Presence of flavoured electronic nicotine delivery system (ENDS) products in US ENDS advertisements, 2015-2020: a content analysis.

OBJECTIVES: Electronic nicotine delivery systems (ENDS) products come in a variety of flavours (eg, fruit, dessert, menthol). Tobacco advertising has historically used flavours as an advertising tactic, but little is known about flavour type and prevalence in ENDS advertisements. We assess the presence of flavoured ENDS in ads over time, by media outlet (eg, magazines, online) and brand. METHODS: We acquired ENDS ads (N=4546) that first ran between 2015-2017 (n=1685; study 1) and 2018-2020 (n=2861; study 2) in outlets including opt-in emails, direct-to-consumer mail (study 1 only), video (TV and online), radio (study 2 only), static online/mobile (ie, ads without video or moving graphics), social media, outdoor (eg, billboards; study 2 only) and consumer magazines. We coded for presence of flavoured ENDS products and flavour type (eg, fruit, tobacco, menthol) and merged this information with metadata on ad year, outlet and manufacturer/retailer brand. RESULTS: Overall, nearly half (45.5%; n=2067) of ads in our sample featured a flavoured product. Tobacco (59.1%; n=1221), menthol (42.9%; n=887) and fruit (38.6%; n=797) were the most advertised flavours. Over time, the proportion of ads containing tobacco-flavoured and menthol-flavoured ENDS generally decreased before menthol rebounded in 2020. The proportion of ads containing fruit, mint and dessert flavours generally increased over time, with a substantive drop in 2020. We found notable differences in flavoured ENDS advertising by outlet and brand. CONCLUSIONS: The overall presence of flavoured ENDS in our sample of ads remained relatively consistent, with tobacco flavour decreasing over time and some non-tobacco flavours increasing over time until 2020 when the presence decreased.

On the possibility of using temperature to aid in thyroid nodule investigation.

Thyroid nodules are common, and their investigation is very important to exclude the possibility of cancer. The increase in blood vessels of malignant tumours may be related to local temperature augmentation detectable on the skin surface. The objective of this paper is to evaluate the feasibility of Infrared Thermography for cancer identification. For this purpose, two studies were performed. One used numerical modelling to simulate regional metabolic temperature propagation to evaluate whether a nodule is perceptible on the skin surface. A second study considered thyroid nodule identification by using convolutional neural networks (CNNs). First, variations in nodular size and fat thickness were investigated, showing that the fat layer has an important role in regional heat transfer. In the second study, the training process achieved accuracy of 96% for in-sample and 95% for validation. In the testing phase, 92% accuracy, 100% precision and 80% recall were achieved. Thus, the presented studies suggest the feasibility of using Infrared Thermography with the CNN Artificial Intelligence technique as additional information in the investigation of thyroid nodules for patients without a very thick subcutaneous fat layer.

Are national antitobacco campaigns reaching high-risk adolescents? A cross-sectional analysis from PATH Wave 2.

Smoking education and prevention campaigns have had marked success in reducing rates of tobacco use among adolescents, however, disparities in use continue to exist. It is critical to assess if adolescents at risk for tobacco use are being exposed to antitobacco campaigns. We used data from Wave 2 of the Population Assessment of Tobacco and Health Study to assess the relationship between exposure to three antitobacco campaigns and key characteristics related to higher risk of cigarette use using full-sample weights and Poisson regression models with robust variance. Adjusted models identified that exposure to antitobacco campaigns was more common among racial and sexual minority adolescents and adolescents who: reported exposure to tobacco marketing, spent more time using media and had household income greater than $25 000. While some high-risk youth are more likely to report exposure to campaigns, there are some priority groups that are not being reached by current efforts compared with non-priority groups, including youth living in households with income below the poverty line and adolescents who are susceptible to cigarette smoking. Future campaigns should consider targeting these groups specifically in order to reduce tobacco use disparities.

Slope distribution of a rough surface measured by transmission scattering and polarization.

Transmission scattering from medium to air was used to measure the slope distribution of the rough plane surface of a transparent glass hemisphere. A facet model successfully explained the measured results of refraction, scattering, and polarization: Transmission scattering existed for incident angles greater than the critical angle, all measured curves for the normalized scattered intensity versus the facet slope angle for different detection directions overlapped, and the measured polarization of scattering was approximately constant for >99% of the facets. The slope distribution obtained by transmission scattering agrees with those of the surface profiles in the valid range of the profiler and can represent the slope distribution of the rough surface.

A randomised trial of the impact of counselling on treatment adherence of tuberculosis patients in Sialkot, Pakistan.

