Effect of tobacco smoking on survival of men and women by social position: a 28 year cohort study

<b>Objective:</b> To assess the impact of tobacco smoking on the survival of men and women in different social positions. <b>Design:</b> A cohort observational study. <b>Setting:</b> Renfrew and Paisley, two towns in west central Scotland. <b>Participants:</b> 8353 women and 7049 men aged 45-64 years recruited in 1972-6 (almost 80% of the population in this age group). The cohort was divided into 24 groups by sex (male, female), smoking status (current, former, or never smokers), and social class (classes I + II, III non-manual, III manual, and IV + V) or deprivation category of place of residence. <b>Main outcome measure:</b> Relative mortality (adjusted for age and other risk factors) in the different groups; Kaplan-Meier survival curves and survival rates at 28 years. <b>Results:</b> Of those with complete data, 4387/7988 women and 4891/6967 men died over the 28 years. Compared with women in social classes I + II who had never smoked (the group with lowest mortality), the adjusted relative mortality of smoking groups ranged from 1.7 (95% confidence interval 1.3 to 2.3) to 4.2 (3.3 to 5.5). Former smokers’ mortalities were closer to those of never smokers than those of smokers. By social class (highest first), age adjusted survival rates after 28 years were 65%, 57%, 53%, and 56% for female never smokers; 41%, 42%, 33%, and 35% for female current smokers; 53%, 47%, 38%, and 36% for male never smokers; and 24%, 24%, 19%, and 18% for male current smokers. Analysis by deprivation category gave similar results. <b>Conclusions:</b> Among both women and men, never smokers had much better survival rates than smokers in all social positions. Smoking itself was a greater source of health inequality than social position and nullified women’s survival advantage over men. This suggests the scope for reducing health inequalities related to social position in this and similar populations is limited unless many smokers in lower social positions stop smoking

Evaluating lay perceptions of maternal mortality to improve risk communication: a case study in Rivers State, Nigeria

Maternal mortality is one of the major challenges in reproductive health in Nigeria. Approximately two-thirds of the women (three-quarters in rural Nigeria) deliver their babies outside of health facilities and without medically skilled birth attendants. Communication and education are vital since so many births take place outside formal healthcare environments, and the high mortality rate suggests there is potential for progress, which can supplement Nigerian government efforts. The purpose of the study was to elicit lay knowledge and interpretations about the major components of the problem as part of a wider mental models study aimed at improving risk communication. These knowledge and perceptions were elicited through semi-structured interviews with women of childbearing age (15-49 years). Interviews were analysed to evaluate common themes that will be used to model lay perceptions for comparison to the expert mental model as part of the wider method. The emergent themes will be presented and discussed in the context of the identification of important gaps in knowledge and misperceptions that have the potential for development of improved risk communication

Towards the classification of fireground cues: a qualitative analysis of expert reports

Whilst there is evidence linking informational cue processing ability to effective decision making on the fireground, only a few studies have actually attempted detailed description and categorization of the cues sought by fireground commanders when managing real fires. In this study, thirty experienced firefighters were interviewed across various fire stations in the UK and Nigeria using the critical decision method protocol. Forty one different cues were identified, which were then categorized into five distinct types namely: safety cues, cues that indicate the nature of problem, environmental cues, emotive cues, and incident command and control cues. The paper concludes by evaluating the role of expertise in cue utilization, drawing on evidence from the naturalistic decision making (NDM) literature

Eliciting experts’ knowledge in emergency response organizations

Purpose: Experienced fire ground commanders are known to make decisions in time-pressured and dynamic environments. The purpose of this paper is to report some of the tacit knowledge and skills expert firefighters use in performing complex fire ground tasks. Design/Methodology/Approach: This study utilized a structured knowledge elicitation tool, known as the critical decision method (CDM), to elicit expert knowledge. Seventeen experienced fire-fighters were interviewed indepth using a semi-structured CDM interview protocol. The CDM protocol was analyzed using the emergent themes analysis (ETA) approach Findings: Findings from the CDM protocol reveal both the salient cues sought, which we termed critical cue inventory (CCI), and the goals pursued by the fire ground commanders at each decision point. The CCI is categorized into five classes based on the type of information each cue generates to the incident commanders Practical Implications: Since the critical decision method is a useful tool for identifying training needs, this study discussed the practical implications for transferring experts’ knowledge to novice firefighters Originality/Value: Although many authors recognize that experts perform exceptionally well in their domains of practice, the difficulty still lies in getting a structured method for unmasking experts’ tacit knowledge. This paper is therefore relevant as it presents useful findings following a naturalistic knowledge elicitation study that was conducted across different fire stations in the UK and Nigeria

Reply to the letter to the editor regarding 'Clinical assessment of subacromial shoulder impingement – which factors differ from the asymptomatic population?'

