Smoking is even more damaging to the heart than previously thought

Reports and Proceedings

EUROPEAN SOCIETY OF CARDIOLOGY

Barcelona, Spain – 25 Aug 2022: Smokers have weaker hearts than non-smokers, according to research presented at ESC Congress 2022.1 The study found that the more people smoked, the worse their heart function became. Some function was restored when people kicked the habit.

“It is well known that smoking causes blocked arteries, leading to coronary heart disease and stroke,” said study author Dr. Eva Holt of Herlev and Gentofte Hospital, Copenhagen, Denmark. “Our study shows that smoking also leads to thicker, weaker hearts. It means that smokers have a smaller volume of blood in the left heart chamber and less power to pump it out to the rest of the body. The more you smoke, the worse your heart function becomes. The heart can recuperate to some degree with smoking cessation, so it is never too late to quit.”

According to the World Health Organization, tobacco kills more than eight million people each year.2 Cigarette smoking is responsible for 50% of all avoidable deaths in smokers, with half of these due to atherosclerotic cardiovascular diseases such as heart attack and stroke.3 The detrimental effects of smoking on the arteries and arterial diseases such as heart attack and stroke are well established.4

Studies have also shown that smoking is associated with a higher risk of heart failure, where the heart muscle does not pump blood around the body as well as it should, usually because it is too weak or stiff. This means that the body does not receive the oxygen and nutrients it needs to work normally. The link between smoking and heart structure and function has not been fully examined. This study therefore explored whether smoking was related to changes in the structure and function of the heart in people without cardiovascular disease, and the effect of changing smoking habits.

The study used data from the 5th Copenhagen City Heart Study which investigated cardiovascular risk factors and diseases in the general population. A total of 3,874 participants aged 20 to 99 years without heart disease were enrolled. A self-administered questionnaire was used to obtain information on smoking history and to estimate pack-years, which is the number of cigarettes smoked through life. One pack-year is defined as 20 cigarettes smoked every day for one year.

Participants had an ultrasound of the heart, called echocardiography, which provides information about its structure and how well it is working. The researchers compared the echocardiography measures of current smokers versus never smokers after adjusting for age, sex, body mass index, hypertension, high cholesterol, diabetes and lung function.

The average age of participants was 56 years and 43% were women. Nearly one in five participants were current smokers (18.6%), while 40.9% were former smokers and 40.5% had never smoked. Compared to never smokers, current smokers had thicker, weaker and heavier hearts. Increasing pack-years were associated with pumping less blood. Dr. Holt explained: “We found that current smoking and accumulated pack-years were associated with worsening of the structure and function of the left heart chamber – the most important part of the heart. Furthermore, we found that over a 10-year period, those who continued smoking developed thicker, heavier and weaker hearts that were less able to pump blood compared to never smokers and those who quit during that time.”

She concluded: “Our study indicates that smoking not only damages the blood vessels but also directly harms the heart. The good news is that some of the damage is reversible by giving up.”

 

ENDS

 

Notes to editors

Email: press@escardio.org

The hashtag for ESC Congress 2022 is #ESCCongress.

Follow us on Twitter @ESCardioNews 

Funding: The Copenhagen City Heart Study is funded by The Danish Heart Foundation and The Metropolitan Region of Denmark.

 

Disclosures: Tor Biering-Sørensen reports: Steering Committee member of the Amgen financed GALACTIC-HF trial. Chief investigator and steering committee chair of the Sanofi Pasteur financed “NUDGE- FLU” trial. Chief investigator and steering committee chair of the Sanofi Pasteur financed “DANFLU-1” trial. Chief investigator and steering committee chair of the Sanofi Pasteur financed “DANFLU-2” trial. Steering Committee member of “LUX-Dx TRENDS Evaluates Diagnostics Sensors in Heart Failure Patients Receiving Boston Scientific's Investigational ICM System” trial. Advisory Board: Sanofi Pasteur, Amgen and GSK. Speaker Honorarium: Novartis, Sanofi Pasteur and GSK. Research grants: GE Healthcare and Sanofi Pasteur. The remaining authors have nothing to disclose.

 

References and notes

1The abstract “The effects of smoking on cardiac structure and function in a general population” will be presented during the session Risk stratification with echocardiographic parameters on Friday 26 August at 10:15 to 11:00 CEST at Station 1.

2World Health Organization tobacco fact sheet: https://www.who.int/news-room/fact-sheets/detail/tobacco.

3Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42:3227–3337.

4Centers for Disease Control and Prevention smoking and cardiovascular disease fact sheet: https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_smoking_CVD_508.pdf.

 

About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2022

It is the world’s largest gathering of cardiovascular professionals, disseminating ground-breaking science both onsite in Barcelona and online – from 26 to 29 August. Explore the scientific programme. More information is available from the ESC Press Office at press@escardio.org.

