Erythropoietin treatment is associated with a reduction in moderate to severe bronchopulmonary dysplasia in preterm infants. A regional retrospective study.

Erythropoietin treatment is associated with a reduction in moderate to severe bronchopulmonary dysplasia in preterm infants. A regional retrospective study. OBJECTIVE: To determine whether premature infants treated with erythropoietin (Epo) in the neonatal period for anemia had a lower incidence of bronchopulmonary dysplasia (BPD), defined as oxygen need at 36 weeks postmenstrual age, and lower rehospitalization rates in the first year of life than infants not exposed. METHODS: Retrospective study of a population of infants born at 23 to 32 weeks gestational age, between January 2009 and December 2014, with birthweight ≤1500 g. Patient characteristics, and risk factors for BPD were compared between patients who received erythropoietin, and those not exposed. To examine the association between the outcomes of BPD at 36 weeks PMA, rehospitalization, and erythropoietin treatment, we performed a propensity score (PS) analysis using inverse probability of treatment weighted (IPTW) approach. For comparison, we conducted a logistic regression adjusting for the same covariates used to generate PS using the original population. RESULTS: The study population included 1821 preterm infants: 928 received Epo and 893 did not. Epo treatment was associated with a reduction in BPD (18.8% versus 25.9%, p < 0.01) at 36 weeks PMA and reduced median length of stay with lowest BPD rate with Epo initiation before 2 weeks of age. There was no difference in rehospitalization rates in the first year of life. CONCLUSION: Erythropoietin treatment was associated with a reduction in BPD but not in rehospitalization rate in the first year of life.

Correlates and prevalence of menthol cigarette use among adults with serious mental illness.

INTRODUCTION: With a focus on protecting vulnerable groups from initiating and continuing tobacco use, the FDA has been considering the regulation of menthol in cigarettes. Using a large sample of adult smokers with serious mental illness (SMI) in the San Francisco Bay Area, we examined demographic and clinical correlates of menthol use, and we compared the prevalence of menthol use among our study participants to that of adult smokers in the general population in California. METHODS: Adult smokers with SMI (N = 1,042) were recruited from 7 acute inpatient psychiatric units in the San Francisco Bay Area. Demographic, tobacco, and clinical correlates of menthol use were examined with bivariate and multivariate logistic regression analyses, and prevalence of menthol use was compared within racial/ethnic groups to California population estimates from the 2008-2011 National Survey on Drug Use and Health. RESULTS: A sample majority (57%) reported smoking menthol cigarettes. Multivariate logistic regression analyses indicated that adult smokers with SMI who were younger, who had racial/ethnic minority status, who had fewer perceived interpersonal problems, and who had greater psychotic symptoms also had a significantly greater likelihood of menthol use. Smokers with SMI had a higher prevalence of menthol use relative to the general population in California overall (24%). CONCLUSIONS: Individuals with SMI-particularly those who are younger, have racial/ethnic minority status, and have been diagnosed with a psychotic disorder-are vulnerable to menthol cigarette use. FDA regulation of menthol may prevent initiation and may encourage cessation among smokers with SMI.

Maximizing retention with high risk participants in a clinical trial.

PURPOSE: To describe effective retention strategies in a clinical trial with a high risk, low-income, and vulnerable patient population with serious mental illness. DESIGN: Follow-up assessments were conducted for a randomized clinical tobacco treatment trial at 3, 6, and 12 months postbaseline. Initial follow-up rates of <40% at 3 months led to implementation of proactive retention strategies including obtaining extensive contact information; building relationships with case managers and social workers; contacting jails and prisons; text messaging, e-mailing, and messaging via social networking sites; identifying appointments via electronic medical record; and field outreach to treatment facilities, residences, and parks. SETTING: Large urban public hospital. SUBJECTS: Participants were current smokers recruited from 100% smoke-free locked psychiatry units. MEASURES: Assessments covered demographics, substance use, and mental health functioning. ANALYSIS: Retention rates were plotted over time in relation to key retention strategies. Chi-square and t-tests were used to examine participant predictors of retention at each follow-up. At the 12-month follow-up, the retention strategies that most frequently led to assessment completion were identified. RESULTS: The sample (N = 100) was 65% male; age x = 39.5 years (SD = 11.3); 44% non-Hispanic white; 46% on Medicaid and 34% uninsured; 79% unemployed; and 48% unstably housed. Proactive retention strategies dramatically increased follow-up rates, concluding at 3 months = 82.65%, 6 months = 89.69%, and 12 months = 92.78%. Married and divorced/separated/widowed participants, those with higher income, and participants with alcohol or illicit drug problems had increased retention from 3- to 12-month follow-up. CONCLUSION: Follow-up rates improved as proactive methods to contact participants were implemented. Dedicated research staff, multiple methods, community networking, and outreach within drug treatment settings improved retention.

Clinical management of tobacco dependence in inpatient psychiatry: provider practices and patient utilization.

OBJECTIVE: This investigation examined predictors of utilization of nicotine replacement therapy (NRT) during a smoke-free psychiatric hospitalization. METHODS: Smokers (N=324) were recruited from smoke-free adult inpatient psychiatric units. Exploratory analyses examined correlates of NRT provision and utilization. RESULTS: The prevalence of NRT use was 51% overall and was greater among patients offered NRT on admission (58%) versus later (34%), among patients with more severe depression and nicotine withdrawal, and among those who reported perceptions that NRT decreases nicotine withdrawal, provides a nicotine substitute, and helps with quitting smoking (p<.05, all comparisons). Although the ratio of nicotine patch dose to usual cigarettes per day was 1.2±.7, the ratio was negatively correlated with time to first cigarette (Spearman's ρ=-.30, p<.01), suggesting potential underdosing of more dependent smokers. CONCLUSIONS: During smoke-free psychiatric hospitalizations, clinical management of nicotine withdrawal may be enhanced by offering patients NRT directly on admission, educating patients on the benefits of NRT, and increasing the dosage for more dependent smokers.

Twitter=quitter? An analysis of Twitter quit smoking social networks.

OBJECTIVE: Widely popular, Twitter, a free social networking and micro-blogging service, offers potential for health promotion. This study examined the activity of Twitter quit smoking social network accounts. DESIGN: A cross-sectional analysis identified 153 activated Twitter quit smoking accounts dating back to 2007 and examined recent account activity for the month of August 2010. RESULTS: The accounts had a median of 155 followers and 82 total tweets per account; 49% of accounts had >100 tweets. Posted content was largely inconsistent with clinical guidelines; 48% linked to commercial sites for quitting smoking and 43% had tweets on e-cigarettes. In August 2010, 81 of the accounts (53%) were still active. CONCLUSIONS: Though popular for building quit smoking social networks, many of the Twitter accounts were no longer active, and tweet content was largely inconsistent with clinical guidelines. Future research is needed to examine the effectiveness of Twitter for supporting smoking cessation.