Trend differences in men and women in rural and urban U.S. settings.

BACKGROUND: Smoking prevalence is declining at a slower rate in rural than urban settings in the United States (U.S.), and known predictors of smoking do not readily account for this trend difference. Given that socioeconomic and psychosocial determinants of health disparities accumulate in rural settings and that life-course disadvantages are often greater in women than men, we examined whether smoking trends are different for rural and urban men and women. METHOD: We used yearly cross-sectional data (n = 303,311) from the U.S. National Survey on Drug Use and Health (NSDUH) from 2007 through 2014 to compare cigarette smoking trends in men and women across rural and urban areas. Current smoking status was modelled using logistic regression controlling for confounding risk factors. RESULTS: Regression derived graphs predicting unadjusted prevalence estimates and 95% confidence bands revealed that whereas the smoking trends of rural men, urban men, and urban women significantly declined from 2007 to 2014, the trend for rural women was flat. Controlling for demographic, socioeconomic and psychosocial predictors of smoking did not explain rural women's significantly different trend from those of the other three groups. CONCLUSION: Rural women lag behind rural men, urban men and urban women in decreasing smoking, a health disparity finding that supports the need for tobacco control and regulatory policies and interventions that are more effective in reducing smoking among rural women.

A growing geographic disparity: Rural and urban cigarette smoking trends in the United States.

Rural areas of the United States have a higher smoking prevalence than urban areas. However, no recent studies have rigorously examined potential changes in this disparity over time or whether the disparity can be explained by demographic or psychosocial characteristics associated with smoking. The present study used yearly cross sectional data from the National Survey on Drug Use and Health from 2007 through 2014 to examine cigarette smoking trends in rural versus urban areas of the United States. The analytic sample included 303,311 respondents. Two regression models were built to examine (a) unadjusted rural and urban trends in prevalence of current smoking and (b) whether differences remained after adjusting for demographic and psychosocial characteristics. Results of the unadjusted model showed disparate and diverging cigarette use trends during the 8-year time period. The adjusted model also showed diverging trends, initially with no or small differences that became more pronounced across the 8-year period. We conclude that differences reported in earlier studies may be explained by differences in rural versus urban demographic and psychosocial risk factors, while more recent and growing disparities appear to be related to other factors. These emergent differences may be attributable to policy-level tobacco control and regulatory factors that disproportionately benefit urban areas such as enforcement of regulations around the sale and marketing of tobacco products and treatment availability. Strong federal policies and targeted or tailored interventions may be important to expanding tobacco control and regulatory benefits to vulnerable populations including rural Americans.

Clinical reappraisal of SHORT syndrome with PIK3R1 mutations: toward recommendation for molecular testing and management.

SHORT syndrome has historically been defined by its acronym: short stature (S), hyperextensibility of joints and/or inguinal hernia (H), ocular depression (O), Rieger abnormality (R) and teething delay (T). More recently several research groups have identified PIK3R1 mutations as responsible for SHORT syndrome. Knowledge of the molecular etiology of SHORT syndrome has permitted a reassessment of the clinical phenotype. The detailed phenotypes of 32 individuals with SHORT syndrome and PIK3R1 mutation, including eight newly ascertained individuals, were studied to fully define the syndrome and the indications for PIK3R1 testing. The major features described in the SHORT acronym were not universally seen and only half (52%) had four or more of the classic features. The commonly observed clinical features of SHORT syndrome seen in the cohort included intrauterine growth restriction (IUGR) <10th percentile, postnatal growth restriction, lipoatrophy and the characteristic facial gestalt. Anterior chamber defects and insulin resistance or diabetes were also observed but were not as prevalent. The less specific, or minor features of SHORT syndrome include teething delay, thin wrinkled skin, speech delay, sensorineural deafness, hyperextensibility of joints and inguinal hernia. Given the high risk of diabetes mellitus, regular monitoring of glucose metabolism is warranted. An echocardiogram, ophthalmological and hearing assessments are also recommended.

Predictors of incomplete response to therapy among Filipino patients with papillary thyroid cancer in a tertiary hospital.

