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Oral submucous fibrosis (OSMF) is a premalignant condition caused by betel chewing. OSMF is a premalignant condition that can lead to oral cancer. A risk that is further increased by concomitant tobacco consumption. OSMF is a diagnosis based on clinical symptoms and confirmation by histopathology. Major constituents of betel quid are arecoline from betel nuts and copper, which are responsible for fibroblast dysfunction and fibrotic band formation. Drug therapy include antifibrotic, anti-inflammatory, and antioxidants, homemade remedies including turmeric and tulsi . Prevention is most important in case of OSMF , because severe cases of OSMF are irreversible.

This report discusses a case of a 75-year-old female patient with metachronous multicentric carcinomas in the oral cavity at 4 different sites. In this patient, there were no generally associated characteristics, such as drinking alcohol, chewing betel quid or smoking cigarettes. However, her elder sister died due to oral carcinoma. Although well-known risk factors for oral carcinoma were not detected, a previous family history was found. These findings suggest the potential for an unknown genetic anomaly associated with oral carcinoma. This is the first report to describe a female patient with oral multicentric carcinoma arising from four different sites.

William J. Niblock (WJN), an Assistant Surgeon at the Madras General Hospital (MGH), published a paper 'Cancer in India' (2 pages of text and 3 pages of tables) in the Indian Medical Gazette in 1902. He appears to have been a popular surgeon in Madras who surgically treated mouth cancers, testicular filariasis, and calcareous stones in the liver, gall bladder, and kidney. His 'Cancer in India' article is a compilation of numerical data of different cancers recorded in MGH from 1892 to 1901 mostly, and from 1896 to 1901 occasionally. In this article, WJN refers to cancers of different internal organs and external parts. He attributes the mouth cancers to constant chewing of 'betel' (the betel quid), which he explains as giving rise to leukoplakia, forerunner of buccal carcinoma. He supplies many, easily comparable, paired tables. These tables are made of raw numbers about the diverse human populations living in Madras, such as the Indians (Hindus and Muslims), Europeans, and Eurasians (Anglo-Indians) extracted from the 10-year records of MGH. None of the tables has been analyzed statistically. Nevertheless, he supplies the total numbers of admissions into MGH, which serve usefully as denominators in this study; occasionally, he presents data as percentages. Despite the lack of parametric statistical analysis, WJN's article, written in 1902, impresses as a useful contribution, because it provides a cross-sectional view of cancer incidence in Madras, particularly in defiance of Saldanha's supposition that cancers do not manifest in dark-skinned people, such as Indians.

Objective: Betel quid dependency (BQD) is characterized by functional and structural brain alterations. Trait impulsivity may influence substance dependence by impacting its neurobiological underpinnings in the frontostriatal circuit. However, little is known about the trait impulsivity and its neural correlates in individuals with BQD. Methods: Forty-eight participants with BQD and 22 normal controls (NCs) were recruited and scanned on a 3T MRI scanner. Barratt impulsiveness scale (BIS) was used to measure trait impulsivity: motor, attention, and no plan impulsivity. We used voxel-based morphometry (VBM) to assess the relationship between trait impulsivity and gray matter volumes. The relevant clusters identified were served as regions of interest (ROI) seeds. The whole-volume psycho-physiological interactions (PPI) analysis was used to investigate the changes of functional connectivity related to ROI seeds in the cue-reactivity task condition (BQ and control images). Results: Behaviorally, the BQD group showed significantly higher trait impulsivity including motor and no plan impulsivity than the NCs group. VBM analyses showed that motor impulsivity was negatively associated with gray matter volume of right caudate in the whole sample. No difference in gray matter volume between the two groups was observed. PPI analyses showed that there was a significantly decreased functional connectivity between the right caudate and right dorsolateral prefrontal cortex (DLPFC) when watching BQ related images than control images in individuals with BQD. Furthermore, functional connectivity between the right caudate and right DLPFC was negatively correlated with BQ dependency scores. Conclusions: Our study demonstrated the structural basis of trait impulsivity in the caudate and provided evidence for abnormal interactions within frontostriatal circuitsin individuals with BQD, which may provide insight into the selection of potential novel therapeutic targets for the treatment of BQ dependency.

