BACKGROUND: Colorectal cancer (CRC) is a common, fatal cancer. Identifying subgroups who may benefit more from intervention is of critical public health importance. Previous studies have assessed multiplicative interaction between genetic risk scores and environmental factors, but few have assessed additive interaction, the relevant public health measure. METHODS: Using resources from CRC consortia, including 45,247 CRC cases and 52,671 controls, we assessed multiplicative and additive interaction (relative excess risk due to interaction, RERI) using logistic regression between 13 harmonized environmental factors and genetic risk score, including 141 variants associated with CRC risk. RESULTS: There was no evidence of multiplicative interaction between environmental factors and genetic risk score. There was additive interaction where, for individuals with high genetic susceptibility, either heavy drinking (RERI = 0.24, 95% confidence interval [CI] = 0.13, 0.36), ever smoking (0.11 [0.05, 0.16]), high body mass index (female 0.09 [0.05, 0.13], male 0.10 [0.05, 0.14]), or high red meat intake (highest versus lowest quartile 0.18 [0.09, 0.27]) was associated with excess CRC risk greater than that for individuals with average genetic susceptibility. Conversely, we estimate those with high genetic susceptibility may benefit more from reducing CRC risk with aspirin/nonsteroidal anti-inflammatory drugs use (-0.16 [-0.20, -0.11]) or higher intake of fruit, fiber, or calcium (highest quartile versus lowest quartile -0.12 [-0.18, -0.050]; -0.16 [-0.23, -0.09]; -0.11 [-0.18, -0.05], respectively) than those with average genetic susceptibility. CONCLUSIONS: Additive interaction is important to assess for identifying subgroups who may benefit from intervention. The subgroups identified in this study may help inform precision CRC prevention.
- MeSH
- dieta MeSH
- dospělí MeSH
- genetická predispozice k nemoci * MeSH
- index tělesné hmotnosti MeSH
- interakce genů a prostředí * MeSH
- jednonukleotidový polymorfismus MeSH
- kolorektální nádory * genetika epidemiologie MeSH
- kouření škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- logistické modely MeSH
- pití alkoholu MeSH
- rizikové faktory MeSH
- senioři MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status. MATERIALS AND METHODS: This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE trial (NCT02400229) involved 3561 patients with suspected coronary artery disease (CAD). The primary endpoint was major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, or stroke). Secondary endpoints included an expanded MACE composite (MACE, transient ischaemic attack, or major procedure-related complications). RESULTS: Of 3445 randomised patients with smoking data (mean age 59.1 years + / - 9.7, 1151 men), at 3.5-year follow-up, the effect of CT vs. ICA on MACE was consistent across smoking groups (p for interaction = 0.98). The percutaneous coronary intervention rate was significantly lower with a CT-first strategy in smokers and former smokers (p = 0.01 for both). A CT-first strategy reduced the hazard of major procedure-related complications (HR: 0.21, 95% CI: 0.03, 0.81; p = 0.045) across smoking groups. In current smokers, the expanded MACE composite was lower in the CT- compared to the ICA-first strategy (2.3% (8) vs 6.0% (18), HR: 0.38; 95% CI: 0.17, 0.88). The rate of non-obstructive CAD was significantly higher in all three smoking groups in the CT-first strategy. CONCLUSION: For patients with stable chest pain referred for ICA, the clinical outcomes of CT were consistent across smoking status. The CT-first approach led to a higher detection rate of non-obstructive CAD and fewer major procedure-related complications in smokers. CLINICAL RELEVANCE STATEMENT: This pre-specified sub-analysis of the DISCHARGE trial confirms that a CT-first strategy in patients with stable chest pain referred for invasive coronary angiography with an intermediate pre-test probability of coronary artery disease is as effective as and safer than invasive coronary angiography, irrespective of smoking status. TRIAL REGISTRATION: ClinicalTrials.gov NCT02400229. KEY POINTS: • No randomised studies have assessed smoking status on CT effectiveness in symptomatic patients referred for invasive coronary angiography. • A CT-first strategy results in comparable adverse events, fewer complications, and increased coronary artery disease detection, irrespective of smoking status. • A CT-first strategy is safe and effective for stable chest pain patients with intermediate pre-test probability for CAD, including never smokers.
