Behavioral tasks sensitive to acute abstinence and predictive of smoking cessation success:a systematic review and meta-analysis

BACKGROUND AND AIMS: Performance on cognitive tasks may be sensitive to acute smoking abstinence and may also predict whether quit attempts fail. Our aim was to conduct a systematic review and meta-analysis to identify cognitive tasks sensitive to acute abstinence and predictive of smoking cessation success.METHODS: Embase, Medline, PsycInfo and Web of Science were searched up to March 2016. Studies were included if they enrolled adults and assessed smoking using used a quantitative measure. Studies were combined in a random effects meta-analysis.RESULTS: We included 42 acute abstinence studies and 13 cessation studies were included. There was evidence for an effect of abstinence on delay discounting [d = 0.26, 95% CI 0.07 to 0.45, p = 0.005], response inhibition [d = 0.48, 95% CI 0.26 to 0.70, p &lt; 0.001], mental arithmetic [d = 0.38, 95% CI 0.06 to 0.70, p = 0.018], and recognition memory [d = 0.46, 95% CI 0.23 to 0.70, p &lt; 0.001]. In contrast performance on the Stroop [d =0 .17, 95% CI -0.17 to 0.51, p = 0.333] and smoking Stroop [d = 0.03, 95% CI -0.11 to 0.17, p = 0.675] task was not influenced by abstinence. We found only weak evidence for an effect of acute abstinence on dot probe task performance [d = 0.15, 95% CI -0.01 to 0.32, p = 0.072]. The design of the cessation studies was too heterogeneous to permit meta-analysis.CONCLUSIONS: Compared with satiated smokers, acutely abstinent smokers display higher delay discounting, lower response inhibition, impaired arithmetic, and recognition memory performance. However, reaction time measures of cognitive bias appear to be unaffected by acute tobacco abstinence. Conclusions about cognitive tasks that predict smoking cessation success were limited by methodological inconsistencies.</p

ehealth technology in cardiac exercise therapeutics for pediatric patients with congenital and acquired heart conditions: a summary of evidence and future directions

Many children and adolescents with congenital and acquired heart disease (CHD) are physically inactive and participate in an insufficient amount of moderate-to-vigorous intensity exercise. Although physical activity (PA) and exercise interventions are effective at improving short- and long-term physiological and psychosocial outcomes in youth with CHD, several barriers including resource limitations, financial costs, and knowledge inhibit widespread implementation and dissemination of these beneficial programs. New and developing eHealth, mHealth, and remote monitoring technologies offer a potentially transformative and cost-effective solution to increase access to PA and exercise programs for youth with CHD, yet little has been written on this topic. In this review, a cardiac exercise therapeutics (CET) model is presented as a systematic approach to PA and exercise, with assessment and testing guiding three sequential PA and exercise intervention approaches of progressive intensity and resource requirements: (1) PA and exercise promotion within a clinical setting; (2) unsupervised exercise prescription; and (3) medically supervised fitness training intervention (i.e., cardiac rehabilitation). Using the CET model, the goal of this review is to summarize the current evidence describing the application of novel technologies within CET in populations of children and adolescents with CHD and introduce potential future applications of these technologies with an emphasis on improving equity and access to patients in low-resource settings and underserved communities

Demographic Factors Contributing to NAS Treatment

Infants that were formula fed, had unpartnered parents, birthing parents who used illicit substances, and multiple medication exposures were more likely to be treated for NAShttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2022/1019/thumbnail.jp

Improving Confidentiality and Alone Time with Adolescents: A Quality Improvement Study