Background Findings from brain structural imaging studies on betel quid dependence have supported relations between betel quid chewing and alterations in gray matter volume and white matter integrity. However, the effect of betel quid chewing on cortical thickness and the link between cortical thickness and symptom severity remains unascertained. Methods In this observational study, we compared cortical thickness measures from 24 male betel quid-dependent chewers with 27 male healthy controls. Using FreeSufer, we obtained three-dimensional T1-weighted images that were used to compute the thickness of the cerebral cortex throughout the cortical layer. Results Compared to healthy controls, betel quid dependent chewers displayed significant decreased cortical thickness in the precuneus, entorhinal, right paracentral, middle temporal, and caudal middle frontal gyri. Betel quid dependence scale scores negatively correlated (r = -0.604; p = 0.002) with reduced cortical thickness in the right caudal middle frontal of betel quid-dependent chewers. Conclusion The findings provide evidence for cortical thickness abnormality in betel dependent chewers and further propose that the severity of betel quid symptoms may be a critical aspect associated with the cortical alterations. The observed alterations may serve as potential mechanisms to explain why BQ chewing behavior is persistent among individuals with betel quid dependence.

Background: Betel quid chewing is a deep-rooted practice in India and neighboring countries, which has migrated to other parts of the world. Betel leaf acts as a carrier for areca nut and most ofte...

Background: Areca nut (AN) and betel quid (BQ) are classified as Group 1 carcinogens. There are approximately 600 million AN/BQ users globally; the majority of users live in the Asia-Pacific region which, correspondingly, has the highest rates of oral cancer. Despite significant disease burden associated with AN/BQ use, there have been no systematic reviews of interventions to reduce product use. Objectives: To analyze interventions that prevent use of AN/BQ, present a basis for a future systematic review on the topic, and provide decision makers with examples of strategies that have demonstrated reduced AN/BQ use. Methods: To identify publications, we searched the literature using terms for AN/BQ and related synonyms in three databases: PubMed, Embase, and Scopus. Interventions that prevent AN/BQ use, that are published in English and that provide original data analysis, were included in this review. Interventions focused primarily on disease outcomes e.g. oral cancers (secondary prevention) were excluded. Results: Our search revealed 21 interventions targeting AN/BQ use between 1990 and 2018. Strategies include product bans, media campaigns, education, cessation, and taxation at individual and population levels, with varying evidence of impact. While these studies yielded some novel and promising findings, particularly regarding the impact of product bans, mass media campaigns, and cessation interventions, research on interventions specific to AN/BQ use remains limited. Conclusions: We have assessed published interventions that reduce AN/BQ use and identified future research priorities. These findings can be used to develop evidence-based interventions and help guide policymakers in implementing evidence-based policy to regulate these products.

Background: The high prevalence of betel quid chewing is associated with a serious burden of oral diseases. However, there is limitertd research on the effects of betel quid, smoking, and alcohol o...

Background: Chewing of betel quid, popularly known as doma khamdo, is prevalent in Bhutan and is associated with Bhutanese customs and traditions. The objective of this paper was to determine the prevalence and explore the correlates of current betel quid use in Bhutan. Materials and methods: This is a retrospective study of secondary data from the National Health Survey 2012 (NHS 2012) of Bhutan. The outcome variable of interest was current betel quid use. The self-reported demographic characteristics were obtained using a questionnaire developed following the WHO STEPwise approach to the surveillance of non-communicable diseases (STEP). Univariate and multivariate logistic regression were performed to identify correlates for betel quid use. Results: The prevalence of current betel quid use in this study was 45.0%. The correlates associated with current betel quid use were: being female; having a primary, high school or a monastic education; being professionals in the armed forces, managers, technicians, service and sales workers, and machine operators; being current smokers; alcohol consumption; and intake of drugs. Correlates associated with decreased betel quid use were: having a diploma/certificate-level and non-formal education, and living in urban areas. Conclusion: The findings indicate that betel quid was consumed by nearly half of the Bhutanese population. Bhutan should immediately initiate national prevention programs targeting these correlates of betel quid use.

Areca or betel nut, the fruit of a type of palm, Areca catechu, contains a number of psychoactive alkaloids, which have stimulating effects on the autonomic nervous system (Chu, 2001). As a result,...

