Objectives To describe the morbidity and mortality in Canadian scleroderma (SSc) patients focusing on gender, SSc type, and organ-specific prognosis in a cohort of patients seen from 1994 to 2004 in ...a Southwestern Ontario SSc clinic. We also compared this cohort to data from the literature, which showed that mean survival in recent studies has risen to 72 months versus 48 months in earlier studies. Methods This was a cohort study of all SSc patients followed at 1 rheumatology center. Data were abstracted by chart review and entered into a database. The demographic and clinical characteristics of SSc patients were compared between those who survived versus those who died over the 10-year follow-up period. Five- and 10-year survival rates were compared between cohort subsets (sex, diffuse/limited disease type, and organ involvement including the following: scleroderma renal crisis, interstitial lung disease (ILD), hypertension, cardiac, gastrointestinal involvement, pulmonary arterial hypertension, and antinuclear antibody positivity). Results One hundred eighty-five subjects (158 women), 63% with limited cutaneous SSc, were included. The mean disease duration until last visit or death was 9.1 years (7.9 years in diffuse and 9.8 years in limited). Although more women had either subtype, men were more likely to have diffuse cutaneous SSc (dcSSc) than women (67% of men had dcSSc versus 32% of women, P = 0.0009), and to have an earlier mean age of diagnosis (41.3 ± 2.8 years old versus 49.7 ± 1.2 years, P = 0.006). Overall mortality was 23%; 22% of men ( n = 6) and 23% of women ( n = 36) were deceased. The 5-year survival was 90% (95% for limited and 81% for diffuse) and the 10-year survival was 82% (92% for limited and 65% for diffuse). Deceased persons were more likely to have had dcSSc ( P = 0.03), cardiac disease ( P < 0.0001), ILD ( P = 0.006), gastrointestinal disease ( P = 0.01), and systemic hypertension ( P = 0.009). Four of 13 patients with scleroderma renal crisis died. Survival analyses demonstrated that persons with dcSSc ( P = 0.001), cardiac disease ( P < 0.0001), and hypertension ( P = 0.01) had worse survival rates than their counterparts without these disorders. The primary cause of death was ascertained for 33 of the 42 deceased individuals and included the following: pulmonary arterial hypertension ( n = 5), renal complications ( n = 9), ILD ( n = 10), and cardiac complications ( n = 9). There appears to be a trend toward longer survival of scleroderma patients over the past few decades. Conclusions We conclude that cardiac involvement, dcSSc, and hypertension are associated with worse survival, and survival of patients with scleroderma is improving compared with older reports in the literature.
COVID-19 is primarily a respiratory illness, and smoking adversely impacts the respiratory and immune systems; this confluence may therefore incentivize smokers to quit. The present study, conducted ...in four high-income countries during the first global wave of COVID-19, examined the association between COVID-19 and: (1) thoughts about quitting smoking; (2) changes in smoking (quit attempt, reduced or increased smoking, or no change); and (3) factors related to a positive change (making a quit attempt or reducing smoking) based on an adapted framework of the Health Belief Model.
This cross-sectional study included 6870 adult smokers participating in the Wave 3 (2020) ITC Four Country Smoking and Vaping Survey conducted in Australia, Canada, England, and United States (US). These four countries had varying responses to the pandemic by governments and public health, ranging from advising voluntary social distancing to implementing national and subnational staged lockdowns. Considering these varying responses, and the differences in the number of confirmed cases and deaths (greatest in England and the US and lowest in Australia), smoking behaviours related to COVID-19 may have differed between countries. Other factors that may be related to changes in smoking because of COVID-19 were also explored (e.g., sociodemographics, nicotine dependence, perceptions about personal and general risks of smoking on COVID-19). Regression analyses were conducted on weighted data.
