Serving Substance Abuse Professionals Since 1993

Last Update: 14.07.11

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Drug-related Morbidity

102 citations. October 2010 to present

Prepared: June 2011

Adamaszek M; Khaw AV; Buck U; Andresen B; Thomasius R. Evidence of neurotoxicity of ecstasy: Sustained effects on electroencephalographic activity in polydrug users. PLoS ONE 5(11): e-article 14097, 2010. (35 refs.)

Objective: According to previous EEG reports of indicative disturbances in Alpha and Beta activities, a systematic search for distinct EEG abnormalities in a broader population of Ecstasy users may especially corroborate the presumed specific neurotoxicity of Ecstasy in humans. Methods: 105 poly-drug consumers with former Ecstasy use and 41 persons with comparable drug history without Ecstasy use, and 11 drug naives were investigated for EEG features. Conventional EEG derivations of 19 electrodes according to the 10-20-system were conducted. Besides standard EEG bands, quantitative EEG analyses of 1-Hz-subdivided power ranges of Alpha, Theta and Beta bands have been considered. Results: Ecstasy users with medium and high cumulative Ecstasy doses revealed an increase in Theta and lower Alpha activities, significant increases in Beta activities, and a reduction of background activity. Ecstasy users with low cumulative Ecstasy doses showed a significant Alpha activity at 11 Hz. Interestingly, the spectral power of low frequencies in medium and high Ecstasy users was already significantly increased in the early phase of EEG recording. Statistical analyses suggested the main effect of Ecstasy to EEG results. Conclusions: Our data from a major sample of Ecstasy users support previous data revealing alterations of EEG frequency spectrum due rather to neurotoxic effects of Ecstasy on serotonergic systems in more detail. Accordingly, our data may be in line with the observation of attentional and memory impairments in Ecstasy users with moderate to high misuse. Despite the methodological problem of polydrug use also in our approach, our EEG results may be indicative of the neuropathophysiological background of the reported memory and attentional deficits in Ecstasy abusers. Overall, our findings may suggest the usefulness of EEG in diagnostic approaches in assessing neurotoxic sequela of this common drug abuse.

Alexandrov K; Rojas M; Satarug S. The critical DNA damage by benzo(a)pyrene in lung tissues of smokers and approaches to preventing its formation. Toxicology Letters 198(special issue): 63-68, 2010. (51 refs.)

Benzo(a)pyrene (BP) and cadmium are environmental pollutants found in foodstuffs, cigarette smoke, and polluted air. BP is converted in liver and lung to benzo(a)pyrene-7,8-diol-9,10-epoxide (BPDE) by the enzymes of the cytochrome P450 (CYP) superfamily, namely CYP1A1/1A2, and CYP1B1. BPDE reacts with DNA primarily at the N-2-position of guanine, producing benzo(a)pyrene-7,8-diol-9,10-epoxide-N-2-deoxyguanosine (BPDE-dG) adduct. BPDE reacts with DNA also at N-6 position of adenine, producing the minor N-6-deoxyadenosine adduct, but BPDE-dG adduct is a well-established risk factor for lung cancer. We thus argue that BPDE-dG adduct could be used as a model biomarker in searching and validating of approaches to reducing lung cancer risk. If the formation of BPDE-dG adduct were to be inhibited or blocked in bronchial epithelial cells, so could lung cancer development. The best way to lower BPDE-dG formation in the lung is to stop smoking. However, the following approaches could also be considered for highly addicted smokers: (a) decrease BP and cadmium intake from food, cigarettes and other environmental sources; (b) avoid meat and other food high in BP and cadmium; (c) decrease the CYP-mediated conversion of BP in liver and lung; (d) lower free radicals and cadmium in cigarette smoke; and (e) increase BPDE detoxification.

Alhelail MA; Hoppe JA; Rhyee SH; Heard KJ. Clinical course of repeated supratherapeutic ingestion of acetaminophen. Clinical Toxicology 49(2): 108-112, 2011. (19 refs.)

Background. Repeated supratherapeutic ingestion (RSTI) of acetaminophen (APAP) is recognized as an important cause of APAP-related morbidity and mortality. This study describes the characteristics and clinical course of patients with RSTI, and identifies the risk factors for developing hepatotoxicity and death. Methods. This secondary analysis of a multicenter retrospective chart review studied patients treated with IV and/or oral N-acetylcysteine for acetaminophen poisoning. For this analysis, we included all subjects coded as RSTIs, defined as ingestions of greater than 4 g of APAP per 24 h over a period longer than 8 h. Data collected include demographics, coingestants, comorbidities, presenting laboratory data, and outcomes. The analysis includes descriptive statistics and associations of demographic and clinical factors with patient outcome. Results. Of the 503 patients enrolled, 119 (23.7%) were RSTI. The mean age was 39.6 years (SD +/- 15); 63.9% of the patients were females, 60.5% Caucasians, 27.7% alcoholics, 5% malnourished, 10.9% had viral hepatitis, and 3.4% had other liver diseases. Coingestants included ethanol, opioids, and antihistamines (17.6, 48.7, and 19.3%, respectively). Among this group, 44 patients developed hepatotoxicity, two received liver transplants, and four died (37.0, 1.7, and 3.4%, respectively). The risk for hepatotoxicity increased with a history of alcoholism, viral hepatitis, and other liver diseases. A history of alcoholism and an elevated presenting serum creatinine were associated with increased risk for death/transplant. The lowest presenting ALT levels in a subject who developed hepatotoxicity and who died were 252 and 426 IU/l, respectively. Conclusion. RSTI-induced hepatotoxicity and poor outcomes can be predicted at the patient's presentation. All patients with RSTI who developed hepatotoxicity presented with an abnormal ALT. A history of alcoholism and an elevated creatinine at presentation are markers of increased risk for hepatotoxicity and death.

Allison DC; Holtom PD; Patzakis MJ; Zalavras CG. Microbiology of bone and joint infections in injecting drug abusers. Clinical Orthopaedics and Related Research 468(8): 2107-2112, 2010. (23 refs.)

Background: The literature contains variable reports on the causative organisms of osteomyelitis and septic arthritis in patients with injecting drug abuse and on the rate of oxacillin-resistant S aureus. It is important to have a clear notion of the organisms to initiate empiric antimicrobial therapy. Questions/purposes: We therefore determined the spectrum of organisms in bone and joint infections in patients who were injecting drug users. Methods: We retrospectively reviewed the medical records of 215 patients (154 male, 61 female) with a history of injecting drug abuse and concurrent bone and/or joint infection from 1998 to 2005. The mean age was 43 years (range, 23-83 years). Osteomyelitis was present in 127 of the 215 patients (59%), septic arthritis in 53 (25%), and both in 35 (16%). The lower extremity was most commonly involved (141 cases, 66%), with osteomyelitis of the tibia present in 70 patients (33%) and septic knee arthritis in 30 patients (14%). Results: Cultures yielded predominately Gram-positive bacteria: Staphylococcus aureus in 52% and coagulase-negative Staphylococcus in 20%. The proportion of oxacillin-resistant S aureus among S aureus infections increased from 21% in 1998 to 73% in 2005. Gram-negative organisms were present in 19% of infections and anaerobes in 13%. Patients with osteomyelitis had a higher prevalence of polymicrobial infections (46% versus 15%), infections due to Gram-negative organisms (24% versus 9%), and anaerobic infections (19% versus 6%) compared to patients with septic arthritis. Conclusions: These findings suggest broad-spectrum empiric antibiotic therapy, including vancomycin, should be considered for bone and joint infections in patients with injecting drug abuse. [Level of Evidence Level IV, diagnostic study.]

Arora M; Schwarz E; Sivaneswaran S; Banks E. Cigarette smoking and tooth loss in a cohort of older Australians: The 45 and Up Study. Journal of The American Dental Association 141(10): 1242-1249, 2010. (35 refs.)

Background. Data regarding the long-term effects of smoking, smoking cessation and environmental tobacco smoke (ETS) on tooth loss are limited. Methods. The authors collected information about tooth loss and other health-related characteristics from a questionnaire administered to 103,042 participants in the 45 and Up Study conducted in New South Wales, Australia. The authors used logistic regression analyses to determine associations of cigarette smoking history and ETS with edentulism, and they adjusted for age, sex, income and education. Results. Current and former smokers had significantly higher odds of experiencing edentulism compared with never smokers (prevalence odds ratio [OR] 2.51; 95 percent confidence interval [CI] 2.31-2.73 and OR, 1.50; 95 percent CI, 1.43-1.58, respectively). Among former smokers, the risk declined significantly with increasing time since smoking cessation; however, the risk remained elevated even in those who ceased smoking 30 or more years previously compared with that in never smokers (OR, 1.10; 95 percent CI, 1.02-1.19). Furthermore, among never smokers, the OR for edentulism was 1.37 (95 percent CI, 1.17-1.60) in those who reported having exposure to ETS for six or more hours per week versus those who were not exposed to any ETS. Conclusions and Clinical Implications. Although the risk of experiencing tooth loss declines with time since smoking cessation, the effects of smoking may persist for at least 30 years. The effect of ETS requires further investigation.

Benotsch EG; Koester S; Luckman D; Martin AM; Cejka A. Non-medical use of prescription drugs and sexual risk behavior in young adults. Addictive Behaviors 36(1-2): 152-155, 2011. (27 refs.)

In recent years the non-medical use of prescription drugs (without a doctor's prescription) has increased dramatically particularly in young adults Previous work has noted associations between the non-medical use of prescription drugs and the use of illicit drugs and associations between the use of illicit drugs and sexual risk behavior Investigations examining associations between the non medical use of prescription drugs (NMUPD) and sexual risk behavior are sparse In the present study undergraduate students (n = 435) ages 18-25 completed an instrument assessing these behaviors Overall 35 6% of participants reported NMUPD Individuals who reported NMUPD were more likely to also report the use of alcohol, marijuana, ecstasy, cocaine, methamphetamine, and poppers Participants who indicated they had used prescription medications without a doctor's consent had significantly higher rates of sexual risk behavior including more sexual partners and more instances of unprotected sex in the previous 3 months. Results: suggest that a significant minority of young adults are using prescription medication recreationally and are risking negative consequences including the potential for addiction dangerous interactions between prescription and recreational drugs and greater risk for contracting sexually transmitted infections.

Blosnich J; Jarrett T; Horn K. Disparities in smoking and acute respiratory illnesses among sexual minority young adults. Lung 188(5): 401-407, 2010. (52 refs.)

Morbidity and mortality from cigarette smoking remain major public health issues. Particularly, smoking has been associated with increased risk of acute respiratory illnesses (ARIs). Literature indicates that lesbian, gay, and bisexual (i.e., sexual minority) persons smoke more than the general population. Additionally, young adulthood is the second-most prevalent period of smoking uptake. Given this constellation of risk correlates, the authors examined whether sexual minority young adults experience increased odds of ARIs (i.e., strep throat, bronchitis, sinus infection, and asthma). Using cross-sectional data from the Spring 2006 National College Health Assessment, prevalence estimates of smoking were generated among young adult (age range, 18-24 years) lesbian/gay, bisexual, unsure, and heterosexual college students (n = 75,164). Nested logistic regression analyses were used to examine whether smoking status mediated the risk of ARIs among sexual orientation groups. Compared with heterosexual smokers, gay/lesbian smokers were more likely to have had strep throat, and bisexual smokers were more likely to have had sinus infection, asthma, and bronchitis. Whereas smoking mediated the risk of ARI, sexual minorities still showed higher odds of ARIs after adjustment for smoking. Sexual minority young adults may experience respiratory health disparities that may be linked to their higher smoking rates, and their higher rates of smoking lend urgency to the need for cessation interventions. Future studies are needed to explore whether chronic respiratory disease caused by smoking (i.e., lung cancer, COPD, emphysema) disproportionately affect sexual minority populations.

Boyle NT; Connor TJ. Methylenedioxymethamphetamine ('Ecstasy')-induced immunosuppression: A cause for concern? (review). British Journal of Pharmacology 161(1): 17-32, 2010. (103 refs.)

Methylenedioxymethamphetamine (MDMA; 'Ecstasy') is a ring-substituted amphetamine and a popular drug of abuse. In addition to ability to induce euphoria, MDMA abuse is associated with a range of acute and long-term hazardous effects. This paper is focused on once such adverse effect: its ability to negatively impact on functioning of the immune system. Research demonstrates that MDMA has immunosuppressive properties, with both innate and adaptive arms of the immune system being affected. The ability of MDMA to suppress innate immunity is indicated by impaired neutrophil phagocytosis and reduced production of dendritic cell/macrophage-derived pro-inflammatory cytokines including tumour necrosis factor-alpha, interleukin (IL)-1 beta, IL-12 and IL-15. MDMA also suppresses innate IFN-gamma production, and considering the role of IFN-gamma in priming antigen-presenting cells, it is not surprising that MDMA reduces MHC class II expression on dendritic cells and macrophages, and inhibits co-stimulatory molecule expression. Paradoxically, studies demonstrate that MDMA elicits pro-inflammatory actions in the CNS by activating microglia, the resident innate immune cells in the brain. In terms of adaptive immunity, MDMA reduces circulating lymphocyte numbers, particularly CD4+ T-cells; suppresses T-cell proliferation; and skews cytokine production in a Th-2 direction. For the most part, the immunosuppressive effects of MDMA cannot be attributed to a direct action of the drug on immune cells, but rather due to the release of endogenous immunomodulatory substances. In this regard, peripheral beta-adrenoceptors and cholinergic receptors have been shown to mediate some immunosuppressive effects of MDMA. Finally, we discuss emerging evidence indicating that MDMA-induced immunosuppression can translate into significant health risks for abusers.

Callaghan RC; Cunningham JK; Sajeev G; Kish SJ. Incidence of Parkinson's disease among hospital patients with methamphetamine-use disorders. Movement Disorders 25(14): 2333-2339, 2010. (55 refs.)

Because methamphetamine exposure to experimental animals can damage brain dopamine neurones, we examined whether hospital patients diagnosed with methamphetamine-related disorders might have greater risk of subsequent admission with a Parkinson's disease diagnosis. This was a population-based cohort study using all statewide inpatient hospital discharge records from July 1, 1990, through June 30. 2000, in California, USA, in which subjects aged at least 50 years were followed for up to 10 years. Individuals with reported methamphetamine-related conditions (n = 1,863; ICD-9 codes 304.4, 305.7, 969.7, and E854.2) were matched on demographic variables and follow-up time with those with primary appendicitis conditions (n = 9,315). The appendicitis group had a Parkinson's disease incidence rate no different than the rate found among members of a large health maintenance organization in California. Cox regression procedures were used to estimate group differences in the rates of receiving a subsequent inpatient diagnosis of Parkinson's disease (ICD-9 332.0). The methamphetamine group showed increased risk of a subsequent admission with Parkinson's disease compared with that of the matched appendicitis group (adjusted hazard ratio = 2.65, 95% CI, 1.17-5.98, P = 0.019). Study limitations include a population limited to hospital admissions, an uncertainty regarding diagnostic validity of the ICD-9 code 332.0 (Parkinson's disease), and a small number of incident cases with suspected Parkinson's disease. We strongly emphasize the preliminary nature of the findings. Nevertheless, these data, requiring replication, provide some evidence that methamphetamine users might be at greater than normal risk for developing Parkinson's disease.

Cataldo JK; Dubey S; Prochaska JJ. Smoking cessation: An integral part of lung cancer treatment. (review). Oncology 78(5-6): 289-301, 2010. (92 refs.)

Lung cancer is the leading cause of cancer death in the US. About 50% of lung cancer patients are current smokers at the time of diagnosis and up to 83% continue to smoke after diagnosis. A recent study suggests that people who continue to smoke after a diagnosis of early-stage lung cancer almost double their risk of dying. Despite a growing body of evidence that continued smoking by patients after a lung cancer diagnosis is linked with less effective treatment and a poorer prognosis, the belief prevails that treating tobacco dependence is useless. With improved cancer treatments and survival rates, smoking cessation among lung cancer patients has become increasingly important. There is a pressing need to clarify the role of smoking cessation in the care of lung cancer patients. Objective: This paper will report on the benefits of smoking cessation for lung cancer patients and the elements of smoking cessation treatment, with consideration of tailoring to the needs of lung cancer patients. Results: Given the significant benefits of smoking cessation and that tobacco dependence remains a challenge for many lung cancer patients, cancer care providers need to offer full support and intensive treatment with a smoking cessation program that is tailored to lung cancer patients' specific needs. Conclusion: A tobacco dependence treatment plan for lung cancer patients is provided.

Cavanaugh CE; Floyd LJ; Penniman TV; Hulbert A; Gaydos C; Latimer WW. Examining racial/ethnic disparities in sexually transmitted diseases among recent heroin-using and cocaine-using women. Journal of Women's Health 20(2): 197-205, 2011. (42 refs.)

Background: This study examined racial differences in the prevalence of sexual risk behaviors and their associations with sexually transmitted diseases (STDs) among recent heroin-using and cocaine-using women. Methods: Participants were 214 women (59% black, 41% white) who were recruited during 2002-2010 using targeted sampling to participate in a study in Baltimore, Maryland, and reported using heroin, cocaine, or crack during the previous 6 months. Participants completed self-report questionnaires about their drug use, sexual risk behaviors, and lifetime history of one of six STDs, including gonorrhea, syphilis, chlamydia, genital herpes, genital warts, or trichomoniasis. Results: More black women (50%) than white women (28%) reported a lifetime STD. Although there were no racial differences in the lifetime prevalence of sexual risk behaviors assessed, there were racial differences in the sexual behaviors associated with ever having a lifetime STD. Simple logistic regressions revealed that ever having a casual sex partner or anal sex were correlates of having a lifetime STD among black women but not among white women. Multiple logistic regression analyses revealed that ever having a casual sex partner was significantly associated with having a lifetime STD among black women, and ever trading sex for money was significantly associated with having a lifetime STD among white women. Conclusions: Findings are consistent with national studies and elucidate racial disparities in STDs and associated sexual behaviors among recent heroin-using and cocaine-using women. Findings underscore the need to tailor STD prevention interventions differently for black and white recent heroin-using and cocaine-using women.

