the main factors believed to influence bacterial resistance are

(p. 298) The main factors believed to influence bacterial resistance are A. poor hand washing, and frequency of resistance genes among bacteria. This does not exclude the possibility that metals and biocides could have an important role in maintaining strains that have already developed co-resistance, regardless of their prior evolutionary history. Gillings, M. R. et al. Long-term application of Swedish sewage sludge on farmland does not cause clear changes in the soil bacterial resistome. A. Science 367, 630632 (2020). Water Health 11, 1320 (2013). Although the most critical form of selection for the evolution of resistance is between strains within species (largest niche overlap), transmission risks for a given resistant pathogen can increase as a consequence of both within-species and between-species selection. 3). D. PVD is often fatal in older adults. Surveillance of antimicrobial resistance in Europe 2017 (Stockholm, Sweden, 2018). B. breast Parnanen, K. M. M. et al. Incidence and death rates are significantly higher among Black men than White men. That said, for the overwhelming majority of ARGs, their recent origin is not known, quite possibly because they originate from environmental species that have not been sequenced yet. D. lung. (p. 332) Marian recently went through a surgery in which blood vessels were taken from her legs and then attached to her coronary arteries to allow a bypass of blood flow around some narrowed vessels. Nat. OPERATIONAL EXCELLENCE. Provided by the Springer Nature SharedIt content-sharing initiative, Nature Reviews Microbiology (Nat Rev Microbiol) Andersson, D. I. (p. 344) Which of the following does NOT trigger an initiating event? White Flach, C. F. et al. C. Malaria D. The greatest risk factor is older age. Assessing emissions from pharmaceutical manufacturing based on temporal high-resolution mass spectrometry data. Flach, C.-F., Hutinel, M., Razavi, M., hrn, C. & Larsson, D. G. J. Jechalke, S., Heuer, H., Siemens, J., Amelung, W. & Smalla, K. Fate and effects of veterinary antibiotics in soil. Environmental contamination with faecal bacteria provides physical contact, and thus increased opportunities for gene exchange between resident environmental bacteria and bacteria adapted to the intestinal tract of human or domestic animals. B. echocardiogram Antimicrobial resistance is an urgent global public health threat, killing at least 1.27 million people worldwide and associated with nearly 5 million deaths in 2019. B. et al. 88. A joint initiative of WHO and Drugs for Neglected Diseases initiative (DNDi), GARDP encourages research and development through public-private partnerships. 10. People with HIV infection have no greater risk than the general population for active tuberculosis. C. Myocardial infarction Bacteria can produce pumps that sit in their membrane or cell wall. B. prion C. Rates of both cancers are decreasing among younger adults. https://doi.org/10.1186/s12915-017-0423-1 (2017). ISSN 1740-1534 (online) Kraupner, N. et al. 17, 913930 (2015). D. cardiomyopathy. Antibiotic resistance leads to higher medical costs, prolonged hospital stays, and increased mortality. The main bactericidal mechanisms of antibiotics are: hindering the synthesis of cell wall, inhibiting nucleic acid and protein synthesis, affecting bacterial metabolism and the function of cell membrane. Sewers and wastewater treatment plant environments harbour dense, complex bacterial communities that often include pathogens. 1441, 1730 (2019). Manaia, C. M. et al. 36. & Saleem, F. Improper disposal of unused antibiotics: an often overlooked driver of antimicrobial resistance. A. prediabetes what area of the brain is responsible for the gross rate and rhythm of the breathing pattern? As bacteria and genes often cross environments and species boundaries, it is critical to understand and acknowledge the connections between the human, animal and environmental microbiota (the One Health Concept9,10) to manage this global health challenge11,12,13,14,15,16,17,18,19,20,21,22,23. The main factors believed to influence bacterial resistance are. PubMed Central In contrast to managing risks with most other pollutants, the relevant protection target related to antibiotic resistance development is bacteria, rather than (aquatic) wildlife or humans. D.G.J.L. These three processes constitute the three basic mechanisms of antimicrobial resistance. The concentrations of antibiotics and other pharmaceuticals in sewage are usually reasonably stable over time, but can show diurnal patterns146. D. Aspirin has been shown to decrease the risk of colon