ABSTRACT
AIMS: Previously reported research suggests a dependence syndrome for areca nut use, though well-designed studies are virtually non-existent. The goal of this study was to examine evidence of areca dependence in a sample of areca-only (i.e. no tobacco) chewers using modified measurement scales. DESIGN: A purposive sample of chewers, identified via local informants and advertisements, was surveyed from January to March of 2005. SETTING: Six villages in Dakshina Kannada District, Karnataka State, India. PARTICIPANTS: Fifty-nine daily areca chewers who do not also currently use any form of tobacco. MEASUREMENTS: Questionnaires included modified versions of the Fagerström Tolerance Questionnaire, Cigarette Dependence Scale (CDS-5) and the Smokeless Tobacco Dependence Scale (STDS). Additional questions assessed demographic characteristics and patterns of use. FINDINGS: Approximately half of respondents reported 1-3 chews/day (mean = 1.9; SD = 0.98). The average number of chewing episodes/day was 4.4 (SD = 3.4) and the average number of nuts/day was 1.2 (SD = 1.1). Users' typical chew lasts up to 20 minutes and includes spitting out the juices and rinsing the mouth with water. Overall, the levels of reported dependence symptoms were quite low, but approximately 44% of chewers endorsed at least one of the following items: continued use despite illness or mouth wounds, difficulty refraining from chewing in forbidden places, or craving during periods of abstinence. Approximately 15.4% of chewers reported at least one intentional quit attempt and a subset had summary scores indicative of dependence (13.6% had scores >16 on the CDS-5 and 5.3% had scores >11 on the STDS). Dependence scores were positively correlated with frequency of chews/day. CONCLUSIONS: The symptoms of dependence observed in a subset of areca-only chewers warrant further investigation. Next steps should include well-controlled laboratory evaluation of dependence features.
Subject(s)
Areca , Behavior, Addictive/epidemiology , Health Knowledge, Attitudes, Practice , Plants, Medicinal , Substance-Related Disorders/epidemiology , Adolescent , Adult , Aged , Arecoline/pharmacology , Behavior, Addictive/psychology , Child , Female , Health Surveys , Humans , India/epidemiology , Male , Middle Aged , Substance Withdrawal Syndrome/psychology , Substance-Related Disorders/psychology , Surveys and Questionnaires , Young AdultSubject(s)
Cardiology , Developed Countries/statistics & numerical data , Developing Countries/statistics & numerical data , Health Services Research/statistics & numerical data , Developed Countries/economics , Developing Countries/economics , Health Expenditures/statistics & numerical data , Health Services Research/economics , Humans , Peer Review, Research , Periodicals as Topic , Socioeconomic FactorsABSTRACT
Chelation therapy is a widely practised mode of treatment for atherosclerotic cardiovascular diseases all over the world. However, evidence for the utility of this therapy is limited and conflicting. We did a systematic review of the literature. The reference listings of the articles, obtained from a Pubmed search using relevant keywords, were searched for additional related articles. Most of the evidence supporting the use of EDTA chelation therapy is from case reports, small series or uncontrolled, open-label clinical trials. The published randomized controlled trials include few patients and their results are of limited value. Uncontrolled studies have reported symptomatic improvements but the few controlled trials suggest that these benefits are due to a placebo effect. The available data do not support the use of chelation in cardiovascular diseases. This therapy should be used only in the context of a research trial including patients who have failed to respond to conventional treatment.