Background: Areca nut (AN) and betel quid (BQ) chewing are ancient practices followed by an extensive proportion of the world's population. These practices are endemic in larger parts of South and Southeast Asia and selected Western Pacific countries. The prevalence of these habits varies across regions, age, gender, cultural practice, and socioeconomic status groups. Considerable variations exist between countries with respect to prevention/intervention programs, and policy guidelines of BQ usage. Objectives: (1) To provide an overview of the BQ chewing prevalence, practices, preventive interventions and policies in selected Asian and Western Pacific countries. (2) To explore the different terminologies associated with BQ use. Method: A narrative review of the current literature related to BQ, AN, and oral cancer was conducted by searching PUBMED, CINAHL, and GOOGLE databases. Results: The literature review revealed that the prevalence of BQ was found to be highest in Papua New Guinea, followed by Bangladesh, India, Pakistan, Myanmar and Sri Lanka. While, Cambodia, Malaysia, Indonesia and Taiwan had comparatively lower prevalence. Smokeless tobacco, BQ with tobacco, BQ without tobacco, AN were some of the terminologies used for BQ in various studies. Conclusions: The prevalence, and the interventional policies related to BQ and AN chewing habits varies widely among the selected countries. With the increasing awareness and association of BQ with oral cancer, there is a need to have better awareness, prevention and interventional strategies in place. We also found considerable variation in the use of terminologies associated with BQ.

Objective To explore the correlations between the habit of betel quid and areca nut (BQ-AN) chewing and the prognosis of oral cancer (OC). Methods We performed a systematic review and meta-analysis to clarify this issue. Data searches were performed using PubMed, Web of Science, Epistemonikos, and Embase databases through November 2019. The primary outcome was the difference in the prognosis of OC between BQ-AN chewers and non-chewers, measured in terms of 5-year overall survival (OS) and 5-year disease-specific survival (DSS) log (HR) reported in articles. The pooled HR with 95% CI of 5-year OS and 5-year DSS was calculated using a fixed-effects model. Results Ten articles with eleven OS or DSS survival studies (one of the articles contained two studies), which were published between 2003 and 2017, were eligible for inclusion in the present study. All the 11 studies were observational studies, among which 10 were retrospective and 1 was prospective. One study measured both OS and DSS. Eight studies, with a total of 2,761 patients, used 5-year OS as the primary endpoint and four studies, with a total of 2,551 patients, used 5-year DSS. Overall, the pooled HR evaluating BQ-AN chewers was 1.26 (95% CI: 1.09-1.46) for 5-year OS and 1.40 (95% CI: 1.15-1.70) for 5-year DSS, compared with non-chewers. There was a significant association between BQ-AN chewing and OC survival. Conclusions Betel quid and areca nut chewing is significantly associated with poor prognosis in patients with OC.

Betel quid is the fourth most popular psychoactive agent worldwide. Imaging studies have found altered brain structure in prefrontal cortex (PFC) in betel-quid dependent (BQD) chewers. However, the brain function in PFC associated with BQ use still remains unclear. The present study aimed to examine brain functional activity in PFC in individuals with BQD. This study recruited 48 participants with BQD and 22 normal controls (NCs). Both BQ-specific cue reactivity and Go/NoGo tasks were administered with functional magnetic resonance imaging (fMRI). Behavioral results showed a deficit in the choice reaction time task in BQD group. The fMRI results of the cue reactivity task suggested that, individuals with BQD exhibited responses in right ventromedial PFC, left posterior cingulate cortex (PCC), left lateral parietal lobe (LPL), left middle temporal gyrus and left visual cortex, when seeing BQ images compared with control images. In the Go/NoGo task, relative to NCs group, individuals with BQD showed higher activity in right dorsolateral PFC, right PCC and bilateral LPL between NoGo and Go trials. Across these two tasks, we consistently found disrupted function in PFC in individuals with BQD, which might lead to impaired craving and response inhibition in BQ addiction. Results of current study might shed light on the neural mechanisms involved in BQ use, which could be used as potential guidelines for diagnosis and treatment of BQ dependence.

Oral submucous fibrosis (OSF) is an oral mucous disease caused by betel quid chewing. It is controversial whether OSF can transform into oral squamous cell carcinoma (OSCC). In this prospective study, a group of 567 patients with OSF were enrolled from 1986 to 2017 and followed-up until 2019. The cancerous information was collected and analyzed. OSF transformed into OSCC in 32 cases (32/567, 5.6%). The patient’s age ranged from 20 to 69 years, and the average age was 52 years. The time taken for transformation ranged from 2 to 24 years, the average being 8.6 years. The cancerous transformation occurred in 18 patients (56%) from years 2 to 9, in 13 patients (41%) from years 10–19 and in 1 patient (3%) from 24 years. We analyzed the betel quid chewing habits and found all 32 patients with OSCC-chewed betel quid. Betel quid chewing was most prevalent in patients aged 40–69 years. Sixteen patients had chewed betel quid for 10–19 years (16/32, 50%) and 19 patients (60%) chewed 10–19 slices each day. The OSCC was located in the left or right buccal regions in 23 patients (23/32; 72%) and in the left or right lingual regions in 4 patients (4/32; 12%). Well, moderately and poorly differentiated squamous cell carcinoma was present in 23 patients (23/32; 72%), 4 patients (3/32; 9%), and 5 patients (5/32; 16%), respectively. Our findings supported that OSF is a real oral premalignant disorder. The long duration of the transformation from the OSF to OSCC suggests more frequent examinations and corresponding treatments are necessary for OSF patients.

