Search Results (1,017)

Background: Tobacco use, and particularly cigarette smoking, is elevated among patients with substance use disorders (SUDs), resulting in health inequities. In rural and medically underserved areas (MUAs), healthcare access is limited; thus, patients with SUDs may receive care in substance use treatment centers (SUTCs) and/or medical healthcare centers (MHCs). Healthcare providers in these settings should know the importance and benefits of quitting tobacco use for patients with SUDs, as this is essential for effective cessation care. This study examined baseline provider knowledge/training receipt and knowledge gains following training in SUTCs and MHCs serving rural and MUAs of Texas, USA. Methods: From 2021 to 2024, 428 providers from 8 SUTCs and 8 MHCs completed an e-survey on tobacco knowledge and past-year training. They then completed 1 to 1.5 h of training. Knowledge gain was assessed via a 10-item test delivered pre- and post-training. Results: Pre-training knowledge and past-year training rates were low across settings; providers at SUTCs were more likely than those at MHCs to know that persons with behavioral disorders like substance misuse are 2 times more likely to smoke than the general USA population. Both groups demonstrated significant knowledge gains from training (SUTCs: 37.41% and MHCs: 45.92% increases; ps < 0.0001). Conclusions: Findings support the need for routine tobacco training in healthcare centers serving rural and MUAs of Texas. Brief educational sessions may help address provider knowledge gaps and, ultimately, strengthen cessation care and reduce tobacco-related disparities in these settings. Full article

Background: Smoking cessation has been associated with reduced lung cancer mortality. This study aimed to synthesize current evidence on the impact of quitting smoking at or around the time of diagnosis of lung cancer on survival, considering factors such as histological subtype, cancer stage, and cessation intervention. Methods: A systematic search was conducted in the Ovid-MEDLINE, Ovid-EMBASE, Cochrane Central Register of Controlled Trials, and KoreaMed databases up to September 2024. Randomized controlled trials and cohort studies enrolling adult current smokers with pathologically confirmed lung cancer and comparing smoking cessation at or around diagnosis with continued smoking, were included. The primary outcome was overall survival (minimum follow-up of 3 months). The included studies were critically appraised using the revised Risk of Bias for Nonrandomized Studies (RoBANS 2) tool and meta-analyzed. Results: A total of 25 cohort studies comprising 17,584 patients were reviewed. Quitting smoking at diagnosis was associated with a 26% reduction in mortality risk (adjusted HR [aHR] 0.74, 95% CI 0.68–0.81). In subgroup analyses, quitting smoking was associated with improved survival in both non-small cell lung cancer (aHR 0.73, 95% CI 0.64–0.83) and small cell lung cancer (aHR 0.61, 95% CI 0.51–0.72), with a more pronounced benefit among patients with early-stage disease (stage I–III or limited stage; aHR 0.64, 95% CI 0.56–0.74). Furthermore, active smoking cessation interventions were significantly associated with improved survival (aHR 0.55, 95% CI 0.35–0.88). Conclusions: The findings underscore the importance of encouraging smoking cessation at the time of lung cancer diagnosis as an integral part of patient management to improve survival outcomes. Full article

