision.     

Enhanced cytotoxic potential of alveolar macrophages from cigarette smokers

Cigarette smoking increases the numbers and oxidative metabolism of alveolar macrophages. Increased production of superoxide (O2-) and H2O2 by alveolar macrophages may contribute to the pathogenesis of cigarette-induced lung diseases. The cytotoxicity mediated by alveolar macrophages from smokers (n = 11) and nonsmokers (n = 13) was compared in an in vitro assay in which the target cells were chromium 51-labeled lung explants. The spontaneous cellular cytotoxicity mediated by smoker macrophages was significantly greater than that of nonsmoker macrophages (cytotoxic index 20.3% +/- 1.9% compared with 5.5% +/- 0.9%, P less than 0.001). Phorbol myristate acetate significantly increased the cytotoxic index of nonsmoker macrophages but did not cause further increases in smoker macrophage killing. The antioxidants superoxide dismutase and catalase produced partial inhibition of smoker macrophage cytotoxicity, suggesting that target cell killing was mediated in part by oxidant mechanisms. Supplementation of smokers' diets with high-dose oral vitamin E failed to decrease smoker alveolar macrophage cytotoxicity. These findings demonstrate that smoker alveolar macrophages possess enhanced cytotoxic potential for normal lung parenchymal cells.     

Risk factors for emphysema. Cigarette smoking is associated with a reduction in the association rate constant of lung alpha 1-antitrypsin for neutrophil elastase.

The increased risk of developing emphysema among individuals who smoke cigarettes and who have normal levels of alpha 1-antitrypsin (alpha 1AT) is hypothesized to result from a decrease in the antineutrophil elastase capacity of the lower respiratory tract alpha 1AT of smokers compared with nonsmokers. To evaluate this hypothesis we compared the time-dependent kinetics of the inhibition of neutrophil elastase by lung alpha 1AT from healthy, young cigarette smokers (n = 8) and nonsmokers (n = 12). alpha 1-antitrypsin was purified from lavage fluid using affinity and molecular sieve chromatography, and the association rate constant (k assoc) for neutrophil elastase quantified. The k assoc of smoker plasma alpha 1AT (9.5 +/- 0.5 X 10(6) M-1s-1) was similar to that of nonsmoker plasma (9.3 +/- 0.7 X 10(6) M-1s-1, P greater than 0.5). In marked contrast, the k assoc of smoker lower respiratory tract alpha 1AT was significantly lower than that of nonsmoker alpha 1AT (6.5 +/- 0.4 X 10(6) M-1s-1 vs. 8.1 +/- 0.5 X 10(6) M-1s-1, P less than 0.01). Furthermore, the smoker lower respiratory tract alpha 1AT k assoc was significantly less than that of autologous plasma (P less than 0.01). When considered in the context of the concentration of alpha 1AT in the lower respiratory tract epithelial lining fluid, the inhibition time for neutrophil elastase of smoker lung alpha 1AT was twofold greater than that of nonsmoker lung alpha 1AT (smoker: 0.34 +/- 0.05 s vs. nonsmoker: 0.17 +/- 0.05 s, P less than 0.01). Consequently, for concentrations of alpha 1AT in the lower respiratory tract it takes twice as long for an equivalent amount of neutrophil elastase to be inhibited in the smoker's lung compared with the nonsmoker's lung. These observations support the concept that cigarette smoking is associated with a decrease in the lower respiratory tract neutrophil elastase inhibitory capacity, thus increasing the vulnerability of the lung to elastolytic destruction and thereby increasing the risk for the development of emphysema.     