Background: Areca nut (AN) is the seed endosperm of the Areca catechu L. palm and a Group 1 carcinogen chewed by 10–20% of the world population. AN is often chewed with Piper betle L. leaf, slaked lime, and tobacco to form a betel quid (BQ). The negative health effects associated with AN/BQ consumption warrant the need for an evidence-based cessation program. However, systematic research on AN/BQ cessation is rare. Methods/design: The Betel Nut Intervention Trial (BENIT; trial #NCT02942745) is a randomized controlled trial designed to test the efficacy of an intensive AN/BQ cessation program. The trial is ongoing in Guam and Saipan with adult chewers who include tobacco in their BQ. Enrolled participants are assessed for their primary (chewing status) and secondary (saliva bio-verification) outcome at baseline, 22 days, and 6 months. Participants randomized into the control arm receive an educational booklet while those randomized into the intervention arm receive the educational booklet and a 22-day cessation program modeled after a smoking cessation program and led by trained facilitators. Information on chewing behavior (history, reasons for chewing, and AN/BQ composition and dependency) are collected. The intervention effectiveness is assessed using the logistic mixed model to compare cessation status between randomization groups. Discussion: AN/BQ chewing affects a large population of people, many of whom live in low and moderate income countries in the Asia-Pacific region. Although the BENIT focuses on chewers in Guam and Saipan, it has the potential for greater regional and global importance. Keywords: Areca nut, Betel quid, BENIT, Cessation, Guam, Saipan

BackgroundBetel quid (BQ) chewing is a common habit and a means of social interaction among the northeastern peoples of Bangladesh. Though this habit integrating in their daily life without knowing its toxic effect. Areca nut, which is one of the main components of BQ and may responsible for this addiction. Here, we assess to see how BQ chewing habit influence hyperglycemia among diabetic patients with respect to their lifestyle.MethodologyRandom blood sugar (RBS) test was evaluated from a total of 961 diabetic patients. Behavioral data associated with their daily lifestyle were collected from August 2018 to February 2019 from Sylhet Diabetic Hospital, Bangladesh. Student’s t-test, ANOVA and Fisher’s exact test were used to assess the RBS status between BQ chewer and non-chewer patients.ResultsHigher RBS was found in BQ chewer patients than non-chewer (mean ± SEM, 263.3 ± 4.768 vs. 251.0 ± 5.915mg/dl). Interestingly, it is significantly higher in raw areca nut user than dry nut (mean ± SEM, 278.0 ± 8.790 vs. 252.1 ± 6.835 mg/dl) only from BQ chewer group, suggesting that the habit of chewing raw nut may contribute to more hyperglycemic effect among diabetic patients. BQ habit enhances higher RBS level among smoker, non-smoker and patient’s having walking habit. In addition, BQ habit significantly influence to have high RBS in patients with family history with diabetes. Lack of awareness being diabetes have also been observed significantly in BQ chewer patients, while a higher level of RBS was seen in BQ group, who work in different sectors with sitting activities.ConclusionsDiabetic patients who chew betel quid are more prone to keep higher hyperglycemic. Utmost attention should be taken to discourage the use of BQ for proper management of diabetes control.

Squamous cell carcinoma is the most common oral malignancy. Betel quid, betel quid with tobacco, smoking, alcohol consumption, mechanical irritation, genetic are the most important risk factors for Oral Squamous Cell Carcinoma (OSCC). The aim of the study was to determine the role of habitual risk factors inOral Squamous Cell Carcinoma. Materials and Methods: This is a cross-sectional study for the determination of the risk factors of OSCC over 2 years period of January 2011 to December 2012. Department of Oral & Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Department of Oral & Maxillofacial Surgery, Dhaka Dental College Hospital, Dhaka,National Institute of Cancer Research & Hospital (NICRH), Mohakhali, Dhaka and Health and Hope Hospital, Dhaka from January 2011 to December 2012 Results:250 patients, comprising 44% male and 56% female were included in the study. Overall mean age was 55.94±10.93 years. The patients of OSCChavemost common habit of betel quid with tobacco 124(49.6%), then betel quid with tobacco and smoking 49(19.6%), betel quid with tobacco and Gul 19(7.6%), only smoking 13(5.2%), Betel quid without tobacco and smoking 13(5.2%), betel quid without tobacco 12(5.2%), betel quid with tobacco and catechu (Khoir) 4(1.6%), betel quid with tobac- co, smoking and gul 3(1.2%), betel quid without tobacco,smoking and alcohol 2(0.8%), betel quid without tobacco and gul 2(0.8%), betel quid without tobacco, smoking and gul 1(0.4%), betel nut chewing 1(0.4%), mechanical irritation but no habit 5(2.0%) and no habitual history 2(0.8%). Conclusion: According to this study betel quid, betel quid with tobacco, gul, smoking are the important risk factors in OSCC.Update Dent. Coll. j: 2018; 8 (1): 29-35

