How useful are the stages of change for targeting interventions? randomized test of a brief intervention to reduce smoking

Objectives. To see whether the stages of change are useful for targeting a brief intervention to reduce smoking based on implementation intentions. A second objective was to rule out demand characteristics as an alternative explanation for the findings of intervention studies based on the transtheoretical model and implementation intentions. Design. Participants (N = 350) were randomized to a passive control condition (questionnaire only), active control condition (questionnaire-plus-instruction to plan to quit) or experimental condition (questionnaire, plan to quit, form an implementation intention). Their behavior and psychosocial orientation to quit were measured at baseline and 2-month follow-up. Main Outcome Measures. Theory of planned behavior variables, nicotine dependence and quitting. Results. Significantly more people quit smoking in the experimental condition than in the control conditions, and the planning instructions changed intention to quit and perceived control over quitting, but not behavior. Stage of change moderated these effects such that implementation intentions worked best for individuals who were in the preparation stage at baseline. Conclusion. Harnessing both motivational and volitional processes seems to enhance the effectiveness of smoking cessation programs, although further work is required to clarify inconsistencies in the literature using the stages of change.</p

Management of early pregnancy loss with mifepristone and misoprostol: clinical predictors of treatment success from a randomized trial.

BackgroundEarly pregnancy loss is a common event in the first trimester, occurring in 15%-20% of confirmed pregnancies. A common evidence-based medical regimen for early pregnancy loss uses misoprostol, a prostaglandin E1 analog, with a dosage of 800 μg, self-administered vaginally. The clinical utility of this regimen is limited by suboptimal effectiveness in patients with a closed cervical os, with 29% of patients experiencing early pregnancy loss requiring a second dose after 3 days and 16% of patients eventually requiring a uterine aspiration procedure.ObjectiveThis study aimed to evaluate clinical predictors associated with treatment success in patients receiving medical management with mifepristone-misoprostol or misoprostol alone for early pregnancy loss.Study designWe performed a planned secondary analysis of a randomized trial comparing mifepristone-misoprostol with misoprostol alone for management of early pregnancy loss. The published prediction model for treatment success of single-dose misoprostol administered vaginally included the following variables: active bleeding, type of early pregnancy loss (anembryonic pregnancy or embryonic and/or fetal demise), parity, gestational age, and treatment site; previous significant predictors were vaginal bleeding within the past 24 hours and parity of 0 or 1 vs &gt;1. To determine if these characteristics predicted differential proportions of patients with treatment success or failure, we performed bivariate analyses; given the small proportion of treatment failures in the combined treatment arm, both arms were combined for analysis. Thereafter, we performed a logistic regression analysis to assess the effect of these predictors collectively in each of the 2 treatment groups separately as well as in the full cohort as a proxy for the combined treatment arm. Finally, by using receiver operating characteristic curves, we tested the ability of these predictors in association with misoprostol treatment success to discriminate between treatment success and treatment failure. To quantify the ability of the score to discriminate between treatment success and treatment failure in each treatment arm as well as in the entire cohort, we calculated the area under the curve. Using multivariable logistic regression, we then assessed our study population for other predictors of treatment success in both treatment groups, with and without mifepristone pretreatment.ResultsOverall, 297 evaluable participants were included in the primary study, with 148 in the mifepristone-misoprostol combined treatment group and 149 in the misoprostol-alone treatment group. Among patients who had vaginal bleeding at the time of treatment, 15 of 17 (88%) in the mifepristone-misoprostol combined treatment group and 12 of 17 (71%) in the misoprostol-alone treatment group experienced expulsion of pregnancy tissue. Among patients with a parity of 0 or 1, 94 of 108 (87%) in the mifepristone-misoprostol treatment group and 66 of 95 (69%) in the misoprostol-alone treatment group experienced expulsion of pregnancy tissue. These clinical characteristics did not predict treatment success in the combined cohort alone (area under the curve=0.56; 95% confidence interval, 0.48-0.64). No other baseline clinical factors predicted treatment success in the misoprostol-alone treatment arm or mifepristone pretreatment arm. In the full cohort, the significant predictors of treatment success were pretreatment with mifepristone (adjusted odds ratio=2.51; 95% confidence interval, 1.43-4.43) and smoking (adjusted odds ratio=2.15; 95% confidence interval, 1.03-4.49).ConclusionNo baseline clinical factors predicted treatment success in women receiving medical management with misoprostol for early pregnancy loss. Adding mifepristone to the medical management regimen of early pregnancy loss improved treatment success; thus, mifepristone treatment should be considered for management of early pregnancy loss regardless of baseline clinical factors

Genetic contribution to radiographic severity in osteoarthritis of the knee

Objective Knee osteoarthritis (OA) has a significant genetic component. The authors have assessed the role of three variants reported to influence risk of knee OA with p<5×10–8 in determining patellofemoral and tibiofemoral Kellgren Lawrence (K/L) grade in knee OA cases. Methods 3474 knee OA cases with sky-line and weight-bearing antero-posterior x-rays of the knee were selected based on the presentation of K/L grade ≥2 at either the tibiofemoral or patellofemoral compartments for one or both knees. Patients belonging to three UK cohorts, were genotyped for rs143383, rs4730250 and rs11842874 mapping to the GDF5, COG5 and MCF2L genes, respectively. The association between tibiofemoral K/L grade and patellofemoral K/L grade was assessed after adjusting for age, gender and body mass index. Results No significant association was found between the rs4730250 and radiographic severity. The rs11842874 mapping to MCF2L was found to be nominally significantly associated with patellofemoral K/L grade as a quantitative trait (p=0.027) but not as a binary trait. The GDF5 single nucleotide polymorphism rs143383 was associated with tibiofemoral K/L grade (β=0.05 (95% CI 0.02 to 0.08) p=0.0011). Conclusions Our data indicate that within individuals affected by radiographic knee OA, OAGDF5 has a modest but significant effect on radiographic severity after adjustment for the major risk factors

National counter-terrorism (C-T) policies and challenges to human rights and civil liberties: Case study of United Kingdom

In the UK the rise post-2005 in “home-grown” terrorism, relying to a significant extent on strikes on soft targets by “self-starters,” means that the search for effective preventive measures remains a continuing concern. Below a number of the preventive counter-terror measures adopted post-9/11, and incrementally strengthened in response to the current threat, are found to fall into three categories and represent interventions at the stages in the path toward attacks. This chapter focuses on selected examples of these preventive measures. In terms of three key stages, firstly, there is the attempt to prevent radicalization, under the “Prevent” strategy. A second strategy relies on taking certain measures to control the activities of those considered likely – on the balance of probabilities – to engage in terrorist-related activity. A third preventive strategy relies on the special terrorism offences under the Terrorism Acts 2000 and 2006, as amended, intended to allow for intervention at a very early stage in terrorist plots and in preparing or instigating terrorist acts (“precursor” offences)

Talking about weight in pregnancy : an exploration of practitioners' and women's perceptions

Prevalence of maternal obesity is increasing, with health risks for mother and infant. Effective health promotion depends on sufficient knowledge and appropriate communication skills. We aimed to explore women's, midwives' and health visitors' perceptions of current practice in helping women manage their weight and supporting healthy behaviour change during pregnancy, and their perceived training needs. A modified grounded theory methodology was adopted, based upon critical realist assumptions. Following consultation events with fifty six practitioners to inform data collection tools, twenty (different) practitioners and nine women participated in focus groups. Comparative analysis generated four themes: A core theme, “Discouraging discourses”, described health professionals’ negative beliefs and reactive approach to communicating about weight. “Staff resources” identified limitations in and requirements for practitioner knowledge, skills and tools for effective communication. “Contextual influences” were social factors, which hindered practitioners’ efforts to achieve healthy behaviour change. “Communicating as a Team” identified the importance of and challenges to a team approach. Findings have implications for weight management in pregnancy, practitioner resources, teamwork, and national health promotion campaigns

P324 RADIOGRAPHIC KNEE OSTEOARTHRITIS IS ASSOCIATED WITH AN INCREASE IN TRABECULAR BUT NOT CORTICAL BONE MINERAL DENSITY USING PERIPHERAL QUANTITATIVE CT

Digitalitzat per Artypla

A breathing source surface for cycles 23 and 24

The potential field source surface (PFSS) model is used to represent the large-scale geometry of the solar coronal magnetic fields. The height of the source surface in this model can be taken as a free parameter. Previous work suggests that varying the source surface height during periods of solar minimum yields better agreement between PFSS models and the measured magnitude of the interplanetary magnetic field (IMF) open flux at 1 AU - in other words, the source surface breathes in and out over the course of the solar cycle. We examine the evolution of open flux during all of cycle 23 and the first part of cycle 24 using photospheric magnetic field maps from the Solar and Heliospheric Observatory's Michelson Doppler Imager and Solar Dynamics Observatory's Helioseismic and Magnetic Imager instruments. We determine the value of source surface height that provides a best fit to the IMF open flux at 1 AU (using the OMNI 2 data set) for the time period 1996-2012. The canonical 2.5 Rs source surface matches the measured IMF open flux during periods of solar maximum but needs to be raised by approximately 15-30% in order to match the measured IMF open flux at the periods of solar minimum

The effect of FTO variation on increased osteoarthritis risk is mediated through body mass index : a mendelian randomisation study

Objective: Variation in the fat mass and obesity-associated (FTO) gene influences susceptibility to obesity. A variant in the FTO gene has been implicated in genetic risk to osteoarthritis (OA). We examined the role of the FTO polymorphism rs8044769 in risk of knee and hip OA in cases and controls incorporating body mass index (BMI) information. Methods: 5409 knee OA patients, 4355 hip OA patients and up to 5362 healthy controls from 7 independent cohorts from the UK and Australia were genotyped for rs8044769. The association of the FTO variant with OA was investigated in case/control analyses with and without BMI adjustment and in analyses matched for BMI category. A mendelian randomisation approach was employed using the FTO variant as the instrumental variable to evaluate the role of overweight on OA. Results: In the meta-analysis of all overweight (BMI≥25) samples versus normal-weight controls irrespective of OA status the association of rs8044769 with overweight is highly significant (OR[CIs] for allele G=1.14 [01.08 to 1.19], p=7.5×10−7). A significant association with knee OA is present in the analysis without BMI adjustment (OR[CIs]=1.08[1.02 to 1.14], p=0.009) but the signal fully attenuates after BMI adjustment (OR[CIs]=0.99[0.93 to 1.05], p=0.666). We observe no evidence for association in the BMI-matched meta-analyses. Using mendelian randomisation approaches we confirm the causal role of overweight on OA. Conclusions: Our data highlight the contribution of genetic risk to overweight in defining risk to OA but the association is exclusively mediated by the effect on BMI. This is consistent with what is known of the biology of the FTO gene and supports the causative role of high BMI in OA