cancer. Bengtsson-Palme, J., Larsson, D. G. J. Lack of clean water and sanitation and inadequate infection prevention and control promotes the spread of microbes, some of which can be resistant to antimicrobial treatment. Epidemiol. The main factors believed to influence bacterial resistance are the overuse and misuse of antibiotics, genetic mutations in the bacteria, the transfer of resistant genes between bacteria, and the lack of development of new antibiotics. Adv. E. Hemorrhagic stroke, 85. Infections caused by, for example, Salmonella spp., enterohaemorrhagic E. coli and Campylobacter jejuni as a result of consumption of contaminated fresh produce occur frequently100, but we are not aware of studies showing that consumers of contaminated produce have an increased probability of being colonized by resistant strains. Clin. Microbiol. MinION nanopore sequencing identifies the position and structure of a bacterial antibiotic resistance island. What are the 3 physical factors influence bacteria - Chegg A. congestive heart failure Minimal selective concentrations (MSC) is an extrapolation of generated competition data, reflecting the concentration at which cost and benefit are predicted to be balanced64. Greenfield, B. K. et al. R. Soc. 6, a025197 (2016). Ann. Strengthen policies, programmes, and implementation of infection prevention and control measures. C. Type-2 Antibiotic resistance is rising to dangerously high levels in all parts of the world. 123, 501511 (2019). D. Acute inflammatory response. PubMed Central Antibiotic resistance occurs when bacteria change in response to the use of these medicines. 58. 56, 161180 (2018). (p. 333) In the United States, ________ people are at high risk of developing diabetes in the next 10 years. Emerging investigators series: sewer surveillance for monitoring antibiotic use and prevalence of antibiotic resistance: urban sewer epidemiology. D. gestational, 52. Broad host range plasmids can invade an unexpectedly diverse fraction of a soil bacterial community. Which of the following is the process of getting oxygen from the environment to the tissues of the body? Weber, D. J., Anderson, D. & Rutala, W. A. Sci. Although single-species competition experiments are simple and easier to reproduce, they may not reflect the situation in more complex communities148. Researchers from Harvard Medical School, Boston Children's Hospital, and the University of Toronto discovered two important environmental factors: temperature and population density. Environ. J. Med. Questions and answers: Does stopping a course of antibiotics early lead to antibiotic resistance? When the presence of antibiotics and antifungals forces bacteria and fungi to adapt, antimicrobial resistance is increased. B. Thrombus B. the rate of bacteria growth, and poor hand washing practices. (p. 326) Which of the following statements regarding tobacco and cardiovascular risk is FALSE? Discovery of a novel integron-borne aminoglycoside resistance gene present in clinical pathogens by screening environmental bacterial communities. Wellington, E. M. et al. As stress-induced HGT is not a new phenomenon, it is unclear whether the induction of HGT by environmental pollutants has a discernible role in the rapid development of resistance in pathogens observed during the antibiotic era. Lancet Planet. Ashbolt, N. J. et al. 22. B. protozoa Total Environ. Transcription factors (article) | Khan Academy A remaining and pressing knowledge gap is our limited understanding of where and under what circumstances the critical steps occur that lead to the emergence of new forms of resistance in clinically important bacteria. Although multiple barriers restrict the flow of both bacteria and genes, pathogens recurrently acquire new resistance factors from other species, thereby reducing our ability to prevent and treat bacterial infections. Water Res. What is Bacterial Pathogenesis? - News-Medical.net One Health 13, 100263 (2021). https://doi.org/10.1128/cmr.00088-17 (2018). 