Centers for Disease Control. Vital Signs: Current cigarette smoking among adults aged �18 years --- United States, 2009 Weekly. MMWR. Morbidity and Mortality Weekly Review 59(35): 1135-1140, 2010. (4 refs.)

Background: Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States, causing approximately 443,000 premature deaths annually. Methods: The 2009 National Health Interview Survey and the 2009 Behavioral Risk Factor Surveillance System were used to estimate national and state adult smoking prevalence, respectively. Cigarette smokers were defined as adults aged �18 years who reported having smoked �100 cigarettes in their lifetime and now smoke every day or some days. Results: In 2009, 20.6% of U.S. adults aged �18 years were current cigarette smokers. Men (23.5%) were more likely than women (17.9%) to be current smokers. The prevalence of smoking was 31.1% among persons below the federal poverty level. For adults aged �25 years, the prevalence of smoking was 28.5% among persons with less than a high school diploma, compared with 5.6% among those with a graduate degree. Regional differences were observed, with the West having the lowest prevalence (16.4%) and higher prevalences being observed in the South (21.8%) and Midwest (23.1%). From 2005 to 2009, the proportion of U.S. adults who were current cigarette smokers did not change (20.9% in 2005 and 20.6% in 2009). Conclusions: Previous declines in smoking prevalence in the United States have stalled during the past 5 years; the burden of cigarette smoking continues to be high, especially in persons living below the federal poverty level and with low educational attainment. Sustained, adequately funded, comprehensive tobacco control programs could reduce adult smoking.

Public Domain

Champagne BM; Sebrie EM; Schargrodsky H; Pramparo P; Boissonnet C; Wilson E. Tobacco smoking in seven Latin American cities: the CARMELA study. Tobacco Control 19(6): 457-462, 2010. (25 refs.)

Objective This study aimed to explore tobacco smoking in seven major cities of Latin America. Methods The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study is a cross-sectional epidemiological study of 11 550 adults between 25 and 64 years old in Barquisimeto, Venezuela; Bogota, Colombia; Buenos Aires, Argentina; Lima, Peru; Mexico City, Mexico; Quito, Ecuador; and Santiago, Chile. Tobacco smoking, including cigarettes, cigars and pipes, was surveyed among other cardiovascular risk factors. Results Santiago and Buenos Aires had the highest smoking prevalence (45.4% and 38.6%, respectively); male and female rates were similar. In other cities, men smoked more than women, most markedly in Quito (49.4% of men vs 10.5% of women). Peak male smoking prevalence occurred among the youngest two age groups (25-34 and 35-44 years old). Men and women of Buenos Aires smoked the highest number of cigarettes per day on average (15.7 and 12.4, respectively). Men initiated regular smoking earlier than women in each city (ranges 13.7-20.0 years vs 14.2-21.1 years, respectively). Exposure to secondhand tobacco smoke at workplace for more than 5 h per day was higher in Barquisimeto (28.7%), Buenos Aires (26.8%) and Santiago (21.5%). The highest prevalence of former smokers was found among men in Buenos Aires, Santiago and Lima (30.0%, 26.8% and 26.0% respectively). Conclusions Smoking prevalence was high in the seven CARMELA cities, although patterns of smoking varied among cities. A major health and economic burden is inevitable in urban Latin America unless effective comprehensive tobacco control measures

Cherner M; Bousman C; Everall I; Barron D; Letendre S; Vaida F et al. Cytochrome P450-2D6 extensive metabolizers are more vulnerable to methamphetamine-associated neurocognitive impairment: Preliminary findings. Journal of the International Neuropsychological Society 16(5): 890-901, 2010. (71 refs.)

While neuropsychological deficits are evident among methamphetamine (meth) addicts, they are often unrelated to meth exposure parameters such as lifetime consumption and length of abstinence. The notion that some meth users develop neuropsychological impairments while others with similar drug exposure do not, suggests that there may be individual differences in vulnerability to the neurotoxic effects of meth. One source of differential vulnerability could come from genotypic variability in metabolic clearance of meth, dependent on the activity of cytochrome P450-2D6 (CYP2D6). We compared neuropsychological performance in 52 individuals with a history of meth dependence according with their CYP2D6 phenotype. All were free of HIV or hepatitis C infection and did not meet dependence criteria for other substances. Extensive metabolizers showed worse overall neuropsychological performance and were three times as likely to be cognitively impaired as intermediate/poor metabolizers. Groups did not differ in their demographic or meth use characteristics, nor did they evidence differences in mood disorder or other substance use. This preliminary study is the first to suggest that efficient meth metabolism is associated with worse neurocognitive outcomes in humans, and implicates the products of oxidative metabolism of meth as a possible source of brain injury.

Chohan KR; Badawy SZA. Cigarette smoking impairs sperm bioenergetics. International Brazil Journal of Urology 36(1): 60-64, 2010. (28 refs.)

Objective: The growing consensus on the negative impact of cigarette smoking on fertility prompted us to compare the rate of sperm respiration in smokers and non-smokers. Materials and Methods: Semen samples from 20 smokers and 58 non-smokers consulting at the andrology laboratory for fertility evaluation were used. Smoking was defined as consumption of at least a half a pack per day. A phosphorescence analyzer that measures O-2 concentration in sperm suspensions as function of time was used to determine the rate of respiration. In a sealed vial, the rate of sperm respiration (k) was defined as -d[O-2]/dt; where [O-2] was obtained from the phosphorescence decay rate of a palladium phosphor. [O-2] in solutions containing sperm and glucose declined linearly with time, showing the kinetics of O-2 consumption was zero-order. Inhibition of O-2 consumption by cyanide confirmed the oxidations that occurred in the sperm mitochondrial respiratory chain. Results: There were no differences (p > 0.28) between smokers and non-smokers for ejaculate volume, motility, concentration, normal morphology, viability and hypo-osmotic swelling test. The rate (mean +/- SD, in mu M O-2/min/10(8) sperm) of sperm mitochondrial O-2 consumption in the smokers was 0.96 +/- 0.58 and in the non-smokers 1.39 +/- 0.67 (p = 0.004). Conclusions: The rate of sperm respiration was significantly lower in smokers. This negative impact of cigarette smoking on sperm aerobic metabolism may, in part, explain the lower rate of fertility in smokers.

Christerson S; Stromberg B. Childhood stroke in Sweden I: incidence, symptoms, risk factors and short-term outcome. Acta Paediatrica 99(11): 1641-1649, 2010. (31 refs.)

Aim: To evaluate the incidence, presenting symptoms, diagnostic delay, risk factors and short-term outcome of childhood stroke in a population-based cohort of Swedish children. Methods: We retrospectively reviewed the records of children experiencing their first stroke during a 7-year period in Uppsala-Orebro Health Care Region covering one-fifth of the Swedish population. Arterial ischaemic stroke (AIS), cerebral sinus venous stroke and nontraumatic haemorrhagic stroke (HS) in children aged > 28 days and < 18 years were included. Results: We identified 51 children (23 boys and 28 girls; median age 13). The average annual incidence of stroke was 1.8 per 100,000 children. AIS was found in 51% of the children, HS in 41% and cerebral sinus venous stroke in 8%. One-third of the children had underlying diseases, and one-third had vascular malformations. Six girls used oral contraceptives, three of these were smokers and two had iron deficiency anaemia. Two children died in the acute stage (4%), and 40/49 (82%) had some neurological dysfunction at discharge. Conclusion: The incidence of childhood stroke was 1.8 per 100,000 children and year, and the primary mortality was 4%. Risk factors of importance were oral contraceptives, smoking and anaemia in combinations.

Cone JD; Harrington MA; Kelley SS; Prince MD; Payne WG; Smith DJ. Drug abuse in plastic surgery patients: Optimizing detection and minimizing complications. Plastic and Reconstructive Surgery 127(1): 445-455, 2011. (42 refs.)

Drugs of abuse present numerous challenges to plastic surgeons, and detection remains difficult. With rates of drug abuse and misuse on the rise, clinicians must remain especially attentive to drug abusers' verbal and nonverbal cues, and be familiar with treating perioperative complications if they arise. Informed deductions regarding drug abuse can enable a plastic surgeon to identify drug abuse, minimize complications, and optimize patient care.

Connell PP; O'Neill EC; Islam FMA; Buttery R; McCombe M; Essex RH et al. Endogenous endophthalmitis associated with intravenous drug abuse seven-year experience at a tertiary referral center. Retina 30(10): 1721-1725, 2010. (25 refs.)

Purpose: Intravenous drug use (IVDU) is a known risk factor for endogenous endophthalmitis. Endogenous fungal endophthalmitis (EFE) is emerging as a common problem among this community. We describe the management and visual outcomes of acute IVDU-associated EFE. Methods: A prospective consecutive case series of 19 patients presenting with presumed acute IVDU-associated EFE from 2001 to 2007 to the Royal Victorian Eye and Ear Hospitalital was included. All data were collected in a standardized manner. Outcome measures included visual acuity, microbial profiles, and vitrectomy rate. Results: Nineteen cases of IVDU-associated EFE were identified. Eight of these (42%) were men, and the mean age was 32.7 years (SD +/- 8.0 years). Presenting visual acuity ranged from 6/6 to perception of light, with 58% having a visual acuity of 6/48 or less at presentation. Thirteen (68.4%) were culture positive with all cultures identifying Candida species, and 52.7% underwent vitrectomy. Fifty percent of subjects overall achieved a final visual acuity of 6/18 or better. Men demonstrated improved visual acuity when compared with women (P = 0.04). Age had no effect on final acuity. Conclusion: Intravenous drug use is a significant risk factor for developing EFE. Good visual outcomes can be achieved with early treatment, often with intravitreal therapy alone.

Cottencin O; Karila L; Lambert M; Arveiller C; Benyamina A; Boissonas A et al. Cannabis arteritis: Review of the literature. (review). Journal of Addiction Medicine 4(4): 191-196, 2010. (53 refs.)

Consumption of cannabis in young adults has continued to increase in recent years. Cannabis arteritis was first described in the 1960s, but the number of cases has continued to increase. We reviewed current knowledge of the different types of cannabis arteritis in young adults and found 70 cases of cannabis arteritis in the literature. We discuss physiopathological arguments in favor of cannabis vascular toxicity per se, although we did not find sufficient evidence to identify cannabis arteritis as a specific diagnostic entity. Many factors suggest a link between cannabis consumption and arteritis in young adults, but it is difficult to say whether this type of arteritis is similar to thromboangiitis obliterans. We were unable to demonstrate a formal association between cannabis smoking and the development of thromboangiitis obliterans, because most case reports showed associated tobacco smoking (97%) and the number of years cannabis had been smoked by the participants was mostly unknown. Cannabis consumption would however seems to be an aggravating factor, together with tobacco, in arteritis, which occurs in young adults.

Crean RD; Crane NA; Mason BJ. An evidence-based review of acute and long-term effects of cannabis use on executive cognitive functions. (review). Journal of Addiction Medicine 5(1): 1-8, 2011. (64 refs.)

Cannabis use may impair cognitive functions on a number of levels-from basic motor coordination to more complex executive function tasks, such as the ability to plan, organize, solve problems, make decisions, remember, and control emotions and behavior. These deficits differ in severity depending on the quantity, recency, age of onset, and duration of marijuana use. Understanding how cannabis use impairs executive function is important for clinicians. Individuals with cannabis-related impairment in executive functions have been found to have trouble learning and applying the skills required for successful recovery, putting them at increased risk for relapse to cannabis use. Here, we review the research on the acute, residual, and long-term effects of cannabis use on executive functions and discuss the implications for treatment.

Crean RD; Tapert SF; Minassian A; MacDonald K; Crane NA; Mason BJ. Effects of chronic, heavy cannabis use on executive functions. Journal of Addiction Medicine 5(1): 9-15, 2011. (38 refs.)

This case describes the clinical course of a cannabis-dependent individual entering a 12-week abstinence-based research program. The case illustrates the effects of chronic, heavy cannabis use on executive functions at 3 time points: (1) 12 hours of abstinence; (2) 4 weeks of abstinence; and (3) 12 weeks of abstinence. It is followed by discussions by 2 clinical psychologists and a psychiatrist. The findings described here have important clinical implications, because executive functions have a vital role in treatment participation and in sustaining recovery. It should be of particular interest to clinicians who work with people with cannabis use disorders.

De Felice M; Ossipov MH; Porreca F. Update on medication-overuse headache. (review). Current Pain and Headache Reports 15(1): 79-83, 2011. (47 refs.)

Medication-overuse headache (MOH) is a syndrome that can develop in migraineurs after overuse of antimigraine drugs, including opiates and triptans especially. MOH manifests as increased frequency and intensity of migraine attacks and enhanced sensitivity to stimuli that elicit migraine episodes. Although the mechanisms underlying MOH remain unknown, it is hypothesized that repeated use of antimigraine drugs could elicit increased headache attacks as a consequence of neuronal plasticity that may increase responsiveness to migraine triggers. Preclinical studies show that exposure to either opiates or triptans can induce pronociceptive neuroadaptive changes in the orofacial division of the trigeminal ganglia that persist even after discontinuation of the drug treatment. Additionally, medications can elicit increased descending facilitatory influences that may amplify evoked inputs from trigeminal afferents leading to behavioral hypersensitivity reminiscent of cutaneous allodynia observed clinically. Importantly, enhanced descending facilitation may manifest as an inhibition of diffuse noxious inhibitory control. Persistent, pronociceptive adaptations in nociceptors as well as within descending modulatory pathways thus may jointly contribute to the development of MOH.

Dechanet C; Anahory T; Daude JCM; Quantin X; Reyftmann L; Hamamah S et al. Effects of cigarette smoking on reproduction. (review). Human Reproduction Update 17(1): 76-95, 2011. (216 refs.)

Background: Cigarette smoking is associated with lower fecundity rates, adverse reproductive outcomes and a higher risk of IVF failures. Over the last few decades, prevalence of smoking among women of reproductive age has increased. This review focuses on current knowledge of the potential effects of smoke toxicants on all reproductive stages and the consequences of smoke exposure on reproductive functions. methods: We conducted a systematic review of the scientific literature on the impact of cigarette smoking and smoke constituents on the different stages of reproductive function, including epidemiological, clinical and experimental studies. We attempted to create hypotheses and find explanations for the deleterious effects of cigarette smoke observed in experimental studies. Results: Cigarette smoke contains several thousand components (e. g. nicotine, polycyclic aromatic hydrocarbons and cadmium) with diverse effects. Each stage of reproductive function, folliculogenesis, steroidogenesis, embryo transport, endometrial receptivity, endometrial angiogenesis, uterine blood flow and uterine myometrium is a target for cigarette smoke components. The effects of cigarette smoke are dose-dependent and are influenced by the presence of other toxic substances and hormonal status. Individual sensitivity, dose, time and type of exposure also play a role in the impact of smoke constituents on human fertility. conclusions: All stages of reproductive functions are targets of cigarette smoke toxicants. Further studies are necessary to better understand the deleterious effects of cigarette smoke compounds on the reproductive system in order to improve health care, help to reduce cigarette smoking and provide a better knowledge of the molecular mechanisms involved in reproductive toxicology.

Dingwall KM; Lewis MS; Maruff P; Cairney S. Assessing cognition following petrol sniffing for indigenous Australians. Australian and New Zealand Journal of Psychiatry 44(7): 631-639, 2010. (33 refs.)

Background: Chronic petrol inhalation can be associated with significant cognitive impairment. While rehabilitation programs can rely on such skills to educate clients and achieve treatment outcomes, cognitive function is rarely assessed on admission. This is particularly true for Indigenous populations where standard assessments are not appropriate. This paper describes a process for assessing cognition in Indigenous Australians. Two studies investigate firstly the demographic factors impacting on cognition for healthy Indigenous Australians and secondly the utility of the assessment process for detecting petrol sniffing related cognitive impairments. Methods: Study One assessed a naturalistic sample of healthy Indigenous Australians from the Northern Territory (N = 206; mean age = 28.03) on computerised tests of psychomotor speed, visual attention, memory, learning, spatial awareness and executive functions. Multiple regression analyses determined the unique contributions of six factors (age, education, gender, familiarity with computers, regular long term cannabis use and locality) to the variance in performance for this group. Study Two examined group differences in cognitive performance on the same tests between healthy Indigenous Australians (N = 96) and Indigenous petrol sniffers (N = 50; both age restricted to < 26 years) while controlling those factors found to impact on performance from Study One. Results: Age, computer familiarity, and education significantly contributed to the variance in performance measures. While controlling these factors, petrol abuse was associated with poorer performance on complex tasks of psychomotor, visual attention, memory, learning, spatial awareness and executive function. Conclusions: This assessment process is useful for detecting substance abuse related impairments in Indigenous Australians and when using this assessment process, age and computer familiarity in particular should be controlled for.

Dove MS; Dockery DW; Mittleman MA; Schwartz J; Sullivan EM; Keithly L et al. The impact of Massachusetts' smoke-free workplace laws on acute myocardial infarction deaths. American Journal of Public Health 100(11): 2206-2212, 2010. (33 refs.)

