Reaching adults who smoke cigarettes in rural Appalachia: Rationale, design & analysis plan for a mixed-methods study disseminating pharmacy-delivered cessation treatment.

INTRODUCTION: Unlike other U.S. geographical regions, cigarette smoking prevalence remains stagnant in rural Appalachia. One avenue for reaching rural residents with evidence-based smoking cessation treatments could be utilizing community pharmacists. This paper describes the design, rationale, and analysis plan for a mixed-method study that will determine combinations of cessation treatment components that can be integrated within community pharmacies in rural Appalachia. The aim is to quantify the individual and synergistic effects of five highly disseminable and sustainable cessation components in a factorial experiment. METHODS: This sequential, mixed-method research design, based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, will use a randomized controlled trial with a 25 fully crossed factorial design (32 treatment combinations) to test, alone and in combination, the most effective evidence-based cessation components: (1) QuitAid (yes vs. no) (2) tobacco quit line (yes vs. no) (3) SmokefreeTXT (yes vs. no) (4) combination NRT lozenge + NRT patch (vs. NRT patch alone), and (5) eight weeks of NRT (vs. standard four weeks). RESULTS: Logistic regression will model abstinence at six-months, including indicators for the five treatment factors and all two-way interactions between the treatment factors. Demographic and smoking history variables will be considered to assess potential effect modification. Poisson regression will model quit attempts and percent of adherence to treatment components as secondary outcomes. CONCLUSION: This study will provide foundational evidence on how community pharmacies in medically underserved, rural regions can be leveraged to increase utilization of existing evidence-based tobacco cessation resources for treating tobacco dependence. CLINICAL TRIALS: NCT05660525.

A retrospective observational study investigating safety netting documentation in the emergency department.

BACKGROUND: Safety netting is an important aspect of medical practice, especially for first contact clinicians. Adequate safety netting provision and documentation is vital for optimal patient care and medicolegal security. This is the first study to report safety netting documentation practices in the emergency department, a specialty with a variety of high-acuity presentations and which is particularly vulnerable to medicolegal issues. METHODS: A retrospective observational study was conducted at University Hospital Wales (UHW) Emergency Department (ED) in the months January-February and August 2023. Randomized paper notes review was performed for adult patients who were discharged from the ED without admission to hospital. Patient characteristics, time of consultation, grade of emergency medicine practitioner (EMP) and presence/level of safety netting documentation was recorded. The statistical software STATA was used to identify any associations between these factors on safety netting practices. RESULTS: A total of 500 notes were included. Safety netting advice was documented in 45% of consultations (n=224). This was 'basic' in 166 cases, 'general' in 32, 'specific' in 15 and both 'general and specific' in 11. Frequency of safety netting documentation was higher for ages < 65 years and consultations within working hours (09:00 - 17:00). CONCLUSION: This study shows that there is no 'universal' level of safety netting documentation amongst practicing EMPs. Although there is well-established guidance about when, what and how safety netting should be provided, there is little guidance in terms of documentation details. Further audit and quality improvement to embed safety netting documentation in ED clerking is required to further improve safety netting practices.

Patient Characteristics and Variables Influencing Acute Medical Flow.

Waiting times are the most widely used indicator of patient flow. This project aims to analyse 24-hour variation in referrals and waiting times for patients referred to the Acute Medical Service (AMS). A retrospective cohort study was conducted at the AMS of Wales' largest hospital. Collected data included patient characteristics, referral times, waiting times and adherence to Clinical Quality Indicators (CQIs). Peak referral times were found between 11:00-19:00. Peak waiting times occurred between 17:00-01:00, which was longer on weekdays in comparison to weekends. Referrals between 17:00-21:00 had the longest waiting times with > 40% of patients failing both junior and senior CQIs. Mean and median age and NEWS were higher between 17:00-09:00. Weekday evening and nights are problematic for acute medical patient flow. Interventions, including workforce, should be targeted towards these findings.

[Growing pains in children: myth or reality?]. / Les douleurs de croissance chez l'enfant existent-elles ?

"Growing pains" are a frequent problem in paediatric practice. Over the last years, their diagnostic and therapeutic approaches have changed. Other syndromes than those well-known by paediatricians are to be taken in consideration. Current treatment consists in reassurance of children and their family reactivation of patients (which means to take up a normal physical activity) and treatment of painful crisis as well as complementary therapies.

Effect of chronic renal failure on mortality rate following arterial reconstruction.

BACKGROUND: There is some evidence that patients with renal failure who have arterial procedures may have a poor outcome. This study compared the hospital mortality rate of arterial surgery in patients with chronic renal failure and those with normal renal function. METHODS: A consecutive series of 1718 patients undergoing arterial reconstructive surgery (excluding amputation) was entered prospectively on to a computerized database. Chronic renal failure was defined as a serum creatinine level over 400 micromol/l, or dialysis (either peritoneal or haemodialysis), or a successful renal transplant. Mortality was assessed at 30 days or in hospital. RESULTS: There were 69 patients (4.0 per cent) who were defined as having chronic renal failure. The mortality rate in this group was 23 per cent (16 patients) compared with 7.3 per cent (120 patients) of the 1649 patients without renal failure. The mortality rate was highest in patients undergoing urgent or emergency surgery and in those undergoing reconstruction for lower limb occlusive disease. The main causes of death were related to the cardiovascular system. CONCLUSION: Patients with chronic renal failure undergoing arterial surgery have a poor outcome compared with those with normal renal function.