SETTING: Tuberculosis Department, Bethania Hospital, Sialkot, Pakistan. OBJECTIVE: To determine whether intensive counselling can improve treatment adherence. DESIGN: In a randomised controlled intervention trial of 1,019 adult tuberculosis patients, 49% were assigned to the intervention group and 51% to the control group. Baseline data were obtained through semi-structured interviews. Patients were followed until the end of treatment (cure, default, referral or death). The intervention included counselling at the start of treatment and at each subsequent visit for ambulatory patients, or weekly for hospitalised patients. Counselling combined health education with strategies to strengthen patients' self-efficacy. Control group patients received the usual care. The outcome measure was treatment default. RESULTS: The default rate was 54% in the control group and 47% in the intervention group: the default risk ratio was 0.87, implying a reduction in defaulting of 13%. The impact was stronger in women, ambulatory patients, re-treatment patients, women who worked in the home, and patients who were not the main provider, those with a poor knowledge of the disease or those with a short treatment delay. CONCLUSIONS: Intensive counselling has a significant, although limited, impact on treatment adherence.

Perception and social consequences of tuberculosis: a focus group study of tuberculosis patients in Sialkot, Pakistan.

Treatment defaulting is one of the major causes of the failure of TB control programs. In Bethania Hospital, Sialkot, defaulting rates are high: 72% for the standard 12 months course and 56% for the 8 months course. Attrition is especially important in the first weeks of treatment: < 70% of the patients start the 10th week of treatment. A focus group discussion study has been carried out to gain a better understanding of the impact of social stigmatization, treatment cost and pregnancy on defaulting. The study population consisted of 3 male and 3 female groups each with 8 hospitalized TB patients. The study shows that TB is perceived as a very dangerous, infectious and incurable disease. This perception has many social consequences: stigmatization and social isolation of TB patients and their families: diminished marriage prospects for young TB patients, and even for their family members: TB in one of the partners may lead to divorce. Due to fear patients often deny the diagnosis and reject the treatment. While both male and female TB patients face many social and economical problems, female patients are more affected. Divorce and broken engagements seem to occur more often in female patients. Females are usually economically dependent on their husbands and family in law, and need their cooperation to avail of treatment. The belief that pregnancy enhances the risk for relapse decreases their marriage prospects. Pregnancy is also a reason for stopping TB treatment as both are considered as incompatible. The findings of this study reveal the urgent need for a health education campaign to convince the general population that tuberculosis is curable. All health care providers should act as destigmatizers.

COPD in the elderly. A reversible cause of functional impairment.

OBJECTIVES: To determine the frequency of referral of patients age 69 years and older to the pulmonary function laboratory at a tertiary-care hospital for airflow limitation studies; to determine the point prevalence of a significant reversible component in patients with COPD as an age-related function; and to determine the proportion of patients who were prescribed bronchodilators following a pulmonary function test (PFT) demonstrating significant reversibility. DESIGN: A retrospective review of pulmonary function tests of patients 69 years and older within calendar year 1990 was performed. Chart review of those showing significant reversibility to bronchodilators during a PFT was performed to determine level of follow-up. SETTING: Referral-based pulmonary division in a tertiary-care hospital. PATIENTS: Men and women 69 years and older who had interpretable PFTs at Northwestern Memorial Hospital (NMH) during the calendar year 1990 (n = 405). Patients whose PFTs were uninterpretable due to poor effort (n = 10) were excluded from the study. INTERVENTIONS: No specific interventions were performed as a part of the study. Referring physicians may have requested a PFT with postbronchodilator (albuterol by nebulizer) testing and may have subsequently prescribed bronchodilators for their patients. MEASUREMENTS: We studied the effect of age, gender, smoking history, and degree of airflow obstruction on changes in spirometry values and reversibility status after bronchodilator (if applicable) as determined by a PFT. MAIN RESULTS: Of the 405 consecutive elderly patients studied, 193 (47.7%) received bronchodilators and 60 (31.1%) of these patients had significant improvement as judged by the criteria listed in the Methods section. The improvement occurred equally across all age groups (p > 0.05) and the percent responding to bronchodilators increased as the degree of obstruction increased (p < 0.001). Those who had never smoked were twice as likely to respond than were current or former smokers; men were more likely to respond than women. Most patients (84%) who responded were subsequently prescribed bronchodilators. CONCLUSIONS: Responses to inhaled bronchodilators occur at all ages. Older patients showed greater reversibility as the degree of obstruction increased, while a smoking history reduced the likelihood of a bronchodilator response. COPD in the elderly may differ from the traditional form of the disease.

Delirium and other cognitive impairment in older adults in an emergency department.

STUDY OBJECTIVE: To determine the prevalence of delirium and other alterations in mental status in older adults in the emergency department setting. DESIGN: Prospective, cross-sectional study. SETTING: Private, nonprofit, academic medical center in a densely populated urban area. PARTICIPANTS: One hundred eighty-eight adults 70 years or older who presented to the ED. INTERVENTIONS: None. RESULTS: Delirium and other alterations in mental status were present in 39.9% of the patients studied; 24% of these patients had delirium. Age and severity of illness were positively correlated with alteration in mental status. Patients with alterations in mental status were more likely to be admitted to an inpatient unit. Among those admitted from home, alterations in mental status in the ED were associated with a higher likelihood of institutionalization at discharge. CONCLUSION: Alterations in mental status are prevalent in ED patients. Older adults with alterations in mental status, particularly alterations in consciousness and delirium, are at high risk for admission to an inpatient unit and institutionalization after discharge. Standardized mental status testing identified high-risk older adults in the ED.