Purpose/Background: Spending time alone with adolescents during routine clinic visits is considered the standard of care. One-on-one time facilitates the development of adolescents’ abilities to manage their own health concerns and also increases physician-adolescent communication about sensitive health topics. Despite this, recent studies suggest that up to 60% of adolescents do not get the opportunity to spend time alone with their provider. In collaboration with other practitioners led by a national faculty panel from the American Academy of Pediatrics and the Society for Adolescent Health and Medicine, we developed a quality improvement project that aimed to review this aspect of adolescent healthcare within the Portland Family Medicine Clinic. We aimed to improve the quality of preventive services delivered to adolescents and young adults by increasing the delivery of private, confidential healthcare through improved documentation. We predicted improvement in the documentation, and provision of, this service when providers are prompted to document this within the well-child check (WCC) note template, thereby improving the quality of confidential care of adolescents within our clinic. Methods/Approach: Our project utilized a “Plan-do-study-act” model. We studied adolescent and young adults (ages 13-26) who were seen for WCC by eight providers on one clinical team at the Portland Family Medicine Clinic. Baseline data were collected through chart reviews of twenty adolescents who were seen for WCC in March 2019. Data included whether there was documentation that adolescents were given access to alone time with their provider, if confidentiality was discussed, and if adolescents were screened for sexual activity, mental health concerns and substance use. We used serial PDSA cycles to test the following changes: prompting providers in the visit note template to document alone time (cycle 1), adding an additional prompt to document who was present at the visit (cycle 2), and adding a third prompt to document screening for sexual activity (cycle 3). We tracked the rates of documentation of these metrics. There was a total of 21 adolescent patients included in cycle 1, 15 in cycle 2 and 10 in cycle 3. Results: Baseline data obtained from chart reviews of adolescent patients showed that our providers were documenting spending “alone time” with adolescents 0% of the time. After the first PDSA cycle, documentation of “alone time” improved to 95.2%. Baseline data also showed that providers were discussing confidential healthcare with adolescents 0% of the time. Documentation of confidentiality improved to 38.1% after PDSA cycle 1 and 46.7% after PDSA cycle 2. Baseline data showed that adolescent patients were screened for sexual activity 33.3% of the time. This improved to 100% after completion of PDSA cycle 3. Conclusions: Prompting providers to document provision of one-on-one time and discussion of confidentiality with adolescent patients improves the delivery of quality of adolescent care

Hypertensive Disorders in Pregnancy

This course is part of a project that aims to reduce maternal mortality in Sub-Saharan Africa by providing specialty training in Obstetrics and Gynecology. This training will be provided in a partnership between high-income and low- and middle-income countries (LMIC). ¶ We hope that you find the course useful in whatever role you play in the reduction of maternal mortality, and that together we will find a way to sustainably improve the lives women, children, and the people who care for them in Sub Saharan Africa.http://deepblue.lib.umich.edu/bitstream/2027.42/120502/1/medical_1000_obgyn_project-hypertensive_disorders_in_pregnancy-Octoboer14.zi

Chromosome Xq23 is associated with lower atherogenic lipid concentrations and favorable cardiometabolic indices

Abstract Autosomal genetic analyses of blood lipids have yielded key insights for coronary heart disease (CHD). However, X chromosome genetic variation is understudied for blood lipids in large sample sizes. We now analyze genetic and blood lipid data in a high-coverage whole X chromosome sequencing study of 65,322 multi-ancestry participants and perform replication among 456,893 European participants. Common alleles on chromosome Xq23 are strongly associated with reduced total cholesterol, LDL cholesterol, and triglycerides (min P = 8.5 × 10−72), with similar effects for males and females. Chromosome Xq23 lipid-lowering alleles are associated with reduced odds for CHD among 42,545 cases and 591,247 controls (P = 1.7 × 10−4), and reduced odds for diabetes mellitus type 2 among 54,095 cases and 573,885 controls (P = 1.4 × 10−5). Although we observe an association with increased BMI, waist-to-hip ratio adjusted for BMI is reduced, bioimpedance analyses indicate increased gluteofemoral fat, and abdominal MRI analyses indicate reduced visceral adiposity. Co-localization analyses strongly correlate increased CHRDL1 gene expression, particularly in adipose tissue, with reduced concentrations of blood lipids