Overall, 46.7% of smokers reported thinking about quitting because of COVID-19, which differed by country (p<0.001): England highest (50.9%) and Australia lowest (37.6%). Thinking about quitting smoking because of COVID-19 was more frequent among: females, ethnic minorities, those with financial stress, current vapers, less dependent smokers (non-daily and fewer cigarettes smoked/day), those with greater concern about personal susceptibility of infection, and those who believe COVID-19 is more severe for smokers. Smoking behaviour changes due to COVID-19 were: 1.1% attempted to quit, 14.2% reduced smoking, and 14.6% increased smoking (70.2% reported no change). Positive behaviour change (tried to quit/reduced smoking) was reported by 15.5% of smokers, which differed by country (p = 0.02), where Australia had significantly lower rates than the other three countries. A positive behavioural smoking change was more likely among smokers with: lower dependence, greater concern about personal susceptibility to infection, and believing that COVID-19 is more severe for smokers.
Though nearly half of smokers reported thinking about quitting because of COVID-19, the vast majority did not change their smoking behaviour. Smokers were more likely to try and quit or reduce their smoking if they had greater concern about susceptibility and severity of COVID-19 related to smoking. Smokers in Australia were least likely to reduce or try to quit smoking, which could be related to the significantly lower impact of COVID-19 during the early phase of the pandemic relative to the other countries.
Patient-reported outcomes are used in clinical practice and trials. We studied a large clinical practice to determine the minimally important difference (MID) estimates for (1) the Health Assessment ...Questionnaire-Damage Index (HAQ-DI): improvement and worsening using patient global assessment anchor; and (2) pain using a patient-reported pain anchor.
Patients with rheumatoid arthritis (RA; N = 225) had clinic visits at 2 timepoints within 1 year, completed the HAQ-DI and pain visual analog scale (VAS; 0-100 mm), and answered the question, "How would you describe your overall status/overall pain since the last visit?", as much worsened, somewhat worsened, the same, somewhat improved, or much improved. If rated as somewhat improved or worsened, they were defined as the minimally changed subgroups.
Eighty-three percent were women, mean age 60 years, with disease duration 11.7 +/- 10.7 years. The baseline HAQ-DI was 0.97 +/- SD 0.76, and at followup 1.0 +/- 0.77 (mean change +0.03 +/- 0.40). The baseline pain VAS was 42.3 +/- 28.8, and at followup 38.5 +/- 27.9 (mean change -2.8 +/- 25.9). The mean (SD) HAQ-DI change score was -0.09 (0.42) for somewhat improved and 0.15 (0.33) for somewhat worsened. The HAQ-DI change for somewhat/much better was -0.20 +/- 0.52, and for somewhat/much worse +0.21 +/- 0.33. For pain, somewhat improved changed by -11.9 mm on the VAS, and somewhat worsened by 6.8 mm. Estimates for HAQ-DI and pain were larger than the for no-change group, 0.03 (0.32) and -3.2 (20.9).
The MID for HAQ-DI in clinical practice is smaller than it is in trials. This may have implications for observational studies and clinical care.
Campylobacter Reactive Arthritis: A Systematic Review Pope, Janet E., MD, MPH, FRCPC; Krizova, Adriana, MD, MSc; Garg, Amit X., MDPhD ...
Seminars in arthritis and rheumatism,
08/2007, Letnik:
37, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Objective To review the literature on the epidemiology of Campylobacter -associated reactive arthritis (ReA). Methods A Medline (PubMed) search identified studies from 1966 to 2006 that investigated ...the epidemiology of Campylobacter -associated ReA. Search terms included: “reactive arthritis,” “spondyloarthropathy,” “Reiter’s syndrome,” “gastroenteritis,” “diarrhea,” “epidemiology,” “incidence,” “prevalence,” and “Campylobacter.” Results The literature available to date suggests that the incidence of Campylobacter ReA may occur in 1 to 5% of those infected. The annual incidence of ReA after Campylobacter or Shigella may be 4.3 and 1.3, respectively, per 100,000. The duration of acute ReA varies considerably among reports, and the incidence and impact of chronic ReA from Campylobacter infection is virtually unknown. Conclusions Campylobacter -associated ReA incidence and prevalence varies widely among reviews due to case ascertainment differences, exposure differences, lack of diagnostic criteria for ReA, and perhaps genetics and ages of exposed individuals. At the population level it may not be associated with HLA-B27, and inflammatory back involvement is uncommon. Follow-up for long-term sequelae is largely unknown. Five percent of Campylobacter ReA may be chronic or relapsing (with respect to musculoskeletal symptoms).
