Active Smoking Before Liver Transplantation in Patients with Alcohol Use Disorder: Risk Factors and Outcomes

Tobacco use is more prevalent among alcohol liver disease (ALD) transplant patients and exerts harmful effects to the patient and to the graft. The aims of this study were to examine the impact of smoking status (nonsmoker, ex-smoker, active smoker) on patient survival and clinical outcomes, and to assess risk factors for active smoking before and after liver transplant (LT). An observational retrospective cohort study with 314 ALD patients undergoing LT from January 2004 to April 2016. Recipients were followed until April 2017 or death. Kaplan–Meier and Cox proportional hazards regression analyses were used to assess risk of mortality according to smoking status before LT. Smokers had a 79% higher risk of dying than those who had never smoked or quit smoking before LT. Ex-smokers had a greater survival probability (96.2%, 93.8%, 86.9%, and 83.1% at 1, 3, 5, and 10 years after LT) than active smokers until LT (96.0%, 85.6%, 80.0%, and 70.4%). Active smokers before LT with poor toxicity awareness had more than a twofold higher risk of mortality (Cox HR = 2.20, 95% CI: 1.05–4.58, p = 0.04) than ex-smokers. Younger age (OR = 94), higher Model for End-Stage Liver Disease (MELD) (OR = 1.06), and comorbid substance use disorder (OR = 2.35) were predictors of smoking until LT. Six months or less of alcohol abstinence (OR = 3.23), and comorbid substance use disorder (OR = 4.87) were predictors of active smoking after LT. Quitting smoking before transplantation improved survival. Evidence based smoking cessation interventions should be offered before and after LT.

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Menthol cigarette use in substance use disorder treatment before and after implementation of a county-wide flavoured tobacco ban

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056000 ◽

2020 ◽

pp. tobaccocontrol-2020-056000

Author(s):

Joseph R Guydish ◽

Elana R Straus ◽

Thao Le ◽

Noah Gubner ◽

Kevin L Delucchi

Keyword(s):

Substance Use ◽

San Francisco ◽

Substance Use Disorder ◽

Smoking Status ◽

Smoking Behaviour ◽

Cross Sectional ◽

Menthol Cigarette ◽

Menthol Cigarettes ◽

Readiness To Quit ◽

The Impact

IntroductionThis study examined the impact of a San Francisco City and County ban on all flavoured tobacco products, including menthol cigarettes, among clients in residential substance use disorder (SUD) treatment.MethodsWe conducted cross-sectional surveys of clients at two residential SUD programmes before the County began enforcing the ban (n=160) and twice after enforcement began (n=102, n=120). The samples were compared on demographic characteristics, smoking status, smoking behaviours and the proportion reporting menthol as their usual cigarette. Menthol smokers were asked whether they smoked only menthol cigarettes, mostly menthol, both menthol and non-menthol or mostly non-menthol. Post-ban samples were asked about awareness of the ban and access to menthol cigarettes.ResultsIn multivariate analyses, we found no evidence that the ban was associated with decreased number of cigarettes per day or increased readiness to quit among current smokers. However, odds were lower post-ban for reporting menthol as the usual cigarette (OR=0.80, 95% CI 0.72 to 0.90), and for smoking only menthol cigarettes (OR=0.19, 95% CI 0.18 to 0.19). Perhaps most importantly, and with the ability to influence all other findings, 50% of self-identified menthol smokers reported purchasing menthol cigarettes in San Francisco nearly 1 year after the ban was implemented.ConclusionIn subgroups where smoking has remained elevated, like those receiving SUD treatment, local menthol bans may have only modest impacts on smoking behaviour. Broader regional, state or national bans, that effectively restrict access to menthol products, may be needed to show stronger effects on smoking behaviour.

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Predicting attrition in long-term residential substance use disorder treatment: A modifiable risk factors perspective.

Psychological Services ◽

10.1037/ser0000333 ◽

2020 ◽

Vol 17 (4) ◽

pp. 472-482

Author(s):

Danielle E. Baker ◽

Keith A. Edmonds ◽

Maegan L. Calvert ◽

Sarah M. Sanders ◽

Ana J. Bridges ◽

...

