The Next Generation of Users: Prevalence and Longitudinal Patterns of Tobacco Use Among US Young Adults

Objectives. We monitored the prevalence and patterns of use of the array of tobacco products available to young adults, who are at risk for initiation and progression to established tobacco use.Methods. We used data from waves 1 to 3 of GfK’s KnowledgePanel (2011–2012), a nationally representative cohort of young adults aged 18 to 34 years (n = 2144). We examined prevalence and patterns of tobacco product use over time, associated demographics, and state-level tobacco policy. We used multivariable logistic regression to determine predictors of initiation of cigarettes as well as noncombustible and other combustible products.Results. The prevalence of ever tobacco use rose from 57.28% at wave 1 to 67.43% at wave 3. Use of multiple products was the most common pattern (66.39% of tobacco users by wave 3). Predictors of initiation differed by product type and included age, race/ethnicity, policy, and use of other tobacco products.Conclusions. Tobacco use is high among young adults and many are using multiple products. Efforts to implement policy and educate young adults about the risks associated with new and emerging products are critical to prevent increased initiation of tobacco use.The 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA)1 gave the US Food and Drug Administration (FDA) the authority to regulate tobacco and marked a new beginning in the field of tobacco control. A number of restrictions arising from the FSPTCA have already taken place, including banning characterizing flavors in cigarettes and tobacco brand sponsorships of sports and entertainment events.1 At the same time, there has been increased use of noncigarette combustible products, such as cigars,2 and the introduction of several noncombustible tobacco products (NCPs), including e-cigarettes and snus. A spokesman for Phillip Morris recently called NCPs their “most exciting growth opportunity,”3^(p5) and several tobacco companies have endorsed their development for harm reduction.4–6 However, rather than promoting these products as a substitution for cigarettes, they are often advertised as an extension of major cigarette brands7 and promoted for use alongside cigarettes.8,9 These new products—as well as other noncigarette combustible products such as cigars and hookahs—also may be especially attractive to young adults.10–12Since the 1998 Master Settlement Agreement put forth restrictions on tobacco industry marketing to youths,13 young adults have become an increasingly important target audience.14,15 This is evident in the data, as approximately 20% of young adults still smoke cigarettes,16 and recent national data show that young adults aged 18 to 25 years had the highest prevalence of current tobacco use (40.8%) compared with youths (ages 12–17 years) or adults (ages 26 years and older).17 Use of certain noncigarette products are particularly high; for example, data from a nationally representative sample found that 30% of young adults aged 18 to 34 years had ever used cigars; 26% had used little cigars, cigarillos, or bidis; and 18% had used a hookah.18 This last finding corroborates other studies reporting high rates of hookah use among young adults,19–23 reaching past 30-day rates of 8.5% among college-age students.19 Young adults were also more likely than older adults to have ever used snus,10 and expressed interest in experimenting with the product.24 e-Cigarette use has also been reported to be inversely related to age,25,26 with rates in adults decreasing by 2% to 3% with every year of increased age.11Tobacco use is the number one cause of preventable death in America27 and results in almost 5.2 million years of potential life lost each year.28 In light of the increasingly diversified tobacco product marketplace, and the introduction of products that currently fall outside FDA regulatory authority, it is critical to monitor tobacco product use among young adults. This includes not only current, regular use but also experimentation. To decrease the prevalence and improve long-term health outcomes, focus should be extended to understanding to what extent consumers are using multiple tobacco products (poly-use). Little is known about patterns of poly-use, but studies suggest that this is becoming increasingly prevalent among young adults. For example, a recent study found that 30% of young adult current tobacco users had ever used multiple tobacco products,18 which corroborates findings in other samples.29,30 Another nationally representative study reported the highest prevalence of poly-use among those aged 18 to 24 years compared with those aged 25 years and older.17 This has implications as poly-users may have higher rates of nicotine addiction,7,31 may have more withdrawal symptoms during quit attempts,31 and may be less likely to quit.32Young adulthood marks a critical developmental period,33 one that often coincides with the both the initiation34–36 and establishment of regular tobacco use.35–37 Prevention efforts directed at this audience will depend on a precise understanding of the degree to which young adults are using different tobacco products. To address this, we examined the prevalence and patterns of tobacco product use over time, demographic correlates of use, and predictors of initiation among a large, nationally representative cohort of young adults. Data will help inform program planners and policymakers on the impact of new and alternative tobacco product use among young adults.     