Objectives. We examined the rate of acute myocardial infarction (AMI) deaths in Massachusetts before and after the implementation of a comprehensive smoke-free workplace law in July 2004. Methods. We used Poisson regression models to examine the impact of the state law in cities and towns with and without previous local smoking bans and the effect of the local laws for the period of 1999 through 2006. Results. The AMI mortality rate decreased by 7.4% (95% confidence interval [CI]=3.3%, 11.4%) after implementation of the state law. The state ban had an impact in cities and towns with no prior local smoking ban (9.2% decrease; P<.001) but not cities and towns with a prior local smoking ban. However, there was a nonsignificant 4.9% (95% CI=-5.0%, 13.9%) decrease associated with the local smoking ban that preceded the effect of the state ban. The effect of the state ban was modest (-1.6%) in the first 12 months after implementation but much larger after the first 12 months (-18.6%; P<.001). Conclusions. Comprehensive statewide smoke-free workplace laws in Massachusetts were associated with an estimated 270 fewer AMI deaths per year. These results add to the evidence suggesting that smoke-free air laws are associated with lower rates of AMI.

Fabregas JM; Gonzalez D; Fondevila S; Cutchet M; Fernandez X; Barbosa PCR et al. Assessment of addiction severity among ritual users of ayahuasca. Drug and Alcohol Dependence 111(3): 257-261, 2010. (25 refs.)

Ayahuasca is a psychoactive beverage used for magico-religious purposes in the Amazon. Recently, Brazilian syncretic churches have helped spread the ritual use of ayahuasca abroad. This trend has raised concerns that regular use of this N N-dimethyltryptamine-containing tea may lead to the medical and psychosocial problems typically associated with drugs of abuse Here we assess potential drug abuse-related problems in regular ayahuasca users Addiction severity was assessed using the Addiction Severity Index (ASI) and history of alcohol and illicit drug use was recorded In Study 1 Jungle-based ayahuasca users (n = 56) were compared vs rural controls (n = 56) In Study 2 urban-based ayahuasca users (n = 71) were compared vs urban controls (n = 59). Follow-up studies were conducted 1 year later In both studies ayahuasca users showed significantly lower scores than controls on the ASI Alcohol Use and Psychiatric Status subscales. The Jungle-based ayahuasca users showed a significantly higher frequency of previous illicit drug use but this had ceased at the time of examination except for cannabis At follow-up abstinence from illicit drug use was maintained in both groups except for cannabis in Study 1. However differences on ASI scores were still significant in the Jungle-based group but not in the urban group. Despite continuing ayahuasca use a time-dependent worsening was only observed in one subscale (Family/Social relationships) in Study 2 vet all the ritual use of ayahuasca as assessed with the ASI in currently active users does not appear to be associated with the deleterious psychosocial effects typically caused by other drugs of abuse.

Fareed A; Musselman D; Byrd-Sellers J; Vayalapalli S; Casarella J; Drexler K et al. Onsite basic health screening and brief health counseling of chronic medical conditions for veterans in methadone maintenance treatment. Journal of Addiction Medicine 4(3): 160-166, 2010. (34 refs.)

Background: To improve the delivery of health services for chronic medical conditions in our methadone clinic, we added an onsite health screening and brief health counseling to the treatment plans for patients receiving methadone maintenance treatment (MMT) at the Atlanta Veterans Affairs Medical Center. We then conducted a follow-up retrospective chart review to assess whether this intervention improved health outcome for those patients. Methods: We reviewed the charts of 102 patients who received treatment at Atlanta Veterans Affairs Medical Center methadone clinic between 2002 and 2008. We sought to determine whether our increased health education and screening intervention were associated with (1) improved drug addiction outcome (as measured by comparing percentage of opiate and cocaine positive drug screens from admission with most recent). (2) Basic health screening (as measured by the patient's compliance with primary care physician appointments and current smoking status). (3) Management of co-occurring medical conditions (as measured by levels of low-density lipoprotein cholesterol, hemoglobin A1c, and systolic blood pressure). (4) Presence of QT interval corrected (QTc) prolongation (difference in QTc between baseline and most recent electrokardiogram). Results: Illicit drug use (opiate and cocaine) markedly decreased in patients overall. The effect was more robust for those successfully "retained" (n = 55, P < 0.0001) in treatment, compared with those who "dropped out" (n = 40, P = 0.05) of treatment. Compliance with primary care physician appointments was high (82% and 88% before and after the onsite intervention, respectively) for retained patients. Low-density lipoprotein cholesterol level was within normal range for all patients. A1c improved by 40% after the onsite intervention as reflected by the decreased percentage of patients with A1c >7% from before to after the intervention (90% vs 50%, P =0.05). However, the prevalence of uncontrolled hypertension did not significantly improve after the onsite intervention (38% vs 28%, P = 0.34). As might be expected with MMT, the prevalence of QTc prolongation actually increased from 399 (+/- 92) to 439 (+/- 22) milliseconds after the onsite intervention (P = 0.003). Conclusions: Our retrospective study supports the previous literature that methadone maintenance therapy is effective in reducing illicit drug use. Although patients with history of heroin dependence and in MMT are at increased risk for chronic medical conditions, such as hepatitis C and diabetes, there are minimal federal guidelines for medical care, except than a physical examination on admission, and basic screening for some infectious diseases, eg, HIV and hepatitis C for those patients. Our study demonstrated the need for and potential benefit of enhancing the delivery of health promotion services for chronic medical conditions in methadone maintained patients. Improving management of hepatitis C, diabetes, hypertension, and other related conditions, in this high risk, difficult-to-treat, and underserved population may reduce their morbidity and premature mortality.

Fatovich DM; McCoubrie DL; Song SJ; Rosen DM; Lawn ND; Daly FF. Brain abnormalities detected on magnetic resonance imaging of amphetamine users presenting to an emergency department: A pilot study. Medical Journal of Australia 193(5): 266-268, 2010. (13 refs.)

Objectives: To determine the prevalence of occult brain abnormalities in magnetic resonance imaging of active amphetamine users. Design, setting and participants: Prospective convenience study in a tertiary hospital emergency department (ED). Patients presenting to the ED for an amphetamine-related reason were eligible for inclusion. We collected demographic data, drug use data, and performed a mini-mental state examination (MMSE). Main outcome measures: The proportion of patients with an abnormality on their MRI scan. Results: Of 38 patients enrolled, 30 had MRI scans. Nineteen were male and their mean age was 26.7 +/- 5.4 years (range 19-41 years). The mean age of first amphetamine use was 18 years (range 13-26 years). Sixteen patients used crystal methamphetamine (mean amount 2.5 g/week), nine used amphetamine ("speed") (mean amount 2.9 g/week), and 23 used ecstasy (mean amount 2.3 tablets/week). Marijuana was smoked by 26 (mean amount 5.9 g/week), and 28 drank alcohol (mean amount 207 g/week). The median MMSE score was 27/30 (interquartile range, 26-29). Abnormalities on brain MRI scans were identified in six patients, most commonly an unidentified bright object (n = 4). Conclusion: In this pilot study of brain MRI of young people attending the ED with an amphetamine-related presentation, one in five had an occult brain lesion. While the significance of this is uncertain, it is congruent with evidence that amphetamines cause brain injury.

Fernandez-Serrano MJ; Perez-Garcia M; Rio-Valle JS; Verdejo-Garcia A. Neuropsychological consequences of alcohol and drug abuse on different components of executive functions. Journal of Psychopharmacology 24(9): 1317-1332, 2010. (122 refs.)

Several studies have shown alterations in different components of executive functioning in users of different drugs, including cannabis, cocaine and heroin. However, it is difficult to establish a specific association between the use of each of these drugs and executive alterations, since most drug abusers are polysubstance abusers, and alcohol is a ubiquitous confounding factor. Moreover, in order to study the association between consumption of different drugs and executive functioning, the patterns of quantity and duration of drugs used must be considered, given the association between these parameters and the executive functioning alteration degree. Based on the multicomponent approach to executive functions, the aims of the present study were: (i) to analyse the differential contribution of alcohol versus cocaine, heroin and cannabis use on executive functions performance; and (ii) to analyse the contribution made by the severity of the different drugs used (quantity and duration patterns) on these functions in a sample of polysubstance abusers that requested treatment for cannabis-, cocaine-or heroin-related problems. We administered measures of fluency, working memory, analogical reasoning, interference, cognitive flexibility, decision-making and self-regulation to two groups: 60 substance-dependent individuals (SDIs) and 30 healthy control individuals (HCIs). SDIs had significantly poorer performance than HCIs across all of the executive domains assessed. Results from hierarchical regression models showed the existence of common correlates of the use of alcohol, cannabis and cocaine on verbal fluency and decision-making; common correlates of quantity of cannabis and cocaine use on verbal working memory and analogical reasoning; common correlates of duration of cocaine and heroin use on shifting; and specific effects of duration of cocaine use on inhibition measures. These findings indicate that alcohol abuse is negatively associated with fluency and decision-making deficits, whereas the different drugs motivating treatment have both generalized and specific deleterious effects on different executive components.

Flouris AD; Koutedakis Y. Immediate and short-term consequences of secondhand smoke exposure on the respiratory system. Current Opinion In Pulmonary Medicine 17(2): 110-115, 2011. (62 refs.)

Purpose of review: This review critically evaluates the existing biological evidence regarding the immediate and short-term respiratory consequences of secondhand smoke (SHS). Recent findings: A 1-h exposure to SHS at bar/restaurant levels generates a marked inflammatory reaction and significant decrements on lung function. These deleterious effects of SHS are exacerbated when physical activity follows the SHS exposure, particularly in less fit individuals. The main respiratory effect mechanisms of SHS include a direct induction of growth factors resulting in airway remodelling and alterations in nitric oxide regulation. Pharmacological agents that increase either apical membrane chloride conductance or basolateral membrane potassium conductance may be of therapeutic benefit in patients with diseases related to SHS exposure. Moreover, treatment with statins has shown beneficial effects towards preventing the SHS-induced pulmonary hypertension, vascular remodelling, and endothelial dysfunction. Summary: Based on recently discovered evidence, even brief and short-term exposures to SHS generate significant adverse effects on the human respiratory system. Future research directions in this area include the concentrations of tobacco smoke constituents in the alveolar milieu following SHS exposure, individual susceptibility to SHS, as well as pharmacological treatments for reversing the SHS-induced airway remodelling.

Foti DJ; Kotov R; Guey LT; Bromet EJ. Cannabis use and the course of schizophrenia: 10-year follow-up after first hospitalitalization. American Journal of Psychiatry 167(8): 987-993, 2010. (40 refs.)

Objective: The authors examined the relationship between cannabis use and the course of illness in schizophrenia over 10 years of follow-up after first psychiatric hospitalization. Method: The authors assessed 229 patient S with a schizophrenia spectrum disorder five times: during the first admission and 6 months, 2 years, 4 years, and 10 years later. Ratings of cannabis use and psychiatric symptoms (psychotic, negative, disorganized, and depressive) were made at each assessment. Results: The lifetime rate of cannabis use was 66.2%, and survival analysis revealed that lifetime use was associated with an earlier onset of psychosis. The rates of current use ranged from 10% to 18% across assessments. Cannabis status was moderately stable, with tetrachoric correlation coefficients between waves ranging from 0.48 to 0.78. Mixed-effects logistic regression revealed that changes in cannabis use were associated with changes in psychotic symptoms over time even after gender, age, socioeconomic status, other drug use, antipsychotic medication use, and other symptoms were controlled for. Structural equation modeling indicated that the association with psychotic symptoms was bidirectional. Conclusions: Cannabis use is associated with an adverse course of psychotic symptoms in schizophrenia, and vice versa, even after taking into account other clinical, substance use, and demographic variables.

Fraietta R; Cedenho AP. Cigarette smoking impairs sperm bioenergetics. (editorial). International Brazil Journal of Urology 36(1): 65-65, 2010

Frei MY; Nielsen S; Dobbin MDH; Tobin CL. Serious morbidity associated with misuse of over-the-counter codeine-ibuprofen analgesics: A series of 27 cases. Medical Journal of Australia 193(5): 294-296, 2010. (21 refs.)

Objective: To investigate morbidity related to misuse of over-the-counter (OTC) codeine-ibuprofen analgesics. Design and setting: Prospective case series collected from Victorian hospital-based addiction medicine specialists between May 2005 and December 2008. Main outcome measures: Morbidity associated with codeine-ibuprofen misuse. Results: Twenty-seven patients with serious morbidity were included, mainly with gastrointestinal haemorrhage and opioid dependence. The patients were taking mean daily doses of 435-602 mg of codeine phosphate and 6800-9400 mg ibuprofen. Most patients had no previous history of substance use disorder. The main treatment was opioid substitution treatment with buprenorphine-naloxone or methadone. Conclusions: Although codeine can be considered a relatively weak opioid analgesic, it is nevertheless addictive, and the significant morbidity and specific patient characteristics associated with overuse of codeine-ibuprofen analgesics support further awareness, investigation and monitoring of OTC codeine-ibuprofen analgesic use.

Frohlich S; Lambe E; O'Dea J. Acute liver failure following recreational use of psychotropic "head shop" compounds. Irish Journal of Medical Science 180(1): 263-264, 2011. (4 refs.)

The recreational use of the so-called "legal-highs" has been in both the medical and political arena over the last year as a result of the appearance of "head shops" in many towns in Ireland. These shops specialized in selling new psychotropic compounds that circumvented established drug legislation. Little is known about the potentially harmful effects of these substances but case reports suggest a plethora of harmful psychological and physical effects. Our case describes for the first time acute liver failure associated with the ingestion of two of these amphetamine type compounds.

Gardiner P; Clark PI. Menthol cigarettes: Moving toward a broader definition of harm. (editorial). Nicotine & Tobacco Research 12(Suppl. 2): S85-S93, 2010. (56 refs.)

The current practice of the tobacco industry of primarily focusing on the extent that menthol cigarettes contribute or do not contribute to excess morbidity and mortality in various diseases does not, in and of itself, fully illuminate the harm caused by these products. In fact, this practice actually masks and obscures the public health harm associated with menthol cigarettes. Given this, this commentary develops and presents a broader definition of harm in which to view menthol cigarettes and as the necessary and underlying rationale of why this candy-flavored ingredient should be removed from all tobacco products. This paper relies on the scientific presentations of the 2nd Conference on Menthol Cigarettes, and the peer-reviewed literature on menthol cigarettes. A broader definition of harm from menthol cigarettes must be analyzed from a broad public health perspective and take into account youth uptake and initiation, menthol's ability to augment addiction through unique sensory properties, spurious health messages associated with these products, menthol's role in cessation inhibition and relapse promotion, and the blatant predatory marketing of these products to the most vulnerable sectors of society. The Food and Drug Administration (FDA) should apply the same logic that outlawed other candy flavorings and apply it to menthol cigarettes; in the end, all candy flavorings, including menthol, only serve to make the poisons inherent in tobacco smoke go down easier. Additionally, the mobilization of communities most affected by the menthol cigarettes, the FDA, and candy flavorings and the tobacco industry's machinations will be discussed.

Gass JD; Stein DJ; Williams DR; Seedat S. Intimate partner violence, health behaviours, and chronic physical illness among South African women. American Journal of Public Health 100(9): 582-585, 2010. (26 refs.)

Objectives. An association between intimate partner violence and adverse physical health outcomes and health-risk behaviours among women has been established, most scientific research having been conducted in the USA and other developed countries. There have been few studies in developing countries, including South Africa, which has one of the highest rates of intimate partner violence in the world. We therefore sought to study the association between physical intimate partner violence and physical health outcomes and behaviours among South African women. Methods. Using data from the cross-sectional, nationally representative South African Stress and Health Study, we assessed exposure to intimate partner violence, health-risk behaviours, health-seeking behaviours and chronic physical illness among a sample of 1 229 married and cohabiting women. Results. The prevalence of reported violence was 31%. This correlated with several health-risk behaviours (smoking, alcohol consumption, and use of non-medical sedatives, analgesics and cannabis) and health-seeking behaviours (recent visits to a medical doctor or healer). Intimate partner violence was not significantly associated with chronic physical illness, although rates of headache, heart attack and high blood pressure reached near-significance. Conclusions. Partner violence against women is a significant public health problem in South Africa, associated with health-risk behaviours and increased use of medical services. Public health programmes should incorporate interventions to mitigate the impact of violence on victims and reduce the risk of negative behavioural outcomes. Further investigation of the pathways between violence exposure and health Copyright 2010, South African Medical Association

Gastaldelli A; Folli F; Maffei S. Impact of tobacco smoking on lipid metabolism, body weight and cardiometabolic risk. (review). Current Pharmaceutical Design 16(23): 2526-2530, 2010. (70 refs.)

Tobacco smoking is the most important preventable cause of cardiovascular disease. In this paper we review current epidemiological and pathophysiological evidence linking smoking with cardiovascular and metabolic diseases. Among the effects of smoking there is the alteration of lipid metabolism through the increase in lipolysis, insulin resistance and tissue lipotoxicity. Smoking is both prothrombotic and atherogenic. As an effect, the risk of acute myocardial infarction, sudden cardiac death, stroke, aortic aneurysm and peripheral vascular disease is increased. Even very low doses of exposure increase the risk of cardiovascular disease (CVD) and metabolic alterations. On the other hand, smoking cessation restores, at least in part, lipid metabolism and the benefits can be observed already after a short period of abstinence from smoking, although it occurs several years before the risks approach those of the never-smoker.