Wound can be occured during dental treatment. In outline, there are several phases of wound healing; inflammatory phase, proliferative phase, and maturation phase. Various drugs in various forms are used to accelerate the healing process, but mostly they have side effects. Therefore, traditional medicine, such as betel quid consisted of betel leaf, areca nut, gambier, and calcium hydroxide, is developed. The aim of this study was to investigate the effect of wound healing process in male Wistar rats. A total of 30 male Wistar rats were taken and divided into 5 groups: Group 1, 2, and 3 (K1,K2, K3) were given 5%, 10% and 15% concentrations of betel quid extract oinments; Group 4 (K4) was positive control (hyaluronic acid 0.2% oinment); Group 5 (K5) was negative control (placebo oinment). One mm- diameter of lower lip mucosal wounds on rats were created by using cylinder diamond bur. The oinments were applied twice daily for 10 days. The number of netrophils on first and third day were measured and the thickness of ephitelium on 10 days were determined. All groups of betel quid extracts exhibited the reduction of the number of neutrophils on inflammatory phase. Group 3 shown as the highest effect and had no significant different with positive control. Betel quid extracts in all groups also improved epithelial thickness on proliferative phase, in which group II and group III had no significant different with positive control. Betel quid extract had effect on wound healing process in male Wistar rats due to its ability in supressing inflamation and in increasing reepithelization.

Background: Betel quid chewing has been a major risk factor for oral cancer (OC) in southern China. This study aimed to analyze the scientific publications on the relationship between betel quid chewing and OC and construct a model to quantitatively and qualitatively evaluate pertinent publications from 1998 to 2017. Methods: The publications from 1998 to 2017 were retrieved from the Web of Science Core Collection database. Microsoft Excel, Thomson Data Analyzer, VOSviewer, and CiteSpace software were used to analyze the publication outcomes, journals, countries/regions, institutions, authors, research areas, and research frontiers. Results: A total of 788 publications on the relationship between betel quid chewing and OC published until October 25, 2017, were identified. The top 4 related journals were Journal of Oral Pathology Medicine, Oral Oncology, Plos One, and International Journal of Cancer. The top five countries engaged in related research included China, India, the United States, the United Kingdom, and Malaysia. The corresponding disciplines, such as oncology, oral surgery, pathology, environmental and occupational health, and toxicology, were mainly concentrated in three disciplines. The subject terms squamous cell carcinoma, OC, betel quid, expression, oral submucous fibrosis, India, and p53 ranked first among research hotspots. The burst terms squamous cell carcinoma, OC, betel quid, and expression ranked first in research frontiers. Conclusions: Research in this area emphasized hotspots such as squamous cell carcinoma, OC, oral submucosal fibrosis, betel quid, and tobacco. The annual number of publications steadily decreased from 1998 to 2017, with a lack of a systematic study from interdisciplinary perspectives, inadequate pertinent journals, limited regions with the practice of betel quid chewing, and insufficient participation of researchers, which indicate that as the prevalence of OC increases, particularly in China, research in this area warrants further expansion. Key words: Betel Quid; Bibliometric; CiteSpace; Oral Cancer; VOSviewer

This paper focus on chewing betel quid habit that dominantly happen in the Asia to Pacific region. Betel quid leaves traces of reddish-brown colour on the teeth. It was identified that dental stain was very common on teeth of prehistoric skeletal remains, for example in Thailand and Vietnam. Several studies have shown that chewing betel nut can cause diseases in the teeth and oral cavity. The purpose of this study is to describe the relationship between betel nut chewing and the emergence of tooth pathology in teeth from the prehistoric population from Lewoleba and Liang Bua. Ten individuals were observed using the macroscopic method. The results showed that consumption of betel nut (based on dental stains) was followed by attrition, periodontitis and even antemortem tooth loss.

