A PRMT5-ZNF326 axis mediates innate immune activation upon replication stress.

DNA replication stress (RS) is a widespread phenomenon in carcinogenesis, causing genomic instability and extensive chromatin alterations. DNA damage leads to activation of innate immune signaling, but little is known about transcriptional regulators mediating such signaling upon RS. Using a chemical screen, we identified protein arginine methyltransferase 5 (PRMT5) as a key mediator of RS-dependent induction of interferon-stimulated genes (ISGs). This response is also associated with reactivation of endogenous retroviruses (ERVs). Using quantitative mass spectrometry, we identify proteins with PRMT5-dependent symmetric dimethylarginine (SDMA) modification induced upon RS. Among these, we show that PRMT5 targets and modulates the activity of ZNF326, a zinc finger protein essential for ISG response. Our data demonstrate a role for PRMT5-mediated SDMA in the context of RS-induced transcriptional induction, affecting physiological homeostasis and cancer therapy.

Polypharmacy and potentially inappropriate medications among hospitalized older adults with COVID-19 in Malaysian tertiary hospitals.

INTRODUCTION: Older adults are among the most vulnerable groups during the COVID-19 epidemic, contributing to a large proportion of COVID-19-related death. Medication review and reconciliation by pharmacist can help reduce the number of potentially inappropriate medications but these services were halted during COVID-19. AIM: To assess the prevalence and factors associated with inappropriate medicine use among older populations with COVID-19. METHODS: This was a cross-sectional, retrospective analysis of medications among hospitalized older adults with COVID-19. Potentially inappropriate medication use was categorized using the Beer's and STOPP criteria. RESULTS: Combining both criteria, 181 (32.7%) of the 553 patients were identified to have used at least one or more potentially inappropriate medication. A marginally higher number of inappropriate medications was documented using the Beers 2019 criteria (151 PIM in 124 patients) compared to STOPP criteria (133 PIMS in 104 patients). The long-term use of proton pump inhibitors (n = 68; 12.3%) and drugs which increases the risk of postural hypotension were the most commonly reported PIM (n = 41; 7.4%). Potentially inappropriate medication use was associated with previous history of hospital admission in the past 12 months (Odds ratio [OR]: 2.27; 95% CI 1.29-3.99) and higher number of discharge medications. CONCLUSIONS: Nearly, one in three older adults with COVID-19 had been prescribed a PIM, and the proportion of older adults with polypharmacy increased after discharge. This highlights the importance of having clinical pharmacist conducting medication reviews to identify PIMs and ensure medication appropriateness.

Effect of an intensive patient educational programme on the quality of bowel preparation for colonoscopy: a single-blind randomised controlled trial.

OBJECTIVE: Preprocedural bowel preparation is necessary for optimal colonoscopy visualisation. However, it is challenging to achieve high-quality bowel preparation among patients scheduled for colonoscopy. This study aims to evaluate the impact of an intensive patient educational programme on the quality of bowel preparation. DESIGN: An accessor-blinded randomised controlled trial was carried out at the outpatient surgical clinic of a tertiary hospital. Patients were randomly assigned to the control group (received standard written and verbal instructions) or the experimental group (received an intensive and structured educational programme). All subjects completed a questionnaire before colonoscopy to assess their compliance, acceptability, and tolerability towards bowel preparation regime. Quality of bowel preparation was determined using the Boston Bowel Preparation Scale (BBPS). RESULTS: A total of 300 subjects who fulfilled the inclusion criteria were recruited. The experimental group had a significantly higher proportion of good quality bowel preparation than the control group (98.7% vs 52.3%, p<0.001). The median total BBPS score was also significantly higher in the experimental group (8 vs 5, p<0.001). Factors associated with good quality of bowel preparation included educational programme (OR: 22.79, 95% CI: 4.23 to 122.85, p<0.001), compliance to bowel cleansing agent (OR: 24.98, 95% CI 3.12 to 199.71, p<0.001), very difficult acceptability of preparation (OR: 0.11, 95% CI 0.03 to 0.38, p<0.001), tolerability towards bowel preparation (OR: 4.98, 95% CI 1.44 to 17.20, p<0.011) and hypomotility drugs (OR: 3.03, 95% CI 0.12 to 0.91, p<0.05). CONCLUSION: An intensive patient educational programme can significantly improve the quality of bowel preparation for colonoscopy.