Background/Objectives: Smoking is an established cofactor for cervical carcinogenesis, but evidence on how Smoking Pattern Changes around cohort entry relate to risk in Japan is limited. We quantified cervical cancer risk by baseline smoking status and by changes between two routine health checkups in a nationwide cohort. Methods: We used the Japan Medical Data Center claims–checkup database between January 2005 and July 2022. Women with ≥2 pre-index checkups were included; the index date was the second checkup. Self-reported smoking at each visit defined never, former (quit), new (initiated), and current (persistent) smokers; checkup pairs >36 months apart were excluded. Incident cervical cancer required ICD-10 C53 plus cancer-directed treatment (surgery, radiotherapy, or systemic antineoplastic therapy). Multivariable Cox models estimated hazard ratios (HRs) with 95% CIs, adjusting for age, BMI, alcohol, exercise, hypertension, diabetes, cerebrovascular and cardiovascular disease, and cholangitis. Results: Among 1,330,797 women, incidence rates (per 100,000 person-years) were 151.4 in never smokers and 244.9 in ever smokers. Ever versus never smoking was associated with higher risk (HR 1.53, 95% CI 1.43–1.62). A graded risk was observed across Smoking Pattern Change categories versus never: former HR 1.44 (1.15–1.79), new HR 1.51 (1.20–1.90), current HR 1.54 (1.44–1.64). By age, HRs were 1.58 (1.47–1.70) for <50 years and 1.35 (1.17–1.55) for 50–64 years; ≥65 years was not statistically significant (HR 0.69, 0.30–1.59). Conclusions: Smoking was associated with substantially higher cervical cancer risk, with a clear risk gradient from former to new to current smoking. The rapid elevation in new smokers and residual risk after quitting support integrating proactive cessation and initiation prevention into risk-stratified screening and routine health-check programs in Japan. Full article

Objectives: Determining individuals’ addiction levels plays a crucial role in facilitating more effective smoking cessation. For this purpose, the Fagerstrom Test for Nicotine Dependence (FTND) is used all over the World as a traditional testing method. It can be subjective and may influence the evaluation results. This study’s key innovation is the use of physiological signals to provide an objective classification of addiction levels, addressing the limitations of the inherently subjective Fagerström Test for Nicotine Dependence (FTND). Methods: Physiological parameters were recorded from 123 voluntary participants (both male and female) aged between 18 and 60 for 120 s using the Masimo Rad-G pulse oximeter and the Hartman–Veroval blood pressure monitor. All participants were categorized into four addiction groups: healthy, lightly addicted, moderately addicted, or heavily addicted with the help of FTND. The recorded data were classified using Decision Tree, KNN, and SVM methods. SMOTE and class-weighting techniques were used to eliminate class imbalance. Also, the PCA technique was applied for dimensionality reduction, and the k-fold cross-validation method was employed to enhance the reliability of the machine learning algorithms. Results: Machine learning methods, when evaluated using the SMOTE with a (7380×7) sample of physiological signals recorded every 2 s from 123 participants, showed a high recall of 98.74%, specificity of 99.58%, precision of 98.79%, F-score of 98.74%, and accuracy of 98.75%. Also, it is extracted that there is a direct relationship between physiological parameters and smoking addiction levels. Conclusions: The study’s core novelty lies in leveraging non-invasive physiological signals to objectively classify addiction levels, addressing the subjectivity of the Fagerström Test for Nicotine Dependence (FTND). This study provides a proof-of-concept for the feasibility of using machine learning and physiological signals to assess addiction levels. The results indicate that the approach is promising. Full article

Background: Tobacco use remains a leading preventable cause of morbidity and mortality in the United States, with persistent disparities in cessation outcomes across socioeconomic and racial groups. While numerous interventions exist, their effectiveness is shaped by complex interrelated factors at individual, social, and healthcare system levels. Identifying and modeling these causal pathways is essential to inform equitable intervention design. Methods: This study applied the Evidence Synthesis for Constructing Directed Acyclic Graphs (ESC-DAG) protocol to integrate empirical findings from 35 quantitative studies examining barriers and facilitators of tobacco cessation intervention uptake in the United States. Using the Andersen and Aday Health Services Research Model as a guiding framework, we extracted, harmonized, and synthesized significant causal relationships into a unified DAG, distinguishing exposures, outcomes, mediators, and confounders. Results: The integrated DAG revealed that structural factors such as socioeconomic disadvantage, digital inequities, rurality, and cultural barriers exerted substantial influence on cessation outcomes. These upstream determinants operated through mediators including motivation, treatment engagement, and access barriers, while healthcare system factors such as provider engagement and proactive outreach emerged as consistent facilitators. Digital access and culturally tailored interventions were identified as underexplored yet potentially high-impact pathways. Discussion: The ESC-DAG methodology provided a structured approach to visualize and synthesize causal mechanisms beyond traditional review synthesis, highlighting points of intervention at both policy and practice levels. The findings underscore the importance of multi-level strategies, including financial support, digital equity initiatives, provider outreach, and culturally tailored cessation services. Conclusions: By applying ESC-DAG methodology, this study contributes a novel causal framework for understanding disparities in tobacco cessation intervention uptake. The resulting DAG can inform future statistical modeling, simulation studies, and equity-focused program design, supporting more effective public health strategies to reduce smoking prevalence and associated inequities. Full article

