Introdução: A exposição do feto a grandes quantidades de componentes tóxicos decorrente do consumo de tabaco e álcool durante a gestação pode acarretar problemas tais como prematuridade, baixo peso ao nascer, aborto e distúrbios no desenvolvimento infantil. Essa associação tem sido recentemente objeto de diversos estudos, porém os resultados são contraditórios devido aos métodos e amostras distintos. Objetivo: Estudar a associação entre o consumo de tabaco e/ou álcool pela gestante e o desenvolvimento infantil entre 13 e 30 meses de idade. Método: Estudo descritivo e analítico, prospectivo, de uma coorte de conveniência iniciada no pré-natal (2010), avaliada no nascimento e a partir do início do segundo ano de vida (2011/2013) no município de Ribeirão Preto, SP. A variável dependente foi o escore médio do desempenho dos filhos nas cinco subescalas da Bayley Scales of Infant and Toddler Development ® third edition - screening test (Bayley - III®). A variável exploratória foi o consumo de tabaco e/ou álcool na gestação, classificado como nenhum consumo, consumo isolado de tabaco ou álcool e consumo concomitante das substâncias. As diferenças entre as médias nos escores das cinco subescalas foram comparadas por meio de regressão linear, em quatro modelos: ajustado pelas faixas etárias de aplicação do teste, propostas no manual técnico da escala (modelo 1); ajustado pelas faixas etárias, por consumo de tabaco e/ou álcool na gestação e características da mãe, da gestação e do parto (modelo 2); ajustado pelas faixas etárias, por consumo de tabaco e/ou álcool na gestação e variáveis do seguimento das crianças (modelo 3); ajustado por todas as variáveis dos modelos anteriores (modelo 4). Resultados: Foram estudadas 998 mulheres, das quais 121 (12,1%) fumaram e 246 (24,6%) referiram ter consumido bebida alcoólica na gravidez. O consumo isolado de álcool foi três vezes maior (18,6%) do que o consumo apenas de tabaco (6,1%). O consumo combinado de tabaco e álcool durante a gestação foi de 6,0%, sem diferença segundo a faixa etária das crianças avaliadas (p>0.05). Não houve diferença nas médias do escore cognitivo segundo o consumo das substâncias em nenhum modelo. Consumo concomitante foi associado a menor média dos escores em ambas as subescalas de comunicação (diferença de 1,12 pontos para comunicação receptiva, IC95% 0,45 a 1,79; 1,19 pontos para comunicação expressiva, IC95% 0,31 a 2,07) e motoras (diferença de 1,20 pontos na subescala motora fina, IC95% 0,55 a 1,85; 0,70 pontos para subescala motora grossa, IC95% 0,13 a 1,28), em torno de um ponto em média, comparado com nenhum consumo de tabaco e álcool. Conclusão: Consumo concomitante de tabaco e álcool teve efeito significativo, porém pequeno, na média dos escores de comunicação e motores, mas não na subescala cognitiva. / Introduction: Fetal exposure to large amounts of toxic compounds resulting from the consumption of tobacco and alcohol during pregnancy can lead to problems such as preterm birth, low birth weight, miscarriage and disorders in child development. This association has recently been the subject of several studies, but the results are contradictory due to differences in methods and samples. Objective: To study the association between the consumption of tobacco and/or alcohol by pregnant women and child development between 13 and 30 months of age. Methods: This is a descriptive and analytical, prospective study of a cohort of convenience initiated prenatally (2010), assessed at birth and from the beginning of the second year of life (2011-2013) in the city of Ribeirão Preto, Brazil. The dependent variable was the mean score of the performance of children in the five subscales of the Bayley Scales of Infant and Toddler Development ® third edition - screening test (Bayley - III®). The explanatory variable was the use of tobacco and/or alcohol during pregnancy rated as no consumption, isolated consumption of tobacco and alcohol and concomitant consumption of the substances. The differences between the mean scores in the five subscales were compared using linear regression in four models: adjusted for age of test application proposed in the technical manual of the