Raising cigarette excise tax to reduce consumption in low-and middle-income countries of the Asia-Pacific region:a simulation of the anticipated health and taxation revenues impacts.

BACKGROUND: According to the World Health Organization (WHO), 80% of the world's smokers live in low- and middle-income countries. Moreover, more than half of the world's smoking-addicted population resides in the Asia-Pacific region. The reduction of tobacco consumption has thus become one of the major social policies in the region. This study investigates the effects of price increases on cigarette consumption, tobacco tax revenues and reduction in smoking-caused mortality in 22 low-income as well as middle-income countries in the Asia-Pacific region. METHODS: Using panel data from the 1999-2015 Euromonitor International, the World Bank and the World Health Organization, we applied fixed effects regression models of panel data to estimate the elasticity of cigarette prices and to simulate the effect of price fluctuations. RESULTS: Cigarette price elasticity was the highest for countries with a per capita Gross National Income (GNI) above US$6000 (China and Malaysia), and considerably higher for other economies in the region. The administered simulation shows that with an average annual cigarette price increase of 9.51%, the average annual cigarette consumption would decrease by 3.56%, and the average annual tobacco tax revenue would increase by 16.20%. The number of averted smoking-attributable deaths (SADs) would be the highest in China, followed by Indonesia and India. In total, over 17.96 million lives could be saved by tax increases. CONCLUSION: Excise tax increases have a significant effect on the reduction of smoking prevalence and the number of averted smoking-attributable deaths. Middle- and upper-middle income countries would be most affected by high-taxation policies.

The effects of a rise in cigarette price on cigarette consumption, tobacco taxation revenues, and of smoking-related deaths in 28 EU countries-- applying threshold regression modelling.

BACKGROUND: European Union public healthcare expenditure on treating smoking and attributable diseases is estimated at over €25bn annually. The reduction of tobacco consumption has thus become one of the major social policies of the EU. This study investigates the effects of price hikes on cigarette consumption, tobacco tax revenues and smoking-caused deaths in 28 EU countries. METHODS: Employing panel data for the years 2005 to 2014 from Euromonitor International, the World Bank and the World Health Organization, we used income as a threshold variable and applied threshold regression modelling to estimate the elasticity of cigarette prices and to simulate the effect of price fluctuations. RESULTS: The results showed that there was an income threshold effect on cigarette prices in the 28 EU countries that had a gross national income (GNI) per capita lower than US$5418, with a maximum cigarette price elasticity of -1.227. The results of the simulated analysis showed that a rise of 10% in cigarette price would significantly reduce cigarette consumption as well the total death toll caused by smoking in all the observed countries, but would be most effective in Bulgaria and Romania, followed by Latvia and Poland. Additionally, an increase in the number of MPOWER tobacco control policies at the highest level of achievment would help reduce cigarette consumption. CONCLUSIONS: It is recommended that all EU countries levy higher tobacco taxes to increase cigarette prices, and thus in effect reduce cigarette consumption. The subsequent increase in tobacco tax revenues would be instrumental in covering expenditures related to tobacco prevention and control programs.

The effect of cigarette price increases on cigarette consumption, tax revenue, and smoking-related death in Africa from 1999 to 2013.

OBJECTIVES: This study investigates the effects of price hikes on cigarette consumption, tobacco tax revenues, and reduction in smoking-caused mortality in 36 African countries. METHODS: Using panel data from the 1999-2013 Euromonitor International, the World Bank and the World Health Organization, we applied fixed-effects and random-effects regression models of panel data to estimate the elasticity of cigarette prices and simulate the effect of price fluctuations. RESULTS: Cigarette price elasticity was the highest for low-income countries and considerably lower for other African economies. The administered simulation shows that with an average annual cigarette price increase of 7.38%, the average annual cigarette consumption would decrease by 3.84%, and the average annual tobacco tax revenue would increase by 19.39%. By 2050, the number of averted smoking-attributable deaths (SADs) will be the highest in South Africa, followed by the Democratic Republic of Congo, Madagascar, and Ethiopia. CONCLUSIONS: Excise tax increases have a significant effect on the reduction of smoking prevalence and the number of averted smoking-attributable deaths, Low-income countries are most affected by high taxation policies.