Goddard J; Varnado WC. Human nasal myiasis: Possibly associated with cocaine abuse. Journal of Entomological Science 45(2): 188-189, 2010. (0 refs.)

Note: Myiasis is a condition in which the nasal passage is infected by worms or larva.

Good MM; Solt I; Acuna JG; Rotmensch S; Kim MJ. Methamphetamine use during pregnancy maternal and neonatal implications. Obstetrics and Gynecology 116(2, Part 1): 330-334, 2010. (32 refs.)

OBJECTIVE: To report the demographic characteristics and clinical morbidity of methamphetamine-exposed pregnancies compared with control patients in a tertiary care, urban, academic medical center. METHODS: A single-site chart review from 2000 to 2006 was conducted. International Classification of Diseases, 9th Revision code 648.3x was used to identify potential study participants. Specific inclusion criteria required either a positive urine drug screen for methamphetamine use or by patient statement of methamphetamine use during pregnancy. Data from 276 identified patients were then compared with the 34,055 in the general obstetric population during the same period for various demographic factors and perinatal outcomes. RESULTS: Two hundred seventy-six patients responsible for 273 live births were identified between 2000 and 2006. Factors that were significantly associated with methamphetamine use were age younger than 20 years (9% methamphetamine compared with 16% control patients), non-Hispanic white ethnicity (55% compared with 71%), married (12% compared with 46%), preterm delivery (52% compared with 17%), low Apgar scores (6% compared with 1-2%), cesarean delivery (29% compared with 23%), and neonatal mortality (4% compared with 1%). Additionally, the maternal demographic characteristics suggested that these women were more likely to be unemployed, use other abusive substances, and have higher rates of domestic violence and adoption when compared with the control population. CONCLUSION: Methamphetamine use in pregnancy is complicated by more morbid maternal and neonatal outcomes when compared with the general obstetric population. Because the patients in this study were in a variety of ways demographically distinct, attempts to identify these patients early and intervene in an effort to improve pregnancy-related outcomes appears possible and warranted.

Green KM; Doherty EE; Stuart EA; Ensminger ME. Does heavy adolescent marijuana use lead to criminal involvement in adulthood? Evidence from a multiwave longitudinal study of urban African Americans. Drug and Alcohol Dependence 112(1-2): 117-125, 2010. (58 refs.)

While marijuana use is common during adolescence, it can have adverse long-term consequences, with serious criminal involvement being one of them. In this study, we utilize longitudinal data from the Woodlawn Study of a community cohort of urban African Americans (N = 702) to examine the effects of heavy adolescent marijuana use (20 or more times) on adult criminal involvement, including perpetration of drug, property and violent crime, as well as being arrested and incarcerated. Utilizing propensity score matching to take into account the shared risk factors between drug use and crime, regression analyses on the matched samples show that heavy adolescent marijuana use may lead to drug and property crime and criminal justice system interactions, but not violent crime. The significant associations of early heavy marijuana use with school dropout and the progression to cocaine and/or heroin use only partially account for these findings. Results suggest that the prevention of heavy marijuana use among adolescents could potentially reduce the perpetration of drug and property crime in adulthood, as well as the burden on the criminal justice system, but would have little effect on violent crime.

Green TC; Kershaw T; Lin HQ; Heimer R; Goulet JL; Kraemer KL et al. Patterns of drug use and abuse among aging adults with and without HIV: A latent class analysis of a US Veteran cohort. Drug and Alcohol Dependence 110: 208-220 110(3): 208-220, 2010. (94 refs.)

This study characterized the extent and patterns of self-reported drug use among aging adults with and without HIV, assessed differences in patterns by HIV status, and examined pattern correlates. Data derived from 6351 HIV-infected and uninfected adults enrolled in an eight-site matched cohort, the Veterans Aging Cohort Study (VACS). Using clinical variables from electronic medical records and socio-demographics, drug use consequences, and frequency of drug use from baseline surveys, we performed latent class analyses (LCA) stratified by HIV status and adjusted for clinical and socio-demographic covariates. Participants were, on average, age 50 (range 22-86), primarily male (95%) and African-American (64%). Five distinct patterns emerged: non-users, past primarily marijuana users, past multidrug users, current high consequence multidrug users, and current low consequence primarily marijuana users. HIV status strongly influenced class membership. Non-users were most prevalent among HIV uninfected (36.4%) and current high consequence multidrug users (25.5%) were most prevalent among HIV-infected. While problems of obesity marked those not currently using drugs, current users experienced higher prevalences of medical or mental health disorders. Multimorbidity was highest among past and current multidrug users. HIV-infected participants were more likely than HIV-uninfected participants to be current low consequence primarily marijuana users. In this sample, active drug use and abuse were common. HIV-infected and uninfected Veterans differed on extent and patterns of drug use and on important characteristics within identified classes. Findings have the potential to inform screening and intervention efforts in aging drug users with and without HIV.

Greenwood DC; Alwan N; Boylan S; Cade JE; Charvill J; Chipps KC et al. Caffeine intake during pregnancy, late miscarriage, and stillbirth. (editorial). Obstetrical & Gynecological Survey 65(8): 492-494, 2010. (0 refs.)

Many obstetric guidelines recommend limitation of caffeine intake immediately before and during pregnancy, despite the lack of consistent evidence showing a clear benefit. Although some observational cohort studies have suggested that maternal caffeine intake may be associated with decreased birth weight and fetal growth restriction, in the only reported intervention trial, no substantial effect of caffeine reduction during the second half of pregnancy was found. Evidence for an association between consumption of caffeine and miscarriage earlier in pregnancy may be stronger, but there are no large well-conducted effectiveness trials. This prospective observational cohort study examined the association of maternal caffeine intake with late miscarriage and intrauterine fetal death (stillbirth), using a detailed caffeine assessment tool. The study population included 2643 pregnant singleton women, aged 18 to 45 years, between 8- and 12-weeks' gestation, who attended 2 UK maternity units between 2003 and 2006. Caffeine intake was assessed at different stages of pregnancy, and the pregnancies were monitored for the occurrence of late miscarriage and stillbirth. The data were adjusted for potential confounders, including alcohol intake and smoking status. Total caffeine intake was quantified from all possible sources in the first trimester and throughout pregnancy. The adjusted data showed a strong association between caffeine intake in the first trimester and subsequent late miscarriage between 12 and 24 weeks or stillbirth after 24 weeks. The geometric mean caffeine intake during the first trimester among women whose pregnancies resulted in late miscarriage or stillbirth was higher (145 mg/d, with a 95% confidence interval [CI] of 85-249) compared with those with live births (103 mg/d; with a 95% CI of 98-108). Compared to women with caffeine consumption of 100 mg/d, the adjusted odds ratio for late miscarriage or stillbirth increased to 2.2 (95% CI, 0.7-7.1) for ingestion between 100 and 199 mg/day, to 1.7 (0.4-7.1) for those taking between 200 and 299 mg/d, and to 5.1 (1.6-16.4) for those ingesting over 300 mg/d (P-trend = 0.004). These findings from a small study suggest that increases in late miscarriage and stillbirth are associated with greater caffeine intake during pregnancy, and support observational evidence on which current guidelines are based.

Guilleminault C; Cao M; Yue HJ; Chawla P. Obstructive sleep apnea and chronic opioid use. Lung 188(6): 459-468, 2010. (36 refs.)

The use of opioids has been associated with development of sleep-disordered breathing, including central apneas, nocturnal oxygen desaturations, and abnormal breathing patterns. We describe sleep-disordered breathing and its subsequent treatment in a group of obstructive sleep apneic patients on chronic opioid therapy. Clinical evaluation followed by diagnostic overnight polysomnogram was performed in subjects on chronic opioid therapy who met the study criteria. All subjects had an initial CPAP titration followed by a repeat clinical evaluation. Subjects with an apnea-hypopnea index (AHI) a parts per thousand yen 5 continued to report symptoms and had follow-up titration with bilevel positive therapy; then bilevel positive-pressure therapy with a back-up rate was then performed. Age-, sex-, and disease-severity-matched obstructive sleep apnea patients served as controls. Forty-four study participants, including a large group of women (50%), and 44 controls were enrolled in the study. Opioid subjects had AHI = 43.86 +/- A 1.19, with a central apnea index of 0.64 +/- A 1.36. Two abnormal breathing patterns were seen, including decreased inspiratory effort during an obstructive event and longer than expected pauses in breathing. Despite adequate titration with CPAP and bilevel positive-pressure therapy, nocturnal awakenings and central apnea awakenings persisted (AHI and central apnea indices of 13.81 +/- A 2.77 and 11.52 +/- A 2.12, respectively). Treatment with bilevel positive-pressure therapy with a back-up rate controlled the problem. Nonobese OSA patients with opioid intake have obstructive breathing with a different pattern. In this study, bilevel positive-pressure therapy with a back-up rate was the most effective treatment.

Gupta D; Singh AD; Agarwal R; Aggarwal AN; Joshi K; Jindal SK. Is tobacco smoking protective for sarcoidosis? A case-control study from north India. Sarcoidosis Vasculitis and Diffuse Lung Diseases 27(1): 19-26, 2010. (36 refs.)

Background: While tobacco smoking is commonly believed to be negatively associated with the occurrence of sarcoidosis, the relationship of environmental tobacco smoke (ETS) exposure with sarcoidosis is largely un-explored. We studied the impact of active smoking and ETS exposure on disease severity in newly diagnosed cases of sarcoidosis from India. Methods: Data on demographic variables, smoking habits and exposure to environmental tobacco smoke (ETS) among non-smoker sarcoidosis patients was collected prospectively. Presence of smoking and ETS exposure were compared among cases and controls. Among the sarcoidosis patients, clinical manifestations, radiology, spirometry and histopathological grading of lung biopsy were compared between the smokers vs. non-smokers and ETS exposed vs. not-exposed. Results: We studied 98 newly diagnosed cases of sarcoidosis and 196 age, sex and religion- matched healthy volunteers. The study group comprised of 62 (63%) men and 36 (37%) women. The prevalence of smoking was similar in cases and controls (12.2% vs. 15.3%, p = 0.48). Among the never smoker patients with sarcoidosis, 20 (23%) reported ETS exposure vis-a-vis 57 (34%) in the matched controls. A conditional logistic regression analyses showed insignificant negative association with active smoking (OR 0.75; 95% CI, 0.35-1.56) or ETS exposure (OR 0.58; 95% CI, 0.32-1.06) after adjusting for age, gender, religion, and education. There were no differences in the clinical manifestations, radiological staging, spirometry and histopathological grading of lung biopsy in any of the group comparisons studied. Conclusion: Smoking or ETS exposure may not have significant negative association with sarcoidosis. Also, tobacco smoke might not have any effect on the clinical behavior or disease severity in sarcoidosis. The belief that smoking is protective for sarcoidosis is not substantiated in this study and appears to be misfounded.

Hahn C; Pogun S; Gunturkun O. Smoking modulates language lateralization in a sex-specific way. Neuropsychologia 48(14): 3993-4002, 2010. (119 refs.)

Smoking affects a widespread network of neuronal functions by altering the properties of acetylcholinergic transmission. Recent studies show that nicotine consumption affects ascending auditory pathways and alters auditory attention, particularly in men. Here we show that smoking affects language lateralization in a sex-specific way. We assessed brain asymmetries of 90 healthy, right-handed participants using a classic consonant-vowel syllable dichotic listening paradigm in a 2 x 3 experimental design with sex (male, female) and smoking status (non-smoker, light smoker, heavy smoker) as between-subject factors. Our results revealed that male smokers had a significantly less lateralized response pattern compared to the other groups due to a decreased response rate of their right ear. This finding suggests a group-specific impairment of the speech dominant left hemisphere. In addition, decreased overall response accuracy was observed in male smokers compared to the other experimental groups. Similar adverse effects of smoking were not detected in women. Further, a significant negative correlation was detected between the severity of nicotine dependency and response accuracy in male bur not in female smokers. Taken together, these results show that smoking modulates functional brain lateralization significantly and in a sexually dimorphic manner. Given that some psychiatric disorders have been associated with altered brain asymmetries and increased smoking prevalence, nicotinergic effects need to be specifically investigated in this context in future studies.

Hamalian G; Citrome L. Stimulant-induced trichotillomania. (editorial). Substance Abuse 31(1): 68-70, 2010. (5 refs.)

A prior report described the presentation of cocaine-induced trichotillomania, which resolved with the cessation of cocaine use. Here the authors describe the case of stimulant-induced trichotillomania that resolved with the discontinuation of stimulants and initiation of olanzapine. To the authors' knowledge this is the first reported adult case of stimulant-induced trichotillomania. The case is of a patient with a previous diagnosis of attention deficit hyperactivity disorder whose symptoms of trichotillomania coincide with abuse of amphetamine and with the resolution of symptoms in the absence of amphetamine use. Given the increase in exposure of prescription amphetamines among adults, further study into the association between stimulants and adverse events such as trichotillomania is needed.

Hayaki J; Hagerty CE; Herman DS; de Dios MA; Anderson BJ; Stein MD. Expectancies and marijuana use frequency and severity among young females. Addictive Behaviors 35(11): 995-1000, 2010. (40 refs.)

This study examined associations between the endorsement of drug use expectancies and the frequency and severity of marijuana use in a community sample of 332 women aged 18-24 years who were not explicitly seeking treatment for their marijuana use. Participants were enrolled in a larger intervention study of motivational interviewing for various health behaviors and provided self-reports of their current and past marijuana use, marijuana abuse/dependence symptoms, and marijuana use expectancies. Marijuana use expectancies were measured using the six subscales of the Marijuana Effects Expectancy Questionnaire (MEEQ). Use frequency was defined as the number of use days in the past month, severity as the total number of DSM-IV marijuana abuse or dependence symptom criteria met. Replicating and extending prior research, expectations regarding Relaxation and Tension Reduction emerged as a robust belief in this cohort, predicting not only frequency (p<.01) but also severity (p<.01) of marijuana use in multivariate analyses. Severity of marijuana use was further predicted by expectations regarding loss of control, affective changes following marijuana use, and other aspects of emotion dysregulation (Global Negative Effects, p<.01). These findings document meaningful associations between substance-related cognitions and use behavior and suggest that marijuana users who hold certain beliefs regarding marijuana use may be particularly susceptible to clinically significant problems associated with their substance use. As such, marijuana use expectancies may represent a clinical target that could be incorporated into future interventions.

Hayashi K; Matsuda Y; Kawamichi Y; Shiozaki A; Saito S. Smoking during pregnancy increases risks of various obstetric complications: A case-cohort study of the Japan Perinatal Registry Network Database. Journal of Epidemiology 21(1): 61-66, 2011. (26 refs.)

Background: The adverse effects of maternal smoking on the health of pregnant women have been examined mostly on a disease-by-disease basis. The aims of this study were to evaluate simultaneously the effects of smoking during pregnancy on various obstetric complications, using data from a large medical database, and to investigate the expediency of using a case-cohort design for such an analysis. Methods: A case-cohort study was conducted within the Japan Perinatal Registry Network database. Perinatal information on infant deliveries was entered into the database at 125 medical centers in Japan. The base population of the study was 180 855 pregnant women registered in the database from 2001 through 2005. The outcome measures were the incidences of 11 different obstetric complications. Logistic regression models were used to estimate age-adjusted risk ratios (aRRs) and relative excess incidence proportions (REIs). Results: The overall prevalence of smoking during pregnancy was 5.8% in the base cohort, and the prevalence was higher among younger women. A comparison of the cases and control cohort showed that smokers during pregnancy had statistically significant higher risks for preterm rupture of the membrane (aRR: 1.67, 95% confidence interval [CI]: 1.43-1.96; REI: 40.2%, 95% CI: 29.9%-49.1%), chorioamnionitis (1.65, 1.36-2.00; 39.4%, 26.4%-50.0%), incompetent cervix (1.63, 1.35-1.96; 38.5%, 25.8%-49.1%), threatened premature delivery (1.38, 1.17-1.64; 27.7%, 14.5%-38.9%), placental abruption (1.37, 1.10-1.72; 27.1%, 8.8%-41.7%), and pregnancy-induced hypertension (1.20, 1.01-1.41; 16.4%, 1.2%-29.3%). Conclusions: Maternal smoking was associated with a number of obstetric complications. This highlights the importance of smoking cessation during pregnancy. In addition, case-cohort analysis proved useful in estimating RRs for multiple outcomes in a large database.

Hsieh SJ; Ware LB; Eisner MD; Yu L; Jacob P; Havel C et al. Biomarkers increase detection of active smoking and secondhand smoke exposure in critically ill patients. Critical Care Medicine 39(1): 40-45, 2011. (31 refs.)

Objectives: The association between tobacco smoke exposure and critical illness is not well studied, largely because obtaining an accurate smoking history from critically ill patients is difficult. Biomarkers can provide quantitative data on active and secondhand cigarette smoke exposure. We sought to compare cigarette smoke exposure as measured by biomarkers to exposure by self-report in a cohort of critically ill patients and to determine how well biomarkers of cigarette smoke exposure correlate with each other in this population. Design, Setting, and Patients: Serum and urine cotinine and trans-3'-hydroxycotinine, urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, and hair and nail nicotine levels were measured in 60 subjects enrolled in an observational cohort of critically ill subjects at a tertiary academic medical center in Tennessee. Smoking history was obtained from patients, their surrogates, or the medical chart. Cigarette smoke exposure as measured by biomarkers was compared to exposure by history. Measurements and Main Results: By smoking history, 29 subjects were identified as smokers, 28 were identified as nonsmokers, and 3 were identified as unknown. The combination of serum cotinine and urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol identified 27 of the 28 nonsmokers by history either as active smokers (n = 6, 21%) or as exposed to secondhand smoke (n = 21, 75%). All biomarker levels were strongly correlated with each other (r = .69-.95, p < .0001). Conclusions: The combination of serum cotinine and urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol identified considerably more active smokers than did smoking history and detected a high prevalence of secondhand smoke exposure in a critically ill population. These markers will be important for future studies investigating the relationship between active smoking and secondhand smoke exposure and critical illness.