The World Health Organization regards betel quid (BQ) as a human carcinogen. The current study analyzes whether the BQ cues can elicit activity in the chewers' craving-related brain areas. We adopted a cue-reactivity paradigm to examine the changes in the brain activities. The urge intensity was also included to examine whether it can moderate the brain areas stimulated by BQ cues. Sixteen male BQ chewers and 16 healthy male controls were recruited and analyzed. Four types of cues were adopted: BQ cues, matched food cues, visual control cues, and resting crosshair cued. The most direct and important comparison was between the brain activities elicited by the BQ cues versus those by the food cues. Furthermore, to test the current urge intensity effect, we compared BQ chewers with a strong urge versus those with a weak urge. All of the three-dimension anatomical and multi-slice task-based functional images were acquired using 3 T MRI. We found that (1) the BQ chewers and the healthy controls had similar brain activation patterns when comparing any two cue types, (2) the high-urge (not the low-urge) chewers showed craving-related activations (e.g., anterior cingulate cortex, medial orbitofrontal gyrus, and superior frontal gyrus) in the critical BQ cues vs. the food cue comparisons. (3) The high-urge chewers had larger contrast activations (BQ - Food) in many craving-related brain areas than low-urge chewers did (e.g., frontal gyrus). The urge states endorsed by the chewers can moderate the neural responses to BQ cues. Multisensory cues should be considered to elicit more intense and consistent cravings.

Background: Indigenous tribes are at higher risk of substance misuse, including betel quid. Available studies in this area focused on health hazards, while socio-behavioural aspects of betel quid practices are less studied, especially among the tribal population in India. Objectives: The study was conducted to explore the factors influencing betel quid use among indigenous tribes in Wayanad, Kerala Methods: Using a purposive sampling method, we selected 12 persons with betel quid use form Paniya and Kattunaicker tribal community at Wayanad. Qualitative in-depth interviews were used for data collection. The thematic analysis was done to understand the key themes and categories. Results: We identified that betel quid chewing among tribes often initiated in young age, with influence of the home environment, parental, peer and spouse related factors. Key themes that emerged were the trajectory of betel quid use, betel quid intake, dependency, access and availability of betel quid in tribal dominant areas. Conclusion: As our study result indicated many features of betel quid dependency, community level screening for identifying the potential cases and provision of treatment services might be required. Future studies to assess proper intervention for betel quid chewing can be undertaken.

Yao Yao,1,* Xianghui Chen,2,* Shengzheng Wu,2 Liang Guo,3 Hao Zhang,4 Qiao Zhu,5 Jie Tang,3 Fuxin Luan,5 Yali Zhao,5 Faqin Lv,2 Yao He1 1Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Department of Ultrasonography, Hainan Branch of PLA General Hospital, Sanya, People’s Republic of China; 3Department of Ultrasonography, Chinese PLA General Hospital, Beijing, People’s Republic of China; 4Department of Health Policy and Management, Texas A&M University, College Station, TX, USA; 5Central Laboratory, Hainan Branch of Chinese PLA General Hospital, Sanya, People’s Republic of China *These authors contributed equally to this work Background: Thyroid nodules (TNs) are common thyroid lesions in older population. Few studies have focused on the prevalence of TNs and their relationship to lifestyle characteristics and dietary habits in centenarians. The current study aimed at determining the prevalence of TNs in Chinese centenarians by using high-resolution ultrasound (US) equipment and at investigating its relationship to lifestyle characteristics and dietary habits.Participants and methods: The current study was part of the China Hainan Centenarian Cohort Study that was conducted in Hainan, an iodine-sufficient region in People’s Republic of China. A total of 874 permanent residents aged ≥100 years (mean age =102.8±2.8 years) without any missing data were included in the analysis.Results: Among the participants, 649 of them were detected at least one TN under the US examinations. The overall prevalence rate of TNs was 74.3%. The prevalence of TNs was higher in participants who were women, had hypertension, had diabetes, and were underweight compared with their counterparts. Multivariate logistic regression analyses showed that being female, hypertensive, and diabetic; betel quid consumption; and red meat consumption were independent risk factors, while being underweight and nut consumption were independent protective factors for TNs.Conclusion: Our findings indicate that the presence of TNs was highly prevalent in Chinese centenarians, particularly in women. In addition to gender, having hypertension, having diabetes, and being underweight, the presence of TNs was independently associated with betel quid, red meat, and nut consumption. Further prospective studies are warranted to verify these associations in populations from different age strata, races, cultures, and iodine supplementation.Keywords: thyroid nodules, ultrasound, lifestyle, dietary, betel quid, red meat, nut, centenarians&nbsp

