Descripción de parámetros glóticos basados en el modelado de los pliegues vocales para la detección de patología de la voz

Las patologías de la voz se han transformado en los últimos tiempos en una problemática social con cierto calado. La contaminación de las ciudades, hábitos como el de fumar, el uso de aparatos de aire acondicionado, etcétera, contribuyen a ello. Esto alcanza más relevancia en profesionales que utilizan su voz de manera frecuente, como, por ejemplo, locutores, cantantes, profesores o teleoperadores. Por todo ello resultan de especial interés las técnicas de ayuda al diagnóstico que son capaces de extraer conclusiones clínicas a partir de una muestra de la voz grabada con un micrófono, frente a otras invasivas que implican la exploración utilizando laringoscopios, fibroscopios o videoendoscopios, técnicas en cualquier caso mucho más molestas para los pacientes al exigir la introducción parcial del instrumental citado por la garganta, en actuaciones consideradas de tipo quirúrgico. Dentro de aquellas técnicas se ha avanzado mucho en un período de tiempo relativamente corto. En lo que se refiere al diagnóstico de patologías, hemos pasado en los últimos quince años de trabajar principalmente con parámetros extraídos de la señal de voz –tanto en el dominio del tiempo como en el de la frecuencia– y con escalas elaboradas con valoraciones subjetivas realizadas por expertos a hacerlo también con parámetros procedentes de estimaciones de la fuente glótica. La importancia de utilizar la fuente glótica reside, a grandes rasgos, en que se trata de una señal vinculada directamente al estado de la estructura laríngea del locutor y también en que está generalmente menos influida por el tracto vocal que la señal de voz. Es conocido que el tracto vocal guarda más relación con el mensaje hablado, y su presencia dificulta el proceso de detección de patología vocal. Estas estimaciones de la fuente glótica han sido obtenidas a través de técnicas de filtrado inverso desarrolladas por nuestro grupo de investigación. Hemos conseguido, además, profundizar en la naturaleza de la señal glótica: somos capaces de descomponerla y relacionarla con parámetros biomecánicos de los propios pliegues vocales, obteniendo estimaciones de elementos como la masa, la pérdida de energía o la elasticidad del cuerpo y de la cubierta del pliegue, entre otros. De las componentes de la fuente glótica surgen también los denominados parámetros biométricos, relacionados con la forma de la señal, que constituyen por sí mismos una firma biométrica del individuo. También trabajaremos con parámetros temporales, relacionados con las diferentes etapas que se observan dentro de la señal glótica durante un ciclo de fonación. Por último, consideraremos parámetros clásicos de perturbación y energía de la señal. En definitiva, contamos ahora con una considerable cantidad de parámetros glóticos que conforman una base estadística multidimensional, destinada a ser capaz de discriminar personas con voces patológicas o disfónicas de aquellas que no presentan patología en la voz o con voces sanas o normofónicas. Esta tesis doctoral se ocupa de varias cuestiones: en primer lugar, es necesario analizar cuidadosamente estos nuevos parámetros, por lo que ofreceremos una completa descripción estadística de los mismos. También estudiaremos cuestiones como la distribución de los parámetros atendiendo a criterios como el de normalidad estadística de los mismos, ocupándonos especialmente de la diferencia entre las distribuciones que presentan sujetos sanos y sujetos con patología vocal. Para todo ello emplearemos diferentes técnicas estadísticas: generación de elementos y diagramas descriptivos, pruebas de normalidad y diversos contrastes de hipótesis, tanto paramétricos como no paramétricos, que considerarán la diferencia entre los grupos de personas sanas y los grupos de personas con alguna patología relacionada con la voz. Además, nos interesa encontrar relaciones estadísticas entre los parámetros, de cara a eliminar posibles redundancias presentes en el modelo, a reducir la dimensionalidad del problema y a establecer un criterio de importancia relativa en los parámetros en cuanto a su capacidad discriminante para el criterio patológico/sano. Para ello se aplicarán técnicas estadísticas como la Correlación Lineal Bivariada y el Análisis Factorial basado en Componentes Principales. Por último, utilizaremos la conocida técnica de clasificación Análisis Discriminante, aplicada a diferentes combinaciones de parámetros y de factores, para determinar cuáles de ellas son las que ofrecen tasas de acierto más prometedoras. Para llevar a cabo la experimentación se ha utilizado una base de datos equilibrada y robusta formada por doscientos sujetos, cien de ellos pertenecientes al género femenino y los restantes cien al género masculino, con una proporción también equilibrada entre los sujetos que presentan patología vocal y aquellos que no la presentan. Una de las aplicaciones informáticas diseñada para llevar a cabo la recogida de muestras también es presentada en esta tesis. Los distintos estudios estadísticos realizados nos permitirán identificar aquellos parámetros que tienen una mayor contribución a la hora de detectar la presencia de patología vocal. Alguno de los estudios, además, nos permitirá presentar una ordenación de los parámetros en base a su importancia para realizar la detección. Por otra parte, también concluiremos que en ocasiones es conveniente realizar una reducción de la dimensionalidad de los parámetros para mejorar las tasas de detección. Por fin, las propias tasas de detección constituyen quizá la conclusión más importante del trabajo. Todos los análisis presentes en el trabajo serán realizados para cada uno de los dos géneros, de acuerdo con diversos estudios previos que demuestran que los géneros masculino y femenino deben