Background: Preoperative optimization has emerged as a critical strategy in enhancing surgical outcomes, particularly for oncological patients. By addressing modifiable risk factors before surgery, healthcare providers aim to improve postoperative outcomes. The aim of this study was to evaluate the impact of a preoperative optimization program on postoperative outcomes and improvements in modifiable risk factors (anemia, malnutrition, smoking, and endocrine management) among oncology patients undergoing elective surgery. Methods: A retrospective pretest–posttest study was conducted including all oncology patients who underwent elective general surgery at King Hussein Cancer Center between January 2020 and December 2021. The preoperative optimization program was launched in May 2020 and fully implemented by December 2020. Program elements included anemia management, nutritional support, smoking cessation, and glycemic control. Patients were divided into pre-implementation and post-implementation cohorts, and outcomes were assessed at baseline, immediately preoperatively, and 30 days postoperatively. Results: The sample included 503 individuals, 53.9% had preoperative anemia, 15.5% had malnutrition, 40.6% were smokers, and 41.6% had uncontrolled DM. The optimized group demonstrated significant improvements in hemoglobin, albumin, and smoking cessation rates. In contrast, the control group showed worsening hemoglobin and albumin levels over the same period. Serious complications (Clavien–Dindo III–IV) were significantly more frequent in the control group (p = 0.006). The likelihood of postoperative complications among the control group was significantly higher than the optimized group (OR: 2.2, 95%CI: 1.5–3.2, p < 0.001). Conclusions: Implementation of a comprehensive preoperative optimization program significantly improved modifiable risk factors and reduced serious postoperative complications, highlighting its value for adoption in oncology surgical care. Full article

Background: Combined Pulmonary Fibrosis and Emphysema (CPFE) is a distinct syndrome characterized by upper-lobe emphysema and lower-lobe fibrosis, predominantly in older male smokers. Despite often preserved spirometric volumes, patients exhibit severely reduced diffusing capacity and high susceptibility to complications, including pulmonary hypertension (PH), acute exacerbations, and lung cancer, contributing to poor prognosis. Purpose: This review aims to synthesize current evidence on CPFE, focusing on clinical phenotype, functional impairment, differential diagnosis, complications, and emerging management strategies, highlighting distinctions from idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD). Methods: A narrative review of observational cohorts, retrospective series, and clinical studies examining CPFE patients was performed. Data on demographics, smoking history, symptomatology, pulmonary function, radiology, comorbidities, complications, and treatment approaches were extracted and integrated. Results: CPFE affects mainly males aged 65–70, with >90% reporting > 40 pack–years smoking history. Dyspnea is the cardinal symptom (>95%), often disproportionate to preserved FVC and TLC, accompanied by chronic cough in 30–70%. Exercise-induced desaturation is frequent, correlating with PH, observed in 47–90% of patients. Pulmonary function tests reveal preserved volumes, normal or near-normal FEV1/FVC, and severely reduced DLCO (35–45%), distinguishing CPFE from COPD and IPF. HRCT confirms the combined emphysematous and fibrotic pattern, critical for differential diagnosis. Acute exacerbations occur in 20–28% of cases, lung cancer in 22–46% (mostly squamous cell), and long-term oxygen therapy is required in >70%. Five-year survival is 35–55%, lower than emphysema alone and comparable or worse than IPF. Management focuses on smoking cessation, antifibrotics, oxygen therapy, and complication-specific treatments, and selected patients may undergo lung transplantation. Conclusions: CPFE is a clinically and functionally unique entity with a high burden of pulmonary and systemic complications. Accurate recognition using HRCT and DLCO, along with early intervention and tailored management, is essential to improve patient outcomes and guide prognostic stratification. Full article

