E-learning course improves knowledge in tobacco dependence, electronic nicotine delivery systems and heat-not-burn products in Medical School students.

BACKGROUND: Adequate training in tobacco, nicotine dependence and treatment is lacking in Medical School education. With the rise in popularity of electronic alternatives to cigarettes, future physicians should also be provided with the more recent scientific evidence on these products during their undergraduate studies. We introduced an e-learning course for Medical School students and assessed its effec-tiveness of increasing knowledge on these topics. METHODS: We developed 16 didactic modules divided in 3 courses: tobacco dependence (TDI), treating tobacco dependence (TDII) and electronic products and tobacco control (TDIII). The course was offered to 4th, 5th, and 6th year Medical School students in Italy. To assess learning outcomes, we examined the pre- to post- changes in knowledge scores associated with each course. Paired and independent samples t-tests were performed overall, and among smokers and non-smokers separately. RESULTS: A total of 1318 students completed at least one of the courses; 21% were self-reported smokers. A significant increase in knowledge was observed at the end of TDI (pre-course: 52.1±15.9, post-course: 79.9±13.5, p<0.001), TDII (pre-course: 52.5±13.0, post-course: 66.5±12.0, p<0.001) and TDIII (pre-course: 52.2±15.3, post-course: 76.1±17.7, p<0.001). Smokers showed significantly lower improvements compared to non-smokers. CONCLUSIONS: The e-learning course was effective in increasing knowledge about tobacco dependence, treatments, and electronic ni-cotine products in advanced medical students. Given the fundamental role for healthcare practitioners in encouraging and assisting people in quitting smoking, e-learning may be a useful tool in providing up-to-date and standardized training in the area during Medical School.

Knowledge of nicotine dependence and treatment in clinical practice improved after an e-learning course among medical students.

OBJECTIVE: Tobacco smoking is the leading cause of preventable death in developed countries and smokers should be encouraged to quit. Physicians are instrumental in this, but recent reports suggest inadequate training in medical school. We aimed to assess the knowledge of nicotine dependence and its treatment among Italian medical students. STUDY DESIGN: Prospective observational study. METHODS: We developed an online course consisting of 11 Didactic Modules (6 for Tobacco Dependence I, TDI, and 5 for TDII) on nicotine dependence and treatment. The course was administered to 4th and 5th year medical students in Italy in Academic Years 2016-17 (Course A) and 2017-18 (Course B). A validated questionnaire was used before and after each part in order to measure knowledge of smoking epidemiology, health effects and benefits of giving up smoking ("Score 1", TDI), and effectiveness of cessation treatments ("Score 2", TDII). RESULTS: 324 students took both TDI and TDII and completed all questionnaires (Course A, n = 245; Course B, n = 79). 55 students were current smokers (17%). A significant increase in score 1 and 2 was observed at the end of both TDI (pre-course 47.2±13.1, post-course 66.0±12.3, p <0.0001) and TDII (pre-course 55.6±11.5, post-course 68.1±10.9, p <0.0001). The prevalence of students wishing for a smoke-free medical school significantly increased between the beginning of TDI (74.4%, 241/324) and the end of TDII (88%, 285/324; p <0.0001). CONCLUSIONS: This e-learning course has proven to be an effective tool in teaching students on nicotine dependence and treatment.

Dogs on livestock farms: A cross-sectional study investigating potential roles in zoonotic pathogen transmission.

Dogs are often present on livestock farms, where they serve important management and companion roles, yet may be involved in zoonotic pathogen transmission. Numerous factors can potentially alter the risk of exposure to zoonotic pathogens, such as the dog's access to livestock, close dog-human contact and an increasing immunocompromised human population. The objective of this study was to quantify and qualify dog ownership among livestock owners, their dog husbandry and biosecurity practices, the dogs' access to livestock and potential risks for zoonotic pathogen transmission. A questionnaire was developed and mailed to 2,000 presumed Ohio livestock owners. Data were collected on demographics, dog husbandry practices, attitudes surrounding zoonotic diseases and attachment to and preventive veterinary care for the dogs. There were 446 responders who met the study inclusion criteria as an Ohio livestock farm owner, with 297 (67%) also owning dogs. Approximately 52% of dog-owning households included at least one individual at higher disease risk (i.e., <5 years, ≥65 years, diagnosed with an immunocompromising condition). Most respondents had little/no concern for disease transmission from livestock to dogs (90%), from dogs to livestock (87%) and from dogs to people (94%). Dogs were allowed access to livestock by 70% of respondents and nearly all (96%; 198) indicated at least one higher risk dog-livestock management practice. In addition, many reported never leashing or fencing their dog (61%) and rarely to never picking up dog faeces (76%). Households with higher risk members reported similar husbandry, biosecurity and concern levels as households without those members (all p > .05). Numerous opportunities for zoonotic pathogen transmission and low level of zoonotic disease concern suggest a need for improved education and outreach for the livestock dog-owning community, particularly for higher risk households.