- MeSH
- koronární angiografie * metody MeSH
- kouření * škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci koronárních tepen * diagnostické zobrazování komplikace MeSH
- počítačová rentgenová tomografie * metody MeSH
- propuštění pacienta MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pragmatická klinická studie MeSH
- randomizované kontrolované studie MeSH
BACKGROUND: Healthy behaviors are paramount in preventing long-term adverse health outcomes in childhood, adolescent, and young adult (CAYA) cancer survivors. We systematically reviewed and synthesized existing literature on barriers, facilitators, and other factors associated with health behaviors in this population. METHODS: MEDLINE and PsycInfo were searched for qualitative and quantitative studies including survivors aged 16-50 years at study, a cancer diagnosis ≤25 years and ≥2 years post diagnosis. Health behaviors included physical activity, smoking, diet, alcohol consumption, sun exposure, and a combination of these behaviors (defined as health behaviors in general). RESULTS: Barriers, facilitators, and other factors reported in ≥2 two studies were considered relevant. Out of 4529 studies, 27 were included (n = 31,905 participants). Physical activity was the most frequently examined behavior (n = 12 studies), followed by smoking (n = 7), diet (n = 7), alcohol (n = 4), sun exposure (n = 4), and health behavior in general (n = 4). Relevant barriers to physical activity were fatigue, lack of motivation, time constraints, and current smoking. Relevant facilitators were perceived health benefits and motivation. Influence of the social environment and poor mental health were associated with more smoking, while increased energy was associated with less smoking. No relevant barriers and facilitators were identified for diet, alcohol consumption, and sun exposure. Barriers to healthy behavior in general were unmet information needs and time constraints whereas lifestyle advice, information, and discussions with a healthcare professional facilitated healthy behavior in general. Concerning other factors, women were more likely to be physically inactive, but less likely to drink alcohol and more likely to comply with sun protection recommendations than men. Higher education was associated with more physical activity, and lower education with more smoking. CONCLUSION: This knowledge can be used as a starting point to develop health behavior interventions, inform lifestyle coaches, and increase awareness among healthcare providers regarding which survivors are most at risk of unhealthy behaviors.
- MeSH
- cvičení * MeSH
- dieta MeSH
- dítě MeSH
- dospělí MeSH
- kouření epidemiologie škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádory psychologie epidemiologie MeSH
- pití alkoholu epidemiologie MeSH
- přežívající onkologičtí pacienti * psychologie MeSH
- zdravé chování * MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- systematický přehled MeSH
Fajčenie vo veku 65 rokov a viac so sebou prináša prehlbovanie zdravotných komplikácií. Starší fajčiari naďalej trpia zdravotnými následkami cigariet, čo sa odráža vo vysokej úmrtnosti, závažných chronických ochoreniach a invalidite. Starší dospelí, ktorí prestali fajčiť, zlepšili svoje štatistiky prežitia do 2 rokov a mali nižšiu mieru koronárnych príhod, zlepšenie pľúcnych funkcií a respiračných symptómov a lepšiu kvalitu života. Lekári, ďalší zdravotnícki pracovníci, rodiny a priatelia by mali aktívne nabádať starších mužov a ženy, aby prestali fajčiť. Alternatívy síce existujú, avšak jediným a najlepším riešením pre každú generáciu fajčiarov je prestať fajčiť úplne.
Smoking at the age of 65 and over brings with it a deepening of health complications. Older smokers continue to suffer from the health consequences of cigarettes, which is reflected in high mortality, serious chronic diseases and disability. Older adults who quit smoking improved their 2-year survival statistics and moderate coronary event rates, improved lung function and respiratory symptoms, and better quality of life. Doctors, other health professionals, and families and friends should actively encourage older men and women to quit smoking. Although there are alternatives, the only and best solution for every generation of smokers is to stop smoking completely
Stainless steel welders are exposed to heavy filler metals. We evaluated the concentration of these metals in whole blood and urine, and the relevant biochemical parameters in relation to the total chromosomal aberrations (CAs), chromatid-type (CTA-type, CTAs) and chromosome-type (CSA-type, CSAs), in 117 welders and control individuals. Statistically higher concentrations of the total Cr, Ni and Mn were observed in whole blood and urine of welders, and the concentrations were higher in welders who smoked. On the contrary, concentrations of urinary heavy metals Cr and Mn adjusted for creatinine were significantly higher in the control groups. A statistically higher frequency of total CAs was observed in the whole group of welders, and also in the non-smoking welders, as compared to controls. The frequency of total CAs significantly correlated with the concentration of Cr, Ni and Mn in whole blood (R=0.61, P˂0.0001, R=0.33, P˂0.0001 and R=0.66, P˂0.0001, respectively), with urinary concentrations of Ni and Mn (R=0.27, P=0.003 and R=0.28, P=0.003, respectively) and with urinary concentrations of Cr, Ni and Mn adjusted for creatinine (R=0.22, P=0.029, R=0.26, P=0.005 and R=0.20, P=0.030, respectively). Likewise, the frequency of CTA-types significantly correlated with the concentration of Cr and Mn in whole blood (R=0.31, P=0.0007 and R=0.34, P=0.0002). The frequency of CSA-types significantly correlated with concentrations of Cr, Ni and Mn in whole blood (R=0.43, P˂0.0001, R=0.38, P˂0.0001 and R=0.46, P˂0.0001, respectively). The statistically higher values of serum creatinine and total bilirubin were detected in all welders, as well as in smokers when compared to the corresponding controls. The exposure to heavy metals in welders increased the frequencies of CAs and altered the balance between urinary excretion of heavy metals and their possible accumulation.
