Lost opportunities for smoking cessation among adults with diabetes in Florida (2007) and Maryland (2006).

INTRODUCTION: Diabetes organizations recommend that people with diabetes should not smoke because of increased risk of diabetes complications. We describe smoking rates and health care service use among adults with diabetes in Florida and Maryland and identify the role of dentists in offering smoking cessation advice and services. METHODS: We analyzed data from 3 state telephone surveys: the 2007 Florida Behavioral Risk Factor Surveillance Survey (n = 39,549), the 2007 Florida Tobacco Callback Survey (n = 3,560), and the 2006 Maryland Adult Tobacco Survey (n = 21,799). RESULTS: Findings indicated that 15.7% of adults with diabetes in Florida and 11.6% of adults with diabetes in Maryland currently smoke. Current smoking among people with diabetes was associated with age, education, income, and race/ethnicity. Almost all respondents with diabetes who were current smokers in Florida (92.9%) and Maryland (97.7%) had visited a doctor or health care professional in the past year, and less than half had visited a dentist (40.7% and 44.8%, respectively). Both in Florida and Maryland, approximately two-thirds of adults with diabetes who were smokers and had visited a dentist in the past year had not received advice to quit (63.8% and 63.9%, respectively). In contrast, most adults with diabetes who were smokers and had visited a doctor or health care professional had received advice to quit smoking (95.3% and 84.9%, respectively). CONCLUSION: Dentists are in a unique position to identify and demonstrate the oral effects of smoking in patients with diabetes. These data support continued smoking cessation training and education of oral health professionals.

Fatal Spontaneous Tumor Lysis Syndrome in a Patient with Metastatic Colon Cancer: A Clinical Case of Rare Oncological Emergency.

Tumor lysis syndrome (TLS) is a potentially life-threatening complication of chemotherapy. It usually occurs in rapidly proliferating hematological malignancies. TLS is deemed spontaneous (STLS) when it occurs prior to any cytotoxic or definite treatment. STLS is extremely rare in solid tumors. Here, we report a rare case of fatal STLS in a 47-year-old woman diagnosed with metastatic colon cancer. The patient developed acute renal failure with anuria, electrolyte disturbances, and metabolic acidosis before initiating chemotherapy. Despite appropriate management of TLS, including renal replacement therapy, she died within a few days from multiorgan failure. Only few other case reports of STLS associated with colon cancer have been reported in the literature.

The spatial epidemiology of trauma: the potential of geographic information science to organize data and reveal patterns of injury and services.

Despite important advances in the prevention and treatment of trauma, preventable injuries continue to impact the lives of millions of people. Motor vehicle collisions and violence claim close to 3 million lives each year worldwide. Public health agencies have promoted the need for systematic and ongoing surveillance as a foundation for successful injury control. Surveillance has been used to quantify the incidence of injury for the prioritization of further research, monitor trends over time, identify new injury patterns, and plan and evaluate prevention and intervention efforts. Advances in capability to handle spatial data and substantial increases in computing power have positioned geographic information science (GIS) as a potentially important tool for health surveillance and the spatial organization of health care, and for informing prevention and acute care interventions. Two themes emerge in the trauma literature with respect to GIS theory and techniques: identifying determinants associated with the risk of trauma to guide injury prevention efforts and evaluating the spatial organization and accessibility of acute trauma care systems. We review the current literature on trauma and GIS research and provide examples of the importance of accounting for spatial scale when using spatial analysis for surveillance. The examples illustrate the effect of scale on incident analysis, the geographic variation of major injury across British Columbia's health service delivery areas (HSDAs) and the rates of variation of injury within individual HSDAs.

[Pulmonary Tumor Thrombotic Microangiopathy in a Patient with Metastatic Gastric Cancer]. / Pulmonale tumorthrombotische Mikroangiopathie bei einer Patientin mit metastasierendem Magenkarzinom.

HISTORY AND CLINICAL FINDINGS: A 53-year-old woman with relapsed metastatic gastric cancer after multimodal therapy was hospitalized 6 months after the end of treatment due to acute dyspnea. INVESTIGATIONS AND DIAGNOSIS: The examination showed tachycardia and tachypnea. D-dimers and LDH were elevated, blood gases were still in the standard range. In the CT we could exclude a pulmonary embolism (LE) and pneumonia. The echocardiography (EC) showed no abnormalities. A new malignant pleural effusion on the left was detected. DIAGNOSIS: The diagnosis of pulmonary tumor thrombotic microangiopathy (PTTM) in the context of relapsed metastatic gastric cancer was confirmed. TREATMENT AND COURSE: The patient developed progressive respiratory failure and had to be moved to the intensive care unit. In the EC we discovered a progressive right ventricular heart failure. With the suspicion of a severe LE and vital indication we started a thrombolysis, but it remained unsuccessful. The CT showed changes consistent with a PTTM. The patient died a few days later. CONCLUSION: PTTM is a rare and often fatal tumor-associated pulmonary complication.

Defining rational hospital catchments for non-urban areas based on travel-time.

BACKGROUND: Cost containment typically involves rationalizing healthcare service delivery through centralization of services to achieve economies of scale. Hospitals are frequently the chosen site of cost containment and rationalization especially in rural areas. Socio-demographic and geographic characteristics make hospital service allocation more difficult in rural and remote regions. This research presents a methodology to model rational catchments or service areas around rural hospitals--based on travel time. RESULTS: This research employs a vector-based GIS network analysis to model catchments that better represent access to hospital-based healthcare services in British Columbia's rural and remote areas. The tool permits modelling of alternate scenarios in which access to different baskets of services (e.g. rural maternity care or ICU) are assessed. In addition, estimates of the percentage of population that is served--or not served--within specified travel times are calculated. CONCLUSION: The modelling tool described is useful for defining true geographical catchments around rural hospitals as well as modelling the percentage of the population served within certain time guidelines (e.g. one hour) for specific health services. It is potentially valuable to policy makers and health services allocation specialists.

Peers, tobacco advertising, and secondhand smoke exposure influences smoking initiation in diverse adolescents.

PURPOSE: Identify demographic, social, and environmental factors associated with smoking initiation in a large, racially and ethnically diverse sample of underage youth participating in the 2006 Maryland Youth Tobacco Survey. DESIGN: Cross-sectional, multistage, probability sample survey. SETTING: Schools (308 middle and high schools) in Maryland. SUBJECTS: Subjects were 12- to 17-year-old adolescents participating in a school-based survey. New smokers and nonsmokers were included in the analysis (n  =  57,072). MEASURES: Social and media influence, secondhand smoke exposure, tobacco product use, and demographic information including age, race/ethnicity, and geographic region. ANALYSIS: Chi-square and multiple logistic regression analyses controlling for clustering. RESULTS: Hispanic and Hawaiian/Pacific Islander youth were most likely and Asian and Black youth were least likely to be new smokers. Smoking initiation was positively associated with higher age, living with a current smoker, secondhand smoke exposure, exposure to advertisements for tobacco products, having more friends that smoke, tobacco products offered by friends, risk perceptions, and use of other tobacco products such as smokeless tobacco and cigars. Multivariate logistic regression results suggested that composite measures of peer influence, advertising exposure, and secondhand smoke exposure were independently associated with smoking initiation. CONCLUSIONS: Media, peer influence, and secondhand smoke exposure were the most important factors influencing smoking initiation and were common to all racial/ethnic groups in this study. Interventions combining targeted public awareness, education, and media campaigns directed at parents/guardians should be investigated.

The journey to the end of smoking: A personal and population perspective.

BACKGROUND: Smoking cessation is best represented as a journey and not a single event. This article chronicles the path of change for the population of smokers in Maryland. PURPOSE: This study compared the population of ever-smokers in Maryland over three time points (2000, 2002, and 2006) examining how the population of ever-smokers shifted over time. METHODS: Analysis of process of change and social influence variables conducted using data from the Maryland Adult Tobacco Surveys (MATS) administered in 2000, 2002, and 2006. RESULTS: Analyses indicated an increasing percentage of ever-smokers (100 lifetime cigarettes) who have successfully quit and maintained cessation for more than 5 years. By 2006, the population of current adult smokers (aged > or =18 years) was smaller but seemed less interested in and able to quit. More 2006 smokers were in earlier stages of change for cessation and not interested in or planning to quit in the near term. Many had unsuccessfully tried to quit, with a substantial minority finding that cessation products found effective in research were not effective for them. Despite past failures, the vast majority expects to quit, has considered quitting, and believes that they will likely succeed eventually. Larger percentages of 2006 smokers are being advised to quit by medical professionals, are accessing empirically supported quit-smoking aids, and have multiple quit attempts. They also smoked every day for more years, smoked as many cigarettes per day, and had environments as filled with smoking as their 2000 and 2002 counterparts. CONCLUSIONS: Increasing successful cessation would require not only appropriate use of effective products but also successful negotiation of important tasks in the cessation journey. Health literacy and a consumer perspective can help to bridge gaps in the dissemination and effective use of empirically supported treatments.