Huang S; Trapido E; Fleming L; Arheart K; Crandall L; French M et al. The long-term effects of childhood maltreatment experiences on subsequent illicit drug use and drug-related problems in young adulthood. Addictive Behaviors 36(1-2): 95-102, 2011. (53 refs.)

Objectives: The objective of this study was to examine the associations between (a) childhood maltreatment (i e physical abuse sexual abuse and neglect) and subsequent illicit drug use and (b) childhood maltreatment and drug-related problems in young adulthood. Methods: Wave 1 and Wave 3 public-use data from the National Longitudinal: Study of Adolescent Health were used Logistic regressions controlling for adolescent drug use and other important family and peer contextual processes were estimated to determine the associations between (a) childhood maltreatment experiences and subsequent illicit drug use and (b) childhood maltreatment and drug-related problems in young adulthood. Results: Among the participants 31 9% reported some form of childhood maltreatment Childhood physical abuse was associated with a 37% (OR = 1 37 95% CI = 1 04 1 80) increase in illicit drug use during the 30 days prior to the Wave 3 survey a 48% (OR = 1 48 95% CI = 116 1 89) Increase in illicit drug use during the year prior to the Wave 3 survey and a 96% (OR = 1 96 95% CI = 1 40 2 76) increase in drug related problems in young adulthood. The latter two associations persisted even after controlling for illicit drug use in adolescence. Neglect among females was associated with a higher likelihood of past year illicit drug use in young adulthood (OR = 1 31 95% CI = 1 002 1 71) However this association was not significant once the effect of illicit drug use in adolescence was statistically controlled for. Conclusions: The present findings suggest that childhood maltreatment is related to subsequent illicit drug use and drug-related problems in young adulthood and that some of these associations differ by gender Implications for preventive intervention are discussed.

Ioffe YJM; Elmore RG; Karlan BY; Li AJ. Effect of cigarette smoking on epithelial ovarian cancer survival. Journal of Reproductive Medicine 55(7-8): 346-350, 2010. (20 refs.)

OBJECTIVE: To determine associations between smoking and survival in patients with ovarian cancer. STUDY DESIGN: We performed a retrospective review of patients undergoing surgery for ovarian cancer. Abstracted patient data included age, smoking history, stage, grade, extent of cytoreduction, and survival. Data were examined with Fisher's exact test, Kaplan-Meier survival analysis, and Cox regression analysis. RESULTS: A total of 130 patients met criteria for review. Seventeen (13%) smoked cigarettes at the time of initial laparotomy. Twenty-one (16%) were left with >1 cm residual disease. Smoking did not correlate with the incidence of suboptimal cytoreduction. There were no statistical differences in incidence of hypertension, obesity, or coronary artery disease in smokers compared to nonsmokers. Smoking was found to negatively influence length of progression-free survival. Similarly, smokers were found to have decreased disease-specific overall survival compared to nonsmokers. Cigarette smoking retained independent significance as poor prognostic factors, after controlling for age, stage, and grade. CONCLUSION: These findings identify a negative correlation with cigarette smoking and survival in women with ovarian cancer. Further studies are proposed to elucidate the molecular mechanisms underlying these clinical observations.

Ishii T; Wakabayashi R; Kurosaki H; Gemma A; Kida K. Association of serotonin transporter gene variation with smoking, chronic obstructive pulmonary disease, and its depressive symptoms. Journal of Human Genetics 56(1): 41-46, 2011. (39 refs.)

A serotonin transporter gene, SLC6A4, is thought to be related to nicotine dependence and depression, one of the comorbidities of chronic obstructive pulmonary disease (COPD). To investigate the association between SLC6A4 variation and tobacco consumption, susceptibility to COPD, and depression status. In all, 247 patients with COPD and 119 control subjects were genotyped for 5 tag single-nucleotide polymorphisms (SNPs) of SLC6A4. We analyzed the correlation between these genotypes and COPD, using the results of a pulmonary function test or chest computed tomography; data on tobacco consumption (pack-years); and the depression score based on the hospital anxiety and depression scale (HADS) after adjusting for age, gender, and smoking status (and pack-years, when appropriate). The rare allele rs2020936 was significantly associated with COPD incidence in the trend model (P = 0.003; odds ratio, 2.20; 95% confidence interval, 1.31-3.74). This allele was also associated with the number of pack-years (P = 0.026). The major allele of another SNP of SLC6A4, namely rs3794808, correlated with the HADS depression score (P = 0.016). We conclude that SLC6A4 variation affects COPD pathogenesis, and this effect depends partly on tobacco consumption. SLC6A4 variation also affects depressive symptoms. SLC6A4 could be modified to prevent COPD and treat the depressive symptoms of COPD.

Iudicello JE; Woods SP; Vigil O; Scott JC; Cherner M; Heaton RK et al. Longer term improvement in neurocognitive functioning and affective distress among methamphetamine users who achieve stable abstinence. Journal of Clinical and Experimental Neuropsychology 32(7): 704-718, 2010. (64 refs.)

Chronic use of methamphetamine (MA) is associated with neuropsychological dysfunction and affective distress. Some normalization of function has been reported after abstinence, but little in the way of data is available on the possible added benefits of long-term sobriety. To address this, we performed detailed neuropsychological and affective evaluations in 83 MA-dependent individuals at a baseline visit and following an average one-year interval period. Among the 83 MA-dependent participants, 25 remained abstinent, and 58 used MA at least once during the interval period. A total of 38 non-MA-addicted, demographically matched healthy comparison (i.e., HC) participants were also examined. At baseline, both MA-dependent participants who were able to maintain abstinence and those who were not performed significantly worse than the healthy comparison subjects on global neuropsychological functioning and were significantly more distressed. At the one-year follow-up, both the long-term abstainers and healthy comparison groups showed comparable global neuropsychological performance and affective distress levels, whereas the MA-dependent group who continued to use MA were worse than the comparison participants in terms of global neuropsychological functioning and affective distress. An interaction was observed between neuropsychological impairment at baseline, MA abstinence, and cognitive improvement, with abstinent MA-dependent participants who were neuropsychologically impaired at baseline demonstrating significantly and disproportionately greater improvement in processing speed and slightly greater improvement in motor abilities than the other participants. These results suggest partial recovery of neuropsychological functioning and improvement in affective distress upon sustained abstinence from MA that may extend beyond a year or more.

Javed F; Correa FOB; Chotai M; Tappuni AR; Almas K. Systemic conditions associated with areca nut usage: A literature review. (review). Scandinavian Journal of Public Health 38(8): 838-844, 2010. (66 refs.)

Aim: The adverse effects of areca nut (AN) chewing habit on oral health have been reported. However, the hazards related to the habit are not restricted to the oral cavity but they can also jeopardise the systemic health. Since no review reporting the harmful effects of AN chewing on systemic health is yet available, the aim of the present study was to review the systemic conditions associated with AN usage. Methods: To address the focused question ''What are the deleterious effects of AN usage on systemic health?'', the MEDLINE PubMed databases were explored from 1966 up to and including May 2010. The eligibility criteria included: human studies, individuals using AN, use of controls, and articles published in English. Hand-searching was also performed. Unpublished data was excluded. Results: The review included 28 articles. Seven studies associated AN chewing with cardiovascular disorders and three studies related the habit with cerebrovascular disorders. Eight studies related AN chewing with obesity, hyperglycaemia, metabolic syndrome, and type 2 diabetes mellitus. Five studies related AN chewing with the development of hepatic disorders. Two studies associated the chewing habit with oesophageal inflammation and fibrosis. Three studies associated AN chewing with respiratory discomfort. Renal disorders were related with the chewing abuse in two studies. Two studies showed an adverse effect of AN chewing on birth outcome. Conclusions: AN chewing adversely affects systemic health by damaging the vital organs.

Jaworski F; Dubertret C; Ades J; Gorwood P. Presence of co-morbid substance use disorder in bipolar patients worsens their social functioning to the level observed in patients with schizophrenia. Psychiatry Research 185(1-2): 129-134, 2011. (50 refs.)

Bipolar disorder has been considered to have a better prognosis than schizophrenia at the very beginning of its definition. However, psychosocial functioning may vary not only because of the characteristics of the disorder, but also of co-morbid conditions, especially regarding substance use disorder (SUD). The purpose of this study was to compare the social adjustment level of patients with bipolar disorder with that observed in patients with schizophrenia, taking into account substance use disorder (SUD). Forty subjects with schizophrenia and 40 subjects with bipolar disorder, in the stable phase of the disorder, were matched for age, gender and presence of SUD (DSM-IV criteria). The social adjustment scale was completed with socio-demographic and clinical characteristics of illness. The global adaptation score of bipolar patients with SUD was poorer than bipolar patients without SUD, but was not observed as being significantly different from that of patients with schizophrenia, with or without associated SUD. Suicide attempts, poor compliance, longer hospitalisation, shorter remissions and criminal activity were also more frequently observed in the group of patients with bipolar disorder and SUD. Presence of substance use disorder seems to have a greater weight than the main diagnostic (schizophrenia versus bipolar disorder) to predict worse social adjustment and poorer outcome.

Jee SH; Foong AW; Hur NW; Samet JM. Smoking and risk for diabetes incidence and mortality in Korean men and women. Diabetes Care 33(12): 2567-2572, 2010. (21 refs.)

OBJECTIVE - Mounting evidence suggests that smoking is a cause of type 2 diabetes We explored the association of cigarette smoking with diabetes incidence and mortality in a large cohort of Koreans RESEARCH DESIGN AND METHODS - A 14 year prospective cohort study was performed on 1 236 443 Korean men and women aged 30-95 years at baseline who underwent standardized biennial medical examinations provided by the National Health Insurance Corporation (NHIC) Incident diabetes was identified on the basis of outpatient visits hospitalization or prescription medication treatment for diabetes as captured in the NHIC database Diabetes mortality was obtained through the national statistical office Cox proportional hazards models were used to investigate associations of smoking with indicators of diabetes and diabetes mortality RESULTS - Smoking was significantly associated with increased risk for diabetic outpatient treatment hospitalization and mortality among both men and women and the risk among current smokers increased modestly with the number of cigarettes smoked daily (P-trend < 0 0001 for all associations) Compared with never smokers current male smokers who smoked >= 20 cigarettes/day had increased risk for incident diabetes defined by outpatient treatment (adjusted hazard ratio 1 55 11 51-1 601) incident diabetes defined by >= 3 prescription medications for diabetes (1 71 [1 63-1 80]) and death from diabetes (1 60 [1 25-2 06]) The risks for outpatient treatment among smokers were higher in men than in women with evidence for effect modification by sex and age (P-interaction < 0 0001) CONCLUSIONS - Our study provides longitudinal evidence that smoking increases the risk of incident diabetes and mortality

Jia HM; Lubetkin EI. Recent trends and geographic patterns of the burden of disease attributable to smoking. Value In Health 13(8): 958-964, 2010. (29 refs.)

Purpose: Quality-adjusted life-years (QALYs) use a single number to provide an assessment of the overall health burden of diseases associated both with mortality and morbidity. This study examined the trend and geographic variation of the burden of smoking by calculating smoking-related QALYs lost from 1993 to 2008 for the US adults and individual states. Methods: Population health-related quality of life scores were estimated from the 1993 to 2008 Behavioral Risk Factor Surveillance Systemem. The smoking-related QALYs lost are the sum of QALYs lost due to morbidity and future QALYs lost in expected life years due to premature deaths (mortality). Results: From 1993 to 2008, the percent of US adults who smoked declined from 22.7% to 18.5%, but the smoking-related QALYs lost were relatively stable at 0.0438 QALYs lost per population. Although smoking contributed more QALYs lost for men (0.0535) than for women (0.0339), smoking-related QALYs lost decreased by 2.5% for men but increased by 12.6% for women. Kentucky, Oklahoma, Mississippi, West Virginia, and Tennessee had the most smoking-related QALYs lost wheras Utah, California, Connecticut, Minnesota, and Hawaii had the least QALYs lost. The state tobacco tax rate was strongly and negatively associated with both the percent smoked (r = -0.60) and QALYs lost (r = -0.54), as well as the percentage change in both. Conclusions: This analysis quantified the overall burden of smoking for the nation and individual states from 1993 to 2008. Such data might assist in providing specified quantitative targets for the Healthy People 2020 smoking-related health objectives and for tracking changes on a yearly basis.

Karschner EL; Darwin WD; McMahon RP; Liu F; Wright S; Goodwin RS et al. Subjective and physiological effects after controlled sativex and oral THC administration. Clinical Pharmacology & Therapeutics 89(3): 400-407, 2011. (38 refs.)

Sativex is a cannabis- plant extract delivering nearly 1:Delta(9)-tetrahydrocannabinol (THC) and cannabidiol (CBD) by oromucosal spray. It has been suggested that CBD attenuates THC-induced tachycardia, anxiety, and euphoria. In this study, pharmacodynamic effects were compared over 10.5 h in nine cannabis smokers randomly assigned to receive placebo, 5 and 15 mg oral synthetic THC, and low (5.4 mg THC, 5.0 mg CBD) and high (16.2 mg THC, 15.0 mg CBD) doses of Sativex. At therapeutic doses, no substantial CBD-induced modulation of THC's effects was evident. Oral THC and Sativex produced similar, clinically insignificant increases in heart rate, anxiety, and "good drug effects" with no serious adverse events. Oral and oromucosal THC have slower absorption, lower rate of THC delivery to the brain, and fewer associated adverse events as compared with smoked cannabis. These results indicate that Sativex has a pharmacodynamic safety profile comparable to that of oral THC at low, therapeutic doses.

Katano S; Nakamura Y; Nakamura A; Murakami Y; Tanaka T; Nakagawa H et al. Relationship among physical activity, smoking, drinking and clustering of the metabolic syndrome diagnostic components. Journal of Atherosclerosis and Thrombosis 17(6): 644-650, 2010. (38 refs.)

Aim: To examine the relation between lifestyle and the number of metabolic syndrome (MetS) diagnostic components in a general population, and to find a means of preventing the development of MetS components. Methods: We examined baseline data from 3,365 participants (2,714 men and 651 women) aged 19 to 69 years who underwent a physical examination, lifestyle survey, and blood chemical examination. The physical activity of each participant was classified according to the International Physical Activity Questionnaire (IPAQ). We defined four components for MetS in this study as follows: 1) high BP: systolic BP >= 130 mmHg or diastolic BP >= 85 mmHg, or the use of antihypertensive drugs; 2) dyslipidemia: high-density lipoprotein-cholesterol concentration <40 mg/dL, triglycerides concentration >= 150 mg/dL, or on medication for dyslipidemia; 3) Impaired glucose tolerance: fasting blood sugar level >= 110 mg/d, or if less than 8 hours after meals >= 140 mg/dL), or on medication for diabetes mellitus; 4) obesity: body mass index >= 25 kg/m(2). Results: Those who had 0 to 4 MetS diagnostic components accounted for 1,726, 949, 484, 190, and 16 participants, respectively, in the Poisson distribution. Poisson regression analysis revealed that independent factors contributing to the number of MetS diagnostic components were being male (regression coefficient b = 0.600, p<0.01), age (b = 0.027, p<0.01), IPAQ class (b = -0.272, p = 0.03), and alcohol consumption (b = 0.020, p = 0.01). The contribution of current smoking was not statistically significant (b = -0.067, p = 0.76). Conclusion: Moderate physical activity was inversely associated with the number of MetS diagnostic components, whereas smoking was not associated.

King G; Alicata D; Cloak C; Chang L. Neuropsychological deficits in adolescent methamphetamine abusers. Psychopharmacology 212(2): 243-249, 2010. (32 refs.)

Methamphetamine (METH) is a widely abused psychostimulant that is associated with neurotoxicity and neurocognitive impairments in adults. However, the effects of METH use on neurocognitive performance of adolescents are unclear. Fifty-four adolescent METH users and 74 age-matched comparison subjects (ages 12 to 23 years) were evaluated with a battery of neuropsychological tests. The cognitive domains evaluated include psychomotor (Symbol Digit, Trail Making), executive function (Stroop Interference task, Wisconsin Card Sort task), fine-motor speed (Grooved Pegboard), memory (Digit span and Auditory Verbal Learning Task), as well as attention and working memory (California Computerized Assessment package). METH users were slower on the Stroop Interference task than the comparison subjects (F(1,114) = 4.33, p = 0.03). METH subjects also performed worse than controls on the Wechsler Adult Intelligence Scale III/Wechsler Intelligence Scale for Children IV (WAIS/WISC) Matrices task (F(1,114) = 4.37, p = 0.04) and performed significantly worse on the Peg Board task than the comparison subjects for both the dominant (F(1,114) = 7.56, p = 0.01) and non-dominant (F(1,114) = 6.75, p = 0.01). Lastly, length of abstinence was associated with improved performance on the Peg Board test with the dominant had (r = -0.34), as well as the WAIS/WISC Forward Digit Span task (r = 0.38) METH use is associated with impaired executive functions in adolescent users.

