The Impacts of Genetic and Environmental Factors on the Progression of Chronic Pancreatitis

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Smoking and rheumatoid vasculitis

Summary Smoking habits were compared in 211 patients with rheumatoid arthritis without vasculitis and 45 patients with rheumatoid vasculitis. Smoking was more common in patients with vasculitis (P<0.02) and there was a significant association between smoking and the occurrence of nailfold lesions in males with vasculitis.     

Smoking and physical inactivity patterns during midlife as predictors of all-cause mortality and disability: a 39-year prospective study

This study estimated the long-term mortality hazards and disability risks associated with various combinations of smoking and physical inactivity measured over time in a sample of middle-aged adults. Data have been collected from a national sample of Swedish adults, originally interviewed in 1968 and followed until 2007 (N = 1,682). Smoking and physical activity status were measured at baseline and 13 years later (1981). Different patterns of change and stability in smoking and physical inactivity over this 13 year period were used as predictors of mortality through 2007. Also, associations between different patterns of these health behaviors and the odds of disability (measured in 2004) were estimated among survivors (n = 925). Results suggest that mortality rates were elevated among persistent (HR = 1.7; 95 % CI = 1.5–2.0) and new smokers (HR = 2.5; 95 % CI = 1.6–4.1), but not among discontinued smokers. However, mortality rates remained elevated among discontinued smokers who were also persistently inactive (HR = 1.9; 95 % CI = 1.3–2.6). Additional findings suggest that persistent physical inactivity during midlife was associated with increased odds of late life disability (OR = 1.8; 95 % CI = 1.1–2.7), but that smoking had no clear additive or multiplicative effects on disability. As such, these findings indicate that while persistent smoking during midlife primarily impacts subsequent mortality, persistent physical inactivity during midlife appears to counteract the survival benefits of smoking cessation, while also imposing a long-term risk on late life disability among those who do survive to old age.     

浙江省丽水地区中老年居民吸烟行为及人群特征分析

目的通过了解丽水地区中老年居民的吸烟行为和相应的人群特点,为开展控烟工作提供理论证据。 方法选定丽水地区3个街道（乡镇）中年龄50～80岁的常住户籍人口,按照10%的比例进行整群抽样调查。调查问卷包含基线资料、吸烟（包括主动吸烟和被动吸烟）情况、吸烟健康知识等内容。汇总吸烟人群的调查资料,分析吸烟人群的分布特征。多组间计量资料的比较采用方差分析,计数资料的比较采用χ²检验。 结果共发放问卷5 627份,回收完整有效问卷3 090份。现在吸烟者共631名,现在非吸烟者共2 459名,标化后的吸烟率为21.6%,男性吸烟率为43.4%,女性吸烟率为0.12%。男性调查者中的现在吸烟人群主要表现为不同年龄、文化程度、职业、居住地的分布差异（χ²=37.984、25.445、7.249、25.593,P<0.05）。被动吸烟者789名（其中男性208例,女性551例）,主要表现为不同年龄、性别、文化程度、婚姻状况、居住地的人群分布差异（χ²=54.922、151.962、15.039、19.365、16.316,P<0.05）。健康知识得分总体表现出不同年龄、文化程度、职业、居住地的人群分布差异（F=8.352、24.905、4.598、82.934,P<0.05）。 结论本地区吸烟人群具有明显的分布特征,男性吸烟率和女性被动吸烟率高,应针对吸烟的人群分布特点精准实施控烟宣传推广工作。     

The seventh nationwide epidemiological survey for chronic pancreatitis in Japan: Clinical significance of smoking habit in Japanese patients

ObjectivesA nationwide survey was conducted to clarify the epidemiological features of patients with chronic pancreatitis (CP) in Japan.MethodsIn the first survey, both the prevalence and the incidence of CP in 2011 were estimated. In the second survey, the clinicoepidemiological features of the patients were clarified by mailed questionnaires. Patients were diagnosed by the Japanese diagnostic criteria for chronic pancreatitis 2009.ResultsThe estimated annual prevalence and incidence of CP in 2011 were 52.4/100,000 and 14.0/100,000, respectively. The sex ratio (male/female) of patients was 4.6, with a mean age of 62.3 years. Alcoholic (67.5%) was the most common and idiopathic (20.0%) was the second most common cause of CP. Comorbidity with diabetes mellitus (DM) and pancreatic calcifications (PC) occurred more frequent in ever smokers independently of their drinking status. Among patients without drinking habit, the incidences of DM and PC were significantly higher in ever smokers than in never smokers. The multiple logistic regression analysis revealed smoking was an independent factor of DM and PC in CP patients: DM, Odds ratio (OR) 1.644, 95% confidence interval (CI) 1.202 to 2.247 (P = 0.002): PC, OR 2.010, 95% CI 1.458 to 2.773 (P < 0.001). On the other hand, smoking was not identified as an independent factor for the appearance of abdominal pain by this analysis.ConclusionThe prevalence of Japanese patients with CP has been increasing. Smoking was identified as an independent factor related to DM and PC in Japanese CP patients.     