scale (model 1); adjusted by age groups, for tobacco and/or alcohol use during pregnancy and maternal characteristics of pregnancy and childbirth (model 2); adjusted by age groups, for tobacco and/or alcohol use during pregnancy and variables related to children in the follow-up (model 3); adjusted for all the variables of the previous models (model 4). Results: 998 women were studied, 121 of them (12.1%) smoked and 246 (24.6%) reported having consumed alcohol in pregnancy. The isolated alcohol consumption was three times higher (18.6%) than the consumption of tobacco only (6.1%). The combined use of tobacco and alcohol during pregnancy was 6.0%, with no difference according to the child\'s age group (p> 0.05). There was no difference in mean cognitive score based on consumption of substances in any model. Concomitant intake was associated with lower mean scores in both communication subscales (1.12 points difference for receptive communication, 95% CI 0.45 to 1.79; 1.19 points for expressive communication, 95% CI 0.31 to 2.07) and motor subscale (1.20 points difference in the fine motor subscale, 95% CI 0.55 to 1.85; 0.70 points for gross motor subscale, 95% CI 0.13 to 1.28), around a point on average compared with no consumption of tobacco and alcohol. Conclusion: concomitant consumption of tobacco and alcohol had a significant effect, however small, in the mean score of the communication and motor subscales, but not in the cognitive subscale.

Made available in DSpace on 2016-08-10T10:55:03Z (GMT). No. of bitstreams: 1 JODIE DO AMARAL SODARIO.pdf: 8284737 bytes, checksum: 0998005f311495779270bf94c7d0d236 (MD5) Previous issue date: 2016-03-15 / Oral cavity cancers are considered a public health problem throughout the world and represent the sixth most common cancer. The main risk factors include tobacco, alcohol, micronutrient deficiency and the human papillomavirus (HPV). The metabolism of alcohol depends on the alcohol dehydrogenase (ADH), a family of enzymes with high frequency of genetic polymorphisms that give different individuals a wide range of susceptibility to metabolites. Thus, different genetic polymorphisms in ADH can interfere with the individual risk of cancer associated with alcohol consumption. The aim of this case-control study was to evaluate the frequency of SNP (SNP: single nucleotide polymorphism) in ADH1B gene in 61 patients with cancer of the oral cavity and in 66 healthy controls. The molecular study employed methods including polymerase chain reaction (PCR) associated to restriction fragment analysis (RFLP). The frequencies obtained for the genetic polymorphisms were calculated and compared in both groups, as well as the possible association between these polymorphisms and the characteristics of tumors. The results showed a higher prevalence of these tumors in the male population (74.3%), at ages above 45 years (88.5%), smokers (85.2%) and alcoholic (82.0%). Among the prognostic factors evaluated, the advanced stage (III and IV) was observed in 73.8% of cases and the involvement of regional lymph nodes in 39.3% of cases. Allele frequencies for ADH polymorphism R48H on group of cases were L = 82.8 and A = 17.2%, while in the control group were 79.4% and G = A = 20.6%. The genotypic frequencies obtained for the case group were AA = 16.0%; GA = 2.0% and GG = 81.0%, while for the control group, genotype frequencies were AA = 15.0%; GA = 12.0% and GG = 74.0%. The overall survival evaluated for the group was 49.9%. Significant differences in allele and genotype frequencies were observed between the groups or between the prognostic aspects evaluated. Epidemiological data from the oral cavity cancer have shown worrying trends, stressing the importance of promoting more studies related to this particular type of cancer. / Os cânceres de cavidade oral são considerados um problema de saúde pública em todo o mundo e representam a sexta neoplasia mais comum. Os principais fatores de risco incluem o tabaco, álcool, deficiência de micronutrientes e o Papilomavírus humano (HPV). O metabolismo do álcool depende da álcooldesidrogenase (ADH), uma família de enzimas com alta frequência de polimorfismos genéticos, que