Yao Yao,1,* Xianghui Chen,2,* Shengzheng Wu,2 Liang Guo,3 Hao Zhang,4 Qiao Zhu,5 Jie Tang,3 Fuxin Luan,5 Yali Zhao,5 Faqin Lv,2 Yao He1 1Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Department of Ultrasonography, Hainan Branch of PLA General Hospital, Sanya, People’s Republic of China; 3Department of Ultrasonography, Chinese PLA General Hospital, Beijing, People’s Republic of China; 4Department of Health Policy and Management, Texas A&M University, College Station, TX, USA; 5Central Laboratory, Hainan Branch of Chinese PLA General Hospital, Sanya, People’s Republic of China *These authors contributed equally to this work Background: Thyroid nodules (TNs) are common thyroid lesions in older population. Few studies have focused on the prevalence of TNs and their relationship to lifestyle characteristics and dietary habits in centenarians. The current study aimed at determining the prevalence of TNs in Chinese centenarians by using high-resolution ultrasound (US) equipment and at investigating its relationship to lifestyle characteristics and dietary habits.Participants and methods: The current study was part of the China Hainan Centenarian Cohort Study that was conducted in Hainan, an iodine-sufficient region in People’s Republic of China. A total of 874 permanent residents aged ≥100 years (mean age =102.8±2.8 years) without any missing data were included in the analysis.Results: Among the participants, 649 of them were detected at least one TN under the US examinations. The overall prevalence rate of TNs was 74.3%. The prevalence of TNs was higher in participants who were women, had hypertension, had diabetes, and were underweight compared with their counterparts. Multivariate logistic regression analyses showed that being female, hypertensive, and diabetic; betel quid consumption; and red meat consumption were independent risk factors, while being underweight and nut consumption were independent protective factors for TNs.Conclusion: Our findings indicate that the presence of TNs was highly prevalent in Chinese centenarians, particularly in women. In addition to gender, having hypertension, having diabetes, and being underweight, the presence of TNs was independently associated with betel quid, red meat, and nut consumption. Further prospective studies are warranted to verify these associations in populations from different age strata, races, cultures, and iodine supplementation.Keywords: thyroid nodules, ultrasound, lifestyle, dietary, betel quid, red meat, nut, centenarians&nbsp

Background: To investigate the effectiveness of educating program among primary and secondary school students in Papua New Guinea, where has the highest incidence of oral cancer all over the world. Methods: A cross-sectional school based survey was arranged in primary and secondary school in Papua New Guinea in June, 2015. A self-administrated questionnaire was administered before and after education done by health experts from Taiwan. The subjects were chosen by random. The schools provided the students we educated and did the questionnaires on. Results: Ninety five primary school students and 55 secondary school students in Papua New Guinea participated in the study. Before education, both groups lacked the knowledge that betel quid is harmful to health and had no motivation to quit betel quid consumption with the average score 4.580 out of the total score of 8 for primary school students, and the average score of 4.600 out of the total score of 8 for secondary school students. After education, improvements were noted in knowledge of betel quid among both groups, and reached the statistical significance for secondary school students (mean difference 0.700 ± 0.277, 95% CI 0.164–1.248, p-value = 0.018). Conclusion: A great achievement was gained by a short time of education. To prevent the incidence and mortality of oral cancer in Papua New Guinea, education programs should be arranged aggressively and effectively. Keywords: Betel nut, Betel quid, Education, Papua New Guinea

OBJECTIVE Betel quid chewing (BQC) is an important oral cancer risk factor widespread in the Indian subcontinent. This usage also is common among migrants from this region. As the number of immigrants from South-East Asia is dramatically increasing in Italy, this survey was aimed at investigating BQC prevalence among immigrants from the Indian subcontinent. SUBJECTS AND METHODS First-generation adult male immigrants coming from Pakistan, India, Sri Lanka, and Bangladesh, living in Rome, were consecutively selected. They were interviewed using a validated questionnaire. Descriptive statistics were performed, and factors associated to regular BQC were investigated through regression analysis. RESULTS A total of 211 subjects (mean age, 33.8 years) living in Rome for 11 years, on average, participated in the study. BQC prevalence was 37.9% with few differences between Pakistani, Sri Lankans, and Indians. Prevalence among Bangladeshi was 7.3%. 69% of the consumers chewed BQ at least twice daily, 90% chewed BQ with tobacco; 30.3% subjects were smokers and chewers. Chewing parents, smoking, health illiteracy were associated with BQC. Most chewers believed that BQ helps to relieve stress. CONCLUSIONS The number of oral cancers in Italy is expected to increase because of BQC dissemination. Therefore, specific awareness campaigns directed to residents of South-East Asian origin are needed.