Use of Aspirin in normalization of recombinant human erythropoietin-mediated hyper-reactivity of platelets in rats

Objectives:

The cytokine erythropoietin is the primary stimulator of erythropoiesis and recombinant human erythropoietin (rHuEPO), which is widely used in the treatment of anemia associated with advanced chronic kidney disease (CKD). Adverse cardiovascular outcomes have been observed during clinical trials of anemia correction with rHuEPO in CKD patients. We investigated the effects of short-term, high-dose treatment with rHuEPO on platelet reactivity and effects of aspirin on platelet reactivity in healthy rats.

Materials and Methods:

Animals received three daily dose of rHuEPO (25 μg/kg s.c.). Platelets were isolated after 48 h of last dose of rHuEPO to study the arachidonic acid-induced platelet aggregation. Aspirin (75 mg/kg p.o.) was given to animals just before 1 h of isolation of platelets.

Results:

In rats, treatment with rHuEPO increased platelet reactivity and platelet count. The increased platelet reactivity was paralleled by decreased time-to-occlusion (TTO) in arterial thrombosis model, and decreased bleeding time after tail transection in rats. Treatment with rHuEPO followed by single dose of aspirin showed significant reduction in TTO and bleeding time as compared with aspirin-treated group.

Conclusions:

These findings suggest that rHuEPO increases platelet reactivity and aspirin normalizes the hyper-reactive platelet and may reduce the cardiovascular events associated with rHuEPO in CKD patients.KEY WORDS: Aspirin, chronic kidney disease, platelet, rat, recombinant human erythropoietin     

The impact of the intensity of single symptoms on the diagnosis and prevalence of major depression

Objective

Diagnoses are based on algorithms which count symptoms. The question is whether all or only sufficiently severe complaints of patients should qualify as diagnostic criteria and how prevalence rates of mental disorders change when all or only moderate or severe complaints are counted as symptoms in diagnostic algorithms.

Method

One hundred thirty-nine general practice patients were diagnosed as suffering from major depression according to DSM-IV on the basis of the standardized clinical International Neuropsychiatric Diagnostic Interview (MINI). They additionally filled in the self-rating SCL-90, which allows patients to rate the intensity of each symptom on a five-point Likert scale. The diagnostic algorithm for major depression was modeled on the basis of the SCL-90 self-rating. MINI-diagnoses were compared with SCL-diagnoses when symptoms with different intensity were taken into account.

Results

The prevalence of “SCL-90-major depression” is 77.2% if all symptoms are counted, and 38.7% if only at least moderately severe symptoms, or 5.0% if only extremely severe symptoms are included in the diagnostic algorithm. Sensitivity rates vary from 10.8%, if only extremely severe symptoms are counted, to 94.2% if all complaints were included. Specificity rates vary from 37.4% for all complaints and 100% for extremely severe items. Accuracy is best when “a little bit” of complaint is omitted (78.1%) and lowest if only extremely severe symptoms are counted (58.9%).

Conclusion

The data demonstrate the importance of the severity of single symptoms for the diagnosis of mental disorders. Symptom definition, recognition, and evaluation must find greater attention in research, clinical practice, and training of physicians.     

Mineralokortikoidrezeptorantagonisten als Therapieoption bei akuter und chronischer Chorioretinopathia centralis serosa

Background

It is well known that central serous chorioretinopathy (CSCR) is triggered by endogenous and exogenous glucocorticoids but the exact pathomechanism is not completely understood. According to the results of previous studies overactivation of mineralocorticoid receptors may play a decisive role in the pathogenesis of CSCR.

Methods and results

Experimental studies have shown that overactivation of mineralocorticoid receptors in endothelial cells of the choroid induces increased permeability. In a pilot study inhibition of mineralocorticoid receptors was successful in treating CSCR. This article reports about the use of spironolactone in the treatment of CSCR. In this observational case series spectral-domain optical coherence tomographv (SD-OCT) showed either reduction or complete reabsorption of subretinal fluid. In pilot studies and in this case series inhibition of mineralocorticoid receptors as a therapeutic option was effective and safe; however, the efficacy is difficult to distinguish from spontaneous recovery, especially in acute CSCR.

Conclusion

For further assessment of this treatment controlled clinical trials are urgently required as this therapy would offer a new approach for patients with chronic CSCR and no tendency towards recovery.     

Psychophysiological responses to pain identify reproducible human clusters

Pain is a ubiquitous yet highly variable experience. The psychophysiological and genetic factors responsible for this variability remain unresolved. We hypothesised the existence of distinct human pain clusters (PCs) composed of distinct psychophysiological and genetic profiles coupled with differences in the perception and the brain processing of pain. We studied 120 healthy subjects in whom the baseline personality and anxiety traits and the serotonin transporter-linked polymorphic region (5-HTTLPR) genotype were measured. Real-time autonomic nervous system parameters and serum cortisol were measured at baseline and after standardised visceral and somatic pain stimuli. Brain processing reactions to visceral pain were studied in 29 subjects using functional magnetic resonance imaging (fMRI). The reproducibility of the psychophysiological responses to pain was assessed at 1 year. In group analysis, visceral and somatic pain caused an expected increase in sympathetic and cortisol responses and activated the pain matrix according to fMRI studies. However, using cluster analysis, we found 2 reproducible PCs: at baseline, PC1 had higher neuroticism/anxiety scores (P ? 0.01); greater sympathetic tone (P < 0.05); and higher cortisol levels (P ? 0.001). During pain, less stimulus was tolerated (P ? 0.01), and there was an increase in parasympathetic tone (P ? 0.05). The 5-HTTLPR short allele was over-represented (P ? 0.005). PC2 had the converse profile at baseline and during pain. Brain activity differed (P ? 0.001); greater activity occurred in the left frontal cortex in PC1, whereas PC2 showed greater activity in the right medial/frontal cortex and right anterior insula. In health, 2 distinct reproducible PCs exist in humans. In the future, PC characterization may help to identify subjects at risk for developing chronic pain and may reduce variability in brain imaging studies.     

A unique foot-worn device for patients with degenerative meniscal tear

Purpose

The purpose of the current study was to assess the effects of a new foot-worn device on the gait, physical function and pain in patients suffering from knee osteoarthritis (OA) who had a low-impact injury to the medial meniscus causing a degenerative meniscal tear.

Methods

A retrospective analysis of 34 patients with knee OA and a degenerative medial meniscal tear was performed. Patients underwent a gait evaluation, using an electronic walkway mat, and completed the SF-36 health survey and the WOMAC questionnaire at baseline and after 3 and 12 months of therapy. AposTherapy is a functional, biomechanical, non-invasive rehabilitation therapy consisting of a foot-worn device that is individually calibrated to each patient and is used during activities of daily living. Repeated-measures analyses were performed to compare gait parameters and self-evaluation questionnaires between baseline, and 3 and 12 months.

Results

Significant improvements were found in gait velocity, step length and single-limb support of the involved knee following 12 weeks of therapy (all p < 0.01), alongside an improvement in limb symmetry. These results were maintained at the 12-month follow-up examination. Significant improvements were also found in all three domains of the WOMAC index (pain, stiffness and physical function) and in the SF-36 Physical Health Scale and the SF-36 Mental Health Scale (all p < 0.01).

Conclusions

Patients with knee OA and a degenerative medial meniscal tear using a biomechanical foot-worn device for a year showed improvement in gait, physical function and pain. Based on the findings of this study, it can be postulated that this biomechanical device might have a positive effect on this population.

Level of evidence

Therapeutic study, Level IV.     

Interstitial brachytherapy vs. intensity-modulated radiation therapy for patients with cervical carcinoma not suitable for intracavitary radiation therapy

PurposeInterstitial brachytherapy (IBT) is the standard alternative treatment for patients with cervical carcinoma not suitable for intracavitary radiotherapy. There is an emerging belief that intensity-modulated radiotherapy (IMRT) has the potential to replace IBT. We aimed to compare the dosimetry achieved by IBT and IMRT in such patients.Methods and MaterialsThe CT imaging data, previously used for IBT planning of 12 patients with cervical carcinoma, were transferred to IMRT planning system to generate parallel IMRT plans. Prescribed dose to the planning target volume (PTV) was 20 Gy delivered in 2-weekly high-dose-rate fractions of 10 Gy each with IBT (biologically equivalent dose [BED₁₀] 40 Gy) and 33 Gy/13 fractions/2.5 wk with IMRT (BED₁₀ 41 Gy). For comparison, dose–volume parameters for target and organs at risk were recorded and expressed in terms of BED₁₀ and BED₃, respectively.ResultsFor PTV, the mean D₉₅ (dose received by 95% of PTV) was better with IBT (57.16 Gy vs. 41.47 Gy, p = 0.003). The mean conformity index was 0.94 and 0.90 with IBT and IMRT, respectively (p = 0.034). IBT delivered significantly reduced doses to 1.0 cc (D_max), 5.0 cc (D_{5 cc}), 50% (D₅₀), and 75% (D₇₅) of bladder volume as compared with IMRT. The mean rectal D_max was significantly better with IBT as compared with IMRT (54.64 Gy vs. 62.63 Gy, p = 0.02).ConclusionsIBT provides superior PTV coverage and organs at risk sparing to IMRT. Thus, IBT remains the standard treatment for patients with cervical carcinoma unsuitable for intracavitary radiotherapy.     

Improved neonatal survival after participatory learning and action with women’s groups: a prospective study in rural eastern India

Objective

To determine whether a women’s group intervention involving participatory learning and action has a sustainable and replicable effect on neonatal survival in rural, eastern India.

Methods

From 2004 to 2011, births and neonatal deaths in 36 geographical clusters in Jharkhand and Odisha were monitored. Between 2005 and 2008, these clusters were part of a randomized controlled trial of how women’s group meetings involving participatory learning and action influence maternal and neonatal health. Between 2008 and 2011, groups in the original intervention clusters (zone 1) continued to meet to discuss post-neonatal issues and new groups in the original control clusters (zone 2) met to discuss neonatal health. Logistic regression was used to examine neonatal mortality rates after 2008 in the two zones.

Findings

Data on 41 191 births were analysed. In zone 1, the intervention’s effect was sustained: the cluster-mean neonatal mortality rate was 34.2 per 1000 live births (95% confidence interval, CI: 28.3–40.0) between 2008 and 2011, compared with 41.3 per 1000 live births (95% CI: 35.4–47.1) between 2005 and 2008. The effect of the intervention was replicated in zone 2: the cluster-mean neonatal mortality rate decreased from 61.8 to 40.5 per 1000 live births between two periods: 2006–2008 and 2009–2011 (odds ratio: 0.69, 95% CI: 0.57–0.83). Hygiene during delivery, thermal care of the neonate and exclusive breastfeeding were important factors.

Conclusion

The effect of participatory women’s groups on neonatal survival in rural India, where neonatal mortality is high, was sustainable and replicable.     

Two-dimensional gel electrophoresis in peritoneal fluid samples identifies differential protein regulation in patients suffering from peritoneal or ovarian endometriosis

Endometriosis is determined by local and systemic proinflammatory dysregulation and therefore differential protein expression in peritoneal fluid (PF). Of highest interest is lesion formation and the establishment and persistence of endometriosis. In this study we analyzed well-characterized PF samples of patients with ovarian or peritoneal endometriosis and compared them to control samples. We found 11 proteins differentially regulated, of which some might play a key role in the pathogenesis of endometriosis.     

Postpartale H?morrhagie

Important proactive strategies are anticipating risk factors, active management of third stage labour and prophylactic oxytocin. Nearly 70% of maternal deaths caused by obstetric hemorrhage are considered preventable. Immediate treatment of the cause by drugs or surgery, resuscitation and timely correction of coagulopathy is the key to the management of postpartum hemorrhages (PPH). If medical therapy (oxytocin, sulprostone) fails uterine balloon tamponade and, if bleeding persists, uterine compression sutures successfully arrest bleeding in more than 80% of cases. Failure of all the procedures is an indication for hysterectomy. Uterine artery embolization may be useful in patients with placenta accreta/increta or ongoing bleeding after surgery. Manual removal of the placenta is mandatory, if the placenta is not separated within 30?min after birth. If coagulopathy is suspected clinically, intravenous tranexamic acid and fibrinogen should be given in a timely fashion. Activated recombinant factor VIIa should only be considered in patients refractory to adequate surgical and hemostasis-stabilizing procedures.