conferem aos diferentes indivíduos uma grande variação de suscetibilidade aos seus metabólitos. Assim, diferentes polimorfismos genéticos na ADH podem interferir no risco individual ao câncer associado ao etilismo. O objetivo deste estudo caso-controle foi avaliar a frequência de polimorfismo de nucleotídeo único (SNP: single nucleotide polymorphism) no gene ADH1B em 61 pacientes com câncer de cavidade oral e em 66 controles saudáveis. O estudo empregou métodos moleculares incluindo a reação em cadeia da polimerase (PCR) associada à análise de fragmentos de restrição (RFLP). As frequências obtidas para os polimorfismos genéticos foram calculadas e comparadas nos dois grupos, bem como as possíveis associações entre esses polimorfismos e as características dos tumores. Os resultados mostraram uma maior prevalência desses tumores na população masculina (85,2%), em idades acima de 45 anos (88,5%), tabagistas (85,2%) e etilistas (82,0%). Dentre os fatores prognósticos avaliados, o estádio avançado (III e IV) foi observado em 73,8% dos casos e o comprometimento de linfonodos regionais em 39,3% dos casos. As frequências alélicas para o polimorfismo ADH R48Hno grupo de casos foram G=82,8 e A=17,2%, enquanto no grupo controle foram G=79,4% e A=20,6%. As frequências genotípicas obtidas para o grupo de casos foram AA=16,0%; GA=2,0% e GG=81,0%, enquanto que para o grupo controle, as frequências genotípicas foram AA=15,0%; GA=12,0% e GG=74,0%. A sobrevida global avaliada para o grupo foi de 49,9%. Diferenças significativas nas frequências alélicas e genotípicas não foram observadas entre os grupos e nem entre os aspectos prognósticos avaliados. Dados epidemiológicos do câncer de cavidade oral têm mostrado tendências preocupantes, alertando para a importância de se promover maiores estudos relacionados a este tipo particular de câncer.

Background: Significant evidence exists about J-shaped relationship between alcohol consumption and total or cardiovascular disease (CVD)-specific mortality in US middleaged adults. Epidemiologic investigations presume that the J-shaped distribution is the sum of the detrimental effect of high levels of consumption on other causes of death and the protective effect on coronary heart disease (CHD) morbidity and mortality. Several studies demonstrated that moderate alcohol consumption reduces the risk of CHD. However, results have been inconsistent among heavy drinkers. In this study, we investigated the association of heavy alcohol consumption with CHD among adults aged 18-years or older in the US. Methods: Data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) were used to conduct this study. BRFSS is an annual cross-sectional survey administered to >400,000 adults in all 50 states to collect information about their health-related risk behaviors, chronic health conditions and the use of preventive services. Self-reported responses to BRFSS questionnaire were used to define study variables. Heavy alcohol consumption was defined as greater than 14 drinks (1 drink =12 ounces of beer) per week for men and 7 drinks per week for women. Logistic regression analysis was conducted to determine the association between history of coronary heart disease or angina and heavy alcohol consumption. The model was also adjusted for demographics (age, sex, and race), behaviors (exposure to tobacco smoking, physical activity, fruit consumption), other chronic conditions such as high blood pressure (ever been told having high blood pressure or not), high cholesterol (ever been told having high blood cholesterol or not) and overweight or obese. Results: Approximately 6% of study population reported history of CHD and 5% reported heavy alcohol consumption. The odds of having coronary heart disease or angina among heavy alcohol drinkers was 43% less than those who were not heavy alcohol drinkers (adjusted odds ratio: 0.57, 95% confidence interval: 0.52-0.62, pConclusion: The study findings demonstrate that heavy alcohol consumption is a protective factor for CHD morbidity. Future observational studies should be conducted to determine the overall benefits of heavy alcohol consumption as it relates to coronary heart diseases.