tratarse de forma independiente debido a las diferencias orgánicas observadas entre ambos. Sin embargo, en lo referente a la detección de patología vocal contemplaremos también la posibilidad de trabajar con la base de datos unificada, comprobando que las tasas de acierto son también elevadas. Abstract Voice pathologies have become recently in a social problem that has reached a certain concern. Pollution in cities, smoking habits, air conditioning, etc. contributes to it. This problem is more relevant for professionals who use their voice frequently: speakers, singers, teachers, actors, telemarketers, etc. Therefore techniques that are capable of drawing conclusions from a sample of the recorded voice are of particular interest for the diagnosis as opposed to other invasive ones, involving exploration by laryngoscopes, fiber scopes or video endoscopes, which are techniques much less comfortable for patients. Voice quality analysis has come a long way in a relatively short period of time. In regard to the diagnosis of diseases, we have gone in the last fifteen years from working primarily with parameters extracted from the voice signal (both in time and frequency domains) and with scales drawn from subjective assessments by experts to produce more accurate evaluations with estimates derived from the glottal source. The importance of using the glottal source resides broadly in that this signal is linked to the state of the speaker's laryngeal structure. Unlike the voice signal (phonated speech) the glottal source, if conveniently reconstructed using adaptive lattices, may be less influenced by the vocal tract. As it is well known the vocal tract is related to the articulation of the spoken message and its influence complicates the process of voice pathology detection, unlike when using the reconstructed glottal source, where vocal tract influence has been almost completely removed. The estimates of the glottal source have been obtained through inverse filtering techniques developed by our research group. We have also deepened into the nature of the glottal signal, dissecting it and relating it to the biomechanical parameters of the vocal folds, obtaining several estimates of items such as mass, loss or elasticity of cover and body of the vocal fold, among others. From the components of the glottal source also arise the so-called biometric parameters, related to the shape of the signal, which are themselves a biometric signature of the individual. We will also work with temporal parameters related to the different stages that are observed in the glottal signal during a cycle of phonation. Finally, we will take into consideration classical perturbation and energy parameters. In short, we have now a considerable amount of glottal parameters in a multidimensional statistical basis, designed to be able to discriminate people with pathologic or dysphonic voices from those who do not show pathology. This thesis addresses several issues: first, a careful analysis of these new parameters is required, so we will offer a complete statistical description of them. We will also discuss issues such as distribution of the parameters, considering criteria such as their statistical normality. We will take special care in the analysis of the difference between distributions from healthy subjects and the distributions from pathological subjects. To reach these goals we will use different statistical techniques such as: generation of descriptive items and diagramas, tests for normality and hypothesis testing, both parametric and nonparametric. These latter techniques consider the difference between the groups of healthy subjects and groups of people with an illness related to voice. In addition, we are interested in finding statistical relationships between parameters. There are various reasons behind that: eliminate possible redundancies in the model, reduce the dimensionality of the problem and establish a criterion of relative importance in the parameters. The latter reason will be done in terms of discriminatory power for the criterion pathological/healthy. To this end, statistical techniques such as Bivariate Linear Correlation and Factor Analysis based on Principal Components will be applied. Finally, we will use the well-known technique of Discriminant Analysis classification applied to different combinations of parameters and factors to determine which of these combinations offers more promising success rates. To perform the experiments we have used a balanced and robust database, consisting of two hundred speakers, one hundred of them males and one hundred females. We have also used a well-balanced proportion where subjects with vocal pathology as well as subjects who don´t have a vocal pathology are equally represented. A computer application designed to carry out the collection of samples is also presented in this thesis. The different statistical analyses performed will allow us to determine which parameters contribute in a more decisive way in the detection of vocal pathology. Therefore, some of the analyses will even allow us to present a ranking of the parameters based on their importance for the detection of vocal pathology. On the other hand, we will also conclude that it is sometimes desirable to perform a dimensionality reduction in order to improve the detection rates. Finally, detection rates themselves are perhaps the most important conclusion of the work. All the analyses presented in this work have been performed for each of the two genders in agreement with previous studies showing that male and female genders should be treated independently, due to the observed functional differences between them. However, with regard to the detection of vocal pathology we will consider the possibility of working with the unified database, ensuring that the success rates obtained are also high.