Impacts of common factors of life style on serum liver enzymes

AIM: To investigate the impacts of gender, age and factors of life style (alcohol, overweight, coffee and smoking) on serum liver enzymes.METHODS: Serum alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) were measured from 6269 apparently healthy individuals (2851 men, 3418 women, mean age 45 ± 12 years, range 25-74 years) in a national cross-sectional health survey. All subjects underwent detailed clinical examinations and interviews including the amount and pattern of alcohol use, coffee consumption and smoking habits.RESULTS: In this population with a mean ± SD alcohol consumption of 65 ± 105 g/wk and body mass index (BMI) of 26.1 ± 4.3 kg/m², both ALT and GGT were significantly influenced by alcohol use (P < 0.001) and BMI (P < 0.001), whereas smoking increased only GGT (P < 0.001). A significant effect of age on ALT was seen in men (P < 0.001) whereas not in women. Significant two-factor interactions of alcohol use in men were observed with age (ALT: P < 0.01; GGT: P < 0.001) and BMI (GGT: P < 0.05). For ALT, a significant interaction also occurred between BMI and age (P < 0.005). In contrast, women showed significant interactions of alcohol use with BMI (GGT: P < 0.05), smoking (GGT: P < 0.001), and coffee consumption (GGT: P < 0.001).CONCLUSION: Life-style associated changes in liver enzymes may reflect health risks, which should be considered in the definition of normal limits for liver enzymes.     

Patient reported exposure to smoking and alcohol abuse are associated with pain and other complications in patients with chronic pancreatitis

Background/objectivesSmoking and alcohol abuse are established risk factors for chronic pancreatitis (CP). Few studies have examined how exposure to smoking and alcohol abuse act as risk factors for complications in CP. Our aim was to examine associations between patient reported exposure to smoking and alcohol abuse and complications in CP in a large cohort of patients from the Scandinavian and Baltic countries.MethodsWe retrieved data on demographics, CP related complications and patients’ histories of exposure to smoking and alcohol abuse from the Scandinavian Baltic Pancreatic Club database. Associations were investigated by univariate and multivariate logistic regression analyses. Results are presented as odds ratios (OR) with 95% confidence intervals.ResultsA complete history of smoking and alcohol exposure was available for 932 patients. In multivariate regression analyses, the presence of pain and exocrine pancreatic insufficiency were both significantly associated with history of smoking (OR 1.94 (1.40–2.68), p < 0.001 and OR 1.89 (1.36–2.62), p < 0.001, respectively) and alcohol abuse (OR 1.66 (1.21–2.26), p = 0.001 and 1.55 (1.14–2.11), p = 0.005, respectively). Smoking was associated with calcifications (OR 2.89 (2.09–3.96), p < 0.001), moderate to severe ductal changes (OR 1.42 (1.05–1.92), p = 0.02), and underweight (OR 4.73 (2.23–10.02), p < 0.001). History of alcohol abuse was associated with pseudocysts (OR 1.38 (1.00–1.90) p = 0.05) and diabetes mellitus (OR 1.44 (1.03–2.01), p = 0.03). There were significantly increased odds-ratios for several complications with increasing exposure to smoking and alcohol abuse.ConclusionSmoking and alcohol abuse are both independently associated with development of complications in patients with CP. There seems to be a dose-dependent relationship between smoking and alcohol abuse and complications in CP.     

Process evaluation of a mHealth program: Lessons learned from Stop My Smoking USA,a text messaging-based smoking cessation program for young adults

Objective

Report lessons learned in an RCT of Stop My Smoking (SMS) USA, a mHealth smoking cessation program for young adult smokers.

Methods

164 18–24-year-olds were recruited nationally, online in 2011. Program evaluation data were provided at 12-week post-Quit Day.

Results

(1) Inviting participants to complete a brief text messaging survey and then asking them to complete a longer online survey resulted in the highest response rate (89%). (2) The positive tone of program messages was the most commonly noted program strength. (3) Suggested improvements included more social connectivity and additional assistance overcoming stressful situations. (4) Half of intervention participants moved through the program linearly and half went through various paths that reflected multiple relapses. Suggestions to use pharmacotherapy resulted in 22% of heavy smokers to utilize it.

Conclusion

Participant feedback provided concrete ways in which this and other young adult-focused interventions can improve messaging and program features to be even more salient.

Practice implications

Future young adult mHealth interventions could: Integrate models that are flexible to different “paths” of behavior change; address stressful life events directly and comprehensively; integrate proactive messaging that promotes pharmacotherapy options; and use text messaging as a gateway to longer online surveys.     

Nicotine withdrawal and stress‐induced changes in pain sensitivity: A cross‐sectional investigation between abstinent smokers and nonsmokers

Chronic smoking has been linked with alterations in endogenous pain regulation. These alterations may be pronounced when individuals quit smoking because nicotine withdrawal produces a variety of psychological and physiological symptoms. Smokers interested in quitting (n = 98) and nonsmokers (n = 37) completed a laboratory session including cold pressor test (CPT) and heat thermal pain. Smokers set a quit date and completed the session after 48 h of abstinence. Participants completed the pain assessments once after rest and once after stress. Cardiovascular and nicotine withdrawal measures were collected. Smokers showed blunted cardiovascular responses to stress relative to nonsmokers. Only nonsmokers had greater pain tolerance to CPT after stress than after rest. Lower systolic blood pressure was related to lower pain tolerance. These findings suggest that smoking withdrawal is associated with blunted stress response and increased pain sensitivity.