Keyword(s):

Risk Factors ◽

Substance Use ◽

Substance Use Disorder ◽

Modifiable Risk Factors ◽

Substance Use Disorder Treatment ◽

Disorder Treatment

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Decision letter for "Placement of chronically homeless into different types of permanent supportive housing before and after a coordinated entry system: The influence of severe mental illness, substance use disorder, and dual diagnosis on housing configuration and intensity o"

10.1002/jcop.22428/v2/decision1 ◽

2020 ◽

Keyword(s):

Mental Illness ◽

Substance Use ◽

Severe Mental Illness ◽

Substance Use Disorder ◽

Dual Diagnosis ◽

Supportive Housing ◽

Permanent Supportive Housing ◽

Different Types ◽

Before And After

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Characteristics of patients with substance use disorder before and after the Affordable Care Act

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2018.08.028 ◽

2018 ◽

Vol 193 ◽

pp. 124-130 ◽

Cited By ~ 3

Author(s):

Cynthia I. Campbell ◽

Sujaya Parthasarathy ◽

Andrea Altschuler ◽

Kelly C. Young-Wolff ◽

Derek D. Satre

Keyword(s):

Substance Use ◽

Substance Use Disorder ◽

Affordable Care Act ◽

Before And After ◽

The Affordable Care Act

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Correlates of Youth Suicide Attempters in Australian Community and Clinical Samples

Australian & New Zealand Journal of Psychiatry ◽

10.1046/j.1440-1614.2003.01179.x ◽

2003 ◽

Vol 37 (3) ◽

pp. 286-293 ◽

Cited By ~ 12

Author(s):

Gregory L. Carter ◽

Cathy Issakidis ◽

Kerrie Clover

Keyword(s):

Mental Health ◽

Risk Factors ◽

Substance Use ◽

Substance Use Disorder ◽

Suicidal Behaviour ◽

Clinical Sample ◽

Community Sample ◽

Community Control ◽

Clinical Group ◽

Health Related

Objective: This study (i) explores differences between a clinical sample of deliberate selfpoisoning (DSP) patients and a community sample who reported previous attempted suicide (AS); and (ii) examines correlates of suicidal behaviour in these groups compared with a community control group (CC) with no suicidal behaviour. Method: The study design was: case–case, case–control and cross-sectional population studies. A clinical sample of DSP (n = 51), a community sample of AS (n = 31) and a community sample with no suicidal behaviour (n = 842) were used, all aged 18–24 years. The DSP and AS groups were compared on several variables and two logistic regression models were developed for risk of (i) DSP and (ii) AS compared to community controls. Results: The adjusted odds ratios for DSP were: female gender (OR = 5.7, CI = 1.7–19.4), anxiety (OR = 7.4, CI = 2.2–25.1), affective (OR = 23.0, CI = 6.9–76.5), or substance-use disorder (OR = 19.2, CI = 5.6–65.4) and greater mental health related disability (OR = 0.5, CI = 0.3–0.7 for 1 SD decrease). For AS the results were: anxiety (OR = 9.4, CI = 1.7–52.8) or substance-use disorder (OR = 3.0, CI = 1.1–8.7) and greater mental health disability (OR = 0.5, CI = 0.4–0.7). Affective disorder was close to significant for the AS group (OR = 4.0, CI = 0.9–17.1). Conclusions: Correlates of DSP/AS were usually more powerful in the clinical group, but showed a similar pattern of psychiatric disorder and disability factors in both groups, supporting a continuum of risk factors across these groups. Interventions based on modifiable risk factors could target the same factors for public health, primary care or hospital populations: anxiety, depression and substance use disorders and mental health related disability.

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Nephrectomy Delay of More than 10 Weeks from Diagnosis Is Associated with Decreased Overall Survival in pT3 RCC

Journal of Kidney Cancer and VHL ◽

10.15586/jkcvhl.v8i2.125 ◽

2021 ◽

Vol 8 (2) ◽

pp. 27-33

Author(s):

Jiping Zeng ◽

Ken Batai ◽

Benjamin Lee

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Logistic Regression ◽

Proportional Hazards ◽

Surgical Margin ◽

Cox Proportional Hazards ◽

Cancer Center ◽

Integrated Network ◽

Factors Associated ◽

The Impact

In this study, we aimed to evaluate the impact of surgical wait time (SWT) on outcomes of patients with renal cell carcinoma (RCC), and to investigate risk factors associated with prolonged SWT. Using the National Cancer Database, we retrospectively reviewed the records of patients with pT3 RCC treated with radical or partial nephrectomy between 2004 and 2014. The cohort was divided based on SWT. The primary out-come was 5-year overall survival (OS). Logistic regression analysis was used to investigate the risk factors associated with delayed surgery. Cox proportional hazards models were fitted to assess relations between SWT and 5-year OS after adjusting for confounding factors. A total of 22,653 patients were included in the analysis. Patients with SWT > 10 weeks had higher occurrence of upstaging. Using logistic regression, we found that female patients, African-American or Spanish origin patients, treatment in academic or integrated network cancer center, lack of insurance, median household income of <$38,000, and the Charlson–Deyo score of ≥1 were more likely to have prolonged SWT. SWT > 10 weeks was associated with decreased 5-year OS (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.15–1.33). This risk was not markedly attenuated after adjusting for confounding variables, including age, gender, race, insurance status, Charlson–Deyo score, tumor size, and surgical margin status (adjusted HR, 1.13; 95% CI, 1.04–1.24). In conclusion, the vast majority of patients underwent surgery within 10 weeks. There is a statistically significant trend of increasing SWT over the study period. SWT > 10 weeks is associated with decreased 5-year OS.