Risco cardiovascular em profissionais de saúde

Enquadramento: As doenças cardiovasculares são a principal causa de morte, cuja etiologia surge da conjugação de fatores de risco, causando uma patogenia complexa. Objetivos: identificar quais os fatores de risco, em presença, nos profissionais de saúde do Centro Hospitalar Tondela-Viseu; analisar a relação das variáveis sociodemográficas (sexo e idade) com o risco cardiovascular. Métodos: Estudo quantitativo e não experimental, transversal, descritivo e correlacional. Recorreu-se ao Questionário de Nível de Risco Cardiovascular (QNRC) (Cunha & Macário, 2012). A amostragem é não probabilística por conveniência, constituída por 1000 profissionais de saúde do Centro Hospitalar Tondela-Viseu. Resultados: Amostra maioritariamente feminina (71.3%), na faixa etária dos 36-45 anos (35.8%), a exercerem em serviços médicos (40.1%), destacando-se os enfermeiros (42.7%). Quanto à presença de fatores de risco cardiovascular, 5.2% são hipertensos; 3.5% são obesos; 1.6% sofrem de doença cardíaca; 1.6% sofrem de diabetes mellitus; verificou-se a presença de história familiar de hipertensão arterial (40.6%), obesidade (7.8%), doença cardíaca (15.9%), diabetes mellitus (23.4%); 69.9% apresentavam pressão arterial normal; 37.3% relataram hábitos tabágicos; 80.7% não apresentavam situação sem riso em relação aos triglicerídeos, mas em 19.3% esse estava presente; 61.9% não revelaram risco no parâmetro colesterol total, contudo, 38.1% patenteavam; 88.8% não apresentam risco quanto ao colesterol HDL, porém, 11.2% enquadravam-se no grupo de risco face ao colesterol HDL; 64.0% não apresentam valores de colesterol LDL considerados de risco, todavia, 36.0% revelaram valores de colesterol LDL considerados de risco. Conclusão: Os resultados apontam para a realização de sessões de esclarecimento na promoção da saúde e prevenção das doenças cardiovasculares para profissionais de saúde. Palavras-chave: Fatores de Risco Cardiovascular; Profissionais de Saúde.

Ambient Air Pollution and Lung Cancer Risk in the Women's Health Initiative Observational Study

Thesis (Master's)--University of Washington, 2016-06

Evaluation of the healthy village program in Kapit district, Sarawak, Malaysia

Sarawak, Malaysia has a large population of ethnic minorities who live in longhouses in remote rural areas where poverty, non-communicable diseases, accidents and injuries, environmental hazards and communicable diseases all contribute to a lower quality of life than is possible to achieve in these regions. To address these issues and improve the quality of life for longhouse people, the Kapit Divisional Health Office implemented the World Health Organization's Healthy Village programme in 2000. An evaluation was undertaken in 2003 to determine physical and behavioural changes resulting from the programme. The main changes evaluated were those involving smoking habits, exercise habits, health screening, fire safety, environmental improvements and food preparation and hygiene. A qualitative evaluation was conducted using participant observation and key-informant interviews, focus groups and observation. Results indicate that the programme is inspiring changes in various behavioural and physical characteristics of the study population. It is clear that the Healthy Village programme is a widely accepted way of improving health outcomes in longhouses, and that it is succeeding in making beneficial health changes.