Treatment adherence in a lay health adviser intervention to treat tobacco dependence.

Lay health advisers (LHAs) are increasingly used to deliver tobacco dependence treatment, especially with low-socioeconomic status (SES) populations. More information is needed about treatment adherence to help interpret mixed evidence of LHA intervention effectiveness. This study examined adherence to behavioral counseling and nicotine patches in an LHA intervention with 147 Ohio Appalachian female daily smokers. Participants were randomly selected from clinics and randomized to the intervention condition of a randomized controlled trial. Overall, 75.5% of participants received all seven planned LHA visits, 29.3% used patches for >7 weeks and approximately half received high average ratings on participant responsiveness. Depressive symptoms and low nicotine dependence were associated with lower patch adherence while high poverty-to-income ratio was associated with high responsiveness. Compared with those with fewer visits, participants who received all visits were more likely to be abstinent (22.5 versus 2.8%, P=0.026) or have attempted quitting (85.0 versus 47.4%, P=0.009) at 3 months. High participant responsiveness was associated with 12-month abstinence. LHA interventions should focus on improving adherence to nicotine patches and managing depression because it is an independent risk factor for low adherence.

Cigarette and waterpipe smoking associated knowledge and behaviour among medical students in Lebanon

As future physicians capable of controlling tobacco dependence in the population, medical students are considered a main target for tobacco control interventions. This cross-sectional study reported on the prevalence of tobacco use [cigarettes and waterpipes] and associated knowledge and behaviour among 6th-year medical students in 2009-2010 from 6 medical schools in Lebanon. The self-administered questionnaire based on the Global Health Professional Survey [GHPSS] core questions also enquired about training in tobacco cessation approaches. All enrolled students were asked to participate; the response rate was 191/354 [54.3%]. The prevalence of tobacco use was 26.3% for cigarettes and 29.5% for waterpipes. Smoking waterpipes was the only significant predictor for cigarette smoking and there was no difference by sex and socioeconomic status. A minority reported ever receiving any formal training in treatment approaches for tobacco dependence. Medical schools should include tobacco dependence treatment training programmes in their curriculum and discourage tobacco use

Tobacco policy in American prisons, 2007.

OBJECTIVE: To examine current tobacco policy in US prisons and explore changes in prison tobacco policies over time. DATA SOURCE: Telephone survey of the 52 US departments of correction. MAIN OUTCOME MEASURES: Current tobacco policy; distribution of free tobacco; availability of smoking cessation programming and cessation aids. PARTICIPANTS: Complete responses were received from 51 of 52 (98%) departments, while one provided partial information. RESULTS: The majority of correctional systems (60%) reported total tobacco bans on prison grounds, with most remaining facilities (27%) having an indoor ban on tobacco use. No prisons distributed free tobacco. No major violence was reported relating to the implementation of stricter tobacco policies; however many respondents noted that tobacco became a major contraband item following the implementation of a total ban. While most prison systems with an indoor tobacco ban (86%) reported having tobacco cessation programmes, few of those with total bans (39%) continued such programmes after the initial transition period. CONCLUSION: Total tobacco bans have often been accompanied by the termination of tobacco cessation programmes. Such actions undermine efforts to promote long-term cessation resulting in a missed public health opportunity.

Preparing the "Ground War" against tobacco among Chinese Americans in New York City: baseline data.

OBJECTIVES: The objective of this paper is to report on data on the perceptions regarding smoking and environmental tobacco smoke as well as the health communication patterns of a representative sample of 715 adult Chinese families with children under age 18 who had not banned smoking in the home. METHODS: We selected a representative sample of Chinese American families residing in New York's five boroughs: Brooklyn, Bronx, Manhattan, Queens, and Staten Island based on Chinese family surnames and interviewed them by telephone between December 2000-March 2001. All except 4% of the interviews were conducted in English; most respondents chose to speak Cantonese and lesser numbers chose Mandarin. FINDINGS: For the most part, respondents believed in the hazards of smoking, especially as it harms children living at home. To address smoking, respondents believed the physicians is the most trustworthy source of health information and the sources of health information consulted would be overwhelmingly the Chinese language newspaper, followed by Chinese language radio and television. CONCLUSIONS: This study represents the first systematic assessment of Chinese Americans in New York with regard to selected tobacco control issues. The findings provide the empirical base for developing potential messages using the source considered most trustworthy (the physician) and the vehicle most consulted (Chinese language media).

Boron neutron capture therapy of brain tumors: biodistribution, pharmacokinetics, and radiation dosimetry sodium borocaptate in patients with gliomas.

