Interventions for smokeless tobacco use cessation.

BACKGROUND: Use of smokeless tobacco (ST) can lead to nicotine addiction and long-term use can lead to health problems including periodontal disease and cancer. OBJECTIVES: To assess the effects of behavioural and pharmacologic interventions for the treatment of ST use. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, Dissertation Abstracts Online, and Scopus. Date of last search: March, 2007. SELECTION CRITERIA: Randomized trials of behavioural or pharmacological interventions to help users of ST to quit with follow up of at least six months. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data. MAIN RESULTS: Two trials of bupropion SR did not detect a benefit of treatment at six months or longer (Odds Ratio (OR) 0.86, 95% Confidence Interval (CI): 0.47 to 1.57). Four trials of nicotine patch did not detect a benefit (OR 1.16, 95% CI: 0.88 to 1.54), nor did two trials of nicotine gum (OR 0.98, 95% CI: 0.59 to 1.63). There was statistical heterogeneity among the results of 12 behavioural interventions included in the meta-analyses. Six trials showed significant benefits of intervention. In post-hoc subgroup analyses, behavioural interventions which include telephone counselling or an oral examination may increase abstinence rates more than interventions without these components. AUTHORS' CONCLUSIONS: Behavioural interventions should be used to help ST users to quit and telephone counselling or an oral examination may increase abstinence rates. Pharmacotherapies have not been shown to affect long-term abstinence.

Interventions for smokeless tobacco use cessation.

BACKGROUND: Use of smokeless tobacco (ST) can lead to nicotine addiction and health problems including periodontal disease and oral cancer OBJECTIVES: To assess the effects of behavioural and pharmacotherapeutic interventions to treat ST use. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register (February 2004), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2004), MEDLINE (January 1966-February 2004), EMBASE (1988-January 2004), CINAHL (1982-February 2004), PsycINFO (1984-February 2004), Database of Abstract of Reviews of Effectiveness (DARE, The Cochrane Library, Issue 1, 2004). SELECTION CRITERIA: Randomized trials of behavioural or pharmacological interventions to help users of ST to quit, with follow-up of at least six months. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data. MAIN RESULTS: One trial of bupropion did not detect a benefit of treatment after six months (Odds Ratio (OR) 1.00, 95% Confidence Interval (CI): 0.23 to 4.37). Three trials of nicotine patch did not detect a benefit (OR 1.16, 95% CI: 0.88 to 1.54), nor did two trials of nicotine gum (OR 0.98, 95% CI: 0.59 to 1.63). There was statistical heterogeneity among the results of eight trials of behavioural interventions included in the meta-analysis. Three trials showed significant benefits of intervention. In a post-hoc analysis the trials of interventions which included an oral examination and feedback about ST-induced mucosal changes had homogeneous results and when pooled showed a significant benefit (OR 2.41 95% CI: 1.79 to 3.24). REVIEWERS' CONCLUSIONS: Behavioural interventions should be used to help ST users to quit. Pharmacotherapies have not been shown to affect long-term abstinence but larger trials are needed.

Health planning and health care for the poor: the internal ethic of public health.

Health planning involves assessing health care needs of a defined population, setting priorities, then developing, implementing,m and evaluating programs that address priority needs. The concepts of health planning are central to the 1988 report of the Institute of Medicine on the Future of Public Health, which defined the three core functions of public health as assessment, policy development, and assurance. Generally, when health planning is instituted, poor people are identified as having the poorest health status and the greatest need. An internal ethic is therefore created for public health to focus on the health care needs of those in poverty. This internal ethic of public health health can become the driving force for reforming the present U.S. health care system. A reformed health care system would be guided by the principle of care according to need, which not only has a basis in health planning, but in social justice as well.

To use or not use combined hormonal oral contraceptives during lactation.