BACKGROUND: Although survival rate in papillary thyroid cancer (PTC) is high, the risk of persistence and recurrence together with the dramatic rise in its incidence cannot be overemphasized. Filipinos are considered to be at greater risk for negative outcomes. A paradigm shift in the management of PTC introduces re-stratification based on response to therapy which was reported to have better correlation with long-term outcome. The study aimed to identify predictors of incomplete response after thyroidectomy and radioiodine therapy among patients with PTC. The results of the study may have important implications in our understanding of the disease process allowing more aggressive treatment and monitoring of certain subgroups of patients. METHODOLOGY: Retrospective review of 225 patients with PTC (59% ATA low risk, 30 % ATA intermediate risk and 11% ATA high risk) who underwent thyroidectomy and radioiodine therapy was performed. Thirteen variables were considered (age, gender, histopathological variant, stage, extent of disease, MACIS score, AMES score, primary tumour size, lymph node, lymphovascular invasion, bilaterality, multifocality and preoperative TSH level). Logistic regression analysis using Backward Wald algorithm was used to identify independent predictors of incomplete response to therapy after 24 months. RESULTS: Of the 225 patients, 69 (31%) had incomplete response. Biochemical and structural (predominantly thyroid bed, lung and bone) incomplete response was observed in 6 and 63 patients, respectively. Incomplete response was documented in 8, 54 and 92% of low-, intermediate- and high-risk patients based on ATA recommendation. Incomplete response was significantly dependent on gender, lymph node involvement and location, extent of malignancy and multifocality taking into account the size of concurrent tumours (p < 0.05). The model was found to have high sensitivity (71%) and specificity (96%). CONCLUSION: A significant fraction of PTC patients experienced incomplete response to therapy. Our data suggest that male gender, lateral or mediastinal lymph node involvement, class III extent of disease by De Groot and multifocality with concurrent tumour or tumours more than 1 cm are major predictors of incomplete response. Not all predictors of recurrence and mortality are consistent predictors of treatment response which may be equally important in a disease with low mortality but significant morbidity like PTC.

Self-report and urine drug screen concordance among women with co-occurring PTSD and substance use disorders participating in a clinical trial: Impact of drug type and participant characteristics.

BACKGROUND: Self-report measures are important in substance use assessment, yet they are susceptible to reporting errors. Urine drug screens (UDS) are often considered a more valid alternative. However, collecting in-person UDS may not always be feasible, contributing to the need to understand factors that influence the validity of self-reported substance use. METHODS: In this secondary analysis of data from 295 women with co-occurring PTSD and substance use disorders (SUD) who participated in a clinical trial testing behavioral interventions, we examined concordance and discordance between self-reported drug use and associated UDS results. Generalized linear mixed models were used to examine the impact of treatment type and participant characteristics on the associations between self-reported drug use and UDS results. RESULTS: Findings revealed higher disagreement between self-report and UDS for opioids and sedatives (ranging from.77 to.90) and lower disagreement rates for cannabis and cocaine (ranging from.26 to.33). Treatment type was not a significant moderator of the associations between self-report and UDS across all drugs. Among those with a positive opioid UDS, those who reported employment in the past three years were more likely to self-report no opioid use compared to their counterparts without employment in the past three years. CONCLUSIONS: Findings add to the literature that supports the validity of self-reported cannabis and cocaine use. The greater discrepancies between self-report and UDS test results of opioids and sedatives suggest adjunctive UDS may be required, although a variety of factors other than inaccurate self-report may be associated with this discrepancy.

Now is the time to advocate for interventions designed specifically to prevent and control waterpipe tobacco smoking.

Waterpipe tobacco usage is spreading rapidly worldwide, with reports of more youth being waterpipe users compared to adults. In many areas of the world, waterpipe usage surpasses cigarette smoking. Waterpipes and cigarettes are both mechanisms for inhalation of tobacco smoke and therefore have serious health consequences. However, because of the many differences between the two products, prevention and control strategies that have proven effective for cigarettes may not transfer readily to waterpipe. This report highlights the differences between waterpipes and cigarettes in toxicant exposure and physiologic effects, patterns of use, social norms, the extent of evidence, and the policy environment. There is little evidence to date around effective interventions for waterpipe prevention and control. The current state of evidence for intervention to curb or control waterpipe is at ground zero and critically needs attention from both scientists and policy makers. National and global efforts aimed at cigarette prevention have succeeded, particularly in developed countries. We suggest the time has come to harness what we know works for cigarette prevention and control and adapt it to tackle the growing epidemic of waterpipe tobacco use.

Effects of white grubs on soil water infiltration.