44, 2551 (2010). Microb. Murray, A. K. et al. This article highlights the needs to consider the environmental gene reservoir and other factors influencing resistance evolution in the development process for new antibiotics. Google Scholar. Physiol. Biol. 4. (p. 344) A collection of cells that grow abnormally and are capable of spreading to other parts of the body Antibiotic resistance is one of the biggest threats to global health, food security, and development today. (p. 300) Kills 1.5 million children worldwide each year Total. Many low- and middle-income countries (LMICs) are particularly vulnerable to the antibiotic resistance crisis. Trends Microbiol. https://doi.org/10.1186/s43170-020-00001-y (2020). A. Carcinogen Antibiotics and antifungals save lives, but their use can encourage the emergence of bacterial strains that are resistant to them. Dis. Having such limitations in mind is critical for both designing and interpreting environmental surveillance studies. A. Acquired immunity Sewage epidemiology is still in its infancy, at least with regard to how well the regional clinical resistance situation can be predicted. B. chlamydia. Yang, Y., Li, B., Zou, S., Fang, H. H. P. & Zhang, T. Fate of antibiotic resistance genes in sewage treatment plant revealed by metagenomic approach. All approved antibiotic classes so far, whether they be natural, semi-synthetic or synthetic compounds, have been met by resistance in at least some of the pathogens they target. Pal, C. et al. The emergence of new ARGs in the clinic occurs only when all events align in time and space48. This recent study elegantly uses the erratic emission profiles of drugs from manufacturing plants to attribute a large portion of the pharmaceutical residues found in a Swiss river to industrial emissions, further showing that curbing such pollution is an ongoing, worldwide challenge. Mainfactor For those pathogens, growth in the environment is often limited. D. People with diabetes are less likely to have "silent" heart attacks. The two approaches have distinct advantages and disadvantages (Table1). Surveillance of antimicrobial resistance among Escherichia coli in wastewater in Stockholm during 1 year: does it reflect the resistance trends in the society? B. CBC Exposure to and colonisation by antibiotic-resistant E. coli in UK coastal water users: environmental surveillance, exposure assessment, and epidemiological study (Beach Bum Survey). On the technical side, installing basic treatment of waste streams, whether industrial, municipal or from animal sources, should have high priority as it addresses many types of risks, not the least substantial transmission risks for several pathogens (including resistant bacteria) and deterioration of valuable water resources164. C. cardiovascular disease. 70, 261313 (2017). D. T cell, 34. This authoritative and educational review discusses in an insightful way the evolution of resistance, including its origins and future implications. Commun. 369, 20130571 (2014). 123,000 Pollution from drug manufacturing: review and perspectives. C. intermediate density lipoproteins (IDLs) Front. Uppdrag angende frsksverksamhet fr en miljpremie i lkemedelsfrmnssystemet, https://www.regeringen.se/499677/contentassets/36dcec65be904fd58e5e6b01c2f99709/uppdrag-angaende-forsoksverksamhet-for-en-miljopremie-i-lakemedelsformanssystemet-tlv.pdf (2021). The antibiotic kills most of the infecting bacteria, and therefore only the resistant forms remain. A. Pertussis (p. 334) Visceral fat, as indicated by abdominal circumference and lack of physical activity, appears to be a strong indicator of risk for which type of diabetes? D. Most men with chlamydia infection will have symptoms. https://doi.org/10.1038/s41467-018-07992-3 (2019). Bioavailability in solid or semi-solid media can be inconsistent and depends strongly on physicochemical characteristics, including, for example, organic content and structure as well as the nature of the antibiotic78. 17. (p. 362) Approximately how many people living in the United States have had cancer? B. A conceptual framework for the environmental surveillance of antibiotics and antibiotic resistance. C. melanoma, basal cell, and squamous cell, 40. The broad coverage also open opportunities to provide an early warning for the emergence or early spread of rare resistance factors117,118, which would otherwise require extensive surveillance of individuals. The STANDS4 Network. Infect. Genet. Vaccinate animals to reduce the need for antibiotics and use alternatives to antibiotics when available. Int. The main factors believed to influence bacterial resistance are:___. When feasible, cultivation-based approaches are still superior in terms of providing insights into both the phenotype and the context, particularly if combined with whole-genome sequencing. Ann. 48, 30143020 (2014). or Vibrio spp.) B. HIV is a retrovirus. (p. 349) The leading cause of cancer death is attributed to what type of cancer? When assessing a client with partial-thickness burns over 60% of the body, which finding should the nurse report immediately? However, the probability of these events lining up is likely to be much higher within the human or domestic animal microbiota, as selection pressures, commensals and pathogens are more commonly encountered together, and there are no environmental transmission barriers that need to be overcome91. Viruses represent some of the smallest pathogens. Diffusion Let us complete them for you. C. In large studies, more women than men did not have chest pain or discomfort with their heart attack. The American Cancer Society recommends a skin exam every three years between ages 20 and 40, and annually after age 40. 