This thesis investigated lifestyle characteristics including cigarette smoking, alcohol consumption, dietary supplements intake, physical activity, and urinary incontinence status for Japanese patients with chronic obstructive pulmonary disease (COPD). Field studies were conducted in the middle of Japan. The study was conducted using a cross-sectional survey and all patients were recruited from the outpatient departments of six hospitals in three districts/prefectures, namely, Aichi, Gifu, and Kyoto. Three hundred referred COPD patients diagnosed by respiratory physicians were recruited in 2006. Inclusion criteria were (i) aged between 50 and 75 years; and (ii) had COPD as the primary functionally limiting illness which was diagnosed within the past four years. Diagnosis of COPD was confirmed by spirometry with FEV1/FVC < 70%, where FEV1 = forced expiratory volume in one second and FVC = forced vital capacity. A structured questionnaire was administered to collect information on lifestyle characteristics. All interviews, averaging 40 minutes, took place in the hospital outpatient departments. Clinical characteristics, height, weight and presence of any co-morbidity (e.g. diabetes, hypertension, cardiovascular disease), were retrieved from medical records. / A total of 278 eligible participants (244 men and 34 women) were available for analysis. The majority were men (88%) with mean age 66.5 (SD 6.7) years and mean body mass index (BMI) 21.9 (SD 3.6). Most of them were married (84%), had high school or below education (80%) and retired (55%). In relation to cigarette smoking, 62 (53 male and 9 female) participants (22.5%) were current smokers of whom the great majority (89%) smoked daily. Only six (2.1%) participants were never smokers. The prevalence of smoking by time from diagnosis was: 24.5% (< 1 year), 20.6% (1-2 years), and 18.9% (2-4 years). Continuous smoking was inversely associated with age (odds ratio (OR) = 0.94, 95% confidence interval (CI) 0.90-0.98), BMI (OR = 0.88, 95% CI 0.80-0.97) and disease severity vii (OR = 0.29, 95% CI 0.12-0.74 for severe COPD and OR = 0.29, 95% CI 0.09-0.92 for very severe COPD). For alcohol consumption, 158 (150 male and 8 female) patients (56.8%) drank alcohol regularly on at least a monthly basis, the majority of them (73.4%) being daily drinkers. Beer was the most preferred alcoholic beverage drank (30.9%). Alcohol intake appeared to be positively associated with the habit of adding soy sauce to foods, whereas dyspnoea of patients posed significant limitations for them to drink alcoholic beverages. / Also, female patients tended to have lower alcohol consumption levels than male patients. Regarding dietary supplements, 117 (101 male and 16 female) participants (42.1%) were dietary supplement users, but the prevalence for female patients (47.1%) was higher than male patients (41.4%). Younger patients (≤ 60 years) and those with severe COPD had relatively low proportion of users (27.3% and 28.9%, respectively). Dietary supplementation was found to be affected by age (p = 0.04), COPD severity (p = 0.03) and presence of co-morbidity (p = 0.03). Older patients over 60 years were more likely to take dietary supplements (OR = 2.44, 95% CI 1.03-5.80), whereas severe COPD patients (OR = 0.41, 95% CI 0.18-0.95) and those with a co-morbidity (OR = 0.54, 95% CI 0.32-0.94) tended not to use. With respect to physical activity of COPD patients, 198 (175 male and 23 female) of them (77%) participated in physical activities on at least weekly basis, but only 22% and 4% engaged in moderate and vigorous activities, respectively. Over 2/3 of them walked at least weekly. Regression analysis showed that perceived life-long physical activity involvement appeared to be positively associated with total physical activity, whereas patients with very severe COPD tended to have significantly lower total physical activity levels. / Besides COPD severity, both age and smoking exhibited a negative impact on walking. It is evident that walking activities decreased among very severe patients, current smokers and those in advanced age. The prevalence of urinary incontinence was 12.6% (10% for men and 32% for women). The most common occurrence of urine loss was before reaching the toilet (54%) followed by coughing/sneezing (23%). While urge incontinence was reported viii by 63% of male incontinent patients, 82% of female incontinent patients experienced stress incontinence. Incontinence was more likely among female patients (OR = 8.7, 95% CI 3.2-23.4) and older patients over 70 years (OR = 2.3, 95% CI 1.0-5.2). COPD severity was also found to be a significant factor (p = 0.007), with very severe patients at slightly higher risk of urinary incontinence (OR = 1.1, 95% CI 0.3-3.5) than mild COPD patients, though the relationship