Water infiltration rates k were measured in mesocosms with soil and "white grubs" of Ancognatha falsa (Arrow) (Coleoptera: Melolonthidae). Three third instars of A. falsa and three adult earthworms Pontoscolex corethrurus were selected, weighted, and introduced into the mesocosms setting three treatments: soil + A. falsa, soil + P. corethrurus, and control (soil without any macroorganism). The experiment had a completely random design with four replicates per treatment (n = 4). The infiltration rates of soil matrix were assessed in each mesocosms with a minidisk tension infiltrometer. Six measurements were made along the experiment. Results showed that larvae of A. falsa promoted a higher water infiltration in the soil, compared to the control. On day 7, k values were similar among treatments, but k values after 28 days and up to 100 days were much higher in the A. falsa treatment (k = 0.00025 cm s(-1)) if compared to control (k = 0.00011 cm s(-1)) and P. corethrurus (k = 0.00008 cm s(-1)) treatments. The k values were significantly higher in the presence of larvae of A. falsa compared to the control and P. corethrurus treatments. The larvae of A. falsa are potential candidates for new assays on soil water infiltration with different tensions to evaluate the role of pores and holes created by the larvae on soils.

[Efficacy and tolerance of LA 50 mg nicardipine in hypertensive athletes]. / Efficacité et tolérance de la nicardipine LP 50 mg dans l'hypertension artérielle du sportif.

The beneficial effects of physical exercise on the blood pressure are widely recognised. Nevertheless, some athletes remain hypertensive and the treatment of this population makes special demands with respect to treatment efficacy and tolerability, the respect of athletic performance and problems of proscribed substances. For example, the Athletic Boards have prohibited betablockers and diuretics in competitive athletes. The aim of this study was to assess nicardipine LA 50 mg administered twice daily in the special context of hypertensive athletes. Thirty-eight athletes with mild or moderate hypertension undergoing endurance training were included in this double blind trial versus placebo. After two months treatment, the systolic and diastolic blood pressures were significantly lower at rest in the nicardipine than in the placebo group (delta SBP = -18.9 vs -4.1 mmHg, p less than 0.001; delta DBP = -15.7 vs -4.1 mmHg, p less than 0.01). In addition the maximum SBP on effort was significantly lower in the nicardipine group (200 vs 215 mmHg, p less than 0.05). On the other hand, no difference was observed between the two groups as regards the maximum oxygen consumption (delta VO2 max = 6.2 vs -0.4 ml/min/kg, NS) and duration of effort (13.75 vs 12.32 min, NS), showing that athletic performance was unchanged in the group treated by nicardipine LA. These results suggest that treatment with nicardipine LA fulfills the special criteria of hypertensive athletes.

[Digestive disorders and self medication observed during a competition in endurance athletes. Prospective epidemiological study during a championship of triathlon]. / Troubles digestifs et automédication constatés en compétition chez les sportifs d'endurance. Enquête epidémiologique prospective sur une saison sportive de triathlon.

Gastro-intestinal disorders were described during long lasting exercise. However, no systematic evaluation was done before the study of the French Medical Society of Triathlon, which realized an epidemiologic analysis during the French triathlon championship in 1989. The aims of this study were to evaluate the prevalence and the nature of different gastro-intestinal symptoms, to precise the severity and the consequences of these disorders, and to evaluate the self-medication. This study concern 25,640 competitors of the 101 meetings of the French triathlon championship 1989 (75 category A, 19 category B and 7 category C). Two thousand two hundred and seventy four competitors had gastric symptoms like nausea, epigastgric pain or vomiting (8.9%); 2,046 competitors had intestinal troubles like diarrhea or abdominal pain (8%). These results confirm the suffering of the gastro-intestinal tract during a long lasting exercise like a triathlon. These disorders are well known, so self-medication was used for gastric symptoms (0.7%) or intestinal disturbances (18.2%).

[The short-term effects of air pollution on mortality. The results of the EMECAM project in Vitoria-Gasteiz, 1990-94. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad. Resultados del proyecto EMECAM en Vitoria-Gasteiz, 1990-94.

BACKGROUND: The objective of this article is that of assessing the short-term relationship between the black smoke (SM) and SO2 levels and the mortality in Vitoria-Gasteiz over a five-year period by means of employing the procedure for analysis standardized in the EMECAM Project. METHODS: Ecological time series study aimed at estimating the relationship between the daily fluctuations in the mortality (total mortality of all ages and total death rate for those over age 70) and air pollution (sulfur dioxide-SO2 and black smoke), employing the Poisson regression models. The EMECAM methodology was followed. RESULTS: The median of daily deaths was three for the entire population and two for the elderly. The mean black smoke level was 51.15 micrograms/m3 and that of SO2 18.04 micrograms/m3. A statistically significant relationship was found to exist between black smoke and the mortality for the elderly through the cold half of the year, with an RR of 1.014 (CI95%: 1.002-1.026), pertinent to a 10 micrograms/m3 rise in the pollutant. A threshold at 80-90 micrograms/m3 seemed to be detected for black smoke. The relationship with SO2 was not significant. CONCLUSIONS: The black smoke levels for the period studied are related to a rise in the mortality among the elderly, tallying with the results of other studies.

[The EMECAM protocol: an analysis of the short-term effect of air pollution on mortality. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica u la Mortalidad]. / Protocolo EMECAM: análisis del effecto a corto plazo de la contaminacion atmosférica sobre la mortalidad.

The aim of this study is to Mortality show the protocol of analysis which was set out as part of the EMECAM Project, illustrating the application thereof to the effect of pollution has on the mortality in the city of Valencia. The response variables considered will be the daily deaths rate resulting from all causes, except external ones. The explicative variables are the daily series of different pollutants (black smoke, SO2, NO2, CO, O3). As possible confusion variables, weather factors, structural factors and weekly cases of flu are taken into account. A Poisson regression model is built up for each one of the four deaths series in two stages. In the first stage, a baseline model is fitted using the possible confusion variables. In the second stage, the pollution variables or the time legs thereof are included, controlling the residual autocorrelation by including mortality time lags. The process of fitting the baseline model is as follows: 1) Include the significant sinusoidal terms up to the sixth order. 2) Include the significant temperature or temperature squared terms with the time lags thereof up to the 7th order. 3) Repeat this process with the relative humidity. 4) Add in the significant terms of calendar years, daily tendency and tendency squared. 5) The days of the week as dummy variables are always included in the model. 6) Include the holidays and the significant time lags of up to two weeks of flu. Following the reassessment of the model, each one of the pollutants and the time lags thereof up to the fifth order are proven out. The impact is analyzed by six-month periods, including interaction terms.

Maternal administration of glucocorticoid and thyrotropin-releasing hormone enhances fetal lung maturation in undisturbed preterm lambs.

OBJECTIVE: We hypothesized that combined treatment with glucocorticoid plus thyrotropin-releasing hormone administered to pregnant ewes with preterm gestation accelerates fetal lung maturation of undisturbed lambs better than single hormonal treatment does. STUDY DESIGN: Twenty-five pregnant ewes at 123 days of gestation were randomized to receive (1) 0.9% sodium chloride (controls), (2) betamethasone (12 mg intramuscularly every 24 hours two times), (3) thyrotropin-releasing hormone (400 micrograms intravenously every 8 hours six times), or (4) thyrotropin-releasing hormone plus betamethasone. After delivery by cesarean section at 125 days fetal lamb lung compliance and alveolar lavage phospholipid content were determined. RESULTS: Betamethasone plus thyrotropin-releasing hormone significantly increased fetal lung compliance expressed as milliliters of air per gram of wet weight at 40 cm H2O and 5 cm H2O (0.82 +/- 0.13 and 0.35 +/- 0.10 ml/gm wet lung, respectively) versus betamethasone (0.37 +/- 0.02 and 0.07 +/- 0.02), thyrotropin-releasing hormone (0.38 +/- 0.02 and 0.14 +/- 0.03), and control (0.25 +/- 0.03 and 0.09 +/- 0.01) groups. Also, total phospholipids and saturated phosphatidylcholine concentrations in alveolar lavage were significantly higher in the combined betamethasone plus thyrotropin-releasing hormone group (27.3 +/- 4.9 and 16.9 +/- 4.3 micrograms/gm wet lung, respectively) versus betamethasone (10.9 +/- 3.5 and 6.7 +/- 2.1), thyrotropin-releasing hormone (15.2 +/- 5.6 and 7.3 +/- 2.0), and control (7.9 +/- 2.4 and 3.6 +/- 1.0) groups. CONCLUSION: Combined maternal administration of betamethasone plus thyrotropin-releasing hormone improves lung maturation in undisturbed fetal lambs at 125 days' gestation more than does either hormone given alone.