54, 41104120 (2020). Government of India. wrote the article. inadequate sanitation and hygiene. Bacterial Resistance to Antibiotics Repressors decrease transcription. Without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill. C. Most warning signs occur in the early stages of cancer. Environ. Sjlund, M. et al. 76, 24452450 (2010). Pain may radiate to the neck, jaw, left or right shoulder or arm. The drug-resistant bacteria multiply and thrive. Sommer, M. O. (p. 352) Which of the following statements regarding prostate cancer is FALSE? This is one of few studies showing that people more likely to ingest surface waters are also more prone to be carriers of resistant bacteria compared with matched controls. The overuse and misuse of antibiotics are key factors leading to antibiotic resistance. C. Virulence A. helminths Pneumonia Supply chain transparency and the availability of essential medicines. Huijbers, P., Joakim Larsson, D. G. & Flach, C. F. Surveillance of antibiotic resistant Escherichia coli in human populations through urban wastewater in ten European countries. The limited number of antibiotics used to . Although the environment contributes to the problem of antibiotic resistance, both during the evolution of resistance and as a transmission route, it can also provide means to manage it. B Biol. The risk of heart attack or stroke is related to the number of cigarettes smoked and the duration of use. D. Protozoa rarely cause illness in humans. Dis. B Biol. (p. 345) The most significant risk for most cancers is Berendonk, T. U. et al. Which of the following statements about antibiotic resistance is false? 18. Information and translations of main factor in the most comprehensive dictionary definitions resource on the web. Partridge, S. R., Kwong, S. M., Firth, N. & Jensen, S. O. Virulence factors assist pathogens in invasion and resistance of host defenses; these factors include Capsule Enzymes Toxins Capsule Some organisms (eg, certain strains of pneumococci, meningococci, Haemophilus influenzae type b ) have a capsule that blocks phagocytosis, making these organisms more virulent than nonencapsulated strains. 131, 105059 (2019). N. Y. Acad. Using a functional assay targeting mobile genes, this study explores environment communities and finds a completely novel resistance gene that had escaped discovery in clinics despite its presence in pathogens on different continents. 20, 79114 (2007). Technol. The first can be the association of a chromosomal ARG (red) with, for example, insertions sequences (ISs; green), which provide intracellular mobility. Improve surveillance of antibiotic-resistant infections. Sivalingam, P., Pot, J. Antibiotic resistance is prevalent in an isolated cave microbiome. (p. 326) Which of the following statements is true? A. COPD. A. angioplasty McCann, C. M. et al. Insulin Resistance: What It Is, Causes, Symptoms & Treatment Total Environ. 20, e51e60 (2020). By contrast, reoccurring, strong antibiotic selection pressures and close contact with pathogens are more common in humans and domestic animals, although some external environments also share those drivers. Environ. MRSA | Description, Treatment, & Resistance | Britannica Wales, A. Discov. (p. 350) Which of the following statements about colon cancer is FALSE? Ecol. In solid or semi-solid media, such as sediments, soils, and sewage sludge, reported concentrations can often be much higher than in aqueous media51,55,74,75. C. Removal of the ovaries decreases the risk of ovarian cancer. B. hepatitis C Schijven, J. F., Blaak, H., Schets, F. M. & De Roda Husman, A. M. Fate of extended-spectrum -lactamase-producing Escherichia coli from faecal sources in surface water and probability of human exposure through swimming. Philos. As all the bacteria have their opt . Trans. Acquired immunity https://doi.org/10.3389/fmicb.2019.02892 (2019). Microbiol. Hepatitis C Environ. Thank you for visiting nature.com. Such a strong selection pressure on pathogens is rarer elsewhere. Sci. Avoid unfamiliar people. Song, J., Rensing, C., Holm, P. E., Virta, M. & Brandt, K. K. Comparison of metals and tetracycline as selective agents for development of tetracycline resistant bacterial communities in agricultural soil. Dantas, G., Sommer, M. O. 2, 16270 (2017). Quickly and professionally. D. Stem cell 23 744, 140997 (2020). mSphere https://doi.org/10.1128/msphere.00418-20 (2020). B. Bacteria Bhullar, K. et al. Intracellular relocation to, for example, a plasmid allows the ARG to move horizontally across strains and species. Antibiotics: Are you misusing them? - Mayo Clinic C. the human papillomavirus (HPV). BMC Biol. Antibiotic resistance is a global health challenge, involving the transfer of bacteria and genes between humans, animals and the environment. (p. 290) Which of the following is NOT a physical barrier against infection? Nat Rev Microbiol 20, 257269 (2022). 