Multiple defects in arachidonate metabolism in alveolar macrophages from young asymptomatic smokers

This study was undertaken to localize and determine the relative importance of potential biochemical defects in the release and metabolism of arachidonic acid (AA) in alveolar macrophages (AMs) from asymptomatic smokers. Using high-performance liquid chromatography and radioimmunoassay, we compared the metabolism of both endogenously released and exogenously supplied AA in AMs and autologous peripheral blood monocytes (PBMs) from nine healthy nonsmokers and eight healthy smokers. AMs from both groups incorporated similar amounts of radiolabeled AA into cellular lipids. However, AMs from smokers released only about half as much radioactivity as free AA and its metabolites in response to ionophore A23187, when compared to cells from nonsmokers; this suggests that net phospholipase activity was decreased in smokers. In addition, AMs from smokers synthesized less of total cyclooxygenase and 5-lipoxygenase products than did cells from nonsmokers, both constitutively and in response to A23187 as well as the particulate agonist zymosan. Furthermore the metabolism of exogenous AA to both cyclooxygenase and 5-lipoxygenase products was reduced in smoker cells compared to nonsmoker cells. Inverse relationships between eicosanoid synthesis and intensity of smoking were observed. No differences between smoker and nonsmoker PBMs were found. These results show that the major defect in smoker AMs is at the phospholipase level, with additional defects being present at the levels of the cyclooxygenase and 5-lipoxygenase pathways. All these abnormalities are compartmentalized to the mononuclear phagocyte population of the lung.     

Smoking initiation prevention among youths: implications for community health nursing practice

Cigarette smoking among youths has long been documented as a national problem affecting health and economic status in the United States. A number of studies have documented that cigarette-smoking initiation occurs primarily between late childhood and young adolescence. This evidence has brought about the need for awareness among community health nurses to find and deliver effective antismoking programs to reduce the prevalence of youth smoking initiation. Generally, community health nurses are in an excellent position to help the nation achieve its goals in terms of reducing the incidence of youth smoking initiation. However, current knowledge about community health nursing practice and smoking initiation interventions is limited. This article raises awareness about smoking initiation prevention in youth and the need to implement effective smoking prevention programs in practice settings and encourages community health nurses to increase their involvement in antismoking initiation research and interventions.     

Editorial

Cigarette smoking among youths has long been documented as a national problem affecting health and economic status in the United States. A number of studies have documented that cigarette-smoking initiation occurs primarily between late childhood and young adolescence. This evidence has brought about the need for awareness among community health nurses to find and deliver effective antismoking programs to reduce the prevalence of youth smoking initiation. Generally, community health nurses are in an excellent position to help the nation achieve its goals in terms of reducing the incidence of youth smoking initiation. However, current knowledge about community health nursing practice and smoking initiation interventions is limited. This article raises awareness about smoking initiation prevention in youth and the need to implement effective smoking prevention programs in practice settings and encourages community health nurses to increase their involvement in antismoking initiation research and interventions.     

‘I've never been much of a risk-taker at all …’: Exploring the social meaning of smoking in a small group of well-educated women

In this exploratory qualitative study, the views of a small group of mid-life, professional women who smoke were examined. Data were extracted using thematic analysis. Findings revealed a number of common, emergent themes: ‘being addicted to smoking’, ‘weighing up health and risks’, ‘smoking as a pleasure and reward’ and ‘being anti-establishment’. A second analysis extracted three broadly different ‘types’ of smoker: the ‘I want to give up but I'm addicted’ smoker, the ‘ambivalent’ smoker and the ‘anti-establishment’ smoker. Results were discussed in relation to possible health intervention strategies.     

Background,Offence Characteristics,and Criminal Outcomes of Aboriginal Youth Who Sexually Offend: A Closer Look at Aboriginal Youth Intervention Needs

Canada's Aboriginal peoples face a number of social and health issues. Research shows that Aboriginal youths are over-represented in the criminal justice system and youth forensic psychiatric programmes. Within the literature on sex offending youth, there appears to be no published data available to inform clinicians working with adjudicated Aboriginal youth. Therefore, the present study examines the background, offence characteristics, and criminal outcomes of Aboriginal (n = 102) and non-Aboriginal (n = 257) youths who engaged in sexual offending behaviour and were ordered to attend a sexual offender treatment programme in British Columbia between 1985 and 2004. Overall, Aboriginal youths were more likely than non-Aboriginal youths to have background histories of fetal alcohol spectrum disorders (FASD), substance abuse, childhood victimization, academic difficulties, and instability in the living environment. Both Aboriginal and non-Aboriginal youths had a tendency to target children under 12-years-old, females, and non-strangers. Aboriginal youths were more likely than non-Aboriginal youths to use substances at the time of their sexual index offence. Outcome data revealed that Aboriginal youths were more likely than their non-Aboriginal counterparts to recidivate sexually, violently, and non-violently during the 10-year follow-up period. Furthermore, the time between discharge and commission of all types of re-offences was significantly shorter for Aboriginal youths than for non-Aboriginal youths. Implications of these findings are discussed with regards to the needs of Aboriginal youth and intervention.     

