Use and Awareness of Heated Tobacco Products in Europe

BackgroundHeated tobacco products (HTP) are new forms of tobacco consumption with limited information available on their use among the general population. Our objective was to analyze the prevalence and associations of use of HTP across 11 countries in Europe.MethodsWithin the TackSHS Project, in 2017–2018 we conducted a cross-sectional study with information on HTP use in the following countries: Bulgaria, England, France, Germany, Greece, Italy, Latvia, Poland, Portugal, Romania and Spain. In each country, face-to-face interviews were performed on a representative sample of around 1,000 subjects aged ≥15 years, for a total of 10,839 subjects.ResultsOverall, 27.8% of study participants were aware of HTPs, 1.8% were ever HTP users (ranging from 0.6% in Spain to 8.3% in Greece), and 0.1% were current users. Men were more frequently HTP ever users than women (adjusted odds ratio [aOR] 1.47; 95% confidence interval [CI], 1.11–1.95). Ever HTP use was inversely related to age (P for trend <0.001) and more frequent in ex-smokers (compared with never smokers, aOR 4.32; 95% CI, 2.69–6.95) and current smokers (aOR 8.35; 95% CI, 5.67–12.28), and in electronic cigarette past users (compared with never users, aOR 5.48; 95% CI, 3.46–8.68) and current users (aOR 5.92; 95% CI, 3.73–9.40).ConclusionsIn 2017–2018, HTP use was still limited in Europe among the general population; however, the dual use of these products, their high use among younger generations, and the interest of non-smokers in these products are worrying and indicate the need for close monitoring in terms of prevalence and the characteristics of users.Key words: heated tobacco products, heat-not-burn tobacco products, IQOS, survey, Europe     

A Community Study of SARS-CoV-2 Detection by RT-PCR in Saliva: A Reliable and Effective Method

Efficient, wide-scale testing for SARS-CoV-2 is crucial for monitoring the incidence of the infection in the community. The gold standard for COVID-19 diagnosis is the molecular analysis of epithelial secretions from the upper respiratory system captured by nasopharyngeal (NP) or oropharyngeal swabs. Given the ease of collection, saliva has been proposed as a possible substitute to support testing at the population level. Here, we used a novel saliva collection device designed to favour the safe and correct acquisition of the sample, as well as the processivity of the downstream molecular analysis. We tested 1003 nasopharyngeal swabs and paired saliva samples self-collected by individuals recruited at a public drive-through testing facility. An overall moderate concordance (68%) between the two tests was found, with evidence that neither system can diagnose the infection in 100% of the cases. While the two methods performed equally well in symptomatic individuals, their discordance was mainly restricted to samples from convalescent subjects. The saliva test was at least as effective as NP swabs in asymptomatic individuals recruited for contact tracing. Our study describes a testing strategy of self-collected saliva samples, which is reliable for wide-scale COVID-19 screening in the community and is particularly effective for contact tracing.     

The Rise of Creativity: From Primary to Tertiary Process*

This discussion praises Object Relations in Psychoanalytic Theory by Jay Greenberg and Stephen Mitchell for the clarity with which it compares various psychoanalytic theories and their pedagogical usefulness. However, it emphasizes that the book views comparative psychoanalysis based on choices and assumptions with which many might differ. “Object relations” is only one of several possible lenses through which psychoanalytic theories might have been compared. By selecting object relations as the organizing perspective the authors ignore some important theorists such as Arlow and Brenner or Erik Erikson. It also notes that Greenberg and Mitchell view the choice of theoretical position as simply a matter of personal preference. This ignores the possibility of scientifically evaluating which psychoanalytic approach is most likely to achieve the best results.     

Delivering cytokines at tumor site: The immunocytokine-conjugated anti-EDB-fibronectin antibody case

Although considerable efforts have been made in the discovery of new agents for cancer treatment, several promising therapeutics cannot be applied systemically because of their severe side effects. This is the case for various recombinant pro-inflammatory cytokines that, despite their potent anti-cancer activity, can not find their way to clinical exploitation due to their devastating toxicity shown during dose escalation to therapeutically active concentrations. To circumvent these problems, an elegant and efficient way to accumulate therapeutic agents at the tumor site, thus reducing systemic side effects, is their conjugation to tumor-specific antibodies. Here, we review preclinical data about immunocytokines conjugated to a promising single-chain human antibody that selectively targets tumor-associated stroma and blood vessels by binding with high affinity and specificity to the extra domain-B (EDB) of fibronectin.     

Prevalent cardiac,renal and cardiorenal damage in patients with advanced abdominal aortic aneurysms

Chronic kidney disease (CKD), cardiac damage (CD) and the combination of the two are associated with increased morbidity and death in patients admitted to vascular surgery units. We assessed the prevalence of cardiac and renal damage and cardiorenal syndrome (CRS) in 563 patients with abdominal aortic aneurysms (AAA) who underwent cardiac screening before either an endovascular procedure (EVAR) or open surgery (OS) for aneurysm repair. CD was defined by ≥stage B as per the ACC/AHA classification of congestive heart failure (CHF), while CKD was defined by estimated GFR <60 mL/min/1.73 m² (CKD-EPI). Anemia [World Health Organization (WHO) guidelines] and iron deficiency (ID) (criteria for CHF patients) were also calculated. AAA patients were stratified into the following groups: CD, CKD, CRS or none of these conditions [no risk factors (NoRF)]. The prevalence of isolated cardiac and renal structural damage, of combined cardiorenal damage and of ID was 24.1, 15.0, 20.6 and 23.4 %, respectively. The frequency of anemia (mostly unrecognized) among the groups increased from NoRF (12.8 %)/CKD (19 %)/CD (25 %) up to CRS (38.8 %). This large-scale observational study provides clues for the increased CD/CKD risk profiles of unselected AAA patients, and underlines the need for better identification of ID/anemia and for appropriate treatment of CKD and CD before these patients undergo EVAR/OS.     

The cytological screening turned out effective also for adenocarcinoma: a population-based case-control study in Trento, Italy.

To evaluate the effectiveness of a cytological screening to prevent invasive cervical cancer in the province of Trento, a northern Italian area where a population-based cancer registry is active. The history of Pap test was evaluated through a case-control study in 61 population-based invasive cervical cancer patients, incident during 1995-2000, and in 244 age-matched (between 25 and 75 years old) controls. Women who had at least one Pap test had a reduced risk of invasive carcinoma of 80% (odds ratio=0.20; 95% confidence intervals 0.10-0.40). The protection of a previous Pap test for both squamous cell carcinoma (odds ratio=0.23; 95% confidence intervals 0.09-0.58) and adenocarcinoma (odds ratio=0.24; 95% confidence intervals 0.07-0.78) was similar. The overall protective effect of the Pap test was not seen among younger women (<40 years). The protective effect of the Pap test seems to be stronger for shorter intervals. Our study confirms that Pap-test screening, particularly in middle-aged and older women, is an effective public health intervention with encouraging results also for the prevention of cervical adenocarcinoma.