Public call for tougher restrictions on buying tobacco in Britain

Peer-Reviewed Publication

UNIVERSITY COLLEGE LONDON

People in Britain strongly support restricting the sale of tobacco near schools and raising the legal age of sale to 21, finds a new UCL-led study.

In collaboration with The University of Edinburgh and Cardiff University, the research, published in Tobacco Control, examined data from the Cancer Research UK and SPECTRUM*-funded Smoking Toolkit Study, which has surveyed approximately 1,700 adults each month from England since 2006, and 2,200 adults each month from England, Scotland and Wales, since 2020.

The researchers examined data from September 2021, which asked participants about their views on potential policies targeting the availability of tobacco and cigarettes.

The results indicated that most of those surveyed supported retailers having their license revoked if they sold tobacco products to those under-age (89.6%) and for restrictions on the sale of cigarettes and tobacco near schools (69.9%).

Meanwhile, half (49.2%) thought that the legal age of sale for cigarettes and tobacco should be raised to 21, compared with just under a third who were opposed to the idea (30.7%).

Participants were also in favour of reducing the number of retailers selling tobacco in neighbourhoods that already had a high density of tobacco retailers – with almost half (46.5%) showing their support, compared with less than a quarter (23.3%) who disagreed.

Lead author Dr Loren Kock (UCL Institute of Epidemiology & Health) said: “Our findings indicate that policies to restrict tobacco retail near schools, and for tobacco retailer licences would receive strong majority support from the British public if legislated.

“Raising the age of sale to 21 and reducing the number of tobacco retailers also received greater support than opposition.

“However, a substantial proportion of respondents report having no opinion either way on these policies, suggesting there is potential to grow public support through clearer communication on the evidence and benefits of these policies.

“Moreover, support for tobacco availability policy may grow, and opposition diminish, if policies are demonstrated to be effective, and as future generations grow up without cigarettes.”

There are around 6.9million adult cigarette smokers in the UK, who spend approximately £15.6billion a year on legal and illicit tobacco.

Currently the law prohibits the sale of tobacco products to those under the age of 18. And previous studies have shown that a ban on the sale of tobacco products near schools could stop children from taking up the habit.

In 2019, the UK Government set an objective for England to be smokefree by 2030, meaning only 5% of the population would smoke by then. However, a recent report by Dr Javed Khan OBE, highlighted that particularly poorer areas may struggle to reach this target unless the rate of decline of people who smoke is accelerated by 40% **.

Niamh Shortt, Personal Chair of Health Geographies, School of GeoSciences, University of Edinburgh, said: “Across the UK nations targets have been set to radically reduce the proportion of people that smoke over the next decade.

“This new research shows that the public strongly support the introduction of new measures needed to meet these ambitious targets, including reducing the local availability of tobacco products.

“Having wide scale public support to introduce restrictions on the sales of tobacco should embolden the UK and devolved governments to introduce new policies restricting access to tobacco, particularly amongst children, and ensure future generations are tobacco free.”

Study limitations

The use of cross-sectional observational data and potentially unmeasured covariates limits the ability to infer causality between included variables (namely sociodemographic and smoking and quitting characteristics) and support for policies. The sample sizes for the sub-group analyses in Scotland and Wales analyses may also be underpowered.

Data on support for tobacco availability were collected during one survey wave, and if further data were collected the results may change.

* SPECTRUM is a UK Prevention Research Partnership (UKPRP) consortium.

** https://www.gov.uk/government/publications/the-khan-review-making-smoking-obsolete/making-smoking-obsolete-summary

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JOURNAL

Tobacco Control

DOI

10.1136/tc-2022-057508 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Assessing the profile of support for potential tobacco control policies targeting availability in Great Britain: a cross-sectional population survey

ARTICLE PUBLICATION DATE

26-Aug-2022

Sales professionals know how to look after their customers – Everything can be talked about

Peer-Reviewed Publication

UNIVERSITY OF EASTERN FINLAND

Ensuring long-term and productive customer relationships is very important for the continuity of business. Interestingly, customer relationships are always forged between people, even in the context of doing business. Especially in relationship selling, where the aim is to maintain productive and long-term customer relationships, it is extremely important to understand how customer relationships develop between people. So far, earlier studies have not been able to explain why and by which mechanism some customer relationships deepen, while others don’t.

Published in European Journal of Marketing, a study conducted by the University of Eastern Finland researchers explores long-term business-to-business (B2B) customer relationships, and how and to what end such relationships are forged in B2B sales. Applying the social penetration theory, the researchers were particularly interested in how self-disclosure, and weighing the benefits and disadvantages of the customer relationship, either deepened the relationship or didn’t. For the study, the researchers interviewed 47 professionals working in B2B sales.