OBJECTIVE: The purpose of this study was to obtain tumor and normal brain tissue biodistribution data and pharmacokinetic profiles for sodium borocaptate (Na2B12H11SH) (BSH), a drug that has been used clinically in Europe and Japan for boron neutron capture therapy of brain tumors. The study was performed with a group of 25 patients who had preoperative diagnoses of either glioblastoma multiforme (GBM) or anaplastic astrocytoma (AA) and were candidates for debulking surgery. Nineteen of these patients were subsequently shown to have histopathologically confirmed diagnoses of GBM or AA, and they constituted the study population. METHODS: BSH (non-10B-enriched) was infused intravenously, in a 1-hour period, at doses of 15, 25, and 50 mg boron/kg body weight (corresponding to 26.5, 44.1, and 88.2 mg BSH/kg body weight, respectively) to groups of 3, 3, and 13 patients, respectively. Multiple samples of tumor tissue, brain tissue around the tumors, and normal brain tissue were obtained at either 3 to 7 or 13 to 15 hours after infusion. Blood samples for pharmacokinetic studies were obtained at times up to 120 hours after termination of the infusion. Sixteen of the patients underwent surgery at the Beijing Neurosurgical Institute and three at The Ohio State University, where all tissue samples were subsequently analyzed for boron content by direct current plasma-atomic emission spectroscopy. RESULTS: Blood boron values peaked at the end of the infusion and then decreased triexponentially during the 120-hour sampling period. At 6 hours after termination of the infusion, these values had decreased to 20.8, 29.1, and 62.6 microg/ml for boron doses of 15, 25, and 50 mg/kg body weight, respectively. For a boron dose of 50 mg/kg body weight, the maximum (mean +/- standard deviation) solid tumor boron values at 3 to 7 hours after infusion were 17.1+/-5.8 and 17.3+/-10.1 microg/g for GBMs and AAs, respectively, and the mean tumor value averaged across all samples was 11.9 microg/g for both GBMs and AAs. In contrast, the mean normal brain tissue values, averaged across all samples, were 4.6+/-5.1 and 5.5+/-3.9 microg/g and the tumor/normal brain tissue ratios were3.8 and 3.2 for patients with GBMs and AAs, respectively. The large standard deviations indicated significant heterogeneity in uptake in both tumor and normal brain tissue. Regions histopathologically classified either as a mixture of tumor and normal brain tissue or as infiltrating tumor exhibited slightly lower boron concentrations than those designated as solid tumor. After a dose of 50 mg/kg body weight, boron concentrations in blood decreased from 104 microg/ml at 2 hours to 63 microg/ml at 6 hours and concentrations in skin and muscle were 43.1 and 39.2 microg/g, respectively, during the 3- to 7-hour sampling period. CONCLUSION: When tumor, blood, and normal tissue boron concentrations were taken into account, the most favorable tumor uptake data were obtained with a boron dose of 25 mg/kg body weight, 3 to 7 hours after termination of the infusion. Although blood boron levels were high, normal brain tissue boron levels were almost always lower than tumor levels. However, tumor boron concentrations were less than those necessary for boron neutron capture therapy, and there was significant intratumoral and interpatient variability in the uptake of BSH, which would make estimation of the radiation dose delivered to the tumor very difficult. It is unlikely that intravenous administration of a single dose of BSH would result in therapeutically useful levels of boron. However, combining BSH with boronophenylalanine, the other compound that has been used clinically, and optimizing their delivery could increase tumor boron uptake and potentially improve the efficacy of boron neutron capture therapy.

Improved survival after boron neutron capture therapy of brain tumors by Cereport-mediated blood-brain barrier modulation to enhance delivery of boronophenylalanine.

