Effects of electronic cigarettes and hookah (waterpipe) use on home air quality.

INTRODUCTION: A major site of secondhand smoke exposure for children and adults is the home. Few studies have evaluated the impact of e-cigarette or hookah use on home air quality, despite evidence finding toxic chemicals in secondhand e-cigarette aerosols and hookah smoke. We assessed the effect of e-cigarette and hookah use on home air quality and compared it with air quality in homes where cigarettes were smoked and where no smoking or e-cigarette use occurred. METHODS: Non-smoking homes and homes where e-cigarettes, hookah or cigarettes were used were recruited in the New York City area (n=57) from 2015 to 2019. Particulate matter with diameter less than 2.5 µm (PM2.5), black carbon and carbon monoxide (CO) were measured during a smoking or vaping session, both in a 'primary' smoking room and in an adjacent 'secondary' room where no smoking or vaping occurred. Log transformed data were compared with postanalysis of variance Tukey simultaneous tests. RESULTS: Use of hookah significantly increased PM2.5 levels compared with non-smoking homes, in both the primary and secondary rooms, while use of e-cigarettes increased PM2.5 levels only in primary rooms. Additionally, in-home use of hookah resulted in greater CO concentrations than the use of cigarettes in primary rooms. CONCLUSIONS: Use of e-cigarettes or hookah increases air pollution in homes. For hookah, increases in PM2.5 penetrated even into rooms adjacent to where smoking occurs. Extending smoke-free rules inside homes to include e-cigarette and hookah products is needed to protect household members and visitors from passive exposure to harmful aerosols and gases.

Management of Spontaneous Labour at Term in Healthy Women.

OBJECTIVE: The purpose of this guideline is to provide guidance for the intrapartum management of spontaneous labour, whether normal or abnormal, in term, healthy women, and to provide guidance in the management of first and second stage dystocia to increase the likelihood of a vaginal birth and optimize birth outcomes. EVIDENCE: Published literature was retrieved through searches of PubMed and the Cochrane Library in October 2011 using appropriate, controlled vocabulary (e.g., labour pain; labour, obstetric; dystocia) and key words (e.g., obstetric labor, perineal care, dysfunctional labor). When appropriate, results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Results were limited to the last 10 years. Searches were updated on a regular basis and incorporated in the guideline up to June 15, 2015. VALUES: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). SUMMARY STATEMENTS: RECOMMENDATIONS.

Community Health Work and Social Work Collaboration: Integration in Health Care and Public Health Settings: A Conceptual Framework.

Community health worker (CHW) and social worker (SW) collaboration is crucial to illness prevention and intervention, yet systems often engage the 2 workforces in silos and miss opportunities for cross-sector alignment. In 2021, a national workgroup of over 2 dozen CHWs, SWs, and public health experts convened to improve CHW/SW collaboration and integration across the United States. The workgroup developed a conceptual framework that describes structural, systemic, and organizational factors that influence CHW/SW collaboration. Best practices include standardized training, delineated roles and scopes of practice, clear workflows, regular communication, a shared system for documentation, and ongoing support or supervision.

Workforce Readiness Training: A Comprehensive Training Model That Equips Community Health Workers to Work at the Top of Their Practice and Profession.

Background: Recent reports have recognized that only 20 percent of health outcomes are attributed to clinical care. Environmental conditions, behaviors, and social determinants of health account for 80 percent of overall health outcomes. With shortages of clinical providers stressing an already burdened healthcare system, Community Health Workers (CHWs) can bridge healthcare gaps by addressing these nonmedical factors influencing health. This paper details how a comprehensive training model equips CHWs for workforce readiness so they can perform at the top of their practice and profession and deliver well-coordinated client/patient-centered care. Methods: Literature reviews and studies revealed that training CHWs alone is not sufficient for successful workforce readiness, rather CHW integration within the workforce is needed. Consequently, this comprehensive training model is developed for CHWs with varying skill levels and work settings, and supervisors to support organizational readiness and CHW integration efforts. A systematic training program development approach along with detailed implementation methods are presented. Continuing education sessions to support CHW practice and Organizational Readiness Training for supervisors, leadership and team members directly engaged with CHWs in the workplace are also discussed. CHWs were involved in all phases of the research, development, implementation, and actively serve in evaluations and curriculum review committees. Results: Components of the comprehensive training model are presented with an emphasis on the core CHW training. Two CHW training tracks are offered using three delivery modalities. Process measures with student learning objectives, outcome measures developed using the Kirkpatrick model to capture attitude, perceptions, knowledge acquisition, confidence, behavior, and overall experience, and impact stories by two CHWs are presented. Lessons learned from the implementation of the training program are discussed in three categories: Practice-driven curricula, student-centered training implementation, and adaptations in response to COVID-19 pandemic. Conclusion: This comprehensive training model recognizes that training CHWs in a robust training program is key as the demand for well-rounded CHWs increases. Furthermore, a comprehensive training program must include training for supervisors, leadership, and team members working directly with CHWs. Such efforts strengthen the CHW practice and profession to support the delivery of well-coordinated and holistic client/patient-centered care.