Factors affecting Taiwanese smokers' identification of smuggled cigarettes.

OBJECTIVES: To analyze whether the perception that smuggled cigarettes are a greater health risk than legal cigarettes affects Taiwanese smokers' intention to distinguish smuggled cigarettes from legal cigarettes. METHODS: The study used the Recursive Bivariate Probit Model to analyze data from a survey conducted in 2013 of 450 smokers of smuggled cigarettes. RESULTS: The study found that when smokers believe they are more likely to get lung cancer from consuming smuggled cigarettes than they are from consuming legal cigarettes, the probability of the intention to identify smuggled cigarettes increased by 42.46%. CONCLUSIONS: The government should strengthen educational policies and programs that teach consumers about the health risks of smoking in general and the even greater health risks of smoking smuggled cigarettes in particular.

The possible impact of an alcohol welfare surcharge on consumption of alcoholic beverages in Taiwan.

BACKGROUND: The abuse of alcoholic beverages leads to numerous negative consequences in Taiwan, as around the world. Alcohol abuse not only contributes to cardiovascular disease, hypertension, diabetes and cancer, but it is also an underlying cause of many other serious problems, such as traffic accidents, lost productivity, and domestic violence. International leaders in health policy are increasingly using taxation as an effective tool with which to lower alcohol consumption. In this study, we assessed how consumption patterns in Taiwan would be affected by levying a welfare surcharge on alcoholic beverages of 20%, 40% or 60% in accordance with the current excise tax. We also assessed the medical savings Taiwan would experience if consumption of alcoholic beverages were to decrease and how much additional revenue a welfare surcharge would generate. METHODS: We estimated the elasticity of four types of alcoholic beverages (beer, wine, whisky and brandy) using the Central Bureau of Statistics (CBS) Demand Model. Specifically, we estimated alcohol's price elasticity by analyzing the sales prices and time statistics of these products from 1974 to 2009. RESULTS: Alcoholic beverages in Taiwan have the following price elasticities: beer (-0.820), wine (-0.955), whisky (-0.587), brandy (-0.958). A welfare surcharge tax of 40% in accordance with the excise tax would decrease overall consumption of beer, wine, whisky and brandy between 16.24% and 16.42%. It would also generate New Taiwan Dollar (NT$) revenues of 5.782 billion to 5.993 billion. Savings in medical costs would range from NT$871.07 million to NT$897.46 million annually. CONCLUSIONS: A social and welfare surcharge of 40% on alcoholic beverages in Taiwan would successfully lower consumption rates, decrease medical costs, and generate revenue that could be used to educate consumers and further decrease consumption rates. Consequently, we strongly recommend that such a tax be imposed in Taiwan.

The cross-effects of cigarette and betel nut consumption in Taiwan: have tax increases made a difference?

This paper empirically identifies cross-price elasticities of betel nut and cigarette consumption in Taiwan based on the Central Bureau of Statistics demand model. It compares reduction of cigarette consumption as a result of the proposed Betel Nut Health Tax with reduction of betel nut consumption as a result of the Tobacco Health and Welfare Taxes levied in 2002 and 2006, in order to determine which tax is most effective. Results from a simulated comparative analysis indicate that the Betel Nut Health Tax reduces cigarette consumption to a much greater extent than the Tobacco Health and Welfare Taxes reduce betel nut consumption.

Price sensitivity and smoking smuggled cigarettes.

BACKGROUND: This study analysed the socio-economic factors that influence a smoker's decision to consume smuggled cigarettes when faced with the rising costs of legal cigarettes. We hope our findings will help public health authorities create policies that simultaneously discourage consumption of smuggled cigarettes and lower overall smoking levels. METHODS: We conducted a national telephone survey from April to June 2004. We then applied Multiple Logistic Regression to the collected data to answer the following questions: do socio-economically disadvantaged smokers differ significantly in their characteristics? If so, which characteristics are most influential in the decision to purchase smuggled cigarettes? RESULTS: Smokers with a personal monthly income of less than New Taiwan dollar (NT$) 10,000 are 24% more likely to smoke smuggled cigarettes than are smokers who earn NT$10,000 or more. Smokers with the least amount of education are 21% more likely to smoke smuggled cigarettes than those with higher levels of education. Smokers with the most experience purchasing smuggled cigarettes are 31% more likely to do so than those with less experience. Finally, smokers who have a personal monthly income of less than NT$10,000 and the least amount of education are 54% more likely to smoke smuggled cigarettes than those with just one--or none--of these characteristics. CONCLUSION: Low-income, poorly-educated smokers are most likely to purchase smuggled cigarettes. To alter such behaviour, government must understand the motivations and opinions of this population and create marketing messages targeted specifically to their needs.