Deficiency of vitamin E in the alveolar fluid of cigarette smokers. Influence on alveolar macrophage cytotoxicity.

Cigarette smoking produces oxidant-mediated changes in the lung important to the pathogenesis of emphysema. Since vitamin E can neutralize reactive oxygen species and prevent peroxidation of unsaturated lipids, it may constitute an important component of the lung's defense against oxidant injury. To better characterize the antioxidant protective role of vitamin E, young asymptomatic smokers and nonsmokers were evaluated by bronchoalveolar lavage before and immediately after a 3-wk course of oral vitamin E (2,400 IU/d). Smoker alveolar fluid at baseline was relatively deficient in vitamin E compared with nonsmoker fluid (3.1 +/- 0.7 ng/ml vs. 20.7 +/- 2.4 ng/ml, P less than 0.005). Although smoker alveolar fluid vitamin E levels increased to 9.3 +/- 2.3 ng/ml after supplementation, the levels remained significantly lower than nonsmoker baseline levels (P less than 0.01). This deficiency was explained, in part, by the increased oxidative metabolism of vitamin E to the quinone form in the lungs of smokers compared with nonsmokers. Although the significance of a lower concentration of alveolar fluid vitamin E is unclear, it may compromise the antioxidant protection afforded by the alveolar fluid as it coats the lung's epithelial surface. The protective role of vitamin E was assessed by cytotoxicity experiments, which demonstrated that the killing of normal rat lung parenchymal cells by smoker alveolar macrophages was inversely related to the vitamin E content of the parenchymal cells. These findings suggest that vitamin E may be an important lower respiratory tract antioxidant, and that the deficiency seen in young smokers may predispose them to an enhanced oxidant attack on their lung parenchymal cells.     

Adolescent constructions of nicotine addiction.

The purpose of this qualitative study was to extend our understanding of how adolescents view nicotine addiction. This secondary analysis included 80 open-ended interviews with adolescents with a variety of smoking histories. The transcribed interviews were systematically analyzed to identify salient explanations of nicotine addiction. These explanations presuppose causal pathways of nicotine exposure leading to addiction and include repeated use, the brain and body "getting used to" nicotine, personal weakness, and family influences. A further explanation is that some youths pretend to be addicted to project a "cool" image. These explanations illustrate that some youths see themselves as passive players in the formation of nicotine addiction. The findings can be used in the development of programs to raise youth awareness about nicotine addiction.     

An integrated methods study of the experiences of youth with severe disabilities in leisure activity settings: the importance of belonging,fun, and control and choice

Abstract

Purpose: The aim was to examine the leisure activity setting experiences of two groups of youth with severe disabilities – those with complex continuing care (CCC) needs and those who have little functional speech and communicate using augmentative and alternative communication (AAC). Method: Twelve youth took part in a mixed methods study, in which their experiences were ascertained using qualitative methods (observations, photo elicitation and interviews) and the measure of Self-Reported Experiences of Activity Settings (SEAS). Data integration occurred using a “following a thread” technique and case-by-case analysis. Results: The analysis revealed several highly valued aspects of leisure activity setting experiences for youth, including engagement with others, enjoying the moment, and control and choice in selection and participation in activity settings. Conclusions: The findings provide preliminary insights into the nature of optimal activity settings for youth with severe disabilities, and the mediators of these experiences. Compared to other youth, the data illustrate both the commonalities of experiences and differences in the ways in which these experiences are attained. Implications for research concern the utility of mixed methods approaches in understanding the complex nature of participation experiences. Implications for clinical practice concern the importance of not assuming the nature of youths’ experiences.