Cost-effective carotid endarterectomy.

BACKGROUND: Although carotid endarterectomy is increasing in the UK, there is evidence that the procedure is still underused. Methods of reducing cost in a single vascular unit have been assessed using a continuous audit including outcome measures. METHODS: A consecutive series of 333 patients admitted over 7 years under a single consultant surgeon were studied. Outcome measures included the rate of perioperative neurological complication of any kind, and death. The length of hospital stay and the number of readmissions within 30 days were recorded prospectively by computerized audit. RESULTS: Over the interval of the study, the number of preoperative investigations was reduced; angiography and cerebral computed tomography were reserved for specific indications. The median duration of hospital stay decreased from 7 to 2 days. There was no change in the stroke and death rate (3 per cent) during the study and only two patients required readmission within 30 days. CONCLUSION: Carotid endarterectomy can be performed cost-effectively using non-invasive preoperative investigations for the majority of patients. In-hospital stay has been reduced and the routine use of intensive care replaced by a 2-h stay in theatre recovery. These changes have been achieved without compromising patient safety.

The effect of added dietary soybean oil on vitamin E status of the horse.

Fourteen 2-yr-old Quarter Horses and Quarter Horse x Thoroughbreds were randomly assigned to either a control (CTRL) diet or a diet supplemented with 6.4% soybean oil (SBO). The amounts of both diets that were fed met current NRC nutrient requirements and were isoenergetic with similar nutrient:energy ratios. Venous blood samples (20 mL) were taken at d 0, 30, 60, and 90 of the experiment and analyzed for serum alpha-tocopherol, serum cholesterol, and serum triglyceride. The sum of serum cholesterol and serum triglyceride values was used as an estimate of serum total lipid. The ratio of serum alpha-tocopherol:serum total lipid was used as a measure of vitamin E status of horses. The SBO group had higher serum cholesterol concentrations (P < .001) at 30, 60, and 90 d. Serum triglyceride was not affected by diet. Serum total lipids tended to be greater (P < .06) for the SBO group. Serum alpha-tocopherol was greater (P < .001) at 90 d in the SBO group. There was a significant correlation (P < .001, r = .62) between serum total lipids and serum alpha-tocopherol concentrations in the SBO group. This correlation was not significant (P < .07, r = .35) in the CTRL group. The ratio of serum alpha-tocopherol:serum total lipid was not affected by diet. The results of this experiment suggest that vitamin E status in non-exercising, 2-yr-old horses fed currently recommended levels of vitamin E was not affected by the addition of 6.4% SBO to the diet.

The development of gender stereotype components.

Developmental research has been limited by a narrow concept of stereotypes. A more complex model is presented, and developmental changes in gender stereotypes were investigated using the new model. In 2 studies, children were told about several sex-unspecified children, each described as having 1 masculine or 1 feminine characteristic. The children then predicted the likelihood of each story child having other masculine and feminine characteristics. In Study 1, 56 children (4-6 years) were told about target children who liked either a masculine or feminine toy, and then children predicted the targets' interests in other toys. In Study 2, 76 older children (6, 8, 10 years) were told about target children with a masculine or feminine characteristic from 1 of 4 categories (appearance, personality, occupations, toys), and then they predicted the likelihood of targets having other masculine and feminine characteristics from the same and from different categories as the cue. 2 developmental trends emerged: (a) children appear first to learn associations among characteristics relevant to their own sex and, later, to learn them for the other sex, and (b) older children's stereotypic judgments are more extreme than those of younger children. The implications of these results for the development of stereotypes, assessing gender knowledge, and understanding social judgments are discussed.

Moyamoya disease: an unusual cause of cerebral infarction.

A South African Bantu patient presenting with recurrent strokes and a change in personality was found to have cerebral infarction due to moyamoya disease. The disease has a characteristic radiological pattern of narrowing or occlusion of the distal internal carotid arteries associated with a profuse vascular network at the base of the brain and in the basal ganglia: the moyamoya vessels. The clinical features and the collateral vascular pathways that may develop after cerebral vascular occlusion are discussed and the surgical options for increasing cerebral blood flow described. In this patient a development of the technique in which the superficial temporal artery is laid onto the brain without interruption of the donor vessel was used, with improvement in the clinical picture.

Dipyridamole combined with exercise for thallium-201 myocardial imaging.