Does perceived safety of light cigarette encourage smokers to smoke more or to inhale more deeply?

OBJECTIVES: This study investigated the effect of smoking light cigarettes and believing that light cigarettes are less of a health threat on the decision to smoke more light cigarettes or inhale more deeply in Taiwan. METHODS: Demographic and smoking characteristic data for 1,182 smokers who believe that smoking light cigarettes is relatively safe was obtained from the 2002 Survey of the Health Promotion Knowledge, Attitudes, and Behavior of Taiwan Citizens; this data was used to establish Logit models for the decision to smoke more light cigarettes or inhale more deeply. RESULTS: Respectively 5.64% and 4.76% of the light cigarette smokers were motivated to smoke more light cigarettes or inhale more deeply by their belief that light cigarettes are relatively safe. Light cigarette smokers, who believe that light cigarettes are relatively safe and who wish to quit smoking, and light smokers, are both likely to smoke more light cigarettes or inhale light cigarettes more deeply in comparison to ordinary cigarette smokers. CONCLUSIONS: Government should attempt to reverse the tendency for light smokers to smoke more under the misconception that light cigarettes are relatively safe, and correct the erroneous belief among smokers who wish to quit that smoking light cigarettes is an intermediate stage on the path to quitting.

Effect of a large increase in cigarette tax on cigarette consumption: an empirical analysis of cross-sectional survey data.

OBJECTIVES: This study used cigarette price elasticity estimates to assess the possible effects on cigarette consumption of a large increase in cigarette tax. It also investigated different responses to the cigarette tax increase among smokers from different socio-economic backgrounds and with different smoking characteristics. STUDY DESIGN: Cross-sectional study on 483 valid questionnaires completed during a telephone survey of current smokers aged 15 years and above from all 23 major cities and counties in Taiwan. METHODS: This study analysed the willingness of current smokers to quit smoking or reduce cigarette consumption when faced with a tax increase of NT$22 per pack, which would raise the price of cigarettes by 44%. The Tobit regression model and the maximum likelihood method were used to estimate cigarette demand elasticity. RESULTS: Estimation results yielded a cigarette price elasticity of -0.29 in connection with a 44% increase in the price of cigarettes. This suggests that smokers will have relatively little response to such an event. The most significant response to the price increase was found among women, low-income smokers, moderately addicted smokers, and smokers who regularly purchase low-price cigarettes. A 44% increase in the price of cigarettes would reduce the average annual per capita cigarette consumption in Taiwan by 14.86 packs; a reduction of 12.87%. The tax increase would also boost the Government's cigarette tax revenue by approximately NT$41.4 billion, and increase cigarette merchants' income by approximately NT$27.4 billion. CONCLUSIONS: Since current cigarette prices are low in Taiwan and smokers are relatively insensitive to cigarette price hikes, a large increase in cigarette tax would reduce cigarette consumption effectively, and would also increase the Government's cigarette tax revenue and cigarette merchants' income. Clearly, such a tax would create a win-win outcome for the Government, cigarette merchants and smokers, and it is therefore recommended.

The synergistic effect of cigarette taxes on the consumption of cigarettes, alcohol and betel nuts.