 

From being business partners to being collaborative and personal partners

The study showed that long-term and productive customer relationships develop in three phases: first, business partners became collaborative partners and, ultimately, collaborative and personal partners. Sales professionals and customers disclosed things about their personal life and about their company. Both of these domains of self-disclosure deepened as the customer relationship deepened: the things disclosed initially were rather superficial, but became deeper as the relationship deepened, and included topics such as divorce, bankruptcy, personal values, and future business plans.

Some sales professionals, however, felt that they did not wish to share anything about their personal life with the customer. This could have been due to a lack of trust, a desire to maintain strict personal boundaries, or the fact that the customer did not come off as the type of person they’d want to socialise with outside work.
 

Deepest customer relationships increased trust and commitment to common goals

The benefits of a customer relationship in its deepest level were manifold compared to the initial phase. Trust grew deeper, communication became effortless, it was easier to decide and commit to common goals, and to manage conflicts. Sales professionals felt that they had gained benefits in the form of time savings, cost benefits, increased self-confidence, and more efficient work.

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JOURNAL

European Journal of Marketing

DOI

10.1108/EJM-07-2020-0492 

ARTICLE TITLE

Development of long-term B2B customer relationships: the role of self-disclosure and relational cost/benefit evaluation

New study demonstrates clinical and financial impact of patient exposure to ill healthcare worker in long-term care facility

Peer-Reviewed Publication

ASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL

Arlington, Va., August 25, 2022 – A study conducted by researchers in Japan shows that the presence of one ill healthcare worker in a long-term care facility led to respiratory infections among 17 patients and more than $12,000 in total medical costs. Findings from the study, published today in the American Journal of Infection Control (AJIC), suggest that addressing the causative factors for such exposures is critical to help prevent infectious disease outbreaks in similar facilities.

“To our knowledge, this is the first study that used statistical analysis to confirm the source of a respiratory infection in a long-term care ward for patients with severe motor and intellectual disabilities, as well as the first to calculate the corresponding medical costs,” said Naoki Takayama, MSN, RN, of the National Hospital Organization Tenryuu Hospital in Japan, and a study author. “It sheds light on the significant clinical and financial implications of healthcare workers coming to work while ill, a phenomenon known as presenteeism that is detrimental and challenging for many healthcare facilities.”

Respiratory tract infections account for more than 40% of deaths among patients with severe motor and intellectual disabilities (SMID). While many SMID facilities, including the one involved in the current study, follow standard employee health-surveillance protocols to prevent such infections, consistent adherence to these protocols can be difficult. Additionally, multiple issues may contribute to employees’ presenteeism, including concerns about lost income, lack of days off, burdening colleagues, and maintaining professionalism.

In the current study, researchers sought to identify the source and resulting costs of respiratory infections among 18 individuals (one healthcare worker and 17 patients) in the 55-bed SMID ward of a single public hospital in Japan. All individuals in the study cohort had a fever of 99.5o F or higher with respiratory symptoms such as cough and nasal discharge. Researchers first conducted an outbreak investigation, which identified a healthcare worker as the single, initial cause of the outbreak. Researchers confirmed the healthcare worker as the outbreak cause through univariate statistical analysis (odds ratio, 17.5; 95% CI, 3.0-101.8). In this case, the worker was a part-time employee with 10 years of experience who came to work despite having a cough, nasal discharge, sore throat, and headache. She completed a health screening checklist upon arrival for her shift and practiced standard precautionary measures such as wearing a surgical mask.

While the healthcare worker and all 17 patients recovered from their infections, the median time to recovery was 10 days. Based on medical records for all 17 individuals, researchers determined that the total cost for additional treatment and laboratory tests associated with the respiratory infections was $12,324.

“The findings from this study suggest that identifying and eliminating the factors that contribute to employee presenteeism should be a priority for healthcare facilities and providers to better protect their patients and employees from infectious illness,” said Linda Dickey, RN, MPH, CIC, FAPIC, 2022 APIC president.

About APIC

Founded in 1972, the Association for Professionals in Infection Control and Epidemiology (APIC) is the leading association for infection preventionists and epidemiologists. With more than 15,000 members, APIC advances the science and practice of infection prevention and control. APIC carries out its mission through research, advocacy, and patient safety; education, credentialing, and certification; and fostering development of the infection prevention and control workforce of the future. Together with our members and partners, we are working toward a safer world through the prevention of infection. Join us and learn more at apic.org.

About AJIC

As the official peer-reviewed journal of APIC, The American Journal of Infection Control (AJIC) is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. Published by Elsevier, AJIC also publishes infection control guidelines from APIC and the CDC. AJIC is included in Index Medicus and CINAHL. Visit AJIC at ajicjournal.org.

