Randomized controlled trial of a midwife-delivered brief smoking cessation intervention in pregnancy

Objective. To evaluate the efficacy of a brief smoking cessation intervention with pregnant women practicable routinely by midwives. Design. Midwives were randomized to deliver the experimental intervention or usual care. The 10‐15‐minute intervention was based on brief counselling, written materials, arrangements for continuing self‐help support and feedback on expired‐air carbon monoxide levels. The intervention was tailored to the women's needs: those who did not want to stop smoking received a brief motivational intervention, those who wanted to stop received an intervention designed to assist them and those that had stopped recently (recent ex‐smokers) received a relapse prevention intervention. Setting. Booking interviews with pregnant women in nine hospital and community trusts. Subjects. A total of 1120 pregnant women in the third month of pregnancy (249 recent ex‐smokers and 871 current smokers). Main outcome measures. Three indicators of biochemically validated abstinence were collected. Continuous abstinence for at least 3 months prior to delivery, point prevalence abstinence immediately post‐delivery, and continuous abstinence from 3 months pre‐delivery to 6 months post‐delivery. Results. Only a small proportion of the women who would have been eligible to take part in the trial were actually recruited by 178 recruiting midwives, with lack of time being cited as the main barrier. The intervention and usual care groups differed in post‐delivery point prevalence abstinence rates for recent ex‐smokers (65% vs. 53%, p < 0.05, one‐tailed), but not in other outcome measures. Overall, 54% of 'recent ex‐smokers' at booking and 7% of 'current smokers' at booking had been abstinent for at least 3 months at the time of delivery, and 23% and 3%, respectively, were still abstinent by the time the child was 6 months old (i.e. 12 months post‐intervention). Smoking status at follow‐up was predicted by dependence indexed by time to first cigarette in the morning . Conclusions. A brief 'one‐off' smoking cessation intervention by midwives does not seem to be a practicable or effective method of helping pregnant smokers to stop. Other options such as tailored self‐help materials and telephone counselling and other specialist treatments should be examined. Current smoking cessation rates in pregnancy are very low.     

At what age do normal weight Canadian children become overweight adults? Differences according to sex and metric

Background: The prevalence of overweight and obesity doubles between adolescence and young adulthood; however, the exact age, and appropriate metric to use to identify when overweight develops is still debated.

Aim: To examine the age of onset of overweight by sex and four metrics: body mass index (BMI), fat mass (%FM), waist circumference (WC) and waist-to-height ratio (WHtR).

Subjects and methods: Between 1991 and 2017, serial measures of body composition were taken on 237 (108 males) individuals (aged 8–40?years of age). Hierarchical random effects models were used to develop growth curves. Curves were compared to BMI, %FM and WC overweight age- and sex-specific cut-points.

Results: In males, the BMI growth curve crossed the cut-point at 22.0?years, compared to 23.5 and 26.5?years for WHtR and %FM, respectively; WC cut-off was not reached until 36?years. In females, the BMI growth curve crossed the overweight cut-point at 21.5?years, compared to 14.2?years for %FM and 21.9 and 27.5?years for WC and WHtR, respectively.

Conclusion: In summary, overweight onset occurs during young adulthood with the exception of WC in males. BMI in males and %FM in females were the metrics identifying overweight the earliest.     

Facteurs associés aux perdus de vue des patients sous traitement antirétroviral dans un centre de traitement ambulatoire du VIH à Conakry,Guinée

Background

Late or inadequate therapeutic management increases the risk of mortality associated with HIV/AIDS. The aim of this study was to analyze the proportion and factors associated with loss of follow-up in HIV patients who receiving antiretroviral therapy at Conakry.

Regulation of neutrophil migration and superoxide production by recombinant tumor necrosis factors-alpha and -beta: comparison to recombinant interferon-gamma and interleukin-1 alpha