51, 30403047 (2017). (p. 304) Highly contagious infection of the respiratory tract 48, 67636771 (2014). Adv. A. Prions appear to be made entirely of protein. Front. Evolution of viruses (article) | Khan Academy Strategies to identify emerging resistance threats involve computational methods, including hidden Markov models27,29, as well as functional metagenomics screens26,144, which can be adapted to focus on already mobilized genetic elements36,117. J. Antimicrob. Manaia, C. M. Assessing the risk of antibiotic resistance transmission from the environment to humans: non-direct proportionality between abundance and risk. New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases. Biol. Antibiotic resistance is one of the biggest threats to global health, food security, and development today. https://doi.org/10.1128/aac.01686-17 (2018). Similar concerns apply to culture-based analyses where bacteria are not identified to the species level. Strategic approach to pharmaceuticals in the environment, https://www.europarl.europa.eu/doceo/document/TA-9-2020-0226_EN.pdf (2020). 140, 113 (2012). Andersson, D. I., Jerlstrm-Hultqvist, J. Water Res. The shared antibiotic resistome of soil bacteria and human pathogens. A. Carcinogen Int. Evol. An elevated triglyceride level. Sci. 4, 88 (2019). A. Critical knowledge gaps and research needs related to the environmental dimensions of antibiotic resistance. 1). Heuer, H. & Smalla, K. Plasmids foster diversification and adaptation of bacterial populations in soil. A., Oluwasegun, R. D. & Church, G. M. Bacteria subsisting on antibiotics. 150, 106436 (2021). If costs are very low, the estimation of cost, the estimation of balancing benefits and thus estimates of the MSC become more sensitive to noise. Microbiome 4, 54 (2016). More studies of this type, in both high-income and low-income settings, are needed to estimate the role of contaminated water in the transmission of resistant bacteria. Another possible technology involves genomic crosslinking137. C. Bacteria can normally be found in humans. D. the location to which the cancer metastasizes, A. the tissue in which a cancer originates or the primary site, 38. D. Women with a genetic predisposition for ovarian cancer have about a 10 percent chance of developing ovarian cancer. Diarrhea B. Antibiotics 4, 567604 (2015). | Meaning, pronunciation, translations and examples How common the different depicted scenarios are is still largely unknown. Microbiol. CAS (p. 321) An insufficient supply of blood to tissues Environ. That means these germs are not killed and continue to grow. Shaping mitigation strategies places additional demands on recognizing what is feasible from, for example, political, economic and geographical standpoints. Zhu, Y.-G. et al. Boxall, A. Airborne Staphylococcus aureus in different environments a review. C. Carcinoma When antibiotic resistance happens, fewer antibiotics are effective against a particular bacterium. Antibiotics and antifungals save lives, but their use can encourage the emergence of bacterial strains that . 121, 9931001 (2013). Environ. A. prediabetes Steps can be taken at all levels of society to reduce the impact and limit the spread of resistance. B. These bacteria may infect humans and animals, and the infections they cause are harder to treat than those caused by non-resistant bacteria. B. bacteria, that are normally susceptible to antibiotics, become resistant as a result of genetic changes (acquired resistance). https://doi.org/10.3389/fmicb.2013.00145 (2013). (p. 343) The replication of a single cell to produce thousands of copies of itself Water Res. Zhou, S.-Y.-D. et al. Prioritization should ideally be done on a global level, as the consequences of inaction will affect everyone in the long run, regardless of where a resistance factor emerges. Only use antibiotics when prescribed by a certified health professional. This may be achieved by comparing ratios of resistant strains versus non-resistant strains after exposure to different concentrations of antibiotics (given that costs are independent of the exposure concentration), rather than comparing ratios before exposure with those after exposure. (p. 292) The lymphocytes that monitor blood and tissue fluids are which type of cell? Hence, it is crucial to understand where the bottlenecks are in the evolution towards resistance in pathogens. Google Scholar. Int. 13. Other antibiotics often help, but it is important to . 