Natalizumab in Early Relapsing-Remitting Multiple Sclerosis: A 4-Year, Open-Label Study.

INTRODUCTION: STRIVE was a 4-year, multicenter, observational, open-label, single-arm study of natalizumab treatment in anti-JC virus antibody-negative (JCV-negative) relapsing-remitting multiple sclerosis (RRMS) patients with disease duration ≤ 3 years. The objective of STRIVE was to examine no evidence of disease activity (NEDA) status and predictors of NEDA in natalizumab-treated patients with early RRMS. METHODS: Proportions of patients with NEDA were evaluated along with baseline predictors of NEDA, annualized relapse rate, 24-week confirmed disability worsening (CDW), magnetic resonance imaging assessments (T2 and gadolinium-enhancing lesions), and serious adverse events. RESULTS: In years 1 and 2, 56.1% (95% confidence interval [CI] 48.7-63.4%) and 73.6% (95% CI 66.2-80.2%) of patients (intent-to-treat population [N = 222]), respectively, achieved NEDA. In years 3 and 4, 84.6% (95% CI 78.0-89.9%) and 91.9% (95% CI 86.4-95.8%) of patients, respectively, achieved Clinical NEDA (no relapses or 24-week CDW). Baseline predictors of NEDA in year 4 were Expanded Disability Status Scale score ≤ 2.0 (odds ratio [OR] = 3.85 [95% CI 1.54-9.63]; p = 0.004) and T2 lesion volume > 4 cc (OR = 0.39 [95% CI 0.15-0.98]; p = 0.046), with the latter also predicting Clinical NEDA in year 4 (OR = 0.21 [95% CI 0.05-0.92]; p = 0.038). The cumulative probability of CDW at year 4 was 19.3%. Serious adverse events were reported in 11.3% of patients. CONCLUSION: These results support the long-term safety and effectiveness of natalizumab. Baseline predictors of NEDA help to inform benefit-risk assessments of natalizumab treatment in JCV-negative patients with early RRMS. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01485003.

Similarities Between Alcohol and Tobacco Advertising Exposure and Adolescent Use of Each of These Substances.

OBJECTIVE: Underage alcohol use is a major public health problem and substantial corporate money supports alcohol advertising across multiple venues. A diverse research literature demonstrates that adolescent exposure to such advertising is associated with drinking attitudes and behavior, but no scientific body has determined these associations to be causal. The objective of this study was to assess the association between alcohol advertising and teen drinking in the context of the "Analogy" criterion of the Bradford Hill criteria and consider a determination that the association between exposure to alcohol advertising and alcohol use is causal. METHOD: This study was a narrative review on the association between adolescent exposure to alcohol advertising and subsequent alcohol use in the context of domains utilized in the Surgeon General's 2012 Report, Preventing Tobacco Use Among Youth and Young Adults, which concluded, "Advertising and promotional activities by tobacco companies have been shown to cause the onset and continuation of smoking among adolescents and young adults." RESULTS: In every aspect compared (i.e., adolescent knowledge; attitudes toward; initiation of use; continuation of use; mediums of advertisement; the use of mascots, celebrities, and themes; and frequency and density of advertisements and retailers), the findings for both tobacco and alcohol and their association with exposure to advertising are analogous. CONCLUSIONS: Application of the Analogy criterion of the Bradford Hill criteria comparing alcohol and tobacco supports a judgment that the association between exposure to alcohol advertising and increased adolescent knowledge, attitudes toward, initiation, and continuation of alcohol use are causal in nature.

Self-management education programs for age-related macular degeneration: a systematic review.

OBJECTIVE: To review the effectiveness of education programs to improve emotional status, daily living and self-efficacy in adults older than 60 years with age-related macular degeneration (AMD). METHOD: Electronic searches of three databases and manual searches of references lists located randomised controlled trials (RCTs) and quasi-experimental studies. Health education programs aimed at increasing knowledge of AMD, skills training or behavioural change were included. Data extraction and quality assessment were undertaken by two reviewers. A narrative analysis was possible. RESULTS: Three protocols were reported in four studies (n = 532) with three follow-up studies--all contained elements of self-management programs. Effect sizes for the three outcomes ranged from small to very large (0.14-1.21). CONCLUSIONS: Self-management programs appear effective for older adults with AMD. Small sample size, use of non-traditional statistics and methodological quality meant only a narrative analysis was possible. Future studies with more robust methodology including intent-to-treat analysis are still required.