Do lutein, zeaxanthin, and macular pigment optical density differ with age or age-related maculopathy?

Background and aims Current age-related macular disease (ARMD) treatment includes antioxidant supplementation. Lutein (L) and zeaxanthin (Z) are antioxidants that make up macularpigment within the retina and may reduce the risk of developing ARMD. Ageing and smoking are leading risk factors for developing ARMD. We investigated differences in dietary, supplemental and retinal L and Z, and smoking habits in healthy younger eyes (HY), healthy older eyes (HO) and eyes with an early form of ARMD called age-related maculopathy (ARM). Methods HO, HY and ARM groups were assessed for dietary intakes of L and Z using food diaries. Smoking habits and self-administered quantities of L and Z were obtained via questionnaire. Retinal L and Z levels (macularpigmentopticaldensity, or MPOD) were determined using heterochromatic flicker photometry. Results No significant difference was demonstrated for dietary L and Z intake (?2 = 4.983, p = 0.083) or for MPOD between groups (F = 0.40, p = 0.67). There was a significant difference between the HY (mean ± sd: 1.20 ± 2.99), HO (4.51 ± 7.05) ARM groups (9.15 ± 12.28) for pack years smoked (?2 = 11.61, p = 0.03). Conclusions Our results do not support the theory that ARM develops as a result of L and Z deficiency. Higher pack years smoked may be a factor in disease development. Dietary and supplementary L and Z levels must be obtained when assessing MPOD between groups or over time.

Accelerated age-related olfactory decline among type 1 Usher patients

Usher Syndrome (USH) is a rare disease with hearing loss, retinitis pigmentosa and, sometimes, vestibular dysfunction. A phenotype heterogeneity is reported. Recent evidence indicates that USH is likely to belong to an emerging class of sensory ciliopathies. Olfaction has recently been implicated in ciliopathies, but the scarce literature about olfaction in USH show conflicting results. We aim to evaluate olfactory impairment as a possible clinical manifestation of USH. Prospective clinical study that included 65 patients with USH and 65 normal age-gender-smoking-habits pair matched subjects. A cross culturally validated version of the Sniffin' Sticks olfaction test was used. Young patients with USH have significantly better olfactory scores than healthy controls. We observe that USH type 1 have a faster ageing olfactory decrease than what happens in healthy subjects, leading to significantly lower olfactory scores in older USH1 patients. Moreover, USH type 1 patients showed significantly higher olfactory scores than USH type 2, what can help distinguishing them. Olfaction represents an attractive tool for USH type classification and pre diagnostic screening due to the low cost and non-invasive nature of the testing. Olfactory dysfunction should be considered among the spectrum of clinical manifestations of Usher syndrome.