Laaksonen M; Piha K; Rahkonen O; Martikainen P; Lahelma E. Explaining occupational class differences in sickness absence: Results from middle-aged municipal employees. Journal of Epidemiology and Community Health 64(9): 802-807, 2010. (23 refs.)

Objectives: Low socioeconomic position is consistently associated with higher rates of sickness absence. We aimed to examine whether working conditions, health-related behaviours and family-related factors explain occupational class differences in medically certified sickness absence. Methods: The study included 5470 women and 1464 men employees of the City of Helsinki, surveyed in 2000-2002. These data were prospectively linked to sickness absence records until the end of 2005, providing a mean follow-up time of 3.9 years. Poisson regression was used to examine the occurrence of medically certified sickness absence episodes lasting 4 days or more. Results: Medically certified sickness absence was roughly three times more common among manual workers than among managers and professionals in both women and men. Physical working conditions were the strongest explanatory factors for occupational class differences in sickness absence, followed by smoking and relative weight. Work arrangements and family-related factors had very small effects only. The effects of psychosocial working conditions were heterogeneous: job control narrowed occupational class differences in sickness absence while mental strain and job demands tended to widened them. Overall, the findings were quite similar in women and men. Conclusions: Physical working conditions provided strongest explanations for occupational class differences in sickness absence. Smoking and relative weight, which are well-known determinants of health, also explained part of the excess sickness absence in lower occupational classes. Applying tailored work arrangements to employees on sick leave, reducing physically heavy working conditions and promoting healthy behaviours provide potential routes to narrow occupational class differences in sickness absence.

Lardi E; Ott C; Schulzki T; Kuhn M; Bonetti PO; Reinhart WH. Acute effects of short-term exposure to second-hand smoke on induced platelet aggregation. Clinical Hemorheology and Microcirculation 45(2-4): 359-364, 2010. (20 refs.)

Passive smoking may increase cardiovascular events by yet insufficiently understood mechanisms. We, therefore, tested the hypothesis that passive smoking could affect platelet aggregation. Fourteen healthy non-smoking males were exposed to second-hand smoke during 60 min in a room with smokers, who maintained the CO-concentration between 4.5-7.0 ppm throughout that period. Citrated blood was drawn before and immediately after smoke exposure (which took place between 6 and 7 p. m.). The last 7 individuals had blood taken also at 9.00 a. m. before and the day after smoke exposure. Platelet aggregation was measured (a) in flowing whole blood using the platelet function analyser PFA-100 (R), which determines the closure time (CT) of a collagen coated membrane pore by shear-induced platelet aggregation, and (b) with a Chrono-log 700 Aggregometer, assessing platelet aggregation either by the change of impedance in diluted whole blood or light transmission in platelet-rich plasma. After short term second-hand smoke exposure we did not observe an increase in platelet aggregation with any of the instruments. We conclude that acute exposure to second-hand smoke is unlikely to increase platelet aggregability. Other mechanisms must be involved in the increased risk of cardiovascular events associated with passive smoking.

Mahapatra S; Belgrad JL; Adeoye MA. Psychotropic drug-related eosinophilia with systemic symptoms after acute caffeine ingestion. Pediatrics 127(1): E235-E238, 2011. (12 refs.)

Drug-related eosinophilia with systemic symptoms (DRESS) is a potentially life-threatening, multiorgan condition that can result from drug treatment. Antiepileptic medications have provided the best-studied link of any class of medications. Here, we report the case of a 16-year-old boy with long-standing bipolar disorder who was chronically treated with aripiprazole and fluoxetine and developed DRESS syndrome after ingestion of high doses of caffeine. His classic presentation with fever, morbilliform rash, lymphadenopathy, and visceral involvement, including leukocytosis, eosinophilia, and hepatitis, was consistent with this diagnosis. Furthermore, the patient's symptoms dramatically improved after corticosteroid therapy and discontinuation of all psychotropic medications. We propose that the development of DRESS syndrome is a net result of inconsistent medication adherence coupled with the ingestion of near-toxic doses of caffeine, which can lead to rhabdomyolysis and, through renal impairment, lead to the accumulation of toxic oxidative metabolites of either or both psychotropic medications. We also present one of the few reported cases of caffeine-induced rhabdomyolysis and propose its role in the development of DRESS in this patient.

Majlesi N; Lee DC; Ali SS. Dextromethorphan abuse masquerading as a recurrent seizure disorder. Pediatric Emergency Care 27(3): 210-211, 2011. (9 refs.)

Dextromethorphan (DXM) has unique toxicity that may be difficult to diagnose. We present a case of a young woman who presented to our emergency department (ED) initially diagnosed with recurrent seizures. Paramedics brought a 19-year-old woman to the ED. Witnesses noted "shaking," which the patient did not recall. The patient denied fever, antecedent trauma, or neurological complaint. She was recently administered lamotrigine for bipolar disorder. She was a former alcoholic with no history of developing withdrawal. She admitted to marijuana use but denied use of any other illicit substances. Her vital signs and physical examination were unremarkable. She had a normal brain computed tomography, electrocardiogram, and laboratory evaluation. There was no alcohol detected. Her urine drug screen was negative for opiates, benzodiazepines, cocaine, amphetamines, barbiturates, phencyclidine, and tricyclic antidepressants. She was diagnosed with new-onset seizure and discharged home. No abnormalities were seen in the brain magnetic resonance imaging scan and electroencephalogram. She was scheduled for a cardiac syncope workup, but never followed through. Two months later, she presented to the hospital again for a similar complaint. Co-workers reported witnessing sudden tonic-clonic movements and confusion. On ED presentation, the patient was tachycardic with a heart rate of 110 beats/min and had horizontal nystagmus. She was alert with a flat affect. She did not recall events but answered questions appropriately. Repeat radiographic and laboratory evaluations were normal including urine drug screen and computed tomography. Upon questioning, she admitted to abusing DXM for the past several months. A serum DXM level at this time was 988.3 ng/mL. She was admitted to the hospital for 24 hours without sequelae. All further diagnostic testing was cancelled, and she was referred to a drug rehabilitation program. Abuse of DXM is increasing in incidence. The serum level of our patient was almost 10-fold greater than the reported therapeutic level. The toxicity of DXM is unique, and abuse should be considered in all patients presenting to the ED with new-onset seizure. Dextromethorphan abuse should be considered in young adults who present with previously undiagnosed seizure activity.

Maldonado JR. An approach to the patient with substance use and abuse. Medical Clinics of North America 94(6, special issue): 1169+, 2010. (127 refs.)

Substance use is ubiquitous among medically ill patients. The 2008 National Survey on Drug Abuse and Health survey estimated that 20.1 million Americans aged 12 years or older (8% of the US population) had used an illicit drug during the preceding month. Some licit substances also create havoc. The survey found that slightly more than half (56%) of Americans reported being current drinkers of alcohol. A total of 6.2 million (2.5%) Americans used prescription-type psychotherapeutic drugs for nonmedical purposes and 70.9 million Americans (or 28.4%) used tobacco during the survey period. Substance abuse problems were diagnosed in up to 36% of medically hospitalized patients for whom a psychiatric consultation was requested. Given how prevalent the use of substances is among the medically ill and their potential effect on comorbid medical conditions, it is important for physicians to be mindful of their prevalence and presentation. This article covers the presenting symptoms of intoxication and withdrawal states, addresses the acute management of the most commonly encountered substances, and summarizes all others in a table.

Marti J. Successful smoking cessation and duration of abstinence: An analysis of socioeconomic determinants. International Journal of Environmental Research and Public Health 7(7): 2789-2799, 2010. (24 refs.)

Smoking does not affect every socioeconomic subgroup of the population equally, resulting in major inequalities in terms of smoking-related morbidity and mortality. While previous studies mainly focused on inequalities in smoking prevalence, we have analysed the socioeconomic dimensions that might be associated with two other smoking-related outcomes: the odds of successfully quitting and the duration of abstinence. Using nationally representative Swiss data, we found evidence of a socioeconomic gradient in successful cessation and abstinence duration with respect to education level and income for both men and women.

Maziak W. The global epidemic of waterpipe smoking. (review). Addictive Behaviors 36(1-2): 1-5, 2011. (57 refs.)

In the past decade waterpipe (WP) smoking (a ka hookah, shisha, and narghile) has been steadily spreading among the youth around the world. The allure of this tobacco use method for the youth can stem from its pleasant smooth smoke social ambience and the perception of reduced harm. The material in this review is based on detailed Medline search for articles appearing especially in the past two years that are of relevance to WP epidemiology health and addictive effects and WP-related tobacco control policies It shows that WP smoking is continuing to spread among the youth worldwide and perhaps represents the second global tobacco epidemic since the cigarette Available evidence suggests that the prevalence of current (past month) WP smoking range from 6 to 34% among Middle Eastern adolescents 5%-17% among American adolescents and that WP use is increasing globally.Studies on the health effects of WP smoking are limited by methodological quality as well as by the novelty of WP epidemic relative to the long latency of important smoking-related health outcomes. Still, research indicates substantial WP harmful effects similar to those of cigarettes as well as to the potential of providing a bridge to cigarette smoking or relapse. Developing effective interventions to curb WP use among the youth requires a detailed understanding of how dependence develops in WP users and how it is shaped by WP's unique features, such as the following the predominantly intermittent use with prolonged sessions, preparation time, accessibility, potent sensory cues, and convivial experience of group use. It also requires assessing effective policy options, such as factual and visible health warnings on all its parts, as well as youth access and indoor smoking restrictions. WP smoking is currently showing all signs of a burgeoning global epidemic with serious implications for public health and tobacco control worldwide. Investment in research and policy initiatives to understand and curb WP use needs to become a public health priority.

Melin P; Chousterman M; Fontanges T; Ouzan D; Rotily M; Lang JP. Effectiveness of chronic hepatitis C treatment in drug users in routine clinical practice: Results of a prospective cohort study. European Journal of Gastroenterology and Hepatology 22(9): 1050-1057, 2010. (17 refs.)

Objective: Injection drug users are often excluded from hepatitis C virus (HCV) treatment. This study compares sustained virological response, adherence, and quality of life in patients with or without a history of illicit drug use in routine clinical practice. Methods: This is a post-hoc analysis of a prospective, observational study conducted in 1860 patients who received peginterferon alpha-2b/ribavirin combination therapy. Nondrug users (NDUs) were defined as patients without a history of drug addiction; former drug users (FDUs) as patients who had stopped using illicit drugs or opioid maintenance therapy and active drug users (ADUs) as patients using illicit drugs or on opioid maintenance therapy. Virological response, adherence, and the health-related quality of life were assessed by the measure of HCV RNA in the serum, self-report and 36-item short-form health survey Questionnaire, respectively. Results: The analyzed population included 1038 (56%) NDUs, 578 (31%) FDUs, and 244 (13%) ADUs. About 85% of ADUs were on opioid maintenance therapy and 25% used illicit drugs. Although ADUs had a more chaotic lifestyle and more psychiatric disorders, sustained virological response of ADUs (58%) did not differ from that of NDUs (49%) and FDUs (51%) (P = 0.133). Adherence rates were 39% in NDUs and FDUs, and 37% in ADUs (P = 0.883). Health-related quality of life was improved in the three groups after the end of treatment. Conclusion: Our study suggests that HCV therapy in ADUs on opioid maintenance therapy is as effective as in other HCV patients. The effectiveness of HCV therapy in illicit drug users needs to be evaluated in further studies.

Mohammadi S; Mazhari MM; Mehrparvar AH; Attarchi MS. Cigarette smoking and occupational noise-induced hearing loss. European Journal of Public Health 20(4): 452-455, 2010. (25 refs.)

Background: Noise is the most common occupational hazard. Noise-induced hearing loss (NIHL) is a known occupational disease. The economic costs of NIHL have been estimated to be billions of dollars. Besides, cigarette smoking is a common habit worldwide. Methods: In a cross-sectional study, we surveyed the effect of smoking on NIHL in 504 workers in a large wagon manufacturing company exposed to noise >85 dBA. All required data were obtained using direct interview and questionnaires. To determine noise exposure level, we used industrial hygienist's reports of sound level measurements. A qualified audiologist assessed hearing status using standardized audiometric examination. Results: We concluded that the frequency of hearing loss in smokers was higher than non-smokers [based on Model 1: odds ratio (OR) = 9.35, 95% confidence interval (CI) = 5.74-15.22 and P-value <0.001; and based on Model 2: OR = 9.06, 95% CI = 5.93-13.84 and P-value <0.001]. Besides, these results were confirmed by logistic regression statistical method. Conclusions: It can be concluded that smoking may accelerate NIHL, but for confirming this opinion, further studies are warranted.

Muennig P; Fiscella K; Tancredi D; Franks P. The relative health burden of selected social and behavioral risk factors in the United States: Implications for policy. American Journal of Public Health 100(9): 1758-1764, 2010. (54 refs.)

Objectives. We sought to quantify the potential health impact of selected medical and nonmedical policy changes within the United States. Methods. Using data from the 1997-2000 National Health Interview Surveys (linked to mortality data through 2002) and the 1996-2002 Medical Expenditure Panel Surveys, we calculated age-specific health-related quality-of-life scores and mortality probabilities for 8 social and behavioral risk factors. We then used Markov models to estimate the quality-adjusted life years lost. Results. Ranked quality-adjusted life years lost were income less than 200% of the poverty line versus 200% or greater (464 million; 95% confidence interval [CI]=368, 564); current-smoker versus never-smoker (329 million; 95% CI=226, 382); body mass index 30 or higher versus 20 to less than 25 (205 million; 95% CI= 159, 269); non-Hispanic Black versus non-Hispanic White (120 million; 95% CI=83, 163); and less than 12 years of school relative to 12 or more (74 million; 95% CI=52, 101). Binge drinking, overweight, and health insurance have relatively less influence on population health. Conclusions. Poverty, smoking, and high-school dropouts impose the greatest burden of disease in the United States.

Myles TD. Steroids - plenty of benefits, but not without risk. (editorial). Obstetrics and Gynecology 117(2, Part 2 Supplement): 429-430, 2011. (13 refs.)

Nondahl DM; Cruickshanks KJ; Wiley TL; Klein BEK; Klein R; Chappell R et al. The ten-year incidence of tinnitus among older adults. International Journal of Audiology 49(8): 580-585, 2010. (21 refs.)

As part of a population-based study in Beaver Dam, Wisconsin, we estimated the 10-year cumulative incidence of tinnitus and its risk factors. Participants (n = 2922, aged 48-92 years) not reporting tinnitus at baseline (1993-1995) were followed for up to ten years. In addition to audiometric testing and anthropometric measures, data on tinnitus, health, and other history were obtained via questionnaire. Potential risk factors were assessed with discrete-time proportional hazards models. The 10-year cumulative incidence of tinnitus was 12.7%. The risk of developing tinnitus was significantly associated with: history of arthritis (hazard ratio (HR) = 1.37), history of head injury (HR = 1.76), history of ever smoking (HR = 1.40), and among women, hearing loss (HR = 2.59). Alcohol consumption (HR = 0.63 for >= 141 grams/week vs. < 15 grams/week), age (among women, HR = 0.90 for each five-year increase in age), and among men, obesity (HR = 0.55), were associated with decreased risk. The risk of developing tinnitus was high for older adults, and associated with modifiable health and behavioral factors.

Nutt DJ; King LA; Phillips LD. Drug harms in the UK: A multicriteria decision analysis. Lancet 376(9752): 1558-1565, 2010. (20 refs.)

Background: Proper assessment of the harms caused by the misuse of drugs can inform policy makers in health, policing, and social care. We aimed to apply multicriteria decision analysis (MCDA) modelling to a range of drug harms in the UK. Method Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance. Findings: MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places. Interpretation: These findings lend support to previous work assessing drug harms, and show how the improved scoring and weighting approach of MCDA increases the differentiation between the most and least harmful drugs. However, the findings correlate poorly with present UK drug classification, which is not based simply on considerations of harm.

Oberg M; Jaakkola MS; Woodward A; Peruga A; Pruss-Ustun A. Worldwide burden of disease from exposure to second-hand smoke: A retrospective analysis of data from 192 countries. Lancet 377(9760): 139-146, 2011. (38 refs.)

Background: Exposure to second-hand smoke is common in many countries but the magnitude of the problem worldwide is poorly described. We aimed to estimate the worldwide exposure to second-hand smoke and its burden of disease in children and adult non-smokers in 2004. Methods: The burden of disease from second-hand smoke was estimated as deaths and disability-adjusted life-years (DALYs) for children and adult non-smokers. The calculations were based on disease-specific relative risk estimates and area-specific estimates of the proportion of people exposed to second-hand smoke, by comparative risk assessment methods, with data from 192 countries during 2004. Findings Worldwide, 40% of children, 33% of male non-smokers, and 35% of female non-smokers were exposed to second-hand smoke in 2004. This exposure was estimated to have caused 379 000 deaths from ischaemic heart disease, 165 000 from lower respiratory infections, 36 900 from asthma, and 21 400 from lung cancer. 603 000 deaths were attributable to second-hand smoke in 2004, which was about 1.0% of worldwide mortality. 47% of deaths from second-hand smoke occurred in women, 28% in children, and 26% in men. DALYs lost because of exposure to second-hand smoke amounted to 10.9 million, which was about 0.7% of total worldwide burden of diseases in DALYs in 2004. 61% of DALYs were in children. The largest disease burdens were from lower respiratory infections in children younger than 5 years (5 939 000), ischaemic heart disease in adults (2 836 000), and asthma in adults (1 246 000) and children (651 000). Interpretation: These estimates of worldwide burden of disease attributable to second-hand smoke suggest that substantial health gains could be made by extending effective public health and clinical interventions to reduce passive smoking worldwide.