49, 1182511833 (2015). Baquero, F., Coque, T. M., Martnez, J.-L., Aracil-Gisbert, S. & Lanza, V. F. Gene transmission in the one health microbiosphere and the channels of antimicrobial resistance. The scourge of antibiotic resistance: the important role of the environment. https://doi.org/10.1038/s41579-021-00649-x, DOI: https://doi.org/10.1038/s41579-021-00649-x. A. less than 10 percent (p. 344) Which of the following is NOT a safety mechanism in place to help maintain cell order and decrease the chance of cancer developing in the body? A. Atherosclerosis B. Malignant tumor 14, 336356 (2015). Soil Sci. Pollut. Environ. People with diabetes are two to four times more likely than people without diabetes to develop cardiovascular disease. Total Environ. Euro Surveill. FEMS Microbiol. A. 117, 132138 (2018). Understanding and overcoming antibiotic resistance | PLOS Biology Rev. Infect. 14, 7072 (2008). D. Chest X-rays are recommended as a routine screening test for lung cancer. Antibiotic resistance and R factors in coliform bacilli isolated from hospital and domestic sewage. Mainfactor, Acquirer of Direct to Consumer Companies, Officially Launches. Google Scholar. 11, 590776 (2020). Selection of resistant bacteria at very low antibiotic concentrations. & Prabakar, K. Extracellular DNA (eDNA): neglected and potential sources of antibiotic resistant genes (ARGs) in the aquatic environments. Nature Reviews Microbiology thanks J. Martnez, K. Smalla and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. PLoS ONE 8, e69581 (2013). 25. Let us have a look at your work and suggest how to improve it! Contamination of surface, ground, and drinking water from pharmaceutical production. Google Scholar. C. Aneurysm and JavaScript. b. & Lee, J.-K. A review of analytical procedures for the simultaneous determination of medically important veterinary antibiotics in environmental water: sample preparation, liquid chromatography, and mass spectrometry. Still, in most cases, only a minor fraction is bioavailable. A. HDL levels are mainly determined by genetics. (p. 288) The speed and intensity with which a microorganism is likely to cause an infection B. breast Kim, C., Ryu, H.-D., Chung, E. G., Kim, Y. What does main factor mean? Vandecraen, J., Chandler, M., Aertsen, A. These transmission routes can be direct or indirect via the external environment (lower part of the figure), often through faecal contamination. Aminov, R. I. Horizontal gene exchange in environmental microbiota. Hendriksen, R. S. et al. Google Scholar. Odion O. Ikhimiukor, Erkison Ewomazino Odih, Iruka N. Okeke, Erik Bakkeren, Mdric Diard & Wolf-Dietrich Hardt, Stefan Ebmeyer, Erik Kristiansson & D. G. Joakim Larsson, Sara Hernando-Amado, Teresa M. Coque, Jos L. Martnez, Dan I. Andersson, Herv Nicoloff & Karin Hjort, Elizabeth M. Darby, Eleftheria Trampari, Jessica M. A. Blair, Nicholas G. Davies, Stefan Flasche, Katherine E. Atkins, Nature Reviews Microbiology Tobacco triggers spasms that close off blood vessels. B. saliva. C. skin Sci. B. Type-1 D. Tobacco decreases levels of LDL cholesterol. Management is often more challenging in LMICs than in high-income countries because of more limited resources, other pressing basal needs that need to be addressed, and a weaker governance of and trust in the public sector. (p. 326-327) Which of the following is NOT one of the major controllable risk factors known to increase the likelihood of cardiovascular disease? Internet Explorer). A growing number of infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis are becoming harder to treat as the antibiotics used to treat them become less effective. the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in A different study found that recreational swimming might be a risk factor for urinary tract infections with extended-spectrum -lactamase-producing E. coli or Klebsiella pneumoniae98. A. a carcinogen C. High HDL cholesterol levels increase the risk of heart disease. August 26, 2021. C. bacteria Andersson, D. I. Food, including raw vegetables, is another possible exposure route99. Sci. Microbiol. Nijsingh, N., Munthe, C. & Larsson, D. G. J. Lugli, G. A. et al. Health Perspect. (p. 326) Which of the following statements regarding tobacco use and cardiovascular disease is FALSE?

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