BACKGROUND: Consumption of cigarettes and alcoholic beverages creates serious health consequences for individuals and overwhelming financial burdens for governments around the world. In Asia, a third stimulant--betel nuts--increases this burden exponentially. For example, individuals who simultaneously smoke, chew betel nuts and drink alcohol are approximately 123 times more likely to develop oral, pharyngeal and laryngeal cancer than are those who do not. To discourage consumption of cigarettes, the government of Taiwan has imposed three taxes over the last two decades. It now wishes to lower consumption of betel nuts. To assist in this effort, our study poses two questions: 1) Will the imposition of an NT$10 Health Tax on cigarettes effectively reduce cigarette consumption? and 2) Will this cigarette tax also reduce consumption of alcoholic beverages and betel nuts? To answer these questions, we analyze the effect of the NT$10 tax on overall cigarette consumption as well as the cross price elasticities of cigarettes, betel nuts, and alcoholic beverages. METHODS: To establish the Central Bureau of Statistics demand function, we used cigarette, betel nut, and alcoholic beverage price and sales volume data for the years 1972-2002. To estimate the overall demand price elasticity of cigarettes, betel nuts, and alcoholic beverages, we used a seemingly unrelated regression analysis. RESULTS: We find that the NT$10 health tax on cigarettes will reduce cigarette consumption by a significant 27.22%. We also find that cigarettes, betel nuts, and alcoholic beverages have similar inherent price elasticities of -0.6571, -0.5871, and -0.6261 respectively. Because of this complementary relationship, the NT$10 health tax on cigarettes will reduce betel nut consumption by 20.07% and alcohol consumption by 7.5%. CONCLUSION: The assessment of a health tax on cigarettes as a smoking control policy tool yields a win-win outcome for both government and consumers because it not only reduces cigarette consumption, but it also reduces betel nut and alcoholic beverage consumption due to a synergistic relationship. Revenues generated by the tax can be used to fund city and county smoking control programs as well as to meet the health insurance system's current financial shortfall.

Economic gains and health benefits from a new cigarette tax scheme in Taiwan: a simulation using the CGE model.

BACKGROUND: This study evaluates the impact of an increase in cigarette tax in Taiwan in terms of the effects it has on the overall economy and the health benefits that it brings. METHODS: The multisector computable general equilibrium (CGE) model was used to simulate the impact of reduced cigarette consumption resulting from a new tax scheme on the entire economy gains and on health benefits. RESULTS: The results predict that because of the new tax scheme, there should be a marked reduction in cigarette consumption but a notable increase in health benefits that include saving between 28,125 and 56,250 lives. This could save NTD 1.222 approximately 2.445 billion (where USD 1 = NTD 34.6) annually in life-threatening, cigarette-related health insurance expenses which exceeds the projected decrease of NTD 1.275 billion in Gross Domestic Product (GDP) because of reduced consumption and therefore tax revenue. CONCLUSION: Overall, the increased cigarette excise tax will be beneficial in terms of both the health of the general public and the economy as a whole.

The effect of cigarette price increase on the cigarette consumption in Taiwan: evidence from the National Health Interview Surveys on cigarette consumption.

BACKGROUND: This study uses cigarette price elasticity to evaluate the effect of a new excise tax increase on cigarette consumption and to investigate responses from various types of smokers. METHODS: Our sample consisted of current smokers between 17 and 69 years old interviewed during an annual face-to-face survey conducted by Taiwan National Health Research Institutes between 2000 to 2003. We used Ordinary Least Squares (OLS) procedure to estimate double logarithmic function of cigarette demand and cigarette price elasticity. RESULTS: In 2002, after Taiwan had enacted the new tax scheme, cigarette price elasticity in Taiwan was found to be -0.5274. The new tax scheme brought about an average annual 13.27 packs/person (10.5%) reduction in cigarette consumption. Using the cigarette price elasticity estimate from -0.309 in 2003, we calculated that if the Health and Welfare Tax were increased by another NT 3 dollars per pack and cigarette producers shifted this increase to the consumers, cigarette consumption would be reduced by 2.47 packs/person (2.2%). The value of the estimated cigarette price elasticity is smaller than one, meaning that the tax will not only reduce cigarette consumption but it will also generate additional tax revenues. Male smokers who had no income or who smoked light cigarettes were found to be more responsive to changes in cigarette price. CONCLUSIONS: An additional tax added to the cost of cigarettes would bring about a reduction in cigarette consumption and increased tax revenues. It would also help reduce incidents smoking-related illnesses. The additional tax revenues generated by the tax increase could be used to offset the current financial deficiency of Taiwan's National Health Insurance program and provide better public services.