- MeSH
- chrom moč krev MeSH
- chromozomální aberace * chemicky indukované MeSH
- dospělí MeSH
- kouření škodlivé účinky moč krev MeSH
- kreatinin moč krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- mangan moč krev MeSH
- nerezavějící ocel MeSH
- nikl moč krev MeSH
- pracovní expozice * škodlivé účinky analýza MeSH
- studie případů a kontrol MeSH
- svařování * MeSH
- těžké kovy * moč krev MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- biologická terapie MeSH
- hidradenitis suppurativa * diagnóza farmakoterapie patofyziologie MeSH
- klindamycin farmakologie terapeutické užití MeSH
- kouření cigaret škodlivé účinky MeSH
- kvalita života MeSH
- lidé MeSH
- lymfedém etiologie MeSH
- obezita komplikace MeSH
- retinoidy farmakologie terapeutické užití MeSH
- rizikové faktory MeSH
- tetracykliny farmakologie terapeutické užití MeSH
- Check Tag
- lidé MeSH
- MeSH
- alkoholická pankreatitida etiologie MeSH
- bolest MeSH
- chronická pankreatitida * etiologie komplikace patofyziologie MeSH
- diabetes mellitus etiologie MeSH
- exokrinní pankreatická insuficience etiologie terapie MeSH
- kouření tabáku škodlivé účinky MeSH
- lidé MeSH
- malabsorpční syndromy MeSH
- management nemoci * MeSH
- nádory slinivky břišní etiologie MeSH
- osteoporóza etiologie MeSH
- pankreatin farmakologie terapeutické užití MeSH
- rizikové faktory MeSH
- sarkopenie etiologie MeSH
- Check Tag
- lidé MeSH
- MeSH
- agonisté beta-2-adrenergních receptorů farmakologie terapeutické užití MeSH
- antagonisté muskarinových receptorů farmakologie terapeutické užití MeSH
- chronická obstrukční plicní nemoc * epidemiologie farmakoterapie komplikace MeSH
- diagnostické zobrazování metody MeSH
- expektorancia farmakologie terapeutické užití MeSH
- kardiovaskulární nemoci etiologie MeSH
- klinická studie jako téma metody MeSH
- kongresy jako téma MeSH
- kouření cigaret škodlivé účinky MeSH
- lidé MeSH
- počítačová rentgenová tomografie metody MeSH
- progrese nemoci MeSH
- rizikové faktory MeSH
- spirometrie metody MeSH
- Check Tag
- lidé MeSH
Elektronické cigarety a ich používanie známe aj pod pojmom vaping sa stali v poslednej dobe celosvetovým trendom a to najmä v populácii adolescentov a mladých dospelých. Napriek ich popularite však doposiaľ nie sú dostatočne preštudované a môžu predstavovať závažné riziko pre naše zdravie. EVALI (E-cigarette or vaping use-associated lung injury) je nedávno popísaný pojem, ktorý predstavuje poškodenie pľúc v dôsledku inhalácie látok obsiahnutých v e-cigaretách a v súčasnosti je predmetom viacerých výskumov. Ochorenie je sprevádzané širokou škálou symptómov, diagnostika je náročná a spočíva vo vylúčení iných príčin. Takisto pri liečbe neexistujú jednoznačné odporúčania, dobrá klinická odpoveď je na liečbu kortikoidmi. Tento prehľadový článok je doplnený o kazuistiku 17. ročného pacienta, ktorá poukazuje na to, že aj v našich podmienkach je možné sa s EVALI stretnúť a je potrebné po abúze e-cigariet najmä u pacientov v adolescentnom veku anamnesticky pátrať.
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