Effect of brief exercise on urges to smoke in men and women smokers

IntroductionAlthough smoking urges have been demonstrated to vary by gender and also be influenced by exercise, it is unknown if exercise has a differential effect on smoking urges by gender. This study aimed to explore gender-specific effects of an acute bout of exercise on cessation-related symptoms in men and women smokers during acute abstinence.MethodsWe enrolled smokers (≥ 5 cigarettes/day) who were 18–40 years old for a study on exercise and smoking behavior. Participants abstained from smoking for at least 3 h, prior to measurement of their maximal oxygen consumption tested, which was the acute bout of exercise. Prior to and after the exercise, participants completed the Questionnaire of Smoking Urges – Brief and the Minnesota Nicotine Withdrawal Scale.ResultsParticipants (n = 38; 61% women) were, on average, 30.0 ± 0.9 years old and smoked 13.0 ± 0.8 cigarettes/day. All measured aspects of cessation-related symptoms significantly improved after the exercise in both men and women. In women there was a significant decline in anticipated relief from negative affect after the exercise (women: − 0.45 ± 0.20, p = 0.0322; men: − 0.41 ± 0.26, p = 0.1312). In men there was a significant decline in the intention to smoke after the exercise (men: − 0.77 ± 0.23, p = 0.0053; women: − 0.66 ± 0.37, p = 0.0909).ConclusionsAn acute bout of exercise reduced smoking urges in both men and women smokers during an acute state of abstinence. Additional research is needed to replicate these observations in a larger, more diverse sample, and to explore the implication of these observations on cessation.     

Cervical cytology screening among low-income,minority adolescents in New York City following the 2009 ACOG guidelines

ObjectivesIn December 2009, the American College of Obstetricians and Gynecologists recommended that cervical cancer screening begin at age 21 for young women. In this study, we examine receipt of first lifetime Papanicolaou (Pap) test and predictors of over-screening among adolescents within a large urban ambulatory care network.MethodsWe compared the proportion of first lifetime Pap test of adolescents aged 13–20 years between June 2007 — November 2009 (n = 7700) and December 2009–June 2012 (n = 9637) using electronic health records. We employed multivariable regression models to identify demographic and health care factors associated with receiving a first lifetime Pap test at age < 21 years in the post-guideline period (over-screening).ResultsThe proportion of Pap tests declined from 19.3% to 4.2% (p < 0.001) between the two periods. Multivariable logistic regression results showed receiving care from gynecologic/obstetric/family planning clinics compared to pediatric clinics, having more clinic encounters, and older age were associated with over-screening in the post-guideline period.ConclusionsWe found that guideline adherence differed by clinic type, insurance status, and health care encounters. In the quickly evolving field of cervical cancer control, it is important to monitor practice trends as they relate to shifts in population-based guidelines, especially in high-risk populations.     

Rectal carbamazepine as effective long-acting treatment after cluster seizures and status epilepticus

Carbamazepine (CBZ) is the gold standard antiepileptic drug (AED) for focal onset seizures. Despite CBZ being the benchmark AED, with readily available therapeutic drug monitoring, patients presenting with recurrent secondarily generalized tonic–clonic (or cluster) seizures or generalized tonic–clonic status epilepticus (SE) are primarily treated with other long-acting agents. The aim of the study was to examine the potential use of rectal (PR) CBZ as alternative long-acting treatment to parenteral AEDs following the termination of cluster seizures or SE with acute intravenous therapies. Oral CBZ syrup was given PR using 400-mg equivalent aliquots. Serum CBZ levels were requested after administration to confirm achievement of minimum therapeutic levels (total CBZ > 20 μmol·L^− 1). Where levels were subtherapeutic, the procedure was repeated using 400-mg CBZ bolus aliquots until therapeutic levels were achieved. Seven patients received PR CBZ to manage cluster seizures or SE following the initial termination of acute seizures with IV therapies including benzodiazepines. Six patients had no prior history of seizures, and 1 patient with a prior history was not taking AED therapy at the time of presentation. All patients subsequently remained seizure-free, and therapeutic CBZ levels were achieved in 6 of the 7 subjects within 5–10 h of initial CBZ dosing. In conclusion, the present study reports 7 patients who were safely and effectively treated with PR CBZ, which proved to be a viable and safe alternative to parenteral AEDs for maintenance of seizure freedom.     

Electronic health record interventions at the point of care improve documentation of care processes and decrease orders for genetic tests commonly ordered by nongeneticists

ObjectiveTo determine whether electronic health record (EHR) tools improve documentation of pre- and postanalytic care processes for genetic tests ordered by nongeneticists.MethodsWe conducted a nonrandomized, controlled, pre-/postintervention study of EHR point-of-care tools (informational messages and template report) for three genetic tests. Chart review assessed documentation of genetic testing processes of care, with points assigned for each documented item. Multiple linear and logistic regressions assessed factors associated with documentation.ResultsPreimplementation, there were no significant site differences (P > 0.05). Postimplementation, mean documentation scores increased (5.9 (2.1) vs. 5.0 (2.2); P = 0.0001) and records with clinically meaningful documentation increased (score >5: 59 vs. 47%; P = 0.02) at the intervention versus the control site. Pre- and postimplementation, a score >5 was positively associated with abnormal test results (OR = 4.0; 95% CI: 1.8–9.2) and trainee provider (OR = 2.3; 95% CI: 1.2–4.6). Postimplementation, a score >5 was also positively associated with intervention site (OR = 2.3; 95% CI: 1.1–5.1) and specialty clinic (OR = 2.0; 95% CI: 1.1–3.6). There were also significantly fewer tests ordered after implementation (264/100,000 vs. 204/100,000; P = 0.03), with no significant change at the control site (280/100,000 vs. 257/100,000; P = 0.50).ConclusionsEHR point-of-care tools improved documentation of genetic testing processes and decreased utilization of genetic tests commonly ordered by nongeneticists.     

Late-onset seizures and risk of subsequent stroke: A systematic review

Otherwise unexplained late-onset seizures, conventionally defined as epileptic seizures occurring in subjects older than 60 years and in the absence of disorders known to increase the risk of developing epilepsy, have been assumed to be, in most cases, of cerebrovascular origin. We systematically searched the literature to identify the evidence supporting the association between otherwise unexplained late-onset seizures/epilepsy and the risk of subsequent stroke. Most data from the literature indicate that cerebrovascular disease often underlies otherwise unexplained late-onset seizures/epilepsy. Patients presenting with seizures occurring for the very first time in late life and without clinically overt cerebrovascular disease should be considered as at increased risk of stroke. Consequently, these patients should be screened for the presence of vascular risk factors and treated accordingly. Such measures may greatly contribute to prevent strokes in these patients.