PIP: A Tennessee regional health officer reviews the literature to see whether use of combined oral contraceptives (OCs) during lactation affects infant growth and development. He looks at studies with anthropometric measurements, those measuring the amount of steroid secreted in breast milk, and case reports on direct effects of the hormones on the nursing infant. All the studies have weaknesses. Inconsistencies exist between the studies. Study design and conditions can explain some of the inconsistencies. One pattern arises in these studies: use of an OC with more than 50 mcg of estrogen early in the postpartum period negatively affects breast feeding (e.g., reduced infant growth). Other than this, there are no consistent findings of adverse effects of combined OC use on infant growth and development after lactation is established. Some studies show that postpartum women who want to use contraception often have few contraception choices other than OCs, so they choose OCs rather than continue breast feeding. This denies the infant its best source of nutrition. Yet, lactating women who forego contraceptive use may place themselves at risk of an early pregnancy as well as place the child at risk due to short birth spacing. Women who want to use OCs and wait long enough to establish lactation (about 2 months) should not be at risk of pregnancy, however. Another reason for not using OCs immediately postpartum is that women in that period are at an increased risk of thrombotic complications. Based on this literature review, the health official concludes that combined OC use during lactation is reasonable and scientifically justifiable. He does recommend, however, that lactating women use the lowest possible dose OC no sooner than 2-3 months postpartum. They should take the pill each day at the beginning of the longest interval between feedings. They should also allow more suckling time to counteract any possible reduction in the breast milk supply.^ieng

Serological survey and active surveillance for La Crosse virus infections among children in Tennessee.

In 1998 and 1999, we performed a serosurvey and active surveillance for La Crosse encephalitis at a children's hospital in eastern Tennessee. Fifteen cases of La Crosse encephalitis were confirmed. Only 5 (0.5%) of 1000 serum samples being tested at the state laboratory for other diseases had evidence of antibodies to La Crosse virus. These findings suggest that La Crosse virus is newly endemic to eastern Tennessee.

Newly recognized focus of La Crosse encephalitis in Tennessee.

La Crosse virus is a mosquito-borne arbovirus that causes encephalitis in children. Only nine cases were reported in Tennessee during the 33-year period from 1964-1996. We investigated a cluster of La Crosse encephalitis cases in eastern Tennessee in 1997. Medical records of all suspected cases of La Crosse virus infection at a pediatric referral hospital were reviewed, and surveillance was enhanced in the region. Previous unreported cases were identified by surveying 20 hospitals in the surrounding 16 counties. Mosquito eggs were collected from five sites. Ten cases of La Crosse encephalitis were serologically confirmed. None of the patients had been discharged from hospitals in the region with diagnosed La Crosse encephalitis in the preceding 5 years. Aedes triseriatus and Aedes albopictus were collected at the case sites; none of the mosquitos had detectable La Crosse virus. This cluster may represent an extension of a recently identified endemic focus of La Crosse virus infection in West Virginia.

First isolation of La Crosse virus from naturally infected Aedes albopictus.

La Crosse (LAC) virus, a California serogroup bunyavirus, is the leading cause of pediatric arboviral encephalitis in the United States and an emerging disease in Tennessee, West Virginia, and North Carolina. Human cases of LAC encephalitis in Tennessee and North Carolina have increased above endemic levels during 1997 to 1999 and may represent an expansion of a new southeastern endemic focus. This report describes the isolation of LAC virus from the exotic mosquito Aedes albopictus. The discovery of LAC virus in wild populations of Ae. albopictus coupled with its expanding distribution in the southeastern United States, suggests that this mosquito may become an important accessory vector, potentially increasing the number of human cases in endemic foci or expanding the range of the disease.

Carriage of multidrug-resistant Streptococcus pneumoniae and impact of chemoprophylaxis during an outbreak of meningitis at a day care center.

Three cases of meningitis due to multidrug-resistant serotype 14 Streptococcus pneumoniae occurred at a day care center (DCC) over 5 days. Cultures of nasopharyngeal samples were done at the index DCC, 2 comparison DCCs, and a pediatrics practice. Isolates were serotyped and subtyped by pulsed-field gel electrophoresis (PFGE) with SmaI. Pneumococcal carriage rates ranged from 44%-65% at the 3 DCCs and 29% in the pediatrics practice. Carriage of multidrug-resistant serotype 14 S. pneumoniae was noted in 13%-19% of children at the 3 DCCs. An outbreak strain was identified by PFGE at the index DCC and 1 other DCC; a closely related strain was found in the third DCC. Carriage of the outbreak strain was associated with being age 0-24 months, antibiotic use, upper respiratory tract infections, and otitis media. DCC contacts of the ill children were offered chemoprophylaxis with rifampin and clindamycin, which produced a profound but transient decrease in carriage. No additional cases occurred.