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Impact of Ethnicity and Underlying Comorbidity on COVID-19 Inhospital Mortality: An Observational Study in Abu Dhabi, UAE

BioMed Research International ◽

10.1155/2021/6695707 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Asma Deeb ◽

Khulood Khawaja ◽

Nida Sakrani ◽

Abdulla AlAkhras ◽

Ahmed Al Mesabi ◽

...

Keyword(s):

Liver Disease ◽

Observational Study ◽

Older Patients ◽

Statistical Significance ◽

The Philippines ◽

Abu Dhabi ◽

Inhospital Mortality ◽

Risk Of Death ◽

Risk Of Mortality ◽

The Impact

Background. The UAE reported its first cluster of COVID 2019 in a group of returned travellers from Wuhan in January 2020. Various comorbidities are associated with worse disease prognosis. Understanding the impact of ethnicity on the disease outcome is an important public health issue but data from our region is lacking. Aim. We aim to identify comorbidities among patients hospitalized for COVID-19 that are associated with inhospital death. Also, to assess if ethnicity is correlated with increased risk of death. Patients and Method. The study is a single-centre, observational study in Shaikh Shakhbout Medical City, Abu Dhabi. Patients admitted with COVID-19, between 1st of March and the end of May, were enrolled. Records were studied for demography, comorbidity, and ethnicity. Ethnicity was divided into Arabs (Gulf, North Africa, and the Levant), South Asia (India, Pakistan, Bangladesh, Nepal, and Afghanistan), Africans, the Philippines, and others. The study was approved by the Department of Health of Abu Dhabi. Results. 1075 patients (972 males) were enrolled. There were 24 nationalities under 5 ethnicity groups. Mean (average) age was 51 years (20–81). 101 (9.4%) died with deceased patients being significantly older. Death risk was not significantly influenced by sex. Duration of hospitalization among survivors was 6.2 days (0.2–40.4) with older patients and men staying longer ( P < 0.01 ). Comorbidities of diabetes, hypertension, cardiovascular disease, chronic renal disease, liver disease, and malignancy were associated with higher risk of mortality univariate, but only liver disease reached statistical significance after adjustment for age. The highest percentage of death was seen in Arab Levant (21.2) followed by the Asian Afghan (18.8); however, differences among ethnicities did not reach statistical significance ( P = 0.086 ). Conclusion. COVID-19 outcome was worse in older people and those with comorbidities. Men and older patients required longer hospitalization. Ethnicity is not seen to impact the risk of mortality.

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Abstract TP196: New Zealand Workforce Stroke Incidence: Urban and Rural Risk Factor Evaluation

Stroke ◽

10.1161/str.44.suppl_1.atp196 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Hope E Buell ◽

Patricia Metcalf ◽

Daniel Exeter

Keyword(s):

Risk Factors ◽

New Zealand ◽

Stroke Risk ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Smoking Status ◽

Prior History ◽

Stroke Incidence ◽

Stroke Outcomes ◽

The Impact

This analysis aims to assess the impact of urban and rural risk factors on a model of stroke incidence in a New Zealand workforce population. The New Zealand study consisted of 4,926 subjects prospectively enrolled at 46 worksites. The subjects were aged 40-78 years at baseline and had no prior history of stroke. This prospective study defines stroke events experienced by the study subjects during follow-up between 1988 and 2012 based on hospital admission coding. Proportional hazards regression models were fit using baseline characteristics. The difference in stroke outcomes for urban and rural worksites was also evaluated. Results demonstrate that baseline demographic, physical exam, and behavioural measures impact stroke outcomes. While the baseline distribution of stroke risk factors such as Pacific Island ethnicity, smoking status, and increased blood pressure indicates a potentially higher risk of stroke in the rural population, the proportional hazards model does not identify increased stroke risk for rural workers. Additional analysis of the diet, exercise and Quality of Life measures for these subjects may provide further information into the stroke risk profiles of individuals working in different locales.

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