We compared the ability of recombinant human tumor necrosis factor- alpha (rHuTNF-alpha) and tumor necrosis factor-beta (rHuTNF-beta) to stimulate polymorphonuclear neutrophil (PMN) migration and superoxide production. Significant PMN migration occurred across polycarbonate filters after stimulation with rHuTNF-alpha at concentrations ranging from 10(-7) to 10(-10) mol/L and at 10(-7) to 10(-8) mol/L for rHuTNF- beta and N-formylmethionyl-leucyl phenylalanine (FMLP), whereas recombinant human interferon-gamma was only minimally active at 10(-7) mol/L and recombinant human interleukin-1 alpha was inactive at the doses tested. In addition, antibodies to rHuTNF-alpha completely inhibited rHuTNF-alpha but not rHuTNF-beta or FMLP-induced PMN migration. Combinations of rHuTNF-alpha and rHuTNF-beta (at similar molar concentrations) stimulated PMN migration levels comparable to that obtained with rHuTNF-alpha alone. Checkerboard analyses performed by placing different concentrations of rHuTNF-alpha and rHuTNF-beta above and below polycarbonate filters of microchemotaxis chambers demonstrated that rHuTNF-alpha and rHuTNF-beta stimulated both chemotactic and chemokinetic responses by PMN. Additional studies demonstrated that 1 X 10(-8) mol/L rHuTNF-alpha and 3 X 10(-9) mol/L rHuTNF-beta (which represents 10(4) U/mL of each cytokine) were similar in their ability to induce superoxide production by PMNs; however, at ten- to 100-fold lower molar concentrations (10(3) and 10(2) units), rHuTNF-alpha was significantly more active than rHuTNF-beta. At the doses tested, both cytokines were less active than phorbol myristate acetate at stimulating O2- release. The results demonstrate that rHuTNF- alpha and rHuTNF-beta differ quantitatively but not qualitatively in their effects on PMN functions in vitro and suggest that rHuTNF-beta may be less toxic than rHuTNF-alpha in vivo.     

Exercise volume and intensity: a dose–response relationship with health benefits

Introduction

The health benefits of exercise are well established. However, the relationship between exercise volume and intensity and health benefits remains unclear, particularly the benefits of low-volume and intensity exercise.

Purpose

The primary purpose of this investigation was, therefore, to examine the dose–response relationship between exercise volume and intensity with derived health benefits including volumes and intensity of activity well below international recommendations.

Methods

Generally healthy, active participants (n = 72; age = 44 ± 13 years) were assigned randomly to control (n = 10) or one of five 13-week exercise programs: (1) 10-min brisk walking 1×/week (n = 10), (2) 10-min brisk walking 3×/week (n = 10), (3) 30-min brisk walking 3×/week (n = 18), (4) 60-min brisk walking 3×/week (n = 10), and (5) 30-min running 3×/week (n = 14), in addition to their regular physical activity. Health measures evaluated pre- and post-training including blood pressure, body composition, fasting lipids and glucose, and maximal aerobic power (VO₂max).

Results

Health improvements were observed among programs at least 30 min in duration, including body composition and VO₂max: 30-min walking 28.8–34.5 mL kg^?1 min^?1, 60-min walking 25.1–28.9 mL kg^?1 min^?1, and 30-min running 32.4–36.4 mL kg^?1 min^?1. The greater intensity running program also demonstrated improvements in triglycerides.

Conclusion

In healthy active individuals, a physical activity program of at least 30 min in duration for three sessions/per week is associated with consistent improvements in health status.     

Evaluation of admittance control as an alternative to passive arm supports to increase upper extremity function for individuals with Duchenne muscular dystrophy

The degree of upper extremity active range of motion provided by an admittance control robot compared with a commercially available passive arm support for individuals with DMD who have limited arm function was investigated in this study. The reachable workspace evaluation was used to assess active range of motion provided by both devices. A visual analog scale was also used to secure participant-reported outcome measures. The admittance control robot significantly increased reachable surface area scores compared with the passive arm support for the dominant arm (Wilcoxon T = 5, P = .022, r² = 0.263) and for the nondominant arm (paired-samples t test, t(9) = 4.66, P = .001, r² = 0.71). The admittance control robot also significantly decreased participant-reported exertion compared with the passive arm support. Results of this study substantiated the benefits of admittance control for individuals with DMD compared with a commercially available passive arm support.     

Effect of a program to facilitate parent-child communication about sex

U.S. teens have high rates of premarital sexual activity resulting in alarming rates of teenage pregnancy and sexually transmitted disease. One possible way to combat the problem of teenage sexual activity is to promote sexuality education within the family. The purpose of this study was to increase parent-child communication about sex through an educational program for parents. The effect of the educational program was evaluated by a nonrandomized, controlled trial. Volunteer parents were recruited from three middle schools (grade six through eight) located in middle to upper-middle socioeconomic class neighborhoods. The parents participated in four 2-hour sessions which included factual information about sexuality and exercises to improve communication skills. The experimental group (N = 47) were requested to fill out questionnaires immediately before and one month after the program. The control group (N = 17) were requested to fill out questionnaires one month before and again immediately before the program. Parents were asked to report the number of times they talked with their adolescents about 11 sex-related topics. The difference in reported frequency of communication before and after the program was compared using a two-tailed, matched pairs t-test. Twenty-four (51%) experimental group parents and eight (47%) control group parents completed both questionnaires. There was a significant increase in communication reported by the experimental group. The mean difference of the number of topics discussed was 10.9 (SD 7.3) for participants versus -2.5 (SD 5.9) for controls (p = .00053). This study shows that parent-child communication about sex can be facilitated by an educational program for parents.