Okuyemi KS; Lawrence D; Hammons G; Alexander LA. Use of mentholated cigarettes: What can we learn from national data sets? (editorial). Addiction 105(Supplement 1): 1-4, 2010. (7 refs.)

Potula R; Hawkins BJ; Cenna JM; Fan SS; Dykstra H; Ramirez SH et al. Methamphetamine causes mitrochondrial oxidative damage in human t lymphocytes leading to functional impairment. Journal of Immunology (5): 2867-2876, 2010. (80 refs.)

Methamphetamine (METH) abuse is known to be associated with an inordinate rate of infections. Although many studies have described the association of METH exposure and immunosuppression, so far the underlying mechanism still remains elusive. In this study, we present evidence that METH exposure resulted in mitochondrial oxidative damage and caused dysfunction of primary human T cells. METH treatment of T lymphocytes led to a rise in intracellular calcium levels that enhanced the generation of reactive oxygen species. TCR-CD28 linked calcium mobilization and subsequent uptake by mitochondria in METH-treated T cells correlated with an increase in mitochondrion-derived superoxide. Exposure to METH-induced mitochondrial dysfunction in the form of marked decrease in mitochondrial membrane potential, increased mitochondrial mass, enhanced protein nitrosylation and diminished protein levels of complexes I, III, and IV of the electron transport chain. These changes paralleled reduced IL-2 secretion and T cell proliferative responses after TCR-CD28 stimulation indicating impaired T cell function. Furthermore, antioxidants attenuated METH-induced mitochondrial damage by preserving the protein levels of mitochondrial complexes I, III, and IV. Altogether, our data indicate that METH can cause T cell dysfunction via induction of oxidative stress and mitochondrial injury as underlying mechanism of immune impairment secondary to METH abuse.

Reimer RA; Gerrard M; Gibbons FX. Racial disparities in smoking knowledge among current smokers: Data from the health information national trends surveys. Psychology & Health 25(8): 943-959, 2010. (37 refs.)

Although African-Americans (Blacks) smoke fewer cigarettes per day than European-Americans (Whites), there is ample evidence that Blacks are more susceptible to smoking-related health consequences. A variety of behavioural, social and biological factors have been linked to this increased risk. There has been little research, however, on racial differences in smoking-related knowledge and perceived risk of lung cancer. The primary goal of the current study was to evaluate beliefs and knowledge that contribute to race disparities in lung cancer risk among current smokers. Data from two separate nationally representative surveys (the Health Information National Trends surveys 2003 and 2005) were analysed. Logistic and hierarchical regressions were conducted; gender, age, education level, annual household income and amount of smoking were included as covariates. In both studies, Black smokers were significantly more likely to endorse inaccurate statements than were White smokers, and did not estimate their lung cancer risk to be significantly higher than Whites. Results highlight an important racial disparity in public health knowledge among current smokers.

Rodriguez-Sanchez JM; Ayesa-Arriola R; Mata I; Moreno-Calle T; Perez-Iglesias R; Gonzalez-Blanch C et al. Cannabis use and cognitive functioning in first-episode schizophrenia patients. Schizophrenia Research 124(1-3): 142-151, 2010. (76 refs.)

Cannabis is one of the most widely used illicit drugs in the world In healthy individuals cannabis is associated with cognitive impairments. Research into the effect of cannabis use in schizophrenia has yielded contradictory findings. Our aim has been to explore the correlates of cannabis use in cognitive and psychopathological features both cross-sectional and longitudinally in early phases of schizophrenia 104 patients with a first episode of non-affective psychosis and 37 healthy controls were studied Patients were classified according to their use of cannabis prior to the onset of the illness (47 users vs 57 non-users). They were cross-sectionally and longitudinally studied and compared on clinical and cognitive variables and also on their level of premorbid adjustment. Cannabis user patients had better attention and executive functions than non-cannabis user patients at baseline and after 1 year of treatment. Both groups showed similar improvement in their cognitive functioning during the 1-year follow-up period. We also found that users had a better social premorbid adjustment particularly during the early periods of life. The amount of cannabis consumed and the length of time of consumption did not significantly relate to cognitive performance. The use of cannabis does not seem to be associated with a negative effect on cognition in a representative sample of first-episode schizophrenia patients. Cannabis user patients appear to comprise a subgroup of patients with a better premorbid adjustment and premorbid frontal cognitive functions.

Roe B; Beynon C; Pickering L; Duffy P. Experiences of drug use and ageing: Health, quality of life, relationship and service implications. Journal of Advanced Nursing 66(9): 1968-1979, 2010. (47 refs.)

Aim. This paper is a report of an exploration of older people's experiences of substance use in the context of ageing, and its impact on health, quality of life, relationships and service use. Background. Use of illicit drugs by older people is a neglected policy, research and service provision and is generally perceived as a lifestyle of younger populations. Method. A convenience sample of 11 people aged 49-61 years (mean 57 years) in contact with voluntary sector drug treatment services participated in qualitative semi-structured tape-recorded interviews and thematic content analysis was performed. The data were collected in 2008. Findings. Drug use can have negative impacts on health status, quality of life, family relationships and social networks that accrue with age. Participants were identified as early or later onset users of drugs due to the impact of life events and relationships. A range of substances had been used currently and throughout their lives, with no single gateway drug identified as a prelude to personal drug careers. Life review and reflection were common, in keeping with ageing populations, along with regret of ever having started to use drugs. Living alone and their accommodation made them more susceptible to social isolation, and they reported experiences of death and dying of their contemporaries and family members earlier than usual in the life course. Conclusion. Older people who continue to use drugs and require the support of services for treatment and care are an important emerging population and their specific needs should recognized.

Rozen TD. A history of cigarette smoking is associated with the development of cranial autonomic symptoms with migraine headaches. Headache 51(1): 85-91, 2011. (15 refs.)

Objective.- To look at the smoking history of migraine patients and to determine if a history of cigarette smoking is associated with the development of cranial autonomic symptoms with migraine headaches. Background.- It has recently been noted that a significant number of migraine patients may develop autonomic symptoms during their attacks of headache. Why some headache patients activate the trigeminal autonomic reflex and develop cranial autonomic symptoms while others do not is unknown. Cluster headache occurs more often in patients with a history of cigarette smoking, suggesting a link between tobacco exposure and cluster headache pathogenesis. Could cigarette smoking in some manner lead to activation of the trigeminal-autonomic reflex in headache patients? If cigarette smoking does lower the threshold for activation of the trigeminal autonomic reflex then do migraine patients who have a history of cigarette smoking more often develop cranial autonomic symptoms than migraineurs who have never smoked? Methods.- Consecutive patients diagnosed with migraine (episodic or chronic) who were seen over a 7-month time period at a newly established headache center were asked about the presence of cranial autonomic symptoms during an attack of head pain. Patients were deemed to have positive autonomic symptoms along with headache if they experienced at least one of the following symptoms: eyelid ptosis or droop, eyelid or orbital swelling, conjunctival injection, lacrimation, or nasal congestion/rhinorrhea. A smoking history was determined for each patient including was the patient a current smoker, past smoker, or had never smoked. Patients were deemed to have a positive history of cigarette smoking if they had smoked continuously during their lifetime for at least at 1 year. Results.- A total of 117 migraine patients were included in the analysis (96 female, 21 male). Forty-six patients had a positive smoking history, while 71 patients had no smoking history. Some 70% (32/46) of migraineurs with a positive history of cigarette smoking had cranial autonomic symptoms along with their headaches, while only 42% (30/71) of the nonsmoking patients experienced at least 1 autonomic symptom along with headaches and this was a statistically significant difference (P < .005). In total, 74% of current smokers had autonomic symptoms with their headaches compared with 61% of past smokers and this was not a statistically significant difference. There was a statistically significant difference between the number of current smokers who had autonomic symptoms with their headaches compared with the number of patients who never smoked and had autonomic symptoms (P < .05). Overall, 52% of the studied migraineurs had autonomic symptoms. There was a statistically significant difference between autonomic symptom occurrence in male and female smokers vs male and female nonsmokers. Each subtype of cranial autonomic symptoms was all more frequent in smokers. Conclusion.- A history of cigarette smoking appears to be associated with the development of cranial autonomic symptoms with migraine headaches.

Rusanen M; Kivipelto M; Quesenberry CP; Zhou JF; Whitmer RA. Heavy smoking in midlife and long-term risk of Alzheimer disease and vascular dementia. Archives of Internal Medicine 170(19), 2010. (23 refs.)

Background: Smoking is a risk factor for several life-threatening diseases, but its long-term association with dementia is controversial and somewhat understudied. Our objective was to investigate the long-term association of amount of smoking in middle age on the risk of dementia, Alzheimer disease (AD), and vascular dementia (VaD) several decades later in a large, diverse population. Methods: We analyzed prospective data from a multiethnic population-based cohort of 21 123 members of a health care system who participated in a survey between 1978 and 1985. Diagnoses of dementia, AD, and VaD made in internal medicine, neurology, and neuropsychology were collected from January 1, 1994, to July 31, 2008. Multivariate Cox proportional hazards models were used to investigate the association between midlife smoking and risk of dementia, AD, and VaD. Results: A total of 5367 people (25.4%) were diagnosed as having dementia(including 1136 cases of AD and 416 cases of VaD) during a mean follow-up period of 23 years. Results were adjusted for age, sex, education, race, marital status, hypertension, hyperlipidemia, body mass index, diabetes, heart disease, stroke, and alcohol use. Compared with non-smokers, those smoking more than 2 packs a day had an elevated risk of dementia (adjusted hazard ratio [HR], 2.14; 95% CI, 1.65-2.78), AD (adjusted HR, 2.57; 95% CI, 1.63-4.03), and VaD (adjusted HR, 2.72; 95% CI, 1.20-6.18). Conclusions: In this large cohort, heavy smoking in midlife was associated with a greater than 100% increase in risk of dementia, AD, and VaD more than 2 decades later. These results suggest that the brain is not immune to long-term consequences of heavy smoking.

Rychetnik L; Madronio CM. The health and social effects of drinking water-based infusions of kava: A review of the evidence. (review). Drug and Alcohol Review 30(1): 74-83, 2011. (60 refs.)

Issues. To review the evidence on the health and social effects of drinking kava; a water-based infusion of the roots of the kava plant. Approach. Included all empirical studies of the effects of kava published 1987-2008 reporting health and social outcomes. Evidence appraised on study design (level of evidence) and standard epidemiological criteria for causality. Key Findings. Causality indicated: scaly skin rash, weight loss, raised Gamma Glutamyl Transpeptidase liver enzyme levels, nausea, loss of appetite or indigestion; Association indicated but causality unclear: red sore eyes, impotence or loss of sexual drive, self-reported poor health, raised cholesterol, and loss of time and money, low motivation and 'slow/lazy' days following use, reduced alcohol consumption and related violence; Association hypothesised: fits or seizures, Melioidosis, Ischaemic Heart Disease, protective effects for cancer; No association indicated: cognitive performance; No association suggested: cognitive impairment, liver toxicity or permanent liver damage, other pneumonia; No association hypothesised: hallucinations. Implications. The health and social implications of chronic kava drinking can be significant for individuals and communities, although most effects of even heavy consumption appear to be reversible when consumption is stopped. Conclusion. An Australia-wide ban on commercial importation of kava has been in place since mid-2007, but there is no published literature to date on the impact of the ban.

Samet JM. Estimating the burden of smoking: Premature mortality, morbidity, and costs. Salud Publica de Mexico 52(Supplement 2): S98-S107, 2010. (45 refs.)

Estimation of the burden of disease attributable to smoking has now become standard in documenting the impact of the tobacco epidemic and in motivating tobacco control.This paper addresses the methods used to estimate the attributable burden of mortality and the related estimation of morbidity and economic costs. Estimates of attributable mortality and morbidity for the Americas range widely, reflecting the maturity of the tobacco epidemic.The estimates are highest for the United States, and lower for Mexico and other countries of the Americas.

Sampaio FJB. International Brazil Journal of Urology 36(1): 1-2, 2010 Cigarette smoking impairs sperm bioenergetics. (editorial). (0 refs.)

Schepis TS; Desai RA; Cavallo DA; Smith AE; McFetridge A; Liss TB et al. Gender differences in adolescent marijuana use and associated psychosocial characteristics. Journal of Addiction Medicine 5(1): 65-73, 2011. (42 refs.)

Marijuana use in adolescents is associated with many adverse outcomes, including neurobiological and health consequences. Despite this, little is known about gender differences in the correlates of adolescent marijuana use. This study attempted to fill this gap by examining gender differences in the correlates of lifetime and past 30-day marijuana use. Data from a cross-sectional state-wide survey of adolescent risk behavior participation in Connecticut were analyzed using chi(2) and hierarchical logistic regression methodologies to examine the demographic, psychosocial, and risk behavior correlates of adolescent marijuana use. Gender-by-trait interactions were tested with hierarchical logistic regression. Of the 4523 participants (51.8% females, 75.8% white), 40.4% endorsed lifetime marijuana use and 24.5% endorsed past 30-day marijuana use. Risk behavior participation, particularly other substance use, had the most robust associations with lifetime and past 30-day adolescent marijuana use; participation in extracurricular activities seemed protective. Gender interactions were observed for African American, Asian, or other race and participation in extracurricular activities; in these 3 cases, males had a greater likelihood of use. They were also observed for having a job (lifetime use only), with females having elevated odds, and past 30-day cigarette smoking (past 30-day use only), with males having elevated odds. Finally, there was preliminary evidence of a faster transition from initiation of marijuana use to regular use in females, when compared with males. These results indicate important gender differences in the correlates of marijuana use in adolescents, and these findings may facilitate the development of gender-informed prevention and early intervention programs for adolescent marijuana use.

Schweinsburg AD; Schweinsburg BC; Nagel BJ; Eyler LT; Tapert SF. Neural correlates of verbal learning in adolescent alcohol and marijuana users. Addiction 106(3): 564-573, 2011. (64 refs.)

Aims: Alcohol and marijuana are the most widely used intoxicants among adolescents, yet their potential unique and interactive influences on the developing brain are not well established. Brain regions subserving learning and memory undergo continued maturation during adolescence, and may be particularly susceptible to substance-related neurotoxic damage. In this study, we characterize brain response during verbal learning among adolescent users of alcohol and marijuana. Design: Participants performed a verbal paired associates encoding task during functional magnetic resonance imaging (fMRI) scanning. Setting: Adolescent subjects were recruited from local public schools and imaged at a university-based fMRI center. Participants: Participants were 74 16-18-year-olds, divided into four groups: (i) 22 controls with limited alcohol and marijuana experience, (ii) 16 binge drinkers, (iii) eight marijuana users and (iv) 28 binge drinking marijuana users. Measurements: Diagnostic interview ensured that all teens were free from neurological or psychiatric disorders; urine toxicology and breathalyzer verified abstinence for 22-28 days before scanning; a verbal paired associates task was administered during fMRI. Findings: Groups demonstrated no differences in performance on the verbal encoding task, yet exhibited different brain response patterns. A main effect of drinking pointed to decreased inferior frontal but increased dorsal frontal and parietal fMRI response among binge drinkers (corrected P < 0.05). There was no main effect of marijuana use. Binge drinking x marijuana interactions were found in bilateral frontal regions (corrected P < 0.05), where users of either alcohol or marijuana showed greater response than non-users, but users of both substances resembled non-users. Conclusions: Adolescent substance users demonstrated altered fMRI response relative to non-using controls, yet binge drinking appeared to be associated with more differences in activation than marijuana use. Alcohol and marijuana may have interactive effects that alter these differences, particularly in prefrontal brain regions.

Seyidov TH; Elemen L; Solak M; Tugay M; Toker K. Passive smoke exposure is associated with perioperative adverse effects in children. Journal of Clinical Anesthesia 23(1): 47-52, 2011. (23 refs.)

Study Objective: To evaluate the frequency of respiratory adverse events during general anesthesia in children passively exposed to cigarette smoke (PSE). Design: Prospective, double blinded, observational study. Setting: Operating room and recovery room of a university hospital. Measurements: Data were collected from 385 children who underwent elective surgery during general anesthesia from June to November, 2008. PSE was identified by using the child's caregivers' information. Respiratory adverse events were recorded during anesthesia and post-anesthesia. Main Results: Technique of anesthesia induction and management, distribution of patients' age, gender, surgical procedures, and perioperative analgesic methods were similar in the PSE and non-PSE groups. Respiratory adverse events were reported in 58 patients (15.1%): 50 patients (21.4%) were in the PSE and 8 patients (5.3%) were in the non-PSE group (P = 0.00). The frequency of laryngospasm during anesthesia (P = 0.03) and hypersecretions in the recovery room (P = 0.00) were significantly increased in the PSE group. Conclusions: Children who are exposed to environmental tobacco smoke and who undergo general anesthesia seem to have an increased risk of respiratory complications in the recovery period rather than during anesthesia.

Shapiro GK; Buckley-Hunter L. What every adolescent needs to know: Cannabis can cause psychosis. Journal of Psychosomatic Research 69(6): 533-539, 2010. (73 refs.)

Objective: Cannabis is a widely used substance that may be becoming more socially accepted, legally tolerated, and utilized by younger individuals. This review explores the relationship between cannabis and the onset of psychosis as well as the policy ramifications of current research. Method: This article synthesizes published work that was considered by the author to be relevant to the discussion of cannabis and the onset of psychosis. Results: The evidence suggests that, along with other harms, cannabis is a significant risk factor in the etiology of psychosis. Adolescents are more vulnerable to using cannabis, and because of their stage of mental development, the cognitive effects are more pronounced. The mechanism for this change is thought to be neuro-chemical with a stronger effect in those with a diathesis for psychosis. Conclusion: The risk that cannabis poses to adolescent health should not be neglected. Policy measures should use a multifaceted and strategic perspective in order to prevent adolescents from using this drug.