A new stress test for thallium-201 myocardial imaging in which pharmacological coronary vasodilatation with dipyridamole is combined with dynamic exercise is described. In 38 patients with coronary artery disease the sensitivity, total number of defects, degree of redistribution, and visual quality of thallium-201 imaging were greater after dipyridamole with exercise testing than after exercise alone. When the data from these 38 patients were combined with the results of dipyridamole-exercise imaging in 49 patients in whom exercise electrocardiography had been inconclusive then the technique gave a sensitivity for coronary disease of 87% and a specificity of 92%. Dipyridamole also increased the sensitivity of the exercise electrocardiogram, so that no patient with coronary disease had a strictly negative dipyridamole-exercise stress test. Only five of 214 patients who have now undergone this test have had complications requiring reversal of vasodilatation with aminophylline. The combined use of dipyridamole and exercise in this simple technique is a reliable and safe improvement on standard thallium-201 imaging tests.

Migration, remittances and development: a study of Caribbean cane cutters in Florida.

The results of a 1981 survey of 302 Caribbean sugarcane cutters who were temporary immigrants in Florida are presented. The focus is on remittances to the islands of origin. The results provide "no evidence that seasonal stateside employment expands agricultural output, or enhances the productive capacity of small farmers in the Caribbean."

Equilibrium and historical-structural perspectives on migration.

"The equilibrium model of labor mobility and the historical-structural perspective on population movement are summarized and critiqued. A comparative analysis identifies the sources of the growing discontinuity in the contemporary literature on migration by exploring the theoretical and methodological implications of the contrasting paradigms of socioeconomic development in which each perspective is embedded. The last section outlines an alternative approach to the study of migration by shifting the unit of analysis to the household."

The political economy of infant mortality in São Paulo, Brazil.

After the military took power in Brazil in 1964, the government adopted a wide range of policies designed to stimulate economic growth. A central aspect of the Brazilian model of development was the control of wages. From 1964 to 1975 this strategy caused the purchasing power of the minimum wage in the city of Säo Paulo to fall. The decline in the real wage index was associated with a rise in infant mortality during the period. When real wages rose after 1974, the death rate dropped off. The infant mortality trend cannot be explained by other factors that affect the actual or the reported death rate, such as changes in cityward migration, shifts in the distribution of income, and improvements in the quality of vital statistics. The findings of this study indicate a causal relationship between the infant mortality trend and changes in the purchasing power of the urban poor. Additional data on nutrition, changes in household behavior, and shifts in the cause structure of mortality support this conclusion.

[Population growth and distribution of income: the Brazilian case]. / Crescimento populacional e distribuicao da renda familiar: o caso brasileiro.

PIP: The relationship between population growth and the distribution of income in Brazil is examined. Data taken from the 1970 census are used to analyze the relationships among income, fertility, and mortality. Projections of changes in these relationships up to the year 2000 are considered.^ieng

[Mortality, distribution of income and rural-urban residence in Brazil]. / Mortaliad, distribution del ingreso y residencia rural-urbana en Brasil.

PIP: This study defines the relationship among mortality, development planning, and economic growth in Brazil. The estimated life expectancy is a quantitative indication of socioeconomic differences according to region, social class, rural or urban residence. During the last 10 years of economic development there have been important changes in the amount of salaries: while the income of the upper classes, or 5% of the population, augmented 27.3-36.2%, the income of the lower classes, or 40% of the population, decreased 11.2-9.1%. This was the result of government policies designed to control inflation and to stimulate the economic development. Mortality rate in Brazil was strongly influenced by such changes, since a low salary tends to exclude the poor from many medical services, to reduce the quality and quantity of nutrition, and to relegate families to a generally inferior quality of life. Infant mortality was particularly sensible to changes in income, as surveys done in Sao Paulo and in Belo Horizonte amply demonstrated.^ieng

The blood groups, serum groups, red-cell isoenzymes and haemoglobins of the Sandawe and Nyaturu of Tanzania.

Blood specimens from members of the click-speaking Sandawe tribe of Tanzania and of the adjacent Bantu-speaking Nyaturu tribe have been tested for antigens of 11 blood group systems, for variants of 3 plasma-protein systems and 9 red-cell-enzyme systems, for haemoglobin variants. The results are tabulated and gene frequencies computed. For most systems, the frequencies in the two tribes are similar to one another and, in so far as data are available, similar to the neighbouring Bantu-speaking tribes. The principal genetic difference between the Sandawe and the Nyaturu is in their frequencies of haemoglobin S and of glucose-6-phosphate dehydrogenase deficiency, both of which characters are several times higher in the Nyaturu than in the Sandawe; both characters are protective against falciparum malaria, and this suggests that the Nyaturu have in the past been much more strongly exposed to this infection than the Sandawe.

Ethnic variations in the relationship between income and fertility.

The effects of husband'spotential andrelative incomes on completed fertility, as well as their effects on certain parity progression probabilities, are examined within samples of Anglos, Blacks and Mexican Americans. Relationships are estimated using data from the one-percent 1960 and 1970 U.S. Public Use Samples. The results reveal different patterns of relationship by ethnicity between the measures of income and the measures of fertility. The effects on completed fertility of the income measures are positive for Anglos and negative for Blacks, while in the case of Mexican Americans the effect ofpotential income is negative and that ofrelative income is positive. Income effects on the parity progression probabilities are similar in pattern to those from the analyses using completed fertility, although somewhat different patterns tend to appear at different birth orders, especially among Anglos.