Background and Objectives: Lumbar spinal stenosis (LSS) is a leading cause of disability in older adults, but the role of cigarette smoking in its development remains unclear. This study aimed to clarify the association between smoking and the incidence of LSS, with a focus on dose–response relationships and subgroup variations by age and sex. Methods: We conducted a nationwide, population-based cohort study using the Korean National Health Insurance Service database. A total of 2,123,268 adults aged ≥ 40 years who underwent health screening in 2009 were followed until LSS diagnosis, death, or 2020. Smoking status, duration, daily consumption, and pack-years were assessed. Cox proportional hazards models with progressive adjustment for demographic, lifestyle, and clinical factors were applied. Results: Over a mean follow-up of 8.2 years (17.5 million person-years), 721,909 new cases of LSS were identified. Fully adjusted models showed higher risk in former (HR 1.047; 95% CI, 1.039–1.056) and current smokers (HR 1.052; 95% CI, 1.044–1.060) compared with never smokers. A clear dose–response pattern was observed, with the greatest risk in heavy smokers (≥40 pack-years; HR 1.207; 95% CI, 1.191–1.222). Subgroup analyses indicated stronger associations among adults aged ≥ 65 years and in women. Conclusions: Cigarette smoking was independently associated with an increased risk of LSS, with risk increasing according to lifetime exposure. The findings underscore the importance of smoking cessation strategies to reduce the burden of spinal degeneration, especially in older adults and women. Full article

Objective: This study aimed to evaluate the impact of an exclusively vegetarian diet, combined with physical activity and lifestyle interventions, on metabolic parameters in patients with metabolic syndrome, with a focus on preventing premature aging and improving overall health status. Materials and Methods: A total of 150 participants (82 females, 68 males; aged 36–80 years, with a mean age of 61.45 years) diagnosed with metabolic syndrome were enrolled. Participants followed an exclusively vegetarian diet (≈2100 kcal/day; 65% carbohydrates, 23% lipids, 15% proteins, 52.4 g dietary fiber, and 0 mg cholesterol) along with a structured lifestyle program that included physical activity (2.5 h/day, intensity 2–6 METs), psychological counseling, smoking cessation support, weight and blood pressure management, hydrotherapy, massage, phytotherapy, and stress-reduction sessions. Baseline and post-intervention assessments were performed to measure total cholesterol, LDL, HDL, triglycerides, glycemia, BMI, and blood pressure. Results: After 10 days of intervention, significant improvements were observed across all measured parameters: total cholesterol decreased by 41.21 mg/dL (−19.54%), triglycerides decreased by 72.86 mg/dL (−34.9%), LDL cholesterol decreased by 26.24 mg/dL (−19.71%), fasting glycemia decreased by 30.4 mg/dL (−21.61%), BMI decreased by 3%, systolic blood pressure decreased by 10.82 mmHg, and diastolic blood pressure decreased by 6.44 mmHg. Conclusions: Our findings demonstrate that a structured lifestyle intervention, centered on a vegetarian diet and physical activity, has a significant beneficial effect on metabolic health. This approach improves cardiovascular risk factors, glycemic control, and body composition, and may play a preventive role against premature aging. Full article