NOTES FOR EDITORS

“Healthcare workers’ presenteeism causing an outbreak of respiratory infections in a facility for patients with severe motor and intellectual disabilities,” by Naoki Takayama, MSN, RN; Haruyo Sakaki, PhD; Masahiro Shirai, PhD, MD; Atsushi Toyoda, MD; Hiroko Takayanagi, RN; Kazuya Takagi, RN; Kaoru Fujita, MD; Eiko Endo, PhD, RN, was published online in AJIC on August 25, 2022. The article may be found online at: https://doi.org/10.1016/j.ajic.2022.07.016

 

AUTHORS

Naoki Takayama, MSN, RN (corresponding author: takayama.naoki.vw@mail.hosp.go.jp)

National Hospital Organization Tenryuu Hospital, Hamamatsu city, Shizuoka prefecture, Japan

 

Haruyo Sakaki, PhD, RN

International University of Health and Welfare Graduate School, Tokyo, Japan

 

Masahiro Shirai, PhD, MD

National Hospital Organization Tenryuu Hospital, Hamamatsu city, Shizuoka prefecture, Japan

 

Atsushi Toyoda, MD

National Hospital Organization Tenryuu Hospital, Hamamatsu city, Shizuoka prefecture, Japan

 

Hiroko Takayanagi, RN

National Hospital Organization Tenryuu Hospital, Hamamatsu city, Shizuoka prefecture, Japan

 

Kazuya Takagi, RN

National Hospital Organization Tenryuu Hospital, Hamamatsu city, Shizuoka prefecture, Japan

 

Kaoru Fujita, MD

National Hospital Organization Tenryuu Hospital, Hamamatsu city, Shizuoka prefecture, Japan

 

Eiko Endo, PhD, RN

International University of Health and Welfare Graduate School, Tokyo, Japan

 

# # #

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JOURNAL

American Journal of Infection Control

DOI

10.1016/j.ajic.2022.07.016 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Healthcare workers’ presenteeism causing an outbreak of respiratory infections in a facility for patients with severe motor and intellectual disabilities

ARTICLE PUBLICATION DATE

25-Aug-2022

QUIT MAKING THC GUMMI BEARS

Hospitalizations for unintentional cannabis poisonings among Canadian children surged after legalization, particularly in jurisdictions where the sale of cannabis edibles was allowed

Unique Canadian study published in New England Journal of Medicine

Reports and Proceedings

THE OTTAWA HOSPITAL

 

IMAGE: CHANGES IN HOSPITALIZATIONS DUE TO CANNABIS POISONING IN CHILDREN AGED 0-9 YEARS BETWEEN 2015 AND 2021. view more 

CREDIT: DR. DANIEL MYRAN

Canada has seen a 6.3 fold increase in hospitalizations for unintentional cannabis poisoning among children under the age of 10 since the legalization of recreational cannabis, according to a research letter published in the New England Journal of Medicine.

The study found that hospitalizations for paediatric cannabis poisonings increased substantially across the country. Notably, provinces that permitted the sale of cannabis edibles such as gummies, chocolates and baked goods saw an increase in hospitalizations that was more than two times higher than the province that prohibited the sale of edibles (7.5 times vs. 3.0 times, respectively, from the pre-legalization rate).

“A growing number of countries are moving towards legalizing non-medical or recreational cannabis. As this happens, it’s critical to understand that there are many ways to legalize cannabis and not all are equivalent,” said Dr. Daniel Myran, lead author and family physician, public health and preventive medicine specialist and postdoctoral fellow at the University of Ottawa Department of Family Medicine and The Ottawa Hospital. "Our findings suggest that prohibiting the sale of edible cannabis products like candies, desserts and baked goods is a key policy for preventing large increases in cannabis poisonings in young children after legalization.”

These findings are the result of a unique scenario caused by the staggered roll out of cannabis products in Canada and differences in policy approaches to legalization between provinces.

In October 2018, dried cannabis flower was legalized across Canada, but the sale of cannabis edibles such as gummies, chocolates and baked goods was initially prohibited. Starting in January 2020, Ontario, British Columbia and Alberta (Canada’s first, third and fourth most populous province) allowed the sale of cannabis edibles. In contrast, Quebec (Canada’s second most populous province) prohibited the sale of such edibles largely due to their potential appeal to children.

Using health records which contained the cause of all hospitalizations in each province, the researchers identified paediatric hospitalizations due to cannabis poisoning. During the seven-year study period (January 2015 to September 2021), there were a total of 581 hospitalizations in young children for cannabis poisoning. The average age of these children was 3.5 years.

Prior to legalization, the number of unintentional paediatric hospitalizations for cannabis poisoning per 100,000 children was the same in all provinces. Immediately after legalization, when only the sale of dried cannabis flower was allowed, hospitalization rates in all provinces increased 2.6 times compared to pre-legalization.