To assess support among smokers and recent quitters for the Smokefree New Zealand (NZ) 2025 goal and measures to facilitate its achievement.
Data from CATI interviews with 1,155 (386 Māori) smokers ...and recent quitters in Wave 1 (August 2016–April 2017) and 1,020 (394 Māori) in Wave 2 (June–December 2018) of the International Tobacco Control (ITC) NZ Survey.
(Wave 2 unless stated): Almost all (95%) participants were aware of and more than half (56%) supported the smokefree goal. Support was highest (69–92%) for measures to reduce smoking uptake and protect children from exposure to secondhand smoke. Support was also high for other smokefree policies including mandated denicotinisation of smoked tobacco products (73%) and tobacco retailer licensing (70%, Wave 1). Support was lowest (<30%) for increasing the tobacco tax, but higher (59%) if additional revenue raised was used to help smokers to quit. Support for Smokefree 2025 and key measures to achieve it was generally higher among ex‐smokers than smokers but mostly similar among Māori and non‐Māori participants.
There is substantial support among smokers and ex‐smokers for the Smokefree 2025 goal and many measures that could help achieve it.
Implementing a comprehensive strategy to achieve Smokefree 2025 is likely to be acceptable among New Zealand's smokers and ex‐smokers.
Heated tobacco products (HTPs), such as IQOS, glo, and Ploom TECH, with a variety of flavored tobacco-containing inserts, have reportedly achieved a significant market share in Japan. We analyzed ...data from Wave 1 of the ITC Japan Survey, a nationally representative web survey conducted in February to March 2018 among 4684 adult participants to estimate the prevalence of HTP use, describe characteristics of HTP users, and explore user preferences for HTP device and flavor. The overall prevalence of monthly HTP use was 2.7% (1.7% daily use). Virtually all HTP users were current cigarette smokers (67.8%) or former smokers (25.0%); only 1.0% of HTP users were never smokers. Among HTP users, IQOS was the most frequently reported brand used (64.5%), and menthol was the most common flavor reported (41.5%). IQOS was used more by younger respondents and those who reported daily use, while Ploom TECH was more popular among older respondents and non-daily HTP users. This is one of the first non-industry funded studies to explore the use of HTPs in Japan.
The market growth of heated tobacco products (HTPs), such as IQOS, Ploom TECH, and glo, has increased dramatically in Japan since 2016. Little is known about the reasons why current and former ...smokers are using HTPs. The data for this cross-sectional study were from the 2018 (Wave 1) International Tobacco Control (ITC) Japan Survey, a national web-based survey of 4500 people, including 658 current HTP users, of whom 549 were concurrently smoking cigarettes and 109 were former smokers. The most common reasons for regularly using HTPs were: beliefs that HTP are less harmful than cigarettes to themselves (90.6%) or to others (86.7%), enjoyment (76.5%), and social acceptability (74.4%). About half of current smokers (55.1%) reported using HTPs because these products might help them quit smoking. However, a near-equal percentage (52.0%) of current smokers reported using HTPs to replace some of the cigarettes they smoked so that they did not have to give up smoking altogether. If smokers are using HTPs to complement rather than quit their smoking, then the harm reduction potential of HTPs suggested by the toxicity studies will be diminished.