The World Health Organization regards betel quid (BQ) as a human carcinogen, and DSM-IV and ICD-10 dependence symptoms may develop with its heavy use. BQ’s possible effects of an enhanced reward system and disrupted inhibitory control may increase the likelihood of habitual substance use. The current study aimed to employ resting-state fMRI to examine the hypothesized enhanced reward system (e.g., the basal forebrain system) and disrupted inhibitory control (e.g., the prefrontal system) in BQ chewers. The current study recruited three groups of 48 male participants: 16 BQ chewers, 15 tobacco- and alcohol-user controls, and 17 healthy controls. We used functional connectivity (FC), mean fractional amplitude of low-frequency fluctuations (mfALFF), and mean regional homogeneity (mReHo) to evaluate functional alternations in BQ chewers. Graph theoretical analysis (GTA) and network-based statistical (NBS) analysis were also performed to identify the functional network differences among the three groups. Our hypothesis was partially supported: the enhanced reward system for the BQ chewers (e.g., habitual drug-seeking behavior) was supported; however, their inhibitory control was relatively preserved. In addition, we reported that the BQ chewers may have enhanced visuospatial processing and decreased local segregation. The current results (showing an enhanced reward system in the chewers) provided the clinicians with important insight for the future development of an effective abstinence treatment.

Oral potentially malignant disorders have been associated with a betel quid chewing habit. To date, betel quid chewing has a major social and cultural role in the society of Samosir Island, North Sumatra, Indonesia. The purpose of the present study was to evaluate the occurrence of oral potentially malignant disorders associated with the habit of betel quid chewing in the society of Samosir Island, North Sumatra, Indonesia. This case-control study was conducted on all betel quid chewers in the working area of the Ambarita Public Health Centre in Samosir Regency, North Sumatra, Indonesia. All subjects were examined clinically for the presence of any oral lesions and interviewed for their betel quid chewing habit. Chi-square and Fisher’s exact tests were used to analyze the relationship between variables. Among the 51 subjects recruited in the study, 28 subjects suffered from oral potentially malignant disorders who had oral potentially malignant disorders such as submucous fibrosis and/or leukoplakia (the case group) whereas 23 subjects showed no clinically detectable oral potentially malignant disorders (the control group). An increased risk of oral potentially malignant disorders was associated with the habit of chewing areca nut and tobacco (OR=1.600; p=0.542), the duration of betel quid chewing more than 25 years (OR=4.379; p=0.023), and the frequency of betel quid chewing more than 6 times/day (OR=4.800; p=0.021). In conclusion, oral potentially malignant disorders were associated with chewing betel quid habit in the society of Samosir Island, North Sumatra, Indonesia.

Betel quid consumption became prevalent mixed communities such as that in Makkah which is a multicultural society where many ethnic groups bring cultural diversity as well as practicing lifestyle habits that may have an unrecognized harmful health impact. Therefore the purpose of this paper is to increase the awareness of dental professionals in such communities about the habitual use of betel nut and its sequential possible serious health issues.

Background Betel quid (locally–called “paan”) is widely chewed habitually in Pakistan and South and Southeast Asia. It is hand-rolled at paan stalls by smearing a betel leaf (from Piper betel) with slaked lime, catech paste, chopped areca nut, and a variety of condiments and flavoring agents. Paan is considered a group 1 carcinogen for humans by the International Association for Research on Cancer. It is one of the major causes of oral cancer in these regions. The reactive oxygen species released during chewing can initiate carcinogenesis by inducing mutagenesis. Objective The present study was performed to determine the frequency of epithelial dysplasia among habitual paan chewers. It also calculated the association between the quantity and quality of paan chewing and the severity of oral epithelial dysplasia. Methods This was a cross-sectional analytical study. Cytological smears from 300 habitual paan chewers were collected. After fixation with alcohol, smears were then air dried and stained with hematoxylin, eosin, Giemsa, and Pap stains. The material was then examined under an optical microscope. Epithelial dysplasia was identified and graded using the method of Speight. Results Epithelial dysplasia was observed in 57.7% of the habitual paan chewers, which was significantly associated with the number of paans consumed per day as well as duration of paan consumption. These variables were positively correlated with grading of epithelial dysplasia. Conclusions The study concludes that epithelial dysplasia was present in the majority of habitual paan chewers in Lahore city. The correlation between the amount of betel quid chewing and the severity of epithelial dysplasia means the effect is dose-dependent.