• Implications for Rehabilitation

• Service providers can lose sight of the importance of broader concepts of belonging, fun, and control and choice when providing interventions that focus on “participating” in an “activity” to build specific skills.

• In addition to the skill-based outcomes for youth with disabilities that are valued by the rehabilitation system, we suggest that consideration needs to be given to other types of outcomes that matter to youth, such as participating in a leisure activity for the sake of belonging or having fun.

• It is important not to assume that youth with severe disabilities are not enjoying their participation or are not benefiting from their leisure experiences.

• It is important not to “over-therapize” youth with disabilities and promote a balanced approach to therapy and leisure participation, by discussing with youth and families the beneficial developmental outcomes that can accrue from leisure activities.

     

Appreciative Inquiry in Youthful Offender Psychiatric Nursing Research

PROBLEM: Combined with demonstrated impulsive behaviors and culturally bound expectations, youth who are detained in the juvenile justice system are challenged to find opportunities to articulate their stories and life experiences that contribute to a future life. METHODS: Appreciative inquiry (AI) as a research method is used to analyze interviews of youth residing in a juvenile detention center. FINDINGS: The narrative, or life pattern, that youth in detention express is explicated through the four processes of the 4‐D Cycle in AI. The processes are discovery, dreaming, designing, and delivery. CONCLUSIONS: AI as a research method is useful to conduct interviews with detained youth, to provide a data analysis method for qualitative interviews, and generate nursing interventions. Through articulation of their own stories, youth discover voice and envision empowerment.     

Use of smokeless tobacco and cigarettes among Nigerian youths: implications for tobacco control policies in Africa

Background: Smokeless tobacco (SLT) use among youths in Africa is an emerging epidemic. This paper aimed to determine patterns of tobacco use among youths in Nigeria and the implications for tobacco control in Africa. Methods: The cross-sectional study was conducted in Benue state, Nigeria, in 2011. The study population comprised of 536 randomly selected senior high school students aged 9–19 years. Results: About 17.7% of high school youths were current SLT users, 19.4% were current smokers and an alarming 11.9% used both smokeless and cigarette tobacco. After adjustment, significant predictors of SLT use among youths included their parents’ smoking status (OR 1.70, 95% C.I.: 1.01–2.87, p = 0.046) and the perception of the lack of harm from tobacco use (OR 2.06, 95% C.I.: 1.08–3.92, p = 0.027). Current cigarette smoking was again predicted by parental and peer smoking status (OR 2.58, 95% C.I.: 1.55–4.31and OR 2.93, 95% C.I.: 1.84–4.66, respectively). Adjusted regression analysis for dual tobacco use provided similar results. Conclusion: Both SLT and cigarette use, as well as dual use remains high, particularly among rural youth. Tobacco control policies based on the Framework Convention on Tobacco Control (FCTC) that primarily focus on reducing smoking in Nigeria and other African nations where SLT is popular should be modified to address not only cigarettes but also SLT use given the high use of both products singly and concurrently.     

Public policy for the control of tobacco-related disease.

Public policies concerning tobacco shape the environment of the smoker and nonsmoker alike. These policies use diverse means to achieve the common goal of reducing tobacco use and its attendant health consequences. Educational interventions such as warning labels, school curricula, and public service announcements serve to inform the public about the hazards of tobacco smoke. These are countered by the pervasive marketing of tobacco products by the tobacco industry, despite a ban on tobacco advertising on radio and television. Further restrictions on tobacco advertising and promotion have been proposed and await action. Cigarette excise taxes and smoker-nonsmoker insurance premium differentials discourage smoking by making it more costly to purchase cigarettes. Conversely, health insurance reimbursement for smoking cessation programs could reduce the cost of giving up the habit and might encourage cessation. Restricting or banning smoking in public places and workplaces decreases a smoker's opportunities to smoke, further inhibiting this behavior. Reducing the availability of cigarettes to children and adolescents may help to prevent them from starting to smoke. The environment of the smoker is conditioned by this pastiche of influences. Physicians who become involved in tobacco-control issues have the opportunity to alter the environmental influences on their patients. This is likely to be synergistic with physicians' efforts inside the office to encourage individual smokers to quit. As a first step toward advocacy outside the office, physicians can help to create a smoke-free health-care facility in their own institution. Beyond that, advocacy groups or the voluntary health organizations (e.g., American Lung Association) provide avenues for physicians to take a stand on community issues relevant to tobacco control. Physicians who take these steps to alter the environment of smokers beyond the office are likely to magnify the effect of their work with individual patients who smoke.     

