Vulnerable children, stigmatised smokers : The social construction of target audiences in media debates on policies regulating smoking in vehicles

Acknowledgements S.H., S.S. and S.D. developed the study concept and gained funding for the work. S.H. developed the study design. J.B. and H.W. drafted the manuscript. J.B. and H.W. developed the coding frame and coded the articles. S.H., S.S. and S.D. critically revised the manuscript. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was funded by Cancer Research UK (C47682/A16930) and the Scottish School of Public Health Research. Sheila Duffy is Chief Executive of ASH Scotland. Heide Weishaar and Shona Hilton are funded by the UK Medical Research Council as part of the Informing Healthly Public Policy programme (MC_UU12017-15) at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow. The authors declare no additional conflicting interest.Peer reviewedPublisher PD

Newsprint coverage of smoking in cars carrying children : a case study of public and scientific opinion driving the policy debate

Acknowledgements Date of Acceptance:17/10/2014 Acknowledgements: This project was funded by Cancer Research UK (MC_U130085862) and the Scottish School of Public Health Research. Cancer Research UK and the Scottish School of Public Health Research was not involved in the collection, analysis, and interpretation of data, writing of the manuscript or the decision to submit the manuscript for publication. Shona Hilton, Karen Wood, Josh Bain and Chris Patterson are funded by the UK Medical Research Council as part of the Understandings and Uses of Public Health Research programme (MC_UU_12017/6) at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow. We thank Alan Pollock who provided assistance with coding.Peer reviewedPublisher PD

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

UK Newsprint Coverage of the Debate about Further Protective Smoke-Free Laws to Reduce Second-Hand Smoke Exposure to Children in Cars

Since 2007 there has been legislation prohibiting smoking in all enclosed public places throughout the UK. In the intervening period interest has grown in considering other policy interventions to further reduce the harmful effects of second-hand smoke (SHS) exposure to children. This study offers the first UK investigation into how the news media are framing the current debate around the harms of SHS exposure to children in cars and what role they may be playing in presenting ideas about the need for further smoke-free laws to protect children. Methods: Qualitative content analysis was conducted on six UK and three Scottish national newspapers between 1st Jan 2004 to 31st Dec 2013. Findings: Exposure to SHS was increasingly identified as being harmful to the health of children, with cars being described as one of the main places of exposure for children following the smoke-free laws. Legislative action was deemed necessary, as well as enforceable, and growing public support highlighted a change in public attitudes towards smoking and willingness for further legislation on SHS to protect children. There were a wide range of advocates in comparison to a narrow number of critics. Conclusions: Over a decade there was increased reporting on the harms of SHS exposure to children while traveling in cars. This may indicate that there is growing public and policy appetite for further smoke-free legislation to protect children. Previous private vehicle laws suggest that further smoke-free legislation could be successful. Advocates would do well to consider whether there are current opportunities for playing a greater role in the wider debate surrounding the harms of SHS exposure to children in cars

UK Newsprint Coverage of the Debate about Further Protective Smoke-Free Laws to Reduce Second-Hand Smoke Exposure to Children in Cars

Since 2007 there has been legislation prohibiting smoking in all enclosed public places throughout the UK. In the intervening period interest has grown in considering other policy interventions to further reduce the harmful effects of second-hand smoke (SHS) exposure to children. This study offers the first UK investigation into how the news media are framing the current debate around the harms of SHS exposure to children in cars and what role they may be playing in presenting ideas about the need for further smoke-free laws to protect children. Methods: Qualitative content analysis was conducted on six UK and three Scottish national newspapers between 1st Jan 2004 to 31st Dec 2013. Findings: Exposure to SHS was increasingly identified as being harmful to the health of children, with cars being described as one of the main places of exposure for children following the smoke-free laws. Legislative action was deemed necessary, as well as enforceable, and growing public support highlighted a change in public attitudes towards smoking and willingness for further legislation on SHS to protect children. There were a wide range of advocates in comparison to a narrow number of critics. Conclusions: Over a decade there was increased reporting on the harms of SHS exposure to children while traveling in cars. This may indicate that there is growing public and policy appetite for further smoke-free legislation to protect children. Previous private vehicle laws suggest that further smoke-free legislation could be successful. Advocates would do well to consider whether there are current opportunities for playing a greater role in the wider debate surrounding the harms of SHS exposure to children in cars

The Rist radial access system: a multicenter study of 152 patients

BackgroundTransradial access (TRA) for neurointervention is becoming increasingly popular as experience with the technique grows. Despite reasonable efficacy using femoral catheters off-label, conversion to femoral access occurs in approximately 8.6–10.3% of TRA cases, due to an inability of the catheter to track into the vessel of interest, lack of support, or radial artery spasm.MethodsThis is a multicenter, retrospective case series of patients undergoing neurointerventions using the Rist Radial Access System. We also present our institutional protocol for using the system.Results152 patients were included in the cohort. The most common procedure was flow diversion (28.3%). The smallest radial diameter utilized was 1.9 mm, and 44.1% were performed without an intermediate catheter. A majority of cases (96.1%) were completed successfully; 3 (1.9%) required conversion to a different radial catheter, 2 (1.3%) required conversion to femoral access, and 1 (0.7%) was aborted. There was 1 (0.7%) minor access site complication and 4 (2.6%) neurological complications.ConclusionsThe Rist catheter is a safe and effective tool for a wide range of complex neurointerventions, with lower conversion rates than classically reported