Antioxidant and detoxify genes polymorphisms in colorectal cancer predisposition

Colorectal cancer (CRC) results from histologic and gene alterations can lead to a massive cellular proliferation. Most of the authors assume multifactorial causes to CRC genesis. Low physical activity, a fat diet poor in fibers and smoking habits seems to have an important role in CRC. However, there are also genetic causes associated with CRC risk. It has been described that oxidative stress levels could influence CRC development. Thus, cellular balance reactive species and defense enzymes involved in oxidative stress are crucial to maintain a good tissue function and avoid neoplasic process. Therefore, genome variations on these defense enzymes, such as MNSOD, SOD3, GSTP1, GSTT1 and GSTM1, could be important biomarkers to colorectal adenocarcinomas. We intend to determine frequencies distribution of most common polymorphisms involved on oxidative stress regulation (MNSOD, SOD3, GSTP1, GSTT1 and GSTM1) in patients with sporadic colorectal adenocarcinoma (SCA) and in healthy controls, evaluation their possible correlation with SCA risk. Samples common polymorphisms of antioxidant and detoxify genes (MNSOD T175C, SOD3 R213G, GSTP1 A105G, GSTP1 C114T, GSTT1del and GSTM1del) analysis was done by PCR-SSP techniques. In this study we found a higher prevalence of MNSOD 175CC (55% vs 2%; p<0.0001; OR: 58.5; CI 13.3 to 256.7), SOD3 213GG (31% vs 2%; p<0.0001; OR: 21.89; CI 4.93 to 97.29), GSTP1 105GG (46% vs 12%; p<0.0001; OR: 6.14; CI 2.85 to 13.26), GSTP1 114TT (38% vs 0%; p<0.0001; OR: Infinity) and GSTT1 null (75% vs 28%; p<0.0001; OR: 7.71; CI 3.83 to 15.56) mutated genotypes among SCA patients, while the normal genotypes were associated with SCA absence. Furthermore, we found GSTP1 114TT mutated genotype (52% vs 27%; p=0.003; OR: 2.88; CI: 1.41 to 5.89) and GSTT1 null genotype (87% vs 65%; p=0.003; OR: 3.66; CI 1.51 to 8.84) associated with colon samples. These findings suggest a positive association between most of common polymorphisms involved on oxidative stress regulation and SCA prevalence. Dysregulation of MNSOD, SOD3, GSTP1, GSTT1 and GSTM1 genes could be associated with an increase of ROS in colon and rectum tissue and p53 pathway deregulation, induced by oxidative stress on colonic and rectal cells. The present study also provides preliminary evidence that MNSOD 175C, SOD3 213G, GSTP1 105G, GSTP1 114T and GSTT1 null polymorphisms, may be involved in SCA risk and could be useful to clarify this multifactorial disorder.

Accelerated age-related olfactory decline among type 1 Usher patients

Usher Syndrome (USH) is a rare disease with hearing loss, retinitis pigmentosa and, sometimes, vestibular dysfunction. A phenotype heterogeneity is reported. Recent evidence indicates that USH is likely to belong to an emerging class of sensory ciliopathies. Olfaction has recently been implicated in ciliopathies, but the scarce literature about olfaction in USH show conflicting results. We aim to evaluate olfactory impairment as a possible clinical manifestation of USH. Prospective clinical study that included 65 patients with USH and 65 normal age-gender-smoking-habits pair matched subjects. A cross culturally validated version of the Sniffin' Sticks olfaction test was used. Young patients with USH have significantly better olfactory scores than healthy controls. We observe that USH type 1 have a faster ageing olfactory decrease than what happens in healthy subjects, leading to significantly lower olfactory scores in older USH1 patients. Moreover, USH type 1 patients showed significantly higher olfactory scores than USH type 2, what can help distinguishing them. Olfaction represents an attractive tool for USH type classification and pre diagnostic screening due to the low cost and non-invasive nature of the testing. Olfactory dysfunction should be considered among the spectrum of clinical manifestations of Usher syndrome.

The impact of indoor air quality and contaminants on respiratory health of older people living in long-term care residences in Porto

Background: persons who are 65 years or older often spend an important part of their lives indoors thus adverse indoor climate might influence their health status. Objective: to evaluate the influence of indoor air quality and contaminants on older people’s respiratory health. Design: cross-sectional study. Setting: 21 long-term care residences (LTC) in the city of Porto, Portugal. Subjects: older people living in LTC with ≥65 years old. Methods: the Portuguese version of BOLD questionnaire was administered by an interviewer to older residents able to participate (n = 143). Indoor air contaminants (IAC) were measured twice, during winter and summer in 135 areas. Mixed effects logistic regression models were used to study the association between the health questionnaire results and the monitored IAC, adjusted for age, smoking habits, gender and number of years living in the LTC. Results: cough (23%) and sputum (12%) were the major respiratory symptoms, and allergic rhinitis (18%) the main selfreported illness. Overall particulate matter up to 2.5 micrometres in size median concentration was above the reference levels both in winter and summer seasons. Peak values of particulate matter up to 10 micrometres in size (PM10), total volatile organic compounds, carbon dioxide, bacteria and fungi exceeded the reference levels. Older people exposed to PM10 above the reference levels demonstrated higher odds of allergic rhinitis (OR = 2.9, 95% CI: 1.1–7.2). Conclusion: high levels of PM10 were associated with 3-fold odds of allergic rhinitis. No association was found between indoor air chemical and biological contaminants and respiratory symptoms.