Reducing hospital costs for the geriatric patient admitted from the emergency department: a randomized trial.

OBJECTIVE: To test the impact of a geriatric evaluation and management model on the costs of acute hospital management of emergently admitted older adults. DESIGN: Randomized controlled trial. Patients were followed in the acute hospital from admission through discharge. Results based on both univariate and multiple regression analyses. SETTING: Private, nonprofit, academic medical center in a densely populated urban area. PATIENTS: Adults 70 years of age and older admitted from the Emergency Department to the medicine service (non-ICU admission) who did not have an internist on staff at the admitting hospital. Of 141 randomized patients, 111 (78.7%) met eligibility criteria. INTERVENTION: Assignment of a geriatrician and a social worker as the primary managing team during the hospital stay. MAIN OUTCOME MEASURES: Length of stay, total cost of acute hospital care, cost of laboratory, pharmacy, and rehabilitation services. RESULTS: Patients in the intervention group had 2.1 fewer days of hospitalization, but this shorter length of stay was not statistically significant (P = 0.108). There were no differences in mortality or discharge disposition. In risk-adjusted, multiple regression analysis the intervention group had a statistically significant lower predicted total cost per patient than the usual care group (-$2,544, P = 0.029); assignment to the intervention group was associated with a lower predicted cost per patient for laboratory (including cardiology graphics) services (P = 0.007) and pharmacy costs (P = 0.047). CONCLUSIONS: When controlled for important predictors of expected resource use, care provided by a geriatric management team resulted in a significant reduction in the cost of hospitalization. A reduction in the cost of laboratory, cardiographic, and pharmacy services is consistent with the team's philosophy of defining the services needed based on goals related to functional outcomes.

Are congregate meals meeting clients' needs for "heart healthy" menus?

This is a report of a dietary analysis of meals offered in one large congregate feeding program and clients' consumption patterns as they relate to self-reported dietary restrictions. Most meals exceeded dietary guidelines for kilocalories, cholesterol, and proportion of energy from fat. Of 438 congregate meal clients 60 years of age and older who were surveyed at senior citizen centers and congregate meal sites, 30% reported following a "special diet." The most commonly mentioned dietary modifications were low sodium and/or low fat/low cholesterol. Clients who reported dietary restrictions also reported eating fewer congregate meals per week than did clients who denied dietary restrictions.

Patterns of syphilis testing in the elderly.

OBJECTIVE: To evaluate the frequency of inconsistencies in the use of laboratory tests for syphilis among the elderly in an acute care setting. DESIGN: Retrospective medical record review. SETTING: Academic medical center. PATIENTS/PARTICIPANTS: All patients 60 years of age and older who had: 1) positive tests for syphilis and no lumbar puncture performed (n = 71), 2) lumbar punctures performed and no positive test for syphilis (n = 68), and 3) positive tests for syphilis and lumbar punctures performed (n = 8). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The chronology and results of syphilis tests were abstracted from the medical records. Documentation of signs and symptoms of neurosyphilis, including dementia and depression, were abstracted from the medical records by a second reviewer. Most patients had inadequate evaluations; 51 had no follow-up of positive syphilis tests and 43 had cerebrospinal fluid syphilis tests in the absence of positive blood tests for syphilis or signs and symptoms of neurosyphilis. CONCLUSIONS: The inconsistent pattern of serologic testing in this study suggests that the testing was done as a routine procedure and not for a specific purpose. For a majority of the tested individuals, the results did not provide a public health benefit or contribute to the individual's well-being.

Screening elderly veterans for alcoholism.

OBJECTIVE: To determine the sensitivity and specificity of an alcoholism screening test not previously tested in the elderly. DESIGN: Cross-sectional study, face-to-face interviews. SETTING: Veterans Administration (VA) outpatient facility. PATIENTS/PARTICIPANTS: Men greater than or equal to 70 years old seeking care in a newly established VA outpatient facility were invited to participate in a health assessment program. Of 109 participants who enrolled, 96 completed both interviews. INTERVENTIONS: The screening test was administered by an internist as part of a medical history. The Michigan Alcoholism Screening Test (MAST), used as the "gold standard," was administered by a trained interviewer as part of a longer structured interview. MEASUREMENTS AND MAIN RESULTS: The screening test had a sensitivity of 0.52 and a specificity of 0.76 in this sample. CONCLUSIONS: The sensitivity and specificity of the screening test were lower in this sample in comparison with previously reported results in a younger population. Differences in the test performance may be related to differences in attitudes and drinking behaviors of elderly veterans when compared with those of younger men and women.

Scatter intensity mapping of laser-illuminated coating defects.

The ability to detect and locate defects nondestructively in multilayer optical coatings has been demonstrated using a video microscopy system. The system uses laser-excited scattering to illuminate defects responsible for laser-induced damage in multilayer dielectric coatings. Intensity maps and contours can be generated by digitizing the video images of scattering from individual defects. These can reveal characteristic defect scatter features possibly related to damage probability, and they offer a means to follow the development of these features from incipient to catastrophic damage. Examples of defect scatter maps and intensity contours for an antireflection dielectric coated window are presented and discussed.