Introduction: Cigarette smoking is unquestionably associated with an increase in morbidity and mortality worldwide, exerting significant adverse effects on respiratory health. The impact of tobacco persists in the epigenome long after smoking cessation. Furthermore, the offspring of smokers may also be affected by the detrimental effects of smoking. Material and methods: The modifications made to the body, such as DNA methylation, histone modification, and regulation by non-coding RNAs, do not change the DNA sequence but can influence gene expression. In respiratory disease, multigenerational effects have been reported in humans, with an increased risk of asthma or COPD and decreased lung function in offspring, despite them not being exposed to smoke. Prenatal nicotine exposure leads to pulmonary pathology that persists across three consecutive generations, supported by animal studies conducted by Rehan et al. Significant advances in high-throughput genomic and epigenomic technologies have enabled the discovery of molecular phenotypes. These either reflect or are influenced by them. Due to the hidden environmental effects and the rise of artificial intelligence (AI) in biomedical research, new predictive models are emerging that not only explain complex data but also enable earlier detection and prevention of smoking-related diseases. In this narrative review, we synthesise the latest research on how smoking affects gene regulation and chromatin structure, emphasising how tobacco can increase vulnerability to multiple diseases. Discussion: For many years, it was widely believed that diseases are solely inherited through genetics. However, recent research in epigenetics has led to a significant realisation: environmental factors play a crucial role in an individual’s life. External influences leave a mark on DNA that can influence future health and offer insights into potential illnesses. In this context, it is possible that in the future, doctors might treat people not as a whole but as individual beings, with personalised medication, tests, and other approaches. Conclusions: The accumulated evidence suggests that exposure to various environmental factors is associated with multigenerational changes in gene expression patterns, which may contribute to increased disease risk. The application of artificial intelligence in this domain is currently a crucial tool for researching potential future health issues in individuals, and it holds a powerful prospect that could transform current medical and scientific practice. Full article

Background: Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory dermatosis with substantial quality-of-life impact. HS frequently co-exists with obesity and metabolic comorbidities. Cigarette smoking is highly prevalent and has been linked to heightened inflammatory activity and impaired wound healing. The role of cumulative tobacco exposure (packyears) in relation to metabolic comorbidities in HS is less well defined. We therefore investigated whether lifetime pack-years relate to laboratory parameters and the presence of comorbidities in HS. Methods: We conducted a retrospective, single-center study involving 131 patients with HS. We collected clinical data, including disease severity scores and quality of life indices, along with laboratory markers such as complete blood count and C-reactive protein. Smoking status and cumulative exposure (pack-years) were assessed based on patient history. To compare laboratory parameters between smoking subgroups, we used Mann–Whitney U tests. Additionally, we performed logistic regression analyses to evaluate the association between cumulative cigarette exposure and the presence of comorbidities. Results: Among the cohort, 63.4% were active smokers with a median of 15 pack-years. Smokers had significantly higher leukocyte, neutrophil, lymphocyte, monocyte, eosinophil, and basophil counts, indicating elevated systemic inflammation. Hematocrit, hemoglobin, mean corpuscular volume, and mean corpuscular hemoglobin were also significantly higher in smokers, while C-reactive protein levels did not differ notably between groups. Subgroup analysis revealed that patients with arterial hypertension, diabetes mellitus, and hypercholesterolemia had significantly more pack-years than those without these conditions. These comorbidities, components of metabolic syndrome, were strongly associated with higher lifetime tobacco exposure in HS patients. Conclusions: Smoking contributes not only to heightened inflammatory activity in HS but is also significantly associated with the presence of metabolic comorbidities. These findings underscore the importance of early interdisciplinary intervention and structured smoking cessation programs to improve outcomes in HS patients. Full article

Objectives: Tobacco-related habits, including both smoked and smokeless forms, remain a public health concern among incarcerated populations, where stress, stigma, and limited healthcare access contribute to high prevalence rates. This cross-sectional study was conducted among inmates in a central prison in Navi Mumbai, India and aimed to evaluate tobacco-use patterns, cessation motivation, and oral health outcomes among prison inmates in Navi Mumbai. Methods: A total population sampling technique was employed, which included 3321 out of 3333 inmates with varying durations of incarceration. Data were collected using a novel TRACE (Tobacco Use, Risk Factors, Assessment, Cessation, and Effects through Epidemiology) framework, incorporating the MTSS (Motivation to Stop Scale) and clinical assessments using the DMFT (Decayed, Missing, and Filled Teeth) index and OHI-S (Oral Hygiene Index-Simplified). Statistical analysis was performed using SPSS version 21 to explore associations between tobacco use and oral health outcomes in this vulnerable population. Results: Tobacco use was reported by 53.1% of inmates, with 39.5% using smokeless forms. Dental caries affected 43% and periodontal disease 46.0% of participants, both significantly associated with tobacco use (p < 0.001). Oral mucosal lesions were observed in 2.6% of inmates. While 76.3% of tobacco users expressed willingness to quit, access to cessation support remained minimal. Conclusion: These findings underscore the need for targeted interventions, such as in-house tobacco cessation programs and oral health services, in correctional facilities. Integrating cessation counseling into prison healthcare policies could improve outcomes among incarcerated populations. Full article