Olfactory dysfunction in young smokers J.

To establish the prevalence of olfactory dysfunction in smoking and non-smoking students of our Faculty who attend the Department of Otolaryngology (ENT) of our Hospital. Materials and method: Students (smokers and non-smokers) that do and do not suffer from olfactory dysfunction. We applied a questionnaire and a pocket smell test for screening all of the students. Results: We evaluated 207 students, between 18 and 30 years old; 50.7% (n=105) were women and 49.3% (n=102) were men. The smokers among them smoked up to 6 packs per year. One hundred twenty three students were non-smokers and 84 students were smokers. Of the 84 students who were smokers, 67 (79.7%) answered the Pocket Smell Test correctly (3/3) and 17 (20.2%) students had one or more errors. We had 123 non-smoker students and 103 (83.7%) students answered the Pocket Smell Test correctly and 20 (16.2%) answered with one or more errors. The prevalence of olfactory dysfunction in young smokers with a 95% conidence interval would be 32.8%. Conclusions: This study informed us about olfactory dysfunctions in our student population and their smoking habits. We corroborate that the Pocket Smell Test is reliable with the questionnaire; nevertheless it is a screening test. We have a population of young people who smoke one cigarette per day and who didn’t have a signiicant alteration in their ability of smell at the time of the study. This is consistent with medical literature. More studies should be conducted in order to expand this information.

Depression: a predictor of smoking relapse in a 6-month follow-up after hospitalization for acute coronary syndrome

Objective The objective of the study was to investigate whether depression is a predictor of postdischarge smoking relapse among patients hospitalized for myocardial infarction (MI) or unstable angina (ILIA), in a smoke-free hospital. Methods Current smokers with MI or UA were interviewed while hospitalized; patients classified with major depression (MD) or no humor disorder were reinterviewed 6 months post discharge to ascertain smoking status. Potential predictors of relapse (depression; stress; anxiety; heart disease risk perception; coffee and alcohol consumption; sociodemographic, clinical, and smoking habit characteristics) were compared between those with MD (n = 268) and no humor disorder (n = 135). Results Relapsers (40.4%) were more frequently and more severely depressed, had higher anxiety and lower self-efficacy scale scores, diagnosis of UA, shorter hospitalizations, started smoking younger, made fewer attempts to quit, had a consort less often, and were more frequently at the `precontemplation` stage of change. Multivariate analysis showed relapse-positive predictors to be MD [odds ratio (OR): 2.549; 95% confidence interval (CI): 1.519-4.275] (P<0.001); `precontemplation` stage of change (OR: 7.798; 95% CI: 2.442-24.898) (P<0.001); previous coronary bypass graft surgery (OR: 4.062; 95% CI: 1.356-12.169) (P=0.012); and previous anxiolytic use (OR: 2.365; 95% CI: 1.095-5.107) (P=0.028). Negative predictors were diagnosis of MI (OR: 0.575; 95% CI: 0.361-0.916) (P=0.019); duration of hospitalization (OR: 0.935; 95% CI: 0.898-0.973) (P=0.001); smoking onset age (OR: 0.952; 95% CI: 0.910-0.994) (P=0.028); number of attempts to quit smoking (OR: 0.808; 95% CI: 0.678-0.964) (P=0.018); and `action` stage of change (OR: 0.065; 95% CI: 0.008-0.532) (P= 0.010). Conclusion Depression, no motivation, shorter hospitalization, and severity of illness contributed to postdischarge resumption of smoking by patients with acute coronary syndrome, who underwent hospital-initiated smoking cessation.

Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk

Background Quitting tobacco or alcohol use has been reported to reduce the head and neck cancer risk in previous studies. However, it is unclear how many years must pass following cessation of these habits before the risk is reduced, and whether the risk ultimately declines to the level of never smokers or never drinkers. Methods We pooled individual-level data from case-control studies in the International Head and Neck Cancer Epidemiology Consortium. Data were available from 13 studies on drinking cessation (9167 cases and 12 593 controls), and from 17 studies on smoking cessation (12 040 cases and 16 884 controls). We estimated the effect of quitting smoking and drinking on the risk of head and neck cancer and its subsites, by calculating odds ratios (ORs) using logistic regression models. Results Quitting tobacco smoking for 1-4 years resulted in a head and neck cancer risk reduction [OR 0.70, confidence interval (CI) 0.61-0.81 compared with current smoking], with the risk reduction due to smoking cessation after >= 20 years (OR 0.23, CI 0.18-0.31), reaching the level of never smokers. For alcohol use, a beneficial effect on the risk of head and neck cancer was only observed after >= 20 years of quitting (OR 0.60, CI 0.40-0.89 compared with current drinking), reaching the level of never drinkers. Conclusions Our results support that cessation of tobacco smoking and cessation of alcohol drinking protect against the development of head and neck cancer.

Dietary habits, ethanol and tobacco consumption as predictive factors in the development of esophageal carcinoma in patients with head and neck neoplasms

Patients with primary head and neck cancers have a higher risk of developing esophageal cancer. The aim of this study was to investigate esophageal cancer prevalence, its risk factors (ethanol and tobacco consumption) and dietary habits in patients with head and neck cancer. Three hundred and twenty-six adults with primary head and neck cancer were followed by a retrospective observational study in a general university hospital in Sao Paulo, Brazil. Flexible videoendoscopy with lugol chromoscopy was the method used to investigate esophageal cancer prevalence. All subjects were interviewed face-to-face, revealing detailed information about their tobacco and alcohol use, as well as their dietary habits. Thirty-six patients with esophageal cancer were diagnosed and the overall prevalence rate was 11.04%. Patients who developed second esophageal tumors had the following characteristics: earlier age of initial ethanol consumption (P < 0.05), longer duration period of ethanol consumption (P < 0.05) and higher weekly consumption rate (P < 0.05). There was an increased risk of esophageal carcinoma in those patients who both smoked and drank (P < 0.05). There was no association between carcinoma of the esophagus and dietary habits in patients who developed esophageal neoplasms, compared with those who did not. Prevalence rate of esophageal neoplasms was 11.04% in patients with head and neck carcinoma, whose ethanol consumption was associated with esophageal cancer. There was an increased risk between ethanol and tobacco consumption and esophageal carcinoma development. On the other hand, there was no association regarding dietary habits between patients who developed esophageal cancer and those who did not.

Respiratory effects of tobacco smoking among young adults

Background. Respiratory symptoms associated with smoking habit seem to be age dependent. However, there are few reports about the effect of tobacco in young populations. The objective of this study was to analyze the effect of smoking on respiratory symptoms and lung function in 23- to 25-year-old adults in Brazil. This study had a cross-sectional design and included 2063 young people in the city of Ribeirao Preto, Sao Paulo State. Methods: Subjects completed a questionnaire used by the European Community Respiratory Health Survey and underwent spirometry and bronchial challenge test with methacholine. Multiple logistic regression analysis and multiple linear regression analysis were carried out to assess the association between smoking and respiratory symptoms, bronchial hyperresponsiveness, forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC), adjusted for confounding variables. Results: Prevalence of smoking habit was 17.2% with consumption (median) of 10 cigarettes per day (interquartile range 3-20). There was a significant association between smoking and respiratory symptoms. Smoking was associated to wheezing with odds ratio (95%Cl) of 6.11 (4.03-9.28) among those smoking :10 cigarettes per day and 3.36 (2.11-5.37) among those smoking <10 cigarettes per day. Associations were found for other respiratory symptoms. Smoking was associated with lower FEV1/FVC ratio. No association was detected between smoking and FEV1 or bronchial hyperresponsiveness. Conclusions: These findings highlight the early health consequences of smoking among young adults. These results prompt the necessity to elaborate urgent programs to reduce tobacco habit in young populations.