appeared not to be linear across the severity classifications. It is alarming to find mild and moderate COPD patients continue to smoke. The implementation of a co-ordinated tobacco control program immediately post diagnosis is needed for the effective pulmonary rehabilitation of COPD patients. The high alcohol consumption by COPD patients is also alarming. Alcohol control programs targeting male patients should be promoted during pulmonary rehabilitation in order to minimise the harm due to excessive drinking. Dietary supplements are popular for patients with COPD especially among older patients. / The findings are important to clinical trials and experimental interventions advocating nutritional supplementation therapy for pulmonary rehabilitation. Patients with COPD had lower physical activity levels than the general elderly population. Older patients with very severe COPD and those who currently smoke should be targeted for intervention and encouraged to increase their participation in physical activity so as to maintain their health and well being. The high prevalence yet underreporting of urinary incontinence suggested that education and regular assessment are needed after COPD diagnosis. Appropriate exercise and treatment tailored for the specific type of incontinence incurred should be incorporated within the rehabilitation program of COPD patients. To maintain a healthy lifestyle and to achieve optimal outcomes during the pulmonary rehabilitation of COPD patients, the identified factors should be taken into consideration and health awareness programs should be promoted in conjunction with respiratory physicians and allied health professionals.

Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2009.

Background The point of departure in this thesis is that unemployment is a recognised determinant of health, which may vary between different ages and among men and women. Despite governmental policies to tackle unemployment and ease its effects on health, unemployment continues to bea growing public health problem. Aim The objective of the thesis was to analyse, from a gender perspective, the relationships between ill health and unemployment as well as other unstable labour market positions in the transition from youth to adulthood. The aim of each paper was: I. Does the association between ill health and unemployment differ between young people and adults? II. Is the transition from an unstable labour market position to permanent paid job health-protective? III. Is participation in labour market programmes related to mental health? IV. What is the association between ill health among men and women and how could it be analysed with a relational theory of gender? Methods The longitudinal study was carried out in Luleå - a medium-sized industrial town in the Northern Sweden. The cohort, consisting of all 1083 pupils (506 girls and 577 boys) aged 16 who attended the last year of compulsory school in 1981, was followed up at the ages of 16, 18, 21 and 30. The response rates were high e.g. 96.4% at 14 years follow-up. The cohort was followed with extensive and well-validated questionnaires. Multivariate logistic regression was used in all papers, while propensity score matchingwas used in Paper III. Results Paper I. Health effects of long-term unemployment differed between young people and adults. Long-term unemployment was more related to psychological ill health and smoking in young people than in adults. Paper II. The results indicated that after controlling for gender as well as for an indicator of health-related selection, possible confounders and mediators transition from an unstable labour market position to permanent employment could be health-promoting. Paper III. No association was found between participation in active labour market programmes and psychological symptoms. Due to methodological shortages the results have to be interpreted with caution. Adjustment for either all background selection variables or the propensity score in multivariate logistic regression showed similar associations suggesting that propensity score could be used to adjust for background selection variables. Paper IV. A strong association between unemployment and suboptimal self-rated health among women and high alcohol consumption among men was found and a theory of structural relations was used to discuss the gendered patterns for ill health. Conclusion The thesis indicated gendered patterns of relations between unemployment and the health outcomes, in the transition from youth to adulthood. The policy implications of my thesis are that full employment policies should be promoted to reduce the health inequalities associated with unemployment. / The Northern Swedish Cohort study

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.