[Extract] Not surprisingly, impingement is a term which does not reflect the underlying cause of all shoulder pain. Hence there is healthy debateregarding alternate terminology (Braman et al., 2013; J. S. Lewis, 2011 ; McFarland et al., 2013). However, it continues to be a term used throughout the medical literature and in an attempt to embrace this wider audience, until there is agreement about terminology, it was chosen for use in this paper

Isokinetic clinical assessment of rotator cuff strength in subacromial shoulder impingement

Background: Current conservative management of subacromial shoulder impingement (SSI) includes generic strengthening exercises, especially for internal (IR) and external (ER) shoulder rotators. However, there is no evidence that the strength or the ratio of strength between these muscle groups is different between those with SSI (cases) and an asymptomatic population (controls). Objective: To identify if isokinetic rotator cuff strength or the ratio of strength is significantly different between cases and controls. Study Design: Case Control Study. Method: Fifty one cases with SSI and 51 asymptomatic controls matched for age, gender, hand dominance and physical activity level completed isokinetic peak torque glenohumeral IR and ER testing. Within the SSI group, 31 dominant limbs were symptomatic and 20 non-dominant limbs were symptomatic. IR and ER were measured separately using continuous reciprocal concentric (con) and eccentric (ecc) contraction cycles at a speed of 600 degrees per second and again at 1200 degrees per second. Values of peak torque (PT), relative peak torque (RPT) and ratios were compared using independent t-tests between the SSI and asymptomatic groups. Results: Significant strength differences between the two groups were present only when the symptomatic SSI shoulder was the dominant shoulder (con ER PT at 600 /second, ecc ER PT at 1200 /second, ecc ER RPT at 1200 /second and ecc IR PT at 600 /second and 1200 /second). Conclusions: Changes in rotator cuff strength in SSI may be related to limb dominance, which may have implications for strengthening regimes

The effectiveness of a multidisciplinary foot care program for children and adolescents with juvenile idiopathic arthritis: an exploratory trial

Objectives: To evaluate the effectiveness of multidisciplinary foot-care, and to evaluate the methodological considerations of a trial of multidisciplinary care in juvenile idiopathic arthritis. Design: Exploratory randomised controlled trial. Subjects/Patients: Children/adolescents with juvenile idiopathic arthritis and inflammatory joint disease affecting the foot/ankle. Methods: Standard medical care was compared with a 12 month program of multidisciplinary foot-care informed by musculoskeletal ultrasound. This program was centred on strict disease control through rigorous examination and interventions delivered by a team comprised of a paediatric rheumatologist, podiatrist, physiotherapist and musculoskeletal ultrasonographer. Patients were assessed on foot impairment and disability scores using the Juvenile Arthritis Foot Disability Index. Results: Forty-four participants, aged 3-17 years were randomly assigned to receive the experimental (n = 21) or usual care (n = 23) interventions. There was an overall improvement in levels of foot related impairments in both groups over 12 months. Between-group differences in change scores for the Juvenile Arthritis Foot Disability Index were not statistically significant at 6 or 12 month follow-ups. Conclusion: The integrated multidisciplinary foot care interventions described in this trial were safe, but did not improve foot impairment levels relative to usual care. This trial identified several methodological challenges including recruitment/retention, difficulties with outcome tools and potential confounders.</p

Clinical assessment of subacromial shoulder impingement – Which factors differ from the asymptomatic population?

Copyright © 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This author manuscript is made available following 12 month embargo from date of publication (19 Dec 2016) in accordance with publisher’s copyright policyBackground To date, the significance of factors purported to be associated with subacromial shoulder impingement (SSI) and what differences, if any, are present in those with SSI compared to a matched asymptomatic population has not been identified. Gaining information about differences between people with SSI and asymptomatic people may direct clinicians towards treatments that impact upon these differences. Objective Compare the assessment findings of factors suggested to be associated with SSI; passive posterior shoulder range, passive internal rotation range, resting cervical and thoracic postures, active thoracic range in standing and scapula positioning between cases experiencing SSI and a matched asymptomatic group (controls). Method Fifty one SSI cases and 51 asymptomatic controls were matched for age, gender, hand dominance and physical activity level. The suggested associated factors were measured bilaterally. Independent t-tests were used to compare each of these measurements between the groups. Any variables for which a significant difference was identified, were then included in a conditional logistic regression analysis to identify independent predictors of SSI. Results The SSI group had significantly increased resting thoracic flexion and forward head posture, as well as significantly reduced upper thoracic active motion, passive internal rotation range and posterior shoulder range than the matched asymptomatic group. No independent predictors of SSI were identified in conditional logistic regression analysis. Conclusion Thoracic posture, passive internal rotation range and posterior shoulder range were significantly different between cases experiencing SSI and a matched asymptomatic group