OBJECTIVE: Cereport (Alkermes, Inc., Cambridge, MA), or, as it has been previously called, RMP-7 (receptor-mediated permeabilizer-7), is a bradykinin analog that has been shown to produce a transient, pharmacologically mediated opening of the blood-brain barrier. The purpose of the present study was to determine whether the efficacy of boron neutron capture therapy (BNCT) could be enhanced by means of intracarotid (i.c.) infusion of Cereport, in combination with intravenous (i.v.) injection or i.c. infusion of boronophenylalanine (BPA) in the F98 rat glioma model. METHODS: For biodistribution studies, Fischer rats bearing intracerebral implants of the F98 glioma received i.v. or i.c. injections of 300 or 500 mg/kg body weight (b.w.) of BPA with or without i.c. infusion of 1.5 microg/kg b.w. of Cereport. For therapy studies, BNCT was initiated 14 days after intracerebral implantation of 10(3) F98 cells. The i.v. or i.c. injection of BPA (500 mg/kg b.w.) was given with or without Cereport, and the animals were irradiated 2.5 hours later at the Brookhaven Medical Research Reactor with a collimated beam of thermal neutrons delivered to the head. RESULTS: At a BPA dose of 500 mg/kg b.w., tumor boron concentrations (mean +/- standard deviation) were 55.7 +/- 9.6 microg/g with Cereport versus 33.6 +/- 3.9 microg/g without Cereport at 2.5 hours after i.c. infusion of BPA, and concentrations were 29.4 +/- 9.9 microg/g with Cereport versus 15.4 +/- 3.5 microg/g without Cereport (P < 0.05) after i.v. injection of BPA. After i.c. administration of BPA and Cereport, the tumor-to-blood ratio was 5.4 +/- 0.6, and the tumor-to-brain ratio was 5.2 +/- 2.4. After BNCT with BPA at a dose of 500 mg/kg, the survival time was 50 +/- 16 days for i.c. administration of BPA with Cereport versus 40 +/- 6 days without Cereport (P = 0.05), 38 +/- 4 days for i.v. administration of BPA with Cereport versus 34 +/- 3 days without Cereport (P = 0.02), 28 +/- 5 days for irradiated controls, and 23 +/- 3 days for untreated controls. Compared with untreated controls, there was a 117% increase in lifespan in rats that received an i.c. infusion of Cereport and then BPA, and an 86% increase in lifespan in rats that received i.c. administration of BPA without Cereport. CONCLUSION: These studies have established that i.c. administration of Cereport can not only increase tumor uptake of BPA, but also enhance the efficacy of BNCT.

Depression as an antecedent to heart disease among women and men in the NHANES I study. National Health and Nutrition Examination Survey.

BACKGROUND: Depression predicts morbidity and mortality among individuals who have coronary heart disease (CHD), and there is increasing evidence that depression may also act as an antecedent to CHD. The studies that have reported a relationship between depression and CHD incidence or mortality either were restricted to men only or analyzed women and men together. The present investigation was conducted to evaluate the differential effect depression may have on CHD incidence and mortality in women and men. RESEARCH METHODS: We analyzed data from 5007 women and 2886 men enrolled in the first National Health and Nutrition Examination Survey (NHANES I) who were free of CHD at the 1982-1984 interview and who had completed the Center for Epidemiologic Studies Depression Scale (CES-D). Participants were evaluated from the 1982 interview date either until the end of the study (1992 interview date) or until the occurrence of a CHD event. Using CHD incidence and CHD mortality (International Classification of Disease, Ninth Revision, codes 410-414) as the outcome variables, Cox proportional hazards regression models were developed to evaluate the relative risk (RR) of CHD incidence and mortality in the depressed women and men separately, controlling for standard CHD risk factors. RESULTS: The women experienced 187 nonfatal and 137 fatal events, compared with 187 nonfatal and 129 fatal events among the men. The adjusted RR of CHD incidence among depressed women was 1.73 (95% confidence internal [CI], 1.11-2.68) compared with nondepressed women. Depression had no effect on CHD mortality in the women (RR, 0.74; 95% CI, 0.40-1.48). The adjusted RR of CHD incidence among depressed men was 1.71 (95% CI, 1.14-2.56) compared with nondepressed men. Depressed men also had an increased risk of CHD mortality compared with their nondepressed counterparts, with an adjusted RR of 2.34 (95% CI, 1.54-3.56). CONCLUSIONS: In this sample, while controlling for possible confounding factors, depression was associated with an increased risk of CHD incidence in both men and women, as well as CHD mortality in men. Depression had no effect on CHD mortality in women.

Cardiovascular and muscular adaptations to combined endurance and strength training in elderly women.

Twenty-one women aged 60-75 years were examined to determine whether combined endurance and strength training resulted in greater increase in peak oxygen consumption, sub-maximal time to fatigue, cardiac output, stroke volume, and leg extension load when compared to endurance training alone. Subjects in both the endurance training (E) and endurance and strength (E & S) groups trained 3 days a week, for 12 weeks, at an intensity of 70-80% Vo2 peak for 30 min on a cycle ergometer. Subjects in the E & S groups also used resistance equipment to train the knee extensors. The workload for resistance training was based on an initial assessment of 10 repetitions maximum (10 RM), with 80% of that value used for training, three times weekly. Peak oxygen consumption increased to an average of 24.8 and 29.9% in the E and E & S groups, respectively, with no difference between groups. Subjects in the E & S and E groups significantly increased sub-maximal endurance time by 396 and 165%, respectively. Cardiac output, stroke volume, and arteriovenous oxygen difference at 80% peak VO2 were unchanged by either of the training methods. A needle biopsy was taken from the vastus lateralis before and after 12 weeks of training. Chi-square analysis of fibre area data showed an increase in the frequency of larger type I fibres in the post-training data from the E & S group, but an increase in the frequency of smaller fibres in the E group post-training; however, mean fibre area was not significantly changed by training. These data suggest that greater improvements in sub-maximal time to fatigue and strength is achieved when resistance training is added to an aerobic training programme in healthy elderly women.