Magistro baigiamajame darbe analizuojama šiuolaikinė Lietuvos alkoholio kontrolės politika. Stengdamasi atskleisti ir įvertinti Lietuvos alkoholio kontrolės politikos problemas, autorė atliko viešosios nuomonės tyrimą-apklausą, mokslinės literatūros analizę bei naudojo kitus mokslinius metodus. Darbe ne tik atskleidžiamas nepakankamas alkoholio kontrolės įgyvendinimas Lietuvoje, bet ir pateikiamos rekomendacijos, kaip jį pagerinti taikant efektyvias mokslu pagrįstas bei pasaulyje naudojamas alkoholio kontrolės priemones. Lietuvos gyventojai (apklausos rezultatų duomenimis) ir alkoholio kontrolės srities ekspertai alkoholio politiką šalyje vertina vidutiniškai. Daugelis Lietuvos gyventojų bei ekspertų pritartų griežtesnei alkoholio kontrolės politikai. Vienas iš didžiausių trukdžių įrodymais grįstai alkoholio politikai vystyti – aktyvi alkoholio pramonės įtaka šalyje. / Master's thesis analyzes the contemporary Alcohol Control Policy of Lithuania. Author of the work conducted a public opinion survey-interview, used the analysis of scientific literature and other methods of research to disclose and evaluate the issues of the Lithuanian Alcohol Control Policy. The paper not only reveals the lack of implementation of alcohol control in Lithuania, but also provides guidance on how to improve it with/adapting the effective science-based and used globally alcohol control measures. Lithuanian residents (survey data) and alcohol-control experts have an average view of this policy. Many of them support the stronger alcohol control policy. One of the major constraints on evidence-based alcohol policy development – strong influence of the alcohol industry in the country.

As societies across the world are facing grim problems regarding the consumption of tobacco products and alcohol, the Governments of these societies are adapting their strategies to reduce the consumption of these harmful products. These demarketing strategies are implemented to discourage the use of these products and increase the health of consumers. These strategies include a strenuous legal limit when driving under the influence of alcohol, enforcing the placement of warning labels on both cigarette packages as well as alcoholic beverages. Also included are penalties when failing to adhere to these laws, increasing prices, limiting the availability, restricting promotion and advertising, the list goes on. It is therefore seen fit to examine the attitudes of black Generation Y students’ towards the demarketing of smoking and alcohol consumption, because of the research gap concerning black Generation Y students. The primary purpose of this research study was to conclude the attitudes towards the demarketing of smoking and alcohol consumption amongst black Generation Y students within South Africa, and more specifically the Vaal Triangle region. The target population for this study comprised black Generation Y students, aged 18 to 24. A non-probability convenience sample of 200 respondents at each of the two higher education institutions was randomly chosen to participate in this research study making the total sample size 400. A self-administered questionnaire was handed out to each of the respondents to complete. The questionnaire consisted of three sections; Section A – demographical information, Section B – tobacco questionnaire and Section C – alcohol questionnaire. It was required of the respondents to complete the three sections, indicating their agreement or disagreement towards demarketing on a five-point Likert scale. The literature review included in this study comprised marketing as an organisational philosophy and function, market segmentation, targeting and positioning, as well as demarketing. The traditional marketing mix, consumption patterns within South Africa concerning smoking and alcohol, demarketing as a form of social responsibility were also discussed. The term demarketing, the marketing mix in terms of demarketing and the Generation Y cohort were also included within the literature review. The main finding obtained from the main survey questionnaire was that black Generation Y students’ had a positive attitude towards the demarketing of smoking and alcohol consumption. The remaining findings obtained are discussed in order to enhance the understanding of the black Generation Y students’ cohort attitudes. The recommendations for this study are given to guide the successful implementation of demarketing of cigarettes and alcohol. It is concluded from the research, that black Generation Y students’ attitudes towards the demarketing of smoking and alcohol consumption is positive, and that they are in favour of persuading consumers to reduce consumption and ultimately quit the consumption of these products. Therefore, organisations and the Government should continue to implement these demarketing strategies towards smoking and alcohol, especially amongst the black Generation Y students. / Thesis (MCom (Marketing management))--North-West University, Vaal Triangle Campus, 2013

Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2009.