In Japan, the tobacco industry promotes heated tobacco products (HTPs) as a reduced-risk tobacco product. This study examines: (1) smokers' harm perceptions of HTPs relative to combustible ...cigarettes; (2) differences in relative harm perceptions between exclusive smokers and smokers who use HTPs (concurrent users) and between concurrent users based on frequency of product use; and (3) if smokers who were exposed to HTP advertising hold beliefs that are consistent with marketing messages of lower harmfulness. This cross-sectional study included 2614 adult exclusive cigarette smokers and 986 concurrent users who reported their perceptions of harmfulness of HTPs compared to cigarettes, as well as their exposure to HTP advertising in the last six months. Among all smokers, 47.5% perceive that HTPs are less harmful than cigarettes, 24.6% perceive HTPs to be equally as harmful, 1.8% perceive HTPs as more harmful, and 26.1% did not know. Concurrent users are more likely than exclusive smokers to believe that HTPs are less harmful (62.1% versus 43.8%,
< 0.0001) and less likely to report that they did not know (14.3% versus 29.4%,
< 0.0001). Frequent HTP users are more likely than infrequent users to believe that HTPs are less harmful (71.7% versus 57.1%,
≤ 0.001). Believing that HTPs are less harmful than cigarettes was associated with noticing HTP advertising on TV (
= 0.0005), in newspapers/magazines (
= 0.0001), on posters/billboards (
< 0.0001), in stores where tobacco (
< 0.0001) or where HTPs (
< 0.0001) are sold, on social media (
< 0.0001), or in bars/pubs (
= 0.04). HTP users were significantly more likely than non-HTP users to believe that HTPs are less harmful than cigarettes, with this belief being more prominent among frequent users. Smokers who have been exposed to HTP advertising were more likely to perceive HTPs as less harmful than cigarettes.
Comprehensive smoke-free policies such as those called for by the WHO FCTC are the only way to protect the public effectively from the harms of secondhand smoke (SHS), yet Japan has been slow to ...implement this important health measure. This study examines baseline levels of smoking and SHS exposure in public places and support for smoking bans in Japan prior to the implementation of the 2018 national smoke-free law. Data are from the International Tobacco Control (ITC) Japan Wave 1 Survey (Feb-Mar 2018), a web survey of adult cigarette smokers, heated tobacco product users, dual users, and non-users (total
= 4684). Measures included prevalence of smoking (whether respondents noticed people smoking inside restaurants and bars at their last visit, and workplaces in the last month), and support for complete smoking bans in these venues. Smoking prevalence in each venue was high overall in 2018 (49% of workplaces, 55% of restaurants, and 83% of bars), even higher than in China, the country with the greatest toll of SHS. Support for complete smoking bans was very high overall (81% for workplaces, 78% for restaurants, and 65% for bars). Non-users were less likely to be exposed to SHS and had higher support for smoking bans than tobacco users. These findings point to the ineffectiveness of partial smoke-free laws in Japan and reinforce the call for comprehensive smoke-free laws, which even smokers would support at higher levels than in many other ITC countries.
Japan is one of the world's largest cigarette markets and the top heated tobacco product (HTP) market. No forms of tobacco advertising, promotion, and sponsorship (TAPS) are banned under national ...law, although the industry has some voluntary TAPS restrictions. This study examines Japanese tobacco users' self-reported exposure to cigarette and HTP marketing through eight channels, as well as their support for TAPS bans. Data are from the 2018 ITC Japan Survey, a cohort survey of adult exclusive cigarette smokers (
= 3288), exclusive HTP users (
= 164), HTP-cigarette dual users (
= 549), and non-users (
= 614). Measures of overall average exposure to the eight channels of cigarette and HTP advertising were constructed to examine differences in exposure across user groups and products. Dual users reported the highest exposure to cigarette and HTP advertising. Tobacco users (those who used cigarettes, HTPs, or both) reported higher average exposure to HTP compared to cigarette advertising, however non-users reported higher average exposure to cigarette compared to HTP advertising. Retail stores where tobacco or HTPs are sold were the most prevalent channel for HTP and cigarette advertising, reported by 30-43% of non-users to 66-71% of dual users. Non-users reported similar exposure to cigarette advertising via television and newspapers/magazines as cigarette smokers and dual users; however, advertising via websites/social media was lower among non-users and HTP users than among cigarette smokers and dual users (
< 0.05). Most respondents supported a ban on cigarette (54%) and HTP (60%) product displays in stores, and cigarette advertising in stores (58%).
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