Preschool children and their mothers are more exposed to paternal smoking at home than school children and their mothers

BackgroundExposure to secondhand smoke (SHS) is a major risk to human health, and the home is the greatest single source of SHS in children. Here, the authors assessed SHS exposure of children and mothers by paternal smoking at home, and investigated how different this exposure is according to smoking location and children's age.MethodsTwo hundred-five families were enrolled in this study as trios of fathers, mothers, and children. Nicotine concentrations in hair were measured using liquid chromatography–tandem mass spectrometry to determine long-term exposure to SHS.ResultsDifferences between the smoker group and nonsmoker group in nicotine levels were statistically significant in both children and their mothers. However, difference between the indoor-smoker group and outdoor-smoker group was marginally significant in children and was not significant in their mothers. In the indoor-smoker group, preschool children and their mothers had nicotine concentrations about twice as high as school children and their mothers, respectively. In the outdoor-smoker group, however, differences between two age groups in nicotine levels were significant in preschool children, but not their mothers.ConclusionThese findings indicate that paternal smoking at home leads to significant exposure to SHS in their children and spouses, which is not completely prevented by smoking outside. Especially, preschool children and their mothers appear to be most at risk for SHS exposure among nonsmoking household members.     

Older Youth Nearing Their Exit from Congregate Care: Current Innovative Programs

The present paper reviews literature on older youth in foster care with a focus on those older youths in residential. We aim to examine what has been written in the scholarly literature about this specific group. Literature was reviewed from the last decade on the problems these youths face and potential solutions for them in the program literature. A literature review was done utilizing keywords. Further, this paper presents highlights from two informational interviews with residential agencies. Here we aim to describe what the Executive Directors and staff members believe older youths need, how they work with them and the important components of a residential facility for older youth. Findings uncovered that both agencies highlighted the importance of pro-social attachments, or caring relationships, along with education and safety. Also, the critical importance of preparing youths enough so that when they leave residential they will have reduced the gap between their skills and others their age, so as to be able to compete in society for jobs and further education. Limitations include lack of generalizability, among others.     

Is there any effect of volcanic eruptions of Mount Sakurajima on human lungs?--histopathological investigation and measurement of intrapulmonary particulate deposits amounts.

In order to investigate effects of volcanic eruptions of Mt. Sakurajima on human lungs, an amount of intrapulmonary particulate deposits (IPD) and histopathological changes were evaluated, using autopsied lungs of deceased residents of Kagoshima (the area affected most by the volcanic eruptions of Mt. Sakurajima, n = 66) in comparison with those of Saitama (n = 73). The amount of IPD was measured by macroscopic image analysis and by alkaline extraction. Correlation was seen in the IPD values obtained by these two methods (Spearman's correlation coefficient: 0.525). The IPD value measured through chemical digestion, which increased with age, was lower in the residents of Kagoshima (17.0 +/- 6.3 mg/g) than in those of Saitama (26.8 +/- 10.6 mg/g). This difference of IPD value between Kagoshima and Saitama residents was also observed in male, female, smoker and nonsmoker subgroups. The incidence of pulmonary emphysema was not different between Kagoshima and Saitama cases. No silicotic nodules were observed in any cases. But, the incidence of bronchial goblet cell hyperplasia and squamous metaplasia in Kagoshima was higher than that in Saitama in male cases and smoker cases. In Kagoshima cases, the incidence of squamous metaplasia was significantly higher in smokers than in nonsmokers. The synergistic influence of volcanic eruptions and cigarette smoking on human airways was suggested.