During the period when edibles were permitted in Ontario, British Columbia and Alberta, hospitalization rates in those provinces increased a further 2.9 times compared to the initial period following legalization, but remained unchanged in Quebec, where edibles were prohibited.

“By comparing otherwise similar regions that took different approaches to legalizing cannabis edibles, we can isolate the impact of allowing cannabis edibles on poisoning in children,” said Dr. Yaron Finkelstein, senior author and emergency physician, clinical pharmacologist and toxicologist, and senior scientist at The Hospital for Sick Children (SickKids) and professor at University of Toronto. “Cannabis intoxication can have significant effects on young children, such as behavioural changes, seizures, impairment of coordination balance and breathing, and even coma. As different cannabis formulations are legalized across the country, it is important for everyone, including parents and caregivers, to be aware of the potential harms to children and ensure cannabis products are safely stored within the home, out of children’s reach.”

The increases in cannabis hospitalizations occurred despite regulations aimed at preventing such poisonings, including THC limits 10 times lower than allowed in some US regions.

“It’s important to note that the provinces that permitted edibles still had strict rules including plain and child-resistant packaging, a maximum of 10mg of THC per package, and consumer education campaigns,” said Dr. Myran. “Our findings suggest that countries that allow the sale of legal edibles as part of their approach to legalization, regardless of other regulations, could encounter large increases in poisoning events, some severe, in young children.”

Cannabis poisoning in babies, children and youth is a medical emergency. Contact poison control if your child has consumed cannabis, and 9-1-1 if your child is ill, is unconscious or has difficulty breathing. Caregivers can reduce the risk of poisonings by keeping cannabis products in a locked container away from other food and drinks, and out of children’s reach. Learn more about the risks of cannabis and how to prevent unintentional poisoning.

Funding: This study was funded by the Canadian Centre on Substance Use and Addiction

Full Reference: Edible Cannabis Legalization and Unintentional Poisoning in Children. Daniel T Myran, Peter Tanuseputro, Nathalie Auger, Lauren Konikoff, Robert Talarico, Yaron Finkelstein. NEJM. Aug 24, 2022.

Spokespeople and media contacts:

• For interviews with Dr. Myran or French spokesperson Dr. Nathalie Auger, contact Jenn Ganton (jganton@ohri.ca; 613-614-5253) between August 19 and August 21 or Rebecca Abelson (rabelson@toh.ca) between August 22 and August 26.

• For interviews with Dr. Yaron Finkelstein, contact Sarah Warr (sarah.warr@sickkids.ca).

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JOURNAL

New England Journal of Medicine

DOI

10.1056/NEJMc2207661 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Edible Cannabis Legalization and Unintentional Poisonings in Children

ARTICLE PUBLICATION DATE

25-Aug-2022

Legalizing recreational cannabis in the U.S. has increased frequency of use by 20%

Peer-Reviewed Publication

SOCIETY FOR THE STUDY OF ADDICTION

A new study published in the scientific journal Addiction has found that the legalization of recreational cannabis in U.S. states appears to have caused a 20% average increase in cannabis use frequency in those states.

The study evaluated the effects of recreational cannabis legalization in a large sample of adult identical twins.  Of particular interest were the 111 identical twin pairs in which one twin lived in a state with a different recreational cannabis policy to the other.  Twins provide extremely well-matched controls for each other and permit more precise estimation of the causal impact of recreational legalization than studies of unrelated individuals.

Looking at all of the study participants (1,425 individuals living in states with legal recreational cannabis use and 1,997 living in states in which recreational cannabis use is illegal), the study found a ~24% increase in mean cannabis use frequency attributable to legalization.  Looking just at the identical twins living in states with different policies, the twin living in a ‘legal’ state used cannabis ~20% more frequently than their cotwin living in an ‘illegal’ state.  These findings suggest that recreational legalization caused an increase in cannabis use.

Cannabis is the most commonly used federally illegal drug in the United States.  It is also an addictive substance associated with negative health and psychosocial outcomes.  Before 2014, cannabis could not be legally bought or sold for recreational purposes anywhere in the U.S. By early 2022, over 141 million Americans lived in a state with recreationally legal cannabis. 

-- Ends –

For editors:

This paper is free to read for one month after publication from the Wiley Online Library: https://onlinelibrary.wiley.com/doi/10.1111/add.16016 or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org.

To speak with lead author Stephanie Zellers please contact her at the University of Minnesota by email (zelle063@umn.edu).