This study investigates the viability of using ChatGPT 3.5 to produce smoking cessation messages featuring different emotional appeals. The effect of source attribution to Artificial Intelligence (AI) vs. human experts is also examined. A sample of current smokers (N = 480) was recruited from Prolific and randomly assigned to read one of five ChatGPT-generated messages reflecting a 2 (appeal: threat vs. humor) × 2 (source: AI vs. human experts) factorial design plus an irrelevant message control condition. Exposure to the smoking cessation messages led to a pattern of cognitive and emotional responses largely consistent with expectations based on previous research. Compared to control, the smoking cessation messages generated greater risk perceptions on the featured health effects but did not produce significantly stronger intentions to quit. Human experts as the source produced greater perceived source credibility than AI, but there was no source effect on other outcomes. No interaction between message appeals and source attribution was observed. Implications of the findings for tobacco education campaigns are discussed. Full article

Telemedicine has emerged as a promising tool in obstetric and reproductive healthcare, offering new possibilities for patient-centered care delivery. This literature review explores its impact across key areas, including abortion, assisted reproduction, childbirth, contraception, gestational diabetes, mental health, opioid and smoking cessation, and perinatal care during the COVID-19 pandemic. A structured narrative approach was applied, with studies identified through PubMed and Scopus databases for screening, with selection based on predefined inclusion and exclusion criteria, and synthesized narratively with attention to clinical outcomes, access, satisfaction, and barriers to implementation. Perspectives on the acceptance of telemedicine among healthcare providers, technological advancements enhancing reproductive outcomes, and telemedicine’s pivotal role in maintaining continuity of care during crises, such as the COVID-19 pandemic, are examined. The review also addresses challenges and barriers, including technological proficiency and patient acceptance, while emphasizing telemedicine’s potential to improve accessibility, patient satisfaction, and healthcare outcomes across diverse reproductive health services. Full article

Recurrent erysipelas is a common and clinically significant condition that poses challenges for both patients and healthcare systems. Each episode may damage lymphatic vessels, leading to chronic lymphedema, which perpetuates the risk of further relapses. Recurrence rates remain high, ranging from 11% in outpatients during the first year to up to 46% of hospitalized patients within three years. The lower limbs are the most frequent site, although recurrences may also occur in other regions, such as the upper limb after mastectomy with lymph node dissection. This review summarizes current knowledge on risk factors, preventive measures, and chemoprophylaxis in recurrent erysipelas. Modifiable risk factors such as obesity, diabetes, venous insufficiency, tinea pedis, and poor hygiene play an important role, while non-modifiable factors include age, sex, and a history of prior episodes. Non-pharmacological strategies—weight reduction, glycemic control, smoking cessation, compression therapy, and meticulous skin care—form the cornerstone of prevention and may reduce the need for long-term antibiotics. Antibiotic prophylaxis, most commonly with oral penicillin V or intramuscular benzathine penicillin, has been shown to lower recurrence rates. However, efficacy may be reduced in patients with chronic edema or severe obesity. Macrolides serve as alternatives in penicillin-allergic patients, but concerns remain about resistance, adverse effects, and drug–drug interactions. In conclusion, recurrent erysipelas requires a multifaceted approach. While antibiotic prophylaxis is effective, its long-term success depends on simultaneous management of underlying conditions. Further studies are needed to define optimal regimens, treatment duration, and non-antibiotic alternatives. Full article