Gender determinants of smoking practice in Indigenous communities: an exploratory study.

Despite the need to urgently reduce smoking rates among Indigenous Australians, in order to close-the-gap in life expectancy, little is known regarding how this can be achieved. This study aimed to explore whether a focus on gender specific determinants of smoking among Indigenous Australians could be identified, thus providing a potentially novel approach to underpin future efforts at intervention. A qualitative research design was employed. Eighty-two participants, comprised of 43 Indigenous women (mean age 32.15, SD, 12.47) and 39 Indigenous men (mean age 34.91, SD, 11.26), participated in one of 12 focus groups held in metropolitan, regional and rural locations in South Australia. Facilitators prompted discussion in response to the question: 'What is it like being a smoker these days?' Two experienced coders assessed data for themes using Attride-Stirling's (2002) method of analysis. Two global themes emerged for men and women. The first theme, 'It's Harder to Smoke Nowadays', encompassed sub-themes capturing changed smoking practices in response to tobacco control strategies implemented in Australia. Sub-themes of 'smoking in secrecy' coupled with an 'awareness of the effects of passive smoking' were identified among women. Among men, sub-themes that depicted tension between 'a desire to be a role model' and 'guilt about smoking' emerged. The second theme, 'Push and Pull Factors', identified a range of gender specific determinants of smoking. While similar reasons for smoking ('pull factors') were identified in men and women (e.g. addiction, boredom, stress, pleasure, mood stabiliser), different 'push factors' (reasons for not wanting to smoke) emerged. For men, sport, fitness and children were identified as reasons for not wanting to smoke, whereas women identified factors such as respect for non-smokers, and body image concerns. The current findings suggest that there may be fundamental differences in the determinants of smoking (pull factors) as well as reasons for wanting to quit (push factors) between Indigenous men and women. A focus on interventions that target gender specific determinants, or motivators of smoking, offers a novel, and potentially efficacious approach to reduce smoking rates among Indigenous Australians.

Sociodemographic correlates of smoking in pregnancy and antenatal-care attendance in Indigenous and non-Indigenous women in South Australia.

Smoking in pregnancy is a key health issue in Australia, particularly among Indigenous women. However, few studies have examined the sociodemographic factors associated with smoking in pregnancy or the predictors of antenatal-care attendance among Indigenous and non-Indigenous Australian women who smoke. Data from the South Australian perinatal statistics collection of all births from 2000-2010 (n=197538) were analysed separately by Indigenous status to determine the sociodemographic factors associated with smoking in pregnancy and antenatal-care attendance by women who smoke. For Indigenous and non-Indigenous women, smoking in pregnancy was significantly independently associated with socioeconomic disadvantage, residing in regional or remote areas, increased parity, unemployment, being a public patient and attending fewer antenatal care visits. Smoking in pregnancy was associated with younger age and not being partnered only for non-Indigenous women. For Indigenous and non-Indigenous pregnant women who smoked, antenatal-care attendance was lower among women who were of younger age, higher parity, unemployed and not partnered. Differences in attendance within sociodemographic factors were greater for Indigenous women. Therefore, while sociodemographic correlates of smoking in pregnancy and antenatal-care attendance are largely similar for Indigenous and non-Indigenous women, tailored cessation and antenatal-care programs that reflect the differences in sociodemographic groups most at risk may be beneficial.

[Erythema elevatum diutinum associated with pyoderma gangrenosum in an HIV-positive patient]. / Association d'un erythema elevatum diutinum et d'un pyoderma gangrenosum chez un patient infecté par le VIH.

BACKGROUND: Erythema elevatum diutinum (EED) is a very rare form of chronic dermatosis clinically characterised by reddish-violet papular nodules extending to the surfaces of the limbs and extremities. Histologically, there are classically two phases of progression initially involving associated neutrophilic dermatosis and leucocytoclastic vasculitis, which is later followed by fibrosis of characteristic appearance. We report the association of EED and pyoderma gangrenosum in a patient infected with HIV. PATIENTS AND METHODS: A 53-year-old male seen since 1989 for HIV infection had been presenting firm bilateral and symmetrical nodules on the feet for 6 months. Histological analysis of one of these nodules resulted in diagnosis of chronic erythema elevatum diutinum and treatment with dapsone was initiated. Three months later, despite regression of the EED lesions under dapsone, two large pustules appeared on the outer aspect of the right leg; they were confluent and progressed towards a superficial ulcer with rounded edges with a clinical appearance evocative of pyoderma gangrenosum (PG). Histopathological analysis demonstrated a massive dermal infiltrate beneath the ulcer comprising neutrophils with evidence of leucocytoclasia, all of which militated in favour of the diagnosis of pyoderma gangrenosum. DISCUSSION: We report for the first time the association of two forms of neutrophilic dermatosis, EED and PG, in an HIV-positive patient. This case report and certain data in the literature suggest that the various forms of neutrophilic dermatosis tend to result in a range of lesions rather than in clearly distinct entities.

New CIAS1 mutation and anakinra efficacy in overlapping of Muckle-Wells and familial cold autoinflammatory syndromes.

OBJECTIVES: Muckle-Wells syndrome (MWS) and familial cold autoinflammatory syndrome (FCAS) are rare periodic fevers associated with CIAS1 mutations. A third entity, the chronic infantile neurological, cutaneous, articular (CINCA) syndrome was also recently associated with mutation in the same gene. A phenotypic and genotypic continuum seems to exist from the most benign (FCAS) to the most severe forms (CINCA). Although a CIAS1 mutation can be associated with two different phenotypes. METHODS: We report a family of three patients exhibiting the MWS and FCAS phenotypes. These phenotypes were associated with a novel missense mutation in CIAS1. RESULTS: Anakinra controlled inflammatory flares in the three patients. CONCLUSIONS: FCAS, MWS and CINCA could be different phenotype expressions of the same disease.

The clinical use of 131I-meta-iodo-benzylguanidine (MIBG) for the diagnosis of neuroblastoma.

Whole-body scintigraphy with 131I-meta-iodo-benzylguanidine 131I-MIBG) was performed in 41 patients with neuroblastoma. In patients with clinical remission no pathological concentration of 131I-MIBG was found. In 30 patients with residual, recurrent or metastatic disease neuroblastoma was correctly localized by 131I-MIBG scintigraphy. It is concluded that 131I-MIBG whole-body scintigraphy is useful in the diagnosis and follow-up of neuroblastoma.