Sorensen LT; Toft BG; Rygaard J; Ladelund S; Paddon M; James T; Taylor R et al. Effect of smoking, smoking cessation, and nicotine patch on wound dimension, vitamin C, and systemic markers of collagen metabolism. Surgery 148(5): 982-990, 2010. (61 refs.)

Background: Postoperative wound disruption and tissue-destructive disorders are more frequent in smokers than in nonsmokers. Impaired wound healing and altered connective tissue turnover are suggested mechanisms, but exact details remain unknown. Methods. Full-thickness, 5-mm punch biopsy wounds were made lateral to the sacrum in 48 smokers and were randomized double-blinded to continuous smoking, abstinence with transdermal nicotine patch (TNP), or abstinence with placebo patch and 30 never smokers. At 1, 4, 8, and 12 weeks, the wounds were excised and fixed for wound measurement, and blood was collected for measurement of vitamin C, procollagen I N-propeptide (PINP), matrix metalloproteinase 8 (MMP), MMP-9, neutrophils, and eosinophils. Results. One week after wounding, smokers' wounds were 3.1 +/- 0.1 mm (mean, standard error of the mean) wide and were 1.3 +/- 0.1 mm deep compared with the never smokers' wounds, measuring 3.7 +/- 0.1 mix wide and 1.5 +/- 0.1 mm deep (P < .01, respectively). Abstinent smokers' wounds were 3.3 +/- 0.1 mm wide (NS) and were 1.4 +/- 0.1 mm deep (P = .02 compared with smokers). In smokers, vitamin C and PINP were 50.5 +/- 9.0 mu mol/L and were 52.7 +/- 6.6 ng/mL, respectively, compared with 68.8 +/- 14.5 mu molL and 64.7 +/- 4.7 ng/mL in never smokers (P < .001 and P = .07). Both increased significantly after smoking cessation. Plasma MMP-8 and MMP-9 were correlated with neutrophil blood count, which significantly was affected by smoking status. No effect of TNP was found. Conclusion. Smokers have smaller, more superficial wounds and lesser blood levels of vitamin C and PIN]? Smoking cessation resulted in increased wound depth, vitamin C, and PINP as well as a decreased neutrophil blood count. These findings suggest that wound contraction and collagen metabolism are affected by a smoking-induced alteration in vitamin C turnover and by a change in inflammatory cell response.

Steliga MA; Dresler C. Clinical practice and the tobacco epidemic: Relevance of a global public health problem in the clinical setting. (editorial). Expert Review of Anticancer Therapy10:10

It is estimated that by the year 2030, 8.3 million deaths worldwide will be attributed to tobacco-induced diseases, representing 10% of deaths globally. In developed economies, tobacco use is the leading cause of preventable death, with lung cancer killing far more men and women than any other form of cancer. Disability due to cancer, cardiovascular disease and chronic obstructive pulmonary disease is widespread but harder to measure. Direct and indirect healthcare costs for treating victims of tobacco addiction in the USA alone have been estimated to be in the range of US$96 billion per year in health costs, and an equal amount in lost productivity. Perhaps the most striking aspect of the tobacco epidemic is not merely the number of deaths or cost, but the fact that millions of deaths and immeasurable disability due to tobacco use are preventable. Disability due to cancer, cardiovascular disease and chronic obstructive pulmonary disease is widespread but harder to measure. Direct and indirect healthcare costs for treating victims of tobacco addiction in the USA alone have been estimated to be in the range of US$96 billion per year in health costs, and an equal amount in lost productivity. Perhaps the most striking aspect of the tobacco epidemic is not merely the number of deaths or cost, but the fact that millions of deaths and immeasurable disability due to tobacco use are preventable.

Tatli E; Aktoz M. Heroin abuse and myocardial infarction. Trakya Universitesi Tip Fakultesi Dergisi 27(2): 212-214, 2010. (9 refs.)

Information concerning acute myocardial infarction after heroin usage is limited and the actual mechanism of heroin-induced myocardial infarction is not well known. Only one report has been described noting the association between usage heroin and acute myocardial infarction in a young man with normal coronary arteries. We also reported a patient with normal coronary arteries and acute myocardial infarction after heroin abuse.

Temple EC; Brown RF; Hine DW. The 'grass ceiling': Limitations in the literature hinder our understanding of cannabis use and its consequences. Addiction 106(2): 238-244, 2011. (55 refs.)

Aim: To illustrate how limitations in the cannabis literature undermine our ability to understand cannabis-related harms and problems experienced by users and identify users at increased risk of experiencing adverse outcomes of use. Method and results: Limitations have been organized into three overarching themes. The first relates to the classification systems employed by researchers to categorize cannabis users, their cannabis use and the assumptions on which these systems are based. The second theme encompasses methodological and reporting issues, including differences between studies, inadequate statistical control of potential confounders, the under-reporting of effect sizes and the lack of consideration of clinical significance. The final theme covers differing approaches to studying cannabis use, including recruitment methods. Limitations related to the nature of the data collected by researchers are discussed throughout, with a focus on how they affect our understanding of cannabis use and users. Conclusions: These limitations must be addressed to facilitate the development of effective and appropriately targeted evidence-based public health campaigns, treatment programmes and preventative, early intervention and harm minimization strategies, and to inform cannabis-related policy and legislation.

Temple EC; Brown RF; Hine DW. The grassy knoll . . . and an elephant. (editorial). Addiction 106(2): 251-252, 2011. (13 refs.)

van Winkel R. Family-based analysis of genetic variation underlying psychosis-inducing effects of cannabis sibling analysis and proband follow-up. Archives of General Psychiatry 68(2): 148-157, 2011. (60 refs.)

Context: Individual differences exist in sensitivity to the psychotomimetic effect of cannabis; the molecular genetic basis underlying differential sensitivity remains elusive. Objective: To investigate whether selected schizophrenia candidate single-nucleotide polymorphisms (SNPs) moderate effects of cannabis use. Design: Interactions between recent cannabis use, determined by urinalysis results, and 152 SNPs in 42 candidate genes were examined in 740 unaffected siblings of 801 patients with psychosis to examine genetic moderation of the association between Structured Interview for Schizotypy-Revised positive schizotypy and recent cannabis use (at-risk paradigm). The SNPs showing Bonferroni-adjusted association in the at-risk paradigm were used in a case-only analysis in the 801 patients, as well as in a case-sibling and case-control analysis (using 419 controls) focusing on genetic moderation of developmental effects of cannabis on later psychotic disorder. Setting: The Netherlands and Flanders, Belgium. Participants: Eight hundred one patients with psychosis and their 740 unaffected siblings. Main Outcome Measure: Significant interaction between any of the selected SNPs and cannabis in the at-risk paradigm, followed by selective case-only, casesibling, and case-control analyses. Results: In the unaffected siblings, 16 SNPs in 12 genes showed significant interaction at P<.05, 3 of which survived correction for multiple testing (P<.0003), situated in AKT1 (rs2494732 and rs1130233) and LRRTM1 (rs673871). Follow-up analysis supported AKT1 rs2494732 X cannabis interaction in the case-only (beta=0.20; P=.007), case-sibling (interaction P=.040), and case-control (interaction P=.057) analyses, with individuals with C/C genotypes having an approximately 2-fold odds of being diagnosed with a psychotic disorder when having used cannabis. In the unaffected siblings, the AKT1 X cannabis interaction explained 2.2% additional variance in schizotypy in the whole sample and 19.0% additional variance in the exposed siblings with recent cannabis use. Conclusions: Genetic variation in AKT1 may mediate both short-term as well as longer-term effects on psychosis expression associated with use of cannabis, possibly through a mechanism of cannabinoid-regulated AKT1/GSK-3 signaling downstream of the dopamine D-2 receptor.

Virdis A; Giannarelli C; Neves MF; Taddei S; Ghiadoni L. Cigarette smoking and hypertension. (review). Current Pharmaceutical Design 16(23): 2518-2525, 2010. (99 refs.)

Cigarette smoking is a powerful cardiovascular risk factor and smoking cessation is the single most effective lifestyle measure for the prevention of a large number of cardiovascular diseases. Impairment of endothelial function, arterial stiffness, inflammation, lipid modification as well as an alteration of antithrombotic and prothrombotic factors are smoking-related major determinants of initiation, and acceleration of the atherothrombotic process, leading to cardiovascular events. Cigarette smoking acutely exerts an hypertensive effect, mainly through the stimulation of the sympathetic nervous system. As concern the impact of chronic smoking on blood pressure, available data do not put clearly in evidence a direct causal relationship between these two cardiovascular risk factors, a concept supported by the evidence that no lower blood pressure values have been observed after chronic smoking cessation. Nevertheless, smoking, affecting arterial stiffness and wave reflection might have greater detrimental effect on central blood pressure, which is more closely related to target organ damage than brachial blood pressure. Hypertensive smokers are more likely to develop severe forms of hypertension, including malignant and renovascular hypertension, an effect likely due to an accelerated atherosclerosis.

Wahed M; Goodhand JR; West O; McDermott A; Hajek P; Rampton DS. Tobacco dependence and awareness of health risks of smoking in patients with inflammatory bowel disease. European Journal of Gastroenterology & Hepatology 23(1): 90-94, 2011. (32 refs.)

Background and aim Smoking is a risk factor for developing Crohn's disease (CD) and worsens its outcome. Conversely, in ulcerative colitis (UC), the onset may be triggered by the smoking cessation and smoking may be beneficial. To help to ascertain whether patients with inflammatory bowel disease (IBD) would benefit from attending a smoking cessation clinic, we assessed: first, the prevalence of smoking; second, patients' awareness of the effects of smoking, and finally nicotine dependence in IBD patients compared with the healthy and disease-matched controls. Methods A total of 246 consecutive IBD outpatients (173 patients with CD, 73 patients with UC) completed a questionnaire on smoking habits and its effect on IBD. Smokers were assessed for dependence using the Fagerstrom test for nicotine dependence (FTND) score and their results were compared with those of age, sex, and ethnicity-matched healthy (five controls for each IBD patient) and asthma controls (one control for each IBD patient) attending a smoking cessation clinic. Results Thirty five out of 173 patients (20%) with CD and nine out of 73 patients (12%) with UC were current smokers, with 52 out of 173 patients (30%) with CD and 28 out of 73 patients (38%) with UC being ex-smokers. Ninety out of 173 patients (52%) with CD knew that smoking worsens CD, whereas only 15 out of 73 patients (21%) with UC knew of the beneficial effects of smoking on their disease (P = 0.032). Knowledge was unrelated to smoking status. In patients with CD, the median (range) FTND score was 3 (0-8) compared with 7 (2-10) in healthy (P < 0.001) and 6 (2-9) in asthma controls (P < 0.0001). Only seven of the 35 (20%) smoking patients with CD were highly dependent (FTND score >= 6). Similarly, in the patients with UC, the FTND score was 1 (0-4), lower than in healthy, [6 (2-10)], and asthma controls, [7 (4-10); (P < 0.004 for both groups)]. Conclusion Patients with CD were better informed about the effects of smoking on their own disease than the patients with UC. Nicotine dependence in IBD patients is lower than in smokers' clinic clients and comparable with that of the general population. Their low nicotine dependence suggests that most IBD patients could be weaned off the smoking habit successfully in the IBD clinic and referral to a smoking cessation clinic was offered to the highly dependent minority and others expressing interest in attending.

Wakabayashi I. Cross-sectional relationship between alcohol consumption and prevalence of metabolic syndrome in Japanese men and women. Journal of Atherosclerosis and Thrombosis 17(7): 695-704, 2010. (41 refs.)

Aim: The aim of this study was to clarify the relationship between alcohol intake and metabolic syndrome in Japanese men and women. Methods: Japanese female subjects (n = 11,187) were divided into non-, light (<22 g ethanol/day) and heavy (>= 22 ethanol/day) drinkers, and Japanese male subjects (n = 19,398) were divided into non-, light (<22 g ethanol/day), heavy (>= 22 and <44 g ethanol/day) and very heavy (>= 44 g ethanol/day) drinkers. The mean level of each variable and the prevalence of each risk factor and metabolic syndrome were compared among the groups. Results: In men and women, blood pressure and HDL cholesterol tended to be higher, and hemoglobin A1c tended to be lower with increased alcohol intake. Waist circumference showed U-and V-shaped relationships, and log-converted triglyceride showed J- and V-shaped relationships with alcohol intake in men and women, respectively. The prevalence of metabolic syndrome was lowest in light drinkers in men and women and was significantly higher in very heavy drinkers than in nondrinkers in men. In men, the odds ratio vs. non-drinkers for metabolic syndrome was significantly low in light drinkers, while the odds ratio was significantly high in very heavy drinkers. In women, a significantly low odds ratio vs. non-drinkers for metabolic syndrome was obtained in light drinkers. Conclusion: Light drinking is associated with a lower risk of metabolic syndrome in Japanese men and women, while very heavy drinking is thought to increase the risk of metabolic syndrome in Japanese men.

Westover AN; Nakonezny PA. Aortic dissection in young adults who abuse amphetamines. American Heart Journal 160(2): 315-321, 2010. (42 refs.)

Background: Case reports suggest a relationship between amphetamine abuse/dependence and aortic dissection, but no population-based epidemiologic studies have examined this link. Our objective was to test the hypothesis that young adults with a diagnosis of amphetamine abuse/dependence would be at higher risk for aortic dissection after accounting for known risk factors. Methods: In this population-based case-control study of 30,922,098 discharges from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1995 to 2007, among persons aged 18 to 49 years, we identified 3,116 thoracic and thoracoabdominal aortic dissections using International Classification of Disease, Ninth Edition, Clinical Modification codes 441.01 and 441.03. The SURVEYLOGISTIC procedure in SAS 9.2 (SAS Institute, Cary, NC) was used to account for the Nationwide Inpatient Sample sampling methodology. Results: In a multiple logistic regression analysis, while controlling for known risk factors, amphetamine abuse/dependence was significantly associated with aortic dissection (adjusted odds ratio = 3.33, 95% CI = 2.37-4.69, P < .0001). Conclusions: This statistically significant association suggests that amphetamine abuse/dependence may play a role in aortic dissection in young adults in the United States.

Wildeman C. Commentary on Roettger, et al. (2011): Confronting the elephant in the room. (editorial). Addiction 106(1): 133-134, 2011. (15 refs.)

Wu CB; Thompson ME; Fong GT; Li QA; Jiang YA; Yang Y et al. Methods of the International Tobacco Control (ITC) China Survey. Tobacco Control 19(Supplement 2): i1, 2010. (8 refs.)

This paper describes the design features, data collection methods and analytical strategies of the ITC China Survey, a prospective cohort study of 800 adult smokers and 200 adult non-smokers in each of six cities in China. In addition to features and methods which are common to ITC surveys in other countries, the ITC China Survey possesses unique features in frame construction, a large first phase data enumeration and sampling selection; and it uses special techniques and measures in training, field work organisation and quality control. It also faces technical challenges in sample selection and weight calculation when some selected upper level clusters need to be replaced by new ones owing to massive relocation exercises within the cities.

Yang JL; Hammond D; Driezen P; Fong GT; Jiang YA. Health knowledge and perception of risks among Chinese smokers and non-smokers: Findings from the Wave 1 ITC China Survey. Tobacco Control 19(Supplement 2): i18, 2010. (25 refs.)

Background Awareness of health risks of smoking is strongly associated with smoking behaviour. However, there are no population-based studies of smoking-related health knowledge in China. Objective The aim of current study was to use a population-based sample from the International Tobacco Control China Wave 1 survey to examine variations between current, former and never smokers' health knowledge about smoking and the impact of health knowledge awareness on smokers' intention to quit. Methods A face-to-face interview was conducted with 5986 adult smokers and non-smokers from six cities in China. Respondents were asked whether they believed smoking causes heart disease, stroke, impotence, lung cancer, emphysema, stained teeth, premature ageing in smokers and lung cancer in non-smokers. Current smokers were also asked additional questions on how smoking affects their current and future health as well as whether they had plans to quit smoking and if they believe they would have health benefit from quitting. Findings The overall awareness of health risks of smoking in China was low compared to developed countries. Current smokers in China were less likely than non-smokers and former smokers to acknowledge the consequences of smoking. Current smokers who were more aware of the health consequences of smoking were more likely to intend to quit smoking. Conclusion These findings highlight the need to increase awareness about the health effects of smoking in China, particularly among current smokers to increase quitting.

Zvolensky MJ; McMillan KA; Gonzalez A; Asmundson GJG. Chronic musculoskeletal pain and cigarette smoking among a representative sample of Canadian adolescents and adults. Addictive Behaviors 35(11): 1008-1012, 2010. (35 refs.)

The present investigation sought to examine the relation between specific types of chronic musculoskeletal pain and cigarette smoking among a large representative sample of adolescents and adults residing in Canada. Specifically, we examined the relations between chronic back pain, arthritis, and daily smoking status. As predicted, individuals with chronic back pain were more likely to smoke than those without chronic back pain or arthritis; this association remained significant after controlling for sociodemographics and any lifetime anxiety or mood disorder. An opposite, albeit less robust, association was evident for the prescence of lifetime arthritis and smoking. Future work is needed to better understand the mechanisms underlying the association between chronic pain and smoking.