You can't pay me to quit: the failure of financial incentives for smoking cessation in head and neck cancer patients.

OBJECTIVE: A prospective randomised study was conducted at a tertiary care hospital to evaluate the effects of financial incentives for smoking cessation targeted at a high-risk population. METHODS: Patients with a past history of head and neck cancer were voluntarily enrolled over a two-year period. They were randomised to a cash incentives or no incentive group. Subjects were offered enrolment in smoking cessation courses. Smoking by-product levels were assessed at 30 days, 3 months and 6 months. Subjects in the incentive group received $150 if smoking cessation was confirmed. RESULTS: Over 2 years, 114 patients with an established diagnosis of head and neck cancer were offered enrolment. Twenty-four enrolled and 14 attended the smoking cessation classes. Only two successfully quit smoking at six months. Both these patients were in the financially incentivised group and received $150 at each test visit. CONCLUSION: Providing a financial incentive for smoking cessation to a population already carrying a diagnosis of head and neck cancer in order to promote a positive behaviour change was unsuccessful.

Value of an active surveillance policy to document clearance of meticillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci amongst inpatients with prolonged admissions.

This article reports the impact of an active surveillance policy to identify clearance of meticillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) in known colonized inpatients with prolonged admissions in order to discontinue isolation precautions. Amongst 365 colonized patients with hospital admissions exceeding 30 days, clearance rates of 11% for MRSA and 18% for VRE were found after a median of 23 days and 26.5 days, respectively, resulting in a saving of 2152 patient-days of contact precautions over one year. This has proven to be a cost-beneficial policy.

The Cold Weather Plan evaluation: an example of pragmatic evidence-based policy making?

OBJECTIVES: An evaluation of the Cold Weather Plan (CWP) for England 2011-2012 was undertaken in April 2012 to generate the basis for further revisions. It is widely considered good practice to formulate and revise policy on the basis of the best available evidence. This paper examines whether the evaluation is an example of pragmatic evidence-based policy-making. STUDY DESIGN: A process evaluation with a formative multimethods approach. METHODS: An electronic survey and national workshop were conducted alongside the production of a number of summary reports from the Health Protection Agency surveillance systems and Met Office meteorological data. The Department of Health and the Met Office were consulted on how the evaluation recommendations shaped the revised CWP and Met Office Cold Weather Alerting System respectively. RESULTS: The Cold Weather Plan survey had 442 responses, a majority from Local Authorities, and from all regions of England. Thematic analysis generated qualitative data, which along with feedback from the workshop were synthesized into six main recommendations. Reviewing the new CWP and the Met Office Cold Weather Alerting System revealed significant modifications on the basis of the evaluation. CONCLUSIONS: The evaluation sets the context for cold weather and health during the 2011-2012 winter. This study shows that the CWP 2012-2013 was revised on the basis of the national evaluation recommendations and is an example of pragmatic evidence-based policy-making.

Assessing the cost-effectiveness of finding cases of hepatitis C infection in UK migrant populations and the value of further research.

Hepatitis C (HCV) infection can cause cirrhosis, liver cancer and death in the absence of treatment. Many people living in the UK but born overseas are believed to be infected with HCV although many are unlikely to know they are infected. The aim of this study is to assess the potential for a case-finding approach to be cost-effective and to estimate the value of further research. An economic evaluation and value of information analysis was undertaken by developing a model of HCV disease progression and by populating it with evidence from the published literature. They were performed from a UK National Health Services cost perspective, and outcomes were expressed in terms of quality-adjusted life-years (QALYs). The comparator intervention was defined as the background rate of testing (i.e. no intervention). The base case results generated an incremental cost-effectiveness ratio (ICER) of about £23,200 per additional QALY. However, the ICER was shown to be particularly sensitive to HCV seroprevalence, the intervention effect / cost and the probability of treatment uptake. The value of information analysis suggested that approximately £4 million should be spent on further research. This evaluation demonstrates that testing UK migrants for HCV could be cost-effective. However, further research, particularly to refine estimates of the probability of treatment uptake once identified, the utility associated with sustained virological response and the cost of the intervention, would help to increase the robustness of this conclusion.

Diversity in auxology: between theory and practice. Proceedings of the 18th Aschauer Soiree, 13th November 2010.

Auxology has developed from mere describing child and adolescent growth into a vivid and interdisciplinary research area encompassing human biologists, physicians, social scientists, economists and biostatisticians. The meeting illustrated the diversity in auxology, with the various social, medical, biological and biostatistical aspects in studies on child growth and development.

Growth variation, final height and secular trend. Proceedings of the 17th Aschauer Soiree, 7th November 2009.

Growth and body height have always been topics interesting to the public. In particular, the stupendous increase of some 15-19cm in final adult height during the last 150 years in most European countries (the "secular trend"), the concomitant changes in body and head proportions, the tendency towards early onset of sexual maturation, the changes in the age when final height is being reached, and the very recent trend in body mass index, have generated much scientific literature. The marked plasticity of growth in height and weight over time causes problems. Child growth references differ between nations, they tend to quickly become out of date, and raise a number of questions regarding fitting methods, effects caused by selective drop-out, etc. New findings contradict common beliefs about the primary importance of nutritional and health related factors for secular changes in growth. There appears to be a broad age span from mid-childhood to early adolescence that is characterised by a peculiar insusceptibility. Environmental factors that are known to influence growth during this age span appear to have only little or no impact on final height. Major re-arrangements in height occur at an age when puberty has almost been completed and final height has almost been reached, implying that factors, which drive the secular trend in height, are limited to early childhood and late adolescence.

Competency in laparoscopic colorectal surgery is achievable with appropriate training but takes time: a comparison of 300 elective resections with anastomosis.

AIM: The aim of this retrospective cohort study was to compare outcomes in patients who underwent elective laparoscopic colorectal resection with anastomosis performed by a single surgeon or his training fellow. METHOD: A prospective electronic database of all laparoscopic procedures between January 2005 and September 2008 was used. Two groups were compared; those patients operated upon by the Consultant trainer (C) and those by seven supervised Fellows (F). Fellows were either post CCT or in their last year of training. Three hundred consecutive patients undergoing laparoscopic colorectal resection with anastomosis were examined, 150 in each group. Groups were matched for indication, age, American Society of Anesthesiology (ASA) grade, cancer T stage and resection performed. Preoperative work-up, operative surgery and anaesthesia were identical between groups. RESULTS: No significant difference was demonstrated in age, mean 67 (26-91) or ASA grade. Indications for surgery were; cancer (C) 120, (F) 126, diverticular disease (C) 22, (F) 20, Crohn's disease (C) 8, (F) 7. Fellow's mean operative time was significantly longer at 123 min (95%CI 117-134) compared to the consultant trainer -105 min. (95%CI 98-111): P < 0.01). No significant differences in the complication or conversion rates were demonstrated. Length of stay and the 30-day readmission rates were similar. CONCLUSION: In this retrospective cohort study we have demonstrate that when matched patients are compared, supervised trainee operating time is significantly longer than that of the consultant trainer but without any significant increase in length of stay, complication or readmission rates. Training to a level of competency takes time but not at the expense of patient care.

Assessment of some pulmonary parameters and cardiorespiratory fitness status in Nepalese medical students.

Some pulmonary function tests along with cardio respiratory fitness test were performed to assess the health status of the young (19-21 years) non-smokers Nepalese medical students. Results revealed that the vital capacity was 3.46 liters and 2.40 liters among the boys and girls respectively. PEFR was found to be 597.98 l/min among the boys and 456.53 l/min among the girls. Likewise, VO2 max among the boys and girls were 54.32 ml/kg/min and 44.88 ml/kg/min respectively. It was evident from the result that the health status of the Nepalese medical students ill the present study group was fairly well. It might be due to their health awareness, balanced-nutritious diet and the habits of occasional physical exercise.

Explaining body composition by some covariate factors among the elderly Bengalee Hindu women of Calcutta, India.

Understanding the changes in body composition with passage of time and factors associated with them will help to improve our knowledge and understanding about these processes and could guide in the prevention of functional limitations and formulation of better health care among the elderly. The present cross-sectional work was under taken to study the effect of age, menopause, age at first conception, educational level and physical activity in explaining body composition among 200 elderly (55 years and above) Bengalee Hindu women of Calcutta, India. Body composition measures namely percentage of body fat (PBF), fat mass index (FMI), and fat free mass index (FFMI) were calculated from skinfolds thickness using standard equations. Multiple regression analyses of body composition variables by covariate factors revealed that Age, age of onset of menopause, age at first conception, educational level and frequency of walking cumulative explains 35%, 28% and 21% of PBF, FMI and FFMI respectively. Present study revealed that beside age, both biosocial (age of onset of menopause, age at first conception, education level) and physical activity as measured by brisk walking have significant contribution in explaining body composition among elderly females. Significant negative impact of physical activity on PBF, FMI and positive impact on FFMI in the present study were also evident. Therefore, brisk walking could be useful to increase body's fat free mass.

Opportunistic screening for genital chlamydial infection. II: prevalence among healthcare attenders, outcome, and evaluation of positive cases.

OBJECTIVES: To determine the prevalence and treatment outcomes among young women screened opportunistically for genital Chlamydia trachomatis and to evaluate the impact of screening in those participating. DESIGN: An opportunistic screening programme (1 September 1999 to 31 August 2000) using urine samples, tested by ligase chain reaction (LCR). In-depth interviews were used for programme evaluation. SETTING: Screening was offered in two health authorities at general practice, family planning, genitourinary medicine (GUM), adolescent sexual health, termination of pregnancy clinics and women's services in hospitals (antenatal, colposcopy, gynaecology and infertility clinics). Main participants: Sexually active women (16-24 years) attending for any reason. MAIN OUTCOME MEASURES: Screening data: prevalence of infection by age and healthcare setting; proportion of positive patients attending for treatment. Evaluation data: participants' attitudes and views towards screening and follow up. RESULTS: In total, 16 930 women (16-24 years) were screened. Prevalence was higher in younger women (16-20) than those aged 21-24 years and was highly variable at different healthcare settings (range 3.4%-17.6%). Prevalence was approximately 9% in general practice. The role of the project health advisers in managing results and coordinating treatment of positive individuals was essential; the vast majority of all positives were known to be treated. Women felt that screening was beneficial. Improving awareness and education about sexually transmitted infections is required to alleviate negative reactions associated with testing positive for infection. CONCLUSIONS: Prevalence of infection outside GUM clinics is substantial and opportunistic screening using urine samples is an acceptable method of reaching individuals with infection who do not normally present at specialist clinics.

An economised craniofacial identification system.

It has been attempted to develop an economised craniofacial identification system, as a special automated version of photo/video superimposition technique, that can deal with common cases of personal identification with the aid of a skull and a nearly front view face photograph of the suspected victim. The proposed method is economic in respect of (i) cost of hardware configuration, (ii) processing time as well as (iii) manual labour involved. Over and above, it has got a capability to take care of ambiguities due to soft tissue thickness during the selection of facial features, which is a part of the procedure. In order to reconstruct a 2-D cranial image, superimposable over the facial one, the new method does not need any reconstruction of a digitised 3-D cranial image. It works simply by a suitable segment-wise processing of a 2-D cranial image with the aid of the symmetry perceiving adaptive neuronet (SPAN), that has recently been introduced in connection with nearly front view facial image recognition. The final comparison of the facial and the superimposable cranial images is as versatile as the same for facial image recognition by SPAN.A practical application of this extended version of SPAN has been demonstrated in the present paper.

Cervical cancer outcomes analysis: impact of age, race, and comorbid illness on hospitalizations for invasive carcinoma of the cervix.

OBJECTIVE: The aim of this study was to evaluate the association of age, race, and comorbid illness with procedures and complications in hospitalized patients with invasive carcinoma of the cervix in a statewide population-based database over a 3-year period. METHODS: Hospitalizations were classified into homogeneous subgroups based on a diagnosis of invasive cervical cancer. Cancer-related complications and comorbid diseases were evaluated. chi(2) and t tests determined differences in means or proportions. Linear regression techniques were applied to build models for hospitalization charges and lengths of stay (LOS). RESULTS: There were 1009 admissions. The mean age was 49.5, with a median age of 46 (21-100, SD 15.4). Of the total, 606/1009 (60%) were white, 354/1009 (35%) were African-American (AA), and 5% were "other" races. AAs were more likely to have Medicaid or be uninsured (44% vs 23%, P = 0. 001) and were more likely to be admitted for an emergency (unadjusted odds ratio (OR) = 1.6; 1.2-2.2), to have a comorbid illness (P = 0.001), to be admitted for a cancer-related complication (P = 0.036), to be admitted for a transfusion (P = 0. 01), and to be admitted for radiation therapy rather than surgery (P = 0.001). The following were associated with LOS and higher hospital costs: emergency admissions for complications of cancer, comorbid illness, and older age. CONCLUSIONS: Racial differences exist in patterns of admission, type of therapy, and severity of illness; however, there were no differences in charges or LOS for similar procedures. The large percentage of African-Americans uninsured or insured by government-supported programs indicates the potential impact of public policy on the care of these patients. Socioeconomic status rather than phenotypic appearance may be a more important determinant of outcome.

Domestic burns prevention and first aid awareness in and around Jamshedpur, India: strategies and impact.

This article highlights the strategy for awareness creation regarding burns prevention and first aid and its impact in and around the steel-producing city of Jamshedpur, India. This is a joint venture of the Burns Centre and the Medico Social Welfare Unit of the Tata Main Hospital, Jamshedpur in collaboration with the Social Service Division of Tata Steel and city schools. The first phase of 5 years has been devoted to general awareness building in the population through two main programmes, namely "Community Awareness Programmes" for the target group of ladies and teenage girls and "School Education Programmes" for the target group of school children of Standard 8 in the steel-producing city. These programmes include audio-visual presentations as well as face to face interactions regarding structure and arrangements in the kitchen, floor level cooking, clothing while cooking, careful use of electrical appliances, pressure stoves, etc. The discussions also include suicidal and homicidal burns prevention strategies. Various competitions for the target group provide feedback on programmes. The growing awareness about burns prevention among school children and community members, and steady increase in the number of patients who use water as first aid, speak about the success of the strategies.

Comparison of anthropometric characteristics between normotensive and hypertensive individuals among a population of Bengalee Hindu elderly men in Calcutta, India.

A comparative investigation of 99 normotensive and 111 hypertensive Bengalee Hindu elderly men (aged 55 years and above) of Kalighat, South Calcutta, India, was undertaken to study differences in levels of adiposity, body fat distribution and body composition between these two groups. Results revealed that there were significant differences between normotensive (NT) and hypertensive (HT) subjects in the mean values for weight (p < 0.05), body mass index (BMI, p < 0.01); waist (p < 0.001) and hip circumferences (p < 0.05); waist-hip ratio (WHR, p < 0.001), conicity index (CI, p < 0.01) and fat free mass (FFM, p < 0.001). Percentile distributions for all these variables and indices showed consistently higher values among the HT patients as compared with NT subjects. However, the frequency of obesity (BMI > or = 25) was similar (NT = 6.1%, HT = 11.7%) in both groups. Thus, these results indicated that there existed significant differences in central adiposity and FFM between NT and HT subjects although their level of obesity was similar. Hypertensive individuals have significantly enhanced levels of central body fat distribution.

Construction of a recombinant live oral vaccine from a non-toxigenic strain of Vibrio cholerae O1 serotype inaba biotype E1 Tor and assessment of its reactogenicity and immunogenicity in the rabbit model.

The disease cholera is an important cause of mortality in many developing countries. Though it can be controlled through improved sanitation, this goal is not easily attainable in many countries. Development of an efficacious vaccine offers the best immediate solution. A new oral candidate vaccine has been constructed from a non-toxigenic strain of Vibrio cholerae E1 Tor, Inaba, which is not only devoid of the cholera toxin (CT) virulence cassette but also is completely non-reactogenic in rabbit ileal loop assay. The strain, however, had toxR and tcpA genes. Through a series of manipulations, the ctxB gene of V. cholerae, responsible for the production of the 'B' subunit of the cholera toxin (CTB) was introduced into the cryptic hemolysin locus of the strain. The resulting strain, named vaccine attempt 1.3 (VA1.3), was found to be able to produce copious amounts of CTB. In the RITARD model this strain was found to be non-reactogenic and provided full protection against the challenge doses of both V. cholerae O1, classical and E1 Tor. In the immunized rabbit it invoked significant levels of anti-bacterial and anti-toxin immunity.

Developments in liquid membrane separation of beta-lactam antibiotics.

This paper presents an overview on the developments in liquid membrane separation and purification of commercially important beta-lactam antibiotics. Reactive extraction via liquid-liquid ion exchange or ion-pair extraction mechanism can be exploited to develop liquid membrane processes for separation and concentration of penicillins and cephalosporins. Because of high selectivity and flux, liquid membrane processes can be adopted for direct extraction of beta-lactams from fermentation broth. Other advantages of liquid membrane technologies are low capital and operating costs, compact unit installation in commercial plants, low material inventory, etc. Both emulsion liquid membrane and supported liquid membrane techniques can be effective under the reactive extraction conditions. However, the stability problems of liquid membrane should be resolved before commercial application can be established. Alternately, reactive extraction in non-dispersive mode with hollow fiber membranes can be an attractive and viable strategy for practical application. Applicability of the liquid membrane processes has been discussed from process engineering and design considerations.

Smoking habits and respiratory symptoms: observations among college students and professionals.

The study comprising smoking habits among educationally and socially forward class, its impact on respiratory system and response of the said class of people to a questionnaire was undertaken among a random sample of 1188 subjects consisting of students and professionals aged between 15 and 65 years. Results showed that smoking habit was alarmingly high (48.8%) among the students and a little higher (53%) among the professionals. The exact nature and extent of the problem of smoking was not very much clear to all the subjects.

Maternal mortality in Hong Kong 1961-1985.

The maternal mortality rate in Hong Kong fell from 0.45/1000 total births in 1961 to 0.05/1000 total births in 1985. During the period between 1961 and 1985 there were a total of 438 maternal deaths and 2,193,012 births. Of the 438 deaths 150 (34%) were due to haemorrhage during pregnancy and childbirth (ICD 640, 641, 666), 89 (20%) were due to pre-eclampsia (ICD 642, 643) and 60 (13.7%) were due to ectopic pregnancy (ICD 633). Comparison of maternal deaths by cause between the periods 1961-1965 and 1981-1985 showed an 86% reduction in deaths due to haemorrhage and pre-eclampsia and a 72% reduction in deaths due to ectopic pregnancy. Pulmonary embolism was not a major cause of maternal mortality.

PIP: Maternal mortality, i.e., death during pregnancy or within 42 days of an abortion or delivery, has declined in Hong Kong from .45/1000 births in 1961 to .05/1000 births in 1985. 68% of all maternal deaths during this period were due to hemorrhage (34%), pre-eclampsia (20%), and ectopic pregnancy (14%). The number of legal abortions, on the other hand, increased from 184 in 1973 to 15,411 in 1985, but no maternal deaths were associated with legal abortion. The major cause of the declining maternal mortality is a decline in known risk factors. High parity is associated with maternal mortality, and parity in Hong Kong has steadily decreased. Another risk factor is maternal age. Births to women over 35 constituted 16.2% of total births between 1962 and 1970 but only 8.6% of the total between 1971 and 1985. Adverse living conditions due to poverty are another high risk factor. Between 1966 and 1985, the gross domestic product rose 14-fold, and the maternal mortality rate dropped 9-fold. Other factors are the fact that all deliveries occur in institutions, and adequate prenatal care is available, as are transfusions and oxytocics. Pulmonary embolism and sepsis, which cause many maternal deaths in developing countries, are rare in Hong Kong.