Full citation for article: Zellers SM, Ross JM, Saunders GRB, Ellingson JM, Anderson JE, Corley RP, Iacono W, Hewitt CJ, McGue MK, and Vrieze S (2022) Impacts of Recreational Cannabis Legalization on Cannabis Use: A Longitudinal Discordant Twin Study. Addiction: doi: 10.1111/add.16016

Funding: This work was supported by National Institute on Drug Abuse, National Institute of Mental Health, and National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under awards numbers R01DA042755, U01DA046413, R37DA005147, R01DA013240, R01DA036216, R01DA037904, K24DA032555, R01DA035804, P60DA011015, R01DA012845, R01DA038065, R01AA023974, R37AA009367, and R01MH066140.  The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health

Declaration of interests:  The authors declare they have no competing interests.

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884.

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JOURNAL

Addiction

DOI

10.1111/add.16016 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Impacts of Recreational Cannabis Legalization on Cannabis Use: A Longitudinal Discordant Twin Study

ARTICLE PUBLICATION DATE

25-Aug-2022

COI STATEMENT

The authors declare they have no competing interests.

Cannabis legalization boosts use by double-digits

A first-of-its kind study of twins finds those who live in states where marijuana is legal use it 24% more

Peer-Reviewed Publication

UNIVERSITY OF COLORADO AT BOULDER

Residents of states where cannabis has been legalized use marijuana 24% more frequently than those living in states where it remains illegal, according to new research published today in the journal Addiction.

The study of more than 3,400 adult twins, by researchers at University of Minnesota and University of Colorado, constitutes some of the strongest evidence yet that legalization causes increased use.

It comes at a time when cannabis use is rising nationwide, including during adulthood—a phase of life when individuals have historically tended to cut back.

“Across America, there is a trend toward using more marijuana but we found that the change is bigger in states where it is legal,” said lead author Stephanie Zellers, a recent University of Minnesota graduate who began the research while a PhD student at CU Boulder’s Institute for Behavioral Genetics (IBG).

For the study, Zellers and co-authors at CU Boulder, CU Anschutz Medical Campus and University of Minnesota analyzed data from two large longitudinal twin studies, which have tracked twins since childhood in both states: one housed at IBG and another at the Minnesota Center for Twin Family Research.

Participants were asked how frequently they used cannabis before and after 2014 when Colorado became one of the first states to commence legal sales of recreational marijuana. Recreational cannabis remains illegal in Minnesota. Before 2014, there was little difference in use between states, the study found. After 2014, across all participants, residents of states where recreational use of marijuana was legalized used cannabis 24% more frequently than those in illegal states.

When specifically comparing identical twins in which one now lives in a state where marijuana is legal and the other lives in a state where it is illegal, those living in the state with legal marijuana used cannabis 20% more frequently, the researchers found.

Because twins share their genes and tend to share socioeconomic status, parental influences and community norms, they provide well-matched controls for each other, enabling researchers to minimize alternative explanations for results and get at what causes what.

“This is the first study to confirm that the association between legal cannabis and increased use holds within families in genetically identical individuals,” said co-author John Hewitt, a professor in the Department of Psychology and Neuroscience and faculty fellow at IBG. “This makes it much more likely that legalization does, in itself, result in increased use.”

More than 141 million Americans now live in a state with recreationally legal cannabis and, according to the National Institute on Drug Abuse, use among young adults age 19 to 30 is at an all-time high, with 43% reporting use in the past year and 29% in the last month.

“Typically, what we would expect to see is that people tend to increase use as adolescents and then reduce it as they transition into adult roles, family life and stable jobs,” said Zellers. “Interestingly, we saw escalation, not reduction, in adults.”

The authors note that it is unlikely that legalization would cause those who abstained from marijuana before to pick up the habit.

And preliminary results from their broader ongoing research project suggest increased use may not necessarily be a bad thing.

“In other analyses, we are finding that this increased use is not accompanied by increased problems, may be associated with less alcohol-related problems, and otherwise does not, in general, seem to have adverse consequences,” said Hewitt.

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JOURNAL

Addiction

DOI

10.1111/add.16016 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Impacts of recreational cannabis legalization on cannabis use: a longitudinal discordant twin study

ARTICLE PUBLICATION DATE

24-Aug-2022

Health at home: Requests for home care skyrocketed during COVID-19

Researchers from the University of Tsukuba find changes in access to home care during the COVID-19 pandemic

Peer-Reviewed Publication

UNIVERSITY OF TSUKUBA

Tsukuba, Japan—Health care systems have been dramatically affected by the COVID-19 pandemic, with hospitals and aged care homes receiving the lion's share of the media's attention around the world. But now, researchers from Japan have characterized specific changes in access to home care during this period.

In a study recently published in BMC Research Notes, researchers from the University of Tsukuba have revealed that the proportion of individuals requesting home care changed dramatically as a consequence of the COVID-19 pandemic.

Home care, in which health care professionals provide treatment at a patient's residence, is generally sought as an alternative to hospitals and outpatient facilities. Home care is very resource intensive, as medical professionals are required to travel to the patient and to bring necessary supplies. At present, little is known about how access to home care changed during the COVID-19 pandemic, which the researchers at Osaka University aimed to address.

"Home care is an important element of multifaceted community health care services," says lead author of the study Professor Jun Hamano. "The changes in access to home care during the COVID-19 pandemic could reveal important information regarding the way that pandemics influence health care infrastructure."

To examine this, the researchers conducted a multicenter cross-sectional web-based anonymous survey of directors of home care facilities in Japan. The participants provided responses to a questionnaire, which was administered in August 2021.

"The results indicated that the number of home visits was much higher compared with before the COVID-19 pandemic," explains senior Professor Hamano. "Further, the number of patients who died at home increased substantially."

The results did not vary according to the number of doctors in a given area or whether the care home was in an urban or rural location.

"Our findings indicate that the restrictions on access to inpatient facilities instated during the COVID-19 pandemic led more individuals to seek treatment at home. As such, health professionals who conducted home visits were likely to have experienced an increased workload, and thus to need more support and cooperation with community health structures," says Professor Hamano.

Home care is a critical community health care service. Understanding the ways in which access to home care changes during global health emergencies, such as the COVID-19 pandemic, may help public health authorities to plan for future situations in terms of the structure of the home care system, support needed for home care staff, and the relationship between the home care and hospital systems.

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This work was supported by JSPS KAKENHI Grant Number 19K10551, and a research grant of the Mitsubishi Foundation (201930027). The funder had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of data; the preparation, review, and approval of the manuscript; or the decision to submit the manuscript for publication.

Original Paper

The article, "Changes in home visit utilization during the COVID-19 pandemic: a multicenter cross-sectional web-based survey" was published in BMC Research Notes at DOI: 10.1186/s13104-022-06128-7

Correspondence

Assistant Professor HAMANO Jun
Faculty of Medicine, University of Tsukuba

Related Link

Faculty of Medicine

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DOI

10.1186/s13104-022-06128-7 

ARTICLE TITLE

Changes in home visit utilization during the COVID-19 pandemic: a multicenter cross-sectional web-based survey

Pretreating soil with ethanol protects plants from drought

Peer-Reviewed Publication

RIKEN

 

IMAGE: AFTER TWO WEEKS WITHOUT WATER, WHEAT DID NOT SURVIVE WHEN SOIL WAS PRETREATED WITH WATER (LEFT), BUT THRIVED WHEN THE SOIL WAS PRETREATED WITH 3% ETHANOL (RIGHT). THE SAME WAS TRUE FOR RICE AND THE MODEL PLANT ARABIDOPSIS. view more 

CREDIT: RIKEN

Ethanol can help plants survive in times of drought says a new study conducted at the RIKEN Center for Sustainable Resource Science in Japan. Led by Motoaki Seki, researchers show that adding ethanol to soil allows plants, including rice and wheat, to thrive after two weeks without any water. As ethanol is safe, cheap, and widely available, this finding offers a practical way to increase food production all over the world when water is scarce, without the need for costly, time-consuming, and sometimes controversial production of genetically modified plants. The study was published August 25 in Plant and Cell Physiology.

The foreseeable future includes a steadily rising population and climate change-induced increases in water shortages, two conditions that will inevitably lead to food shortages unless action is taken. One option is to find a way to prevent plants from dying when they don’t have access to water. Genetically modifying plants so that their stomata—the pores in their leaves—stay closed, has been somewhat effective because it prevents water from leaving the plants. However, making genetically modified plants is expensive and time consuming, and countries with the greatest need might not have equal access to these modified crops.

Seki and his team have been working on another approach. Knowing that plants produce ethanol when deprived of water, they reasoned that giving it to plants would protect them from future drought. To test this hypothesis, they grew plants for about two weeks with ample water. Then, they pretreated soil with ethanol for three days, followed by water deprivation for two weeks. About 75% of ethanol-treated wheat and rice plants survived after rewatering, while less than 5% of the untreated plants survived.

Having shown that ethanol can protect these two important crops from drought, they next set out to explain why by focusing on the model plant Arabidopsis. First, they looked at the leaves. They found that soon after ethanol-treated Arabidopsis plants were deprived of water, their stomata closed and leaf temperature went up. By 11 and 12 days of water deprivation, these plants had retained more water in their leaves than the untreated plants.

Then, the researchers analyzed gene expression before and during water deprivation and radio-tagged the ethanol before pretreatment. This allowed them to see what processes were activated during drought and what happened to the ethanol after it was taken up by the plant roots. Even before water was deprived, the ethanol-treated plants began to express genes that are normally expressed during water deprivation. Additionally, around the same time that water content was dropping in untreated leaves, the ethanol-treated plants were making sugars from the ethanol and doing photosynthesis.

Seki says that treating the soil with ethanol mitigates drought on several fronts. First, drought-related genes are expressed even before water is missing, giving the plants a head start in preparation. Then, the stomata close, allowing leaves to retain more water. At the same time, some of the ethanol is used to make a variety of sugars, which provide much needed energy that is normally difficult to get with closed stomata.

“We find that treating common crops such as wheat and rice with exogenous ethanol can increase crop production during drought. As in Arabidopsis, this is likely via changes in the metabolomic and transcriptomic profiles that regulate the drought-stress response,” says Seki. “This offers us a cheap and easy way to increase crop yield even when water is limited, without the need for genetic modification.”

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JOURNAL

Plant and Cell Physiology

DOI

10.1093/pcp/pcac114 

Mandated headgear may lower concussion risk among high school lacrosse players

Rate lower in Florida with mandate meeting professional standard than in states without. Headgear may now be worth considering for high schools and other levels of play

Peer-Reviewed Publication

BMJ

Mandated headgear meeting professional standards may lower the risk of concussion among high school girls playing lacrosse, suggests research published online in the British Journal of Sports Medicine.

The concussion rate was lower in the US state where protective headgear is mandatory for high school lacrosse players than in states without such a mandate. 

It may now be worth considering protective headgear for high school players and possibly for other levels of play, such as youth or collegiate level teams, suggest the researchers.

Girls’ lacrosse continues to be the fastest growing high school sport in the USA. Until the pandemic, participation had grown by nearly 54% over the past decade,note the researchers.

While a non-contact sport, incidental concussions and head impacts are common during lacrosse. Because of the non-contact rules for girls’ lacrosse, mandated protective equipment is limited to mouthguards and eyewear. 

In response to growing concerns about the level of incidental contact in the game, the use of soft-shell headgear meeting the ASTM International F3137 performance standard has been permitted since January 2017.

But the use of headgear in lacrosse is the subject of heated debate, with detractors arguing that it prompts more aggressive ‘compensatory’ behaviours during play, contributing to increased injury risk.

To explore the issues further, the researchers compared concussion rates among high school girls’ lacrosse players in the state of Florida, where headgear was mandated in 2018, with 31 states without a headgear mandate for the 2019, 2020, and 2021 seasons.

The researchers drew on concussion injury and risk of injury (exposure) data entered into an existing national high school injury registry by athletic trainers: the High School National Athletic Treatment, Injury and Outcomes Network (NATION). 

Concussions were defined as injuries that occurred as a result of participation in a girls’ high school lacrosse game or practice and diagnosed by an athletic trainer, doctor, or other healthcare professional.

To count, a single athlete had to have actively taken part in one high school-sanctioned practice or game, regardless of duration, in which she was exposed to the risk of injury.

Over a total of 289 school seasons (mandated 96; 193 without a mandate) between 2019 and 2021, 141 concussions (25 mandated; 116 without a mandate) were reported across all games and practices during more than 357, 225 exposures (91,074 mandated; 266,151 without a mandate), resulting in an overall rate of 0.39 concussions/1000 athlete exposures. 

Overall, the concussion injury rate per 1000 athlete exposures was higher among the group without a mandate (0.44) than in the group with a mandate (0.27). 

The concussion rate was higher during match play than during practice for both groups, but significantly (74%) higher during matches among players without mandated headgear.

The researchers acknowledge that not all high schools have athletic training services available or access to NATION monitoring, so this may limit the generalisability of their findings to schools without such services, which are more likely to be in more deprived areas.

And they emphasise: “The results of this study are highly encouraging for athlete safety in high school girls’ lacrosse; however, a measure of caution should be employed given that this study did not employ randomisation or comparisons of injury rates pre and post mandate within the state of Florida.”

Nevertheless, they write: “Our findings provide evidence that mandated use of lacrosse headgear reduces the incidence of concussion in high school girls’ lacrosse game play. We observed that girls participating in states not mandating lacrosse headgear had a 59% greater overall incidence of concussion than those required to wear headgear. 

“Moreover, a 74% greater incidence of concussion was observed during game play in states not mandating headgear.”

And they suggest: “It is possible that protective headgear may have similar effects in different populations of girls’ lacrosse. These may include athletes at the collegiate level or higher, athletes at the developmental, or youth levels or athletes of the same age who are participating in club lacrosse.”

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JOURNAL

British Journal of Sports Medicine

DOI

10.1136/bjsports-2021-105031 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Association of headgear mandate and concussion injury rates in girls’ high school lacrosse

ARTICLE PUBLICATION DATE

24-Aug-2022