Association between respiratory tract diseases and secondhand smoke exposure among never smoking flight attendants: a cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>Little is known about long-term adverse health consequences experienced by flight attendants exposed to secondhand smoke (SHS) during the time smoking was allowed on airplanes. We undertook this study to evaluate the association between accumulated flight time in smoky airplane cabins and respiratory tract diseases in a cohort of never smoking flight attendants.</p> <p>Methods</p> <p>We conducted a mailed survey in a cohort of flight attendants. Of 15,000 mailed questionnaires, 2053 (14%) were completed and returned. We excluded respondents with a personal history of smoking (n = 748) and non smokers with a history of respiratory tract diseases before the age of 18 years (n = 298). The remaining 1007 respondents form the study sample.</p> <p>Results</p> <p>The overall study sample was predominantly white (86%) and female (89%), with a mean age of 54 years. Overall, 69.7% of the respondents were diagnosed with at least one respiratory tract disease. Among these respondents, 43.4% reported a diagnosis of sinusitis, 40.3% allergies, 30.8% bronchitis, 23.2% middle ear infections, 13.6% asthma, 13.4% hay fever, 12.5% pneumonia, and 2.0% chronic obstructive pulmonary disease. More hours in a smoky cabin were observed to be significantly associated with sinusitis (OR = 1.21; p = 0.024), middle ear infections (OR = 1.30; p = 0.006), and asthma (OR = 1.26; p = 0.042).</p> <p>Conclusion</p> <p>We observed a significant association between hours of smoky cabin exposure and self-reported reported sinusitis, middle ear infections, and asthma. Our findings suggest a dose-response between duration of SHS exposure and diseases of the respiratory tract. Our findings add additional evidence to the growing body of knowledge supporting the need for widespread implementation of clean indoor air policies to decrease the risk of adverse health consequences experienced by never smokers exposed to SHS.</p

An assessment of factors associated with quality of randomized controlled trials for smoking cessation

To reduce smoking-related diseases, a research priority is to develop effective interventions for smoking cessation, and evidence from randomized controlled trials (RCTs) is usually considered to be the most valid. However, findings from RCTs may still be misleading due to methodological flaws. This study aims to assess the quality of 1083 RCTs of smoking cessation interventions in 41 relevant Cochrane Systematic Reviews (CSRs). Logistic regression analysis was performed to identify significant variables associated with the quality of RCTs. It was found that evidence for smoking cessation from RCTs was predominantly from high income countries, and the overall quality was high in only 8.6% of the RCTs. High quality RCTs tended to have a larger sample size, to be more recently published, and conducted in multiple countries belonging to different income categories. In conclusion, the overall quality of RCTs of smoking cessation interventions is far from perfect, and more RCTs in less developed countries are required to generate high grade evidence for global tobacco control. Collaboration between researchers in developed and less developed countries should be encouraged

Right Place, Right Time: Preferences of Women with Ovarian Cancer for Delivery of CAM Education

The purpose of this pilot study was to assess the feasibility of on-site complementary and alternative medicine (CAM) education sessions to maximize quality of life for women with ovarian cancer. The pilot intervention consisted of four weekly sessions, each focusing the techniques and benefits of a particular CAM topic (e.g., nutrition, massage, relaxation). Participants were recruited from the Center for Women’s Oncology at H. Lee Moffitt Cancer Center from 2010 to 2012. Eligible participants had an ovarian cancer diagnosis with a life expectancy of at least 12 months, and were 18 years or older. The Gynecologic Oncology research nurse invited women in the outpatient clinic who matched the eligibility criteria. The research nurse explained the study and provided an informed consent form and return envelope. Because ovarian cancer is not only a rare cancer but, also, most patients seen at Moffitt have recurrent or advanced disease, many women did not have an adequate ECOG score. Many women who consented had rapid changes in health status, with morbidity and mortality outpacing recruitment of the 20 needed to proceed with the four education sessions. Baseline and follow-up surveys were conducted to assess changes in QOL, knowledge, and satisfaction with the intervention. While 27 women consented and 24 women completed the baseline survey, only five women participated in the intervention. The five women who participated were all white, and at time of consenting had a mean age of 60 (SD 9.08) and an average of 102 months (SD 120.65) since diagnosis, and were all on active treatment, except for one. The intervention pilot did not encounter difficulties with regard to recruitment, but suffered problems in achieving an adequate number of women to launch the on-site sessions because of rapidly changing morbidity and significant mortality. The team recognized that a larger-scaled intervention comprised of on-site sessions was impractical and compared attendance rates with a more convenient format currently underway in the Women’s Oncology program at Moffitt. While low participation prevented an intervention analysis of scientific merit, the study data is informative with regard to barriers, facilitators, and alternative methods for sharing useful information to women with advanced ovarian cancer. The comparison strongly suggested that CAM education for women compromised by the disease and treatment associated with ovarian cancer would best be delivered in the convenient-access format that allowed remote access to live and recorded discussions of specific topics

Multiple Case Study of Factors Associated with Enrollment of Women with Persistent or Recurrent Ovarian Cancer in Clinical Trials in Central Florida

Study Purpose: Ovarian cancer, the most lethal gynecologic cancer, has had a relatively stable mortality rate since 1975, despite a decrease in mortality for all gynecologic cancers combined. Standard-of-care advances are needed to reduce ovarian cancer morbidity and mortality. Advances must, however, undergo a long, rigorously controlled research process that can take more than ten years before becoming available to the public. Further, few women with persistent or recurrent ovarian cancer are offered or enrolled in the clinical trials that do exist at select sites throughout the nation. The purpose of this multiple-case study is to identify necessary and/or sufficient factors associated with enrollment in ovarian cancer clinical trials, and to identify facilitators and barriers within the practice setting that, in the longer term, can be used to inform targeted interventions to improve trial access and accrual. The multilevel factors that were explored were aligned with the Consolidated Framework for Intervention Research (CFIR). The study sought to answer two research questions. (1) Based on Qualitative Comparative Analysis [QCA (Ragin, 1989)], what necessary and/or sufficient factors would enable a woman with recurrent or persistent ovarian cancer to enroll in a clinical trial in Florida? (2) What barriers and facilitators, practitioner and patient-specific, exist with regard to enrolling women with ovarian cancer in clinical trials? Materials and Methods: This multiple case study used online surveys to obtain quantitative and qualitative data from two populations: women with ovarian cancer and nurses at various referring practice sites. Data from Moffitt Cancer Center’s Total Cancer Care protocol was requested to conduct chart reviews that would identify prospective participants. Qualitative comparative analysis (QCA), which is useful for determining causality in small sample sizes, was used to determine necessary and/or sufficient factors associated with enrollment by women with ovarian cancer in clinical trials, as well as barriers and facilitators related to clinical trial enrollment. Results: Women with ovarian cancer who participated in clinical trials were stage III/IV, wanted information, and engaged in discussion about clinical trials, making those factors necessary for enrollment in a study. Facilitators for participation were discussion with the provider of care, to some extent the existence of patient-accessible clinical trial literature in the practice, knowledge that health insurance covers standard of care costs, and having a provider who offers clinical trials. Absence of those factors thus constitutes a barrier. For nurses, the impact of having a practice team plan was related to enrolling women with ovarian cancer in clinical trials, and feeling informed and comfortable with questions women might ask about trials. Conclusion: Clinical trials are an underutilized priority for improving the standard of care and reducing the high rate of morbidity and mortality associated with ovarian cancer. The data show deficits and needs within two key interrelated populations: medical oncology practice nurses and women with ovarian cancer. Opportunities exist within each level of the Consolidated Framework for Implementation Research (CFIR); interviews should be used to confirm the findings, which can be used to establish an interventional protocol to increase clinical trial enrollment by women with ovarