Application of the ConNECT Framework to achieve digital health equity.

BACKGROUND: The emphasis on digital technology and informatics in health care (digital health) has introduced innovative ways to deliver health care and engage populations in health research. However, inadequate attention to the development and implementation of digital health interventions can exacerbate health disparities. PURPOSE: We applied the transdisciplinary ConNECT Framework principles within the context of digital health, with an aim to describe strategies to achieve digital health equity. METHODS: We described the five ConNECT principles of (a) integrating context, (b) fostering a norm of inclusion, (c) ensuring equitable diffusion of innovations, (d) harnessing communication technology, and (e) prioritizing specialized training within the framework of achieving digital health equity. FINDINGS AND DISCUSSION: We describe proactive, actionable strategies for the systematic application of the ConNECT Framework principles to address digital health equity. Recommendations to reduce the digital health divide in nursing research and practice are also described.

Assessment of plaque control efficacy using two types of toothbrushes in young adults: An interventional crossover study.

OBJECTIVE: Evaluation of plaque removal efficacy of short-headed toothbrush as compared to conventional/traditional toothbrush. METHOD: A total of 20 subjects meeting the inclusion criteria were considered. Selected subjects were divided into test and control groups. Initially, subjects were advised to refrain from brushing teeth for 24 h, to determine the plaque index (PI) and gingival index (GI) at the baseline. Further, crossover observation between the groups was recorded based on short-headed toothbrush (Curaprox CS 5460) and traditional brushes (ultrasoft). Finally, a questionnaire survey was conducted to gather preferences and experiences of each subject. RESULTS: In terms of plaque removal, the short-headed toothbrush and the conventional toothbrush demonstrated comparable results. In terms of PI and GI, the intergroup comparison revealed no significant differences (p = 0.878). Individual acceptability of the short-headed toothbrush was shown to be higher in the questionnaire survey. CONCLUSION: It was observed that both toothbrushes showed similar efficacy. However, the subjects preferred short-headed toothbrush. CLINICAL RELEVANCE: Short-headed toothbrushes comprising a higher number of bristles can be recommended in terms of better oral hygiene.

A framework for addressing health inequities in sexual and gender diverse populations by nurses.

There is a need to increase health equity in sexual and gender diverse (SGD) populations, a medically underserved group with widening health disparities. To better understand and address SGD health disparities, we have developed a multi-level conceptual framework for nurse scientists that incorporates the concepts of stigma, intersectionality, identify affirmation, and life course trajectory. Social determinants of health formed the background of our conceptual framework. Using this framework, we proposed recommendations to promote SGD health equity through nursing research, health care practice, health care education, and public health care policy. These recommendations align with the National Institute of Nursing Research's goals of dismantling structures that perpetuate racism and impede health inequity and the need to implement interventions that address social determinants of health. As a result, nurse scientists are poised to influence health care policy by translating effective interventions to reduce health disparities for the SGD population into practice.

Results of a Feasibility Study of Helpers Stay Quit Training for Smoking Relapse Prevention.

INTRODUCTION: Most smoking quit attempts end in relapse, and interventions focused on relapse prevention are lacking. Helpers Stay Quit (HSQ) is a novel behavioral relapse prevention intervention that teaches newly abstinent smokers to offer a "helping conversation" (HC) to help others quit tobacco. METHODS: Pre-post intervention feasibility study with state quitline participants ≥14 days abstinent. Measures at baseline, 3 months, and 6 months included smoking status, offering HCs, and cessation self-efficacy. Primary outcomes: self-reported 7-day point prevalence abstinence; offering HCs. Cox models explored association of HCs with relapse. Preliminary effects analysis using propensity score matching compared 30-day abstinence of quitline clients with study sample at 7 months. RESULTS: Participants (N = 104) were as follows: mean age of 53 years (SD 13.9 years), 48.1% male, mean of cigarettes smoked/day of 16.2 (SD 9.7). Compared with participants who remained abstinent (n = 82), relapsers (n = 22) had fewer HCs over 6 months (2.6 vs 7.2; 95% confidence interval [CI]: 1.4, 7.8, p = .006). Using adjusted Cox regression, the hazard ratio of relapse for each HC was 0.85 (95% CI: 0.74, 0.99, p = .03). Compared with a matched sample of quitline clients not exposed to HSQ, study participants were 49% more likely to report 30-day abstinence at 7-month quitline follow-up (95% CI: 40%, 59%, p < .0001). CONCLUSIONS: HSQ, delivered to newly abstinent smokers who received standard quitline treatment, was associated with less self-reported relapse. These promising preliminary study results warrant further research to evaluate HSQ as a novel behavioral intervention to prevent smoking relapse. IMPLICATIONS: To date, behavioral interventions for smoking relapse prevention that teach abstainers cessation skills to apply to themselves have not shown effectiveness. This feasibility study examines the preliminary efficacy of a conceptually novel, "help others" behavioral intervention approach for relapse prevention in newly abstinent smokers recruited from a state quitline. HSQ teaches the newly abstinent smoker communication and listening skills to encourage other smokers in their personal social network to quit. Exploratory analysis using propensity score matching suggests that participants exposed to HSQ were significantly more likely to self-report 30-day abstinence at quitline 7-month follow-up than other quitline clients.

Predictors of Tobacco Cessation Among American Indian/Alaska Native Adults Enrolled in a State Quitline.

Background: High rates of smoking are documented among some American Indian and Alaska Native (AI/AN) communities, with potential variability by region and urban/rural settings. Quitlines are a cost-effective strategy for providing evidence-based cessation treatment, but little is known about the effectiveness of quitline services for the AI/AN population. Objectives: This study compared demographic characteristics, tobacco use, and cessation and program utilization behaviors between AI/AN (n = 297) and Non-Hispanic White (NHW; n = 13,497) quitline callers. The study also identified predictors of 30-day cessation at 7-month follow-up among AI/AN callers and determined if predictors were different between AI/AN and NHW callers. Methods: Data from callers to the Arizona Smokers' Helpline between January 2011 and June 2016 were analyzed. Results: At enrollment, AI/AN callers were less likely to use tobacco daily and were less dependent on nicotine compared to NHW callers. Both groups reported similar rates of 30-day cessation at 7-month follow-up (37.3% and 39.7% for AI/AN and NHW callers, respectively). For AI/AN callers, 30-day cessation was significantly associated with tobacco cessation medication use (OR = 2.24, 95% CI: 1.02-4.93), number of coaching sessions (OR = 1.14, 95% CI: 1.04-1.26), and other smokers in the home (OR = 0.41, 95% CI: 0.19-0.91). The effect of other smokers in the home was significantly different between AI/AN and NHW callers (p = .007). Conclusions: Different individual characteristics and predictors of cessation among AI/AN callers compared to NHW callers were documented. Findings may be used to inform the development of culturally-tailored strategies and protocols for AI/AN quitline callers.

Impact of changes in home smoking bans on tobacco cessation among quitline callers.

Home smoking bans may be an effective way to promote tobacco cessation among treatment seeking smokers. Few studies have examined this relationship in a quitline setting. Data were obtained from 14,296 adults who were enrolled in a state quitline between January 2011 and July 2016. This study investigated whether cessation rates varied by changes in home smoking ban implementation between enrollment and 7-month follow-up. The impact of changes in home smoking bans on cessation at follow-up was significantly modified by having other smokers living in the home at follow-up (P < 0.0001). Among callers who did not live with other smokers in the home, the highest odds ratio of 30-day cessation was for callers who reported bans at follow-up only (OR = 10.50, 95%CI: 8.00, 13.70), followed by callers who reported bans at both enrollment and follow-up (OR = 8.02, 95%CI: 6.27, 10.30) and callers who reported bans at enrollment only (OR = 2.06, 95% CI: 1.47, 2.89) compared with callers with no home smoking bans. When callers reported that they lived with other smokers in the home, the effect of home smoking bans on cessation was much smaller. Quitlines should support the implementation of home smoking bans as a part of callers' goal setting activities to achieve tobacco cessation.

Quit outcomes among clients ineligible for cessation medication through the state quitline: a retrospective, observational study.

BACKGROUND: Distribution of tobacco cessation medications through state quitlines increases service utilization and quit outcomes. However, some state quitlines have moved to models in which callers are instructed to obtain quit medications through their health insurance pharmaceutical benefit. We aimed to investigate the impact of this policy on medication access and quit outcomes in the state quitline setting for clients who must obtain covered medications through the state Medicaid program. We hypothesized that clients with Medicaid who were referred by their healthcare provider would be more likely to report using quit medication and have higher quit rates compared to clients with Medicaid who engaged the quitline on their own. METHODS: An observational, retrospective study was conducted using state quitline clients with Medicaid health insurance who were ineligible for quitline provided cessation medications. Clients were stratified by referral type: self-referred, passively referred, and proactively referred. Unadjusted and adjusted logistic regression was used to estimate the effect of referral type on both quit status and cessation medication use. RESULTS: Proactively referred clients were less likely to use quit medication (53.6%) compared to self (56.9%) and passively referred clients (61.1%). Proactively referred clients had lower quit rates (31.4%), as compared to passively referred (36.0%) and self-referred (35.1%). In adjusted models, proactively referred clients were significantly less likely to be quit than passively referred clients (OR = 0.75, 95% CI: 0.56, 0.99). There were no statistically significant differences in medication use or number of coaching sessions among proactive, passive, and self-referred clients in adjusted models. CONCLUSIONS: In adjusted models, medication use did not significantly differ by mode of entry in this population of Medicaid beneficiaries. Psychosocial factors such as intention to quit in the next 30 days, social support for quitting, education level, race, and ethnicity impacted quit status and differed by mode of entry. Quitlines should use tailored strategies to increase engagement and reduce barriers among proactively referred clients.

Factors Predicting Client Re-Enrollment in Tobacco Cessation Services in a State Quitline.

INTRODUCTION: Quitlines are an integral part of tobacco treatment programs and reach groups of smokers who have a wide range of barriers to cessation. Although tobacco dependence is chronic and relapsing, little research exists on factors that predict the likelihood of clients re-engaging and reconnecting with quitlines for treatment. The objective of this study was to describe factors that predict the re-enrollment of clients in Arizona's state quitline. METHODS: This was a retrospective analysis of data collected from clients (N = 49,284) enrolled in the Arizona Smokers' Helpline from January 2011 through June 2016. We used logistic regression to analyze predictors of re-enrollment in services after controlling for theoretically relevant baseline variables (eg, nicotine dependence, smokers in the home) and follow-up variables (eg, program use, quit outcome). RESULTS: Compared with clients who reported being quit after their first enrollment, clients who reported not being quit were almost 3 times as likely to re-enroll (odds ratio = 2.89; 95% confidence interval, 2.54-3.30). Other predictors were having a chronic condition or a mental health condition, greater nicotine dependence, and lower levels of social support. Women and clients not having other smokers in the home were more likely to re-enroll than were men and clients not living with other smokers. CONCLUSION: Understanding baseline and in-program factors that predict client-initiated re-enrollment can help quitlines tailor strategies to proactively re-engage clients who may have difficulty maintaining long-term abstinence.

Tobacco Use Cessation Among Quitline Callers Who Implemented Complete Home Smoking Bans During the Quitting Process.

INTRODUCTION: The implementation of a home smoking ban (HSB) is associated with tobacco use cessation. We identified which quitline callers were most likely to report 30-day cessation among those who implemented complete HSBs after enrollment. METHODS: Our sample consisted of callers to the Arizona Smokers' Helpline who enrolled from January 1, 2011, through July 26, 2015, and who reported no HSB at enrollment and a complete HSB by 7-month follow-up. We used logistic regression to estimate associations between no use of tobacco in the previous 30 days (30-day quit) at 7-month follow-up and demographic characteristics, health conditions, tobacco use, and cessation strategies. RESULTS: At 7-month follow-up, 65.4% of 399 callers who implemented a complete HSB reported 30-day quit. Lower odds of tobacco use cessation were associated with having a chronic health condition (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.18-0.56) and living with other smokers (OR, 0.46; 95% CI, 0.29-0.73). Higher odds of tobacco cessation were associated with completing 5 or more telephone coaching sessions (OR, 2.48; 95% CI, 1.54-3.98) and having confidence to quit (OR, 2.05; 95% CI, 1.05-3.99). However, confidence to quit was not significant in the sensitivity analysis. CONCLUSION: Implementing an HSB after enrolling in quitline services increases the likelihood of cessation among some tobacco users. Individuals with complete HSBs were more likely to quit if they did not have a chronic health condition, did not live with another smoker, and were actively engaged in coaching services. These findings may be used by quitlines to develop HSB intervention protocols primarily targeting tobacco users most likely to benefit from them.

Kids Safe and Smokefree (KiSS): a randomized controlled trial of a multilevel intervention to reduce secondhand tobacco smoke exposure in children.

BACKGROUND: Secondhand smoke exposure (SHSe) harms children's health, yet effective interventions to reduce child SHSe in the home and car have proven difficult to operationalize in pediatric practice. A multilevel intervention combining pediatric healthcare providers' advice with behavioral counseling and navigation to pharmacological cessation aids may improve SHSe control in pediatric populations. METHODS/DESIGN: This trial uses a randomized, two-group design with three measurement periods: pre-intervention, end of treatment and 12-month follow-up. Smoking parents of children < 11-years-old are recruited from pediatric clinics. The clinic-level intervention includes integrating tobacco intervention guideline prompts into electronic health record screens. The prompts guide providers to ask all parents about child SHSe, advise about SHSe harms, and refer smokers to cessation resources. After receiving clinic intervention, eligible parents are randomized to receive: (a) a 3-month telephone-based behavioral counseling intervention designed to promote reduction in child SHSe, parent smoking cessation, and navigation to access nicotine replacement therapy or cessation medication or (b) an attention control nutrition education intervention. Healthcare providers and assessors are blind to group assignment. Cotinine is used to bioverify child SHSe (primary outcome) and parent quit status. DISCUSSION: This study tests an innovative multilevel approach to reducing child SHSe. The approach is sustainable, because clinics can easily integrate the tobacco intervention prompts related to "ask, advise, and refer" guidelines into electronic health records and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines. TRIAL REGISTRATION: NCT01745393 (clinicaltrials.gov).

Development of a Conversational Agent for Individuals Ambivalent About Quitting Smoking: Protocol for a Proof-of-Concept Study.

BACKGROUND: Cigarette smoking is the leading preventable cause of disease and death in the United States. Despite the availability of a plethora of evidence-based smoking cessation resources, less than one-third of individuals who smoke seek cessation services, and individuals using these services are often those who are actively contemplating quitting smoking. There is a distinct dearth of low-cost, scalable interventions to support smokers not ready to quit (ambivalent smokers). Such interventions can assist in gradually promoting smoking behavior changes in this target population until motivation to quit arises, at which time they can be navigated to existing evidence-based smoking cessation interventions. Conversational agents or chatbots could provide cessation education and support to ambivalent smokers to build motivation and navigate them to evidence-based resources when ready to quit. OBJECTIVE: The goal of our study is to test the proof-of-concept of the development and preliminary feasibility and acceptability of a smoking cessation support chatbot. METHODS: We will accomplish our study aims in 2 phases. In phase 1, we will survey 300 ambivalent smokers to determine their preferences and priorities for a smoking cessation support chatbot. A "forced-choice experiment" will be administered to understand participants' preferred characteristics (attributes) of the proposed chatbot prototype. The data gathered will be used to program the prototype. In phase 2, we will invite 25 individuals who smoke to use the developed prototype. For this phase, participants will receive an overview of the chatbot and be encouraged to use the chatbot and engage and interact with the programmed attributes and components for a 2-week period. RESULTS: At the end of phase 1, we anticipate identifying key attributes that ambivalent smokers prefer in a smoking cessation support chatbot. At the end of phase 2, chatbot acceptability and feasibility will be assessed. The study was funded in June 2022, and data collection for both phases of the study is currently ongoing. We expect study results to be published by December 2023. CONCLUSIONS: Study results will yield a smoking behavior change chatbot prototype developed for ambivalent smokers that will be ready for efficacy testing in a larger study. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44041.

Vaping and Sleep as Predictors of Adolescent Suicidality.

PURPOSE: To investigate sleep quantity as a moderator of vaping and self-reported suicidality among adolescents. DESIGN: Cross-sectional. Setting: United States high schools. SAMPLE: 10,520 high-school students with complete data on the primary outcome of suicide attempt in the past year (76.9% response rate). MEASURES: 2019 Youth Risk Behaviors Survey. ANALYSIS: Logistic regression to examine main effects and potential moderation. RESULTS: Students with under seven sleep hours on school nights (OR = 2.6; 95% CI = 2.1-3.3) and who vaped in the past month (OR = 3.0; 95% CI = 2.1-3.9) had higher odds of attempting suicide in the last year. Sleep quantity moderated the relationship between vaping and suicidal thoughts in the past year (P = .01) but did not moderate the relationship between vaping and a suicide plan (P = .15) or suicide attempts (P = .06). Specifically, vaping had a smaller effect on suicidal thoughts among students who slept under seven hours on school nights (OR = 1.8) compared to the descriptively larger effect among participants with more sleep (OR = 2.5). CONCLUSIONS: Students who vape or report low sleep quantity would be ideal participants in suicide prevention interventions as they may be at higher risk for suicidality. Organizations implementing sleep or vaping interventions should incorporate information regarding the higher odds of suicide among students with low sleep quantity or vaping habits.

Feasibility and acceptability of testing a menstrual-cycle timed smoking cessation intervention for women of reproductive age (Project Phase): Results of a pilot randomized control trial.

INTRODUCTION: Menstrual phase influences cigarette smoking-related outcomes. Telephone-based cessation programs (e.g., quitlines) may incorporate the role of the menstrual cycle in an effort to tailor interventions for women. PURPOSE: The goal of this preliminary randomized clinical trial was to examine the feasibility and acceptability of timing quit date to menstrual phase in women in a quitline setting. METHODS: We recruited treatment-seeking women with regular menstrual cycles between the ages of 18-40 years. Participants were randomized to the follicular phase (FP; quit date set 6-8 days post onset of menses) or standard of care (SC; no menstrual timing of quit date). All participants received four weeks of nicotine replacement therapy transdermal patch concurrent with six weeks of telephone-based counseling. We explored self-reported and biochemically-verified seven-day point prevalence abstinence at end-of-treatment and three-month follow-up. RESULTS: Participants (n = 119; FP: n = 58, SC: n = 61) were, on average, 33.4 years old and smoked 13.6 cigarettes/day. The median number of counseling sessions completed was 6 out of 6 available, and 66% of participants completed the intervention. Over 90% of participants reported they would recommend this study to friends/family. Cessation rates did not significantly vary by randomization. CONCLUSIONS: Results of this preliminary trial indicate that timing quit date to FP is an acceptable and feasible approach to address smoking cessation in women of reproductive age. While we observed similar smoking cessation rates between groups, this preliminary study was not fully powered to determine efficacy. Therefore, the feasibility and acceptability results indicate that a fully-powered efficacy trial is warranted.

Medicaid-Insured Client Characteristics and Quit Outcomes at the Arizona Smokers' Helpline.

Medicaid-insured individuals who smoke experience disparities in quitting and are a priority population for assistance. This retrospective cohort study of Arizona Smokers' Helpline clients (Jan 2014-Mar 2019) examined the association between insurance status, treatment, and smoking cessation. When compared to clients with non-Medicaid insurance or no insurance, clients with Medicaid (26%) were more likely to be female, referred directly to the ASHLine by a healthcare or community partner, smoke in the home, and report having a mental health condition. They also were less likely to utilize cessation medication and reported receiving less social support to quit. Controlling for these and other theoretically relevant variables, insurance status was stratified (Medicaid, non-Medicaid, and uninsured), and quit outcomes were compared by level of treatment (4 treatment groups: more and less than 3 coaching sessions and cessation medication use yes/no). Compared to clients who received 3+ coaching sessions, those who had less than 3 coaching sessions had significantly lower adjusted odds of quitting. Results were similar regardless of cessation medication use or insurance status. There is no indication that treatment effects differ by insurance status. While insurance status appears to proxy for other important factors like low social and economic status and higher comorbidity prevalence, in a quitline setting, quitting is associated with additional, high-quality coaching. Where coaching sessions may offset social and economic barriers to quitting, quitlines may consider focusing on assisting Medicaid-insured clients to connect and engage with treatment.

Feasibility and Acceptability of a Telephone-Based Smoking Cessation Intervention for Qatari Residents.

The steady increase in smoking rates has led to a call for wide-reaching and scalable interventions for smoking cessation in Qatar. This study examined the feasibility and acceptability of an evidence-based smoking cessation program delivered by telephone for Qatari residents. A total of 248 participants were recruited through primary care centers and received five weekly scheduled proactive behavioral counseling calls from personnel trained in tobacco cessation and navigation to obtain cessation pharmacotherapy from clinics. Outcomes were assessed at end of treatment (EOT), and 1- and-3-month follow up. The Mann-Whitney test was used to compare the average number of participants recruited per month pre- and post-COVID. We recruited 16 participants/month, the majority (85.5%) attended at least one counselling session, and 95.4% used some of pharmacotherapy. Retention rates were 70% at EOT, 64.4% and 71.7% at 1- and 3-month follow up, respectively; 86% reported being 'extremely satisfied' by the program. Our ITT 7-day point prevalence abstinence was 41.6% at EOT, 38.4% and 39.3% at 1-and 3-month, respectively. The average number of participants recruited per month was significantly higher for pre vs. post-COVID (18.9 vs. 10.0, p-value = 0.02). Average number of participants retained at EOT per recruitment month showed a slight decrease from 8.6 pre- to 8.2 post-COVID; average number who quit smoking at EOT per recruitment month also showed a decrease from 6 to 4.6. The study results indicated that our telephone-based intervention is feasible and acceptable in this population and presents a new treatment model which can be easily disseminated to a broad population of Qatari smokers.

Factors associated with baseline smoking self-efficacy among male Qatari residents enrolled in a quit smoking study.

Smoking self-efficacy, described as confidence in one's ability to abstain from smoking in high-risk situations is a key predictor in cessation outcomes; however, there is a dearth of research on factors that influence self-efficacy surrounding smoking behavior. This study examines factors associated with baseline self-efficacy among treatment seeking participants enrolled in a pilot feasibility smoking cessation study. Participants (n = 247) were daily male smokers, residents of Doha in Qatar (18-60 years) who were enrolled in a telephone-based smoking cessation study. Baseline assessments included self-efficacy, home smoking rules, socio-demographic variables, smoking history, and psychosocial characteristics. Factors associated with self-efficacy were assessed using multiple linear regression analysis. Results showed that after controlling for relevant variables, number of cigarettes smoked ([Formula: see text] = -0.22; 95% CI: -0.37, -0.06), having at least one quit attempt in the past year ([Formula: see text] = 2.30; 95% CI: 0.27, 4.35), and reporting a complete home smoking ban ([Formula: see text] = 3.13; 95% CI: 0.56, 5.70) were significantly associated with higher self-efficacy to quit smoking. These results provide data-driven indication of several key variables that can be targeted to increase smoking self-efficacy in this understudied population.

Effect of Injectable Platelet-Rich Fibrin with a Nano-Hydroxyapatite Bone Graft on the Treatment of a Grade II Furcation Defect.

Background: Periodontal diseases lead to bone loss, crestal defects and even loss of the tooth, which also further makes it difficult to replace the tooth. Autogenous bone grafts are considered the gold standard in bone regenerative procedures. This study aimed to compare and evaluate the bone regenerative effects of i-PRF (Injectable- Platelet-rich fibrin) with a bone graft and a bone graft alone in mandibular grade II furcation defects over a period of 9 months. Method: This was a comparative study of 12 participants, who were randomly selected and grouped into two groups: test and control. Following phase I therapy, both groups were subjected to open flap debridement. In the test group, after debridement, a nano-hydroxyapatite bone graft mixed with i-PRF was inserted, whereas in the control group only a nano-hydroxyapatite bone graft was inserted. The clinical parameters such as plaque index (PI), gingival index (GI), pocket probing depth (PPD), clinical attachment level (CAL), horizontal probing depth (HPD) and vertical probing depth (VPD) were recorded at baseline, 3 months, 6 months and 9 months following the surgery. The bone area fill (BAF) was assessed using intraoral periapical radiographs (IOPARs) taken at baseline and 9 months after surgery. Results: At the baseline, there was no statistically significant difference between the tested parameters. After 9 months all the clinical parameters, PI, GI, PPD, CAL, HPD and VPD as well as radiographic bone fill showed a significant increase in both the groups (p < 0.05) (PI-TGr; CGr−VPD­3.5 ± 0.54 to 0.66 ± 0.51; 3.3 ± 0.81 to 2 ± 0.63/BAF­2.9 ± 0.88 to 5.6 ± 1.10; 3.4 ± 1.39 to 3.9 ± 1.4). On comparison the test group showed better results for each clinical parameter. Conclusion: The results showed increased improvement in clinical conditions in both groups, although better results were seen in the group where i-PRF with a nano-HA bone graft was used in the furcation defect.

Effect of exogenous progesterone administration on smoking topography.

INTRODUCTION: Progesterone has been implicated as protective against drug taking behaviors, including combustible cigarettes. While prior research indicates higher endogenous progesterone levels are associated with a reduction in smoking intensity (as measured by smoking topography), it is unknown if exogenous delivery of progesterone may have the same effect. METHODS: This double-blind, counterbalanced, cross-over randomized trial enrolled women between the ages of 18 and 40 who smoked at least five cigarettes per day and were currently using oral contraceptives. After overnight abstinence participants attended two topography lab sessions. One lab session was conducted during progesterone (200 mg twice per day) treatment and the other was during placebo treatment. Analyses included linear mixed effect models to examine the effect of exogenous progesterone administration and endogenous progesterone values on topography outcomes. RESULTS: Participants (n = 43) were 23.8 (standard deviation [SD] ± 4.5) years old, smoked 10.5 (SD ± 3.7) cigarettes per day. Compared to placebo administration, progesterone administration reduced cumulative puff volume by 300 mL (95% confidence interval [CI]: -536, -65; p-value = 0.01) with additional trends indicating possible reductions in the number of puffs, average puff volume, and average flow. There were no significant effects of endogenous progesterone on smoking topography outcomes. CONCLUSIONS: Progesterone administration has the potential to reduce smoking intensity after overnight abstinence in women of reproductive age. Additional research is needed to explore how this may relate to smoking cessation outcomes in women of reproductive age.

A prevertebral desmoplastic fibroblastoma presenting with sleep-related breathing dysfunction.

Desmoplastic fibromas exceedingly rarely present in the retro/parapharyngeal space but should be considered in differential diagnosis for benign lumps in these anatomical regions.

A telephone-based guided imagery tobacco cessation intervention: results of a randomized feasibility trial.

BACKGROUND: Evidence supports the use of guided imagery for smoking cessation; however, scalable delivery methods are needed to make it a viable approach. Telephone-based tobacco quitlines are a standard of care, but reach is limited. Adding guided imagery to quitline services might increase reach by offering an alternative approach. PURPOSE: To develop and test the feasibility and potential impact of a guided imagery-based tobacco cessation intervention delivered using a quitline model. METHODS: Participants for this randomized feasibility trial were recruited statewide through a quitline or community-based methods. Participants were randomized to guided imagery Intervention Condition (IC) or active behavioral Control Condition (CC). After withdrawals, there were 105 participants (IC = 56; CC = 49). The IC consisted of six sessions in which participants created guided imagery audio files. The CC used a standard six-session behavioral protocol. Feasibility measures included recruitment rate, retention, and adherence to treatment. We also assessed 6-month quit rates and consumer satisfaction. RESULTS: Both the IC and CC protocols were feasible to deliver. We finalized protocols and materials for participants, coaches and study staff, and delivered the protocols with fidelity. We developed successful recruitment methods, and experienced high retention (6 months = 81.9%) and adherence (all sessions = 66.7%). Long-term quit rates (IC = 27.9%; CC = 38.1%) compared favorably to those of quitlines, and program satisfaction was high, suggesting that the protocols are acceptable to smokers and may contribute to smoking abstinence. CONCLUSIONS: The guided imagery intervention is feasible and promising, suggesting that a fully powered RCT to test the efficacy of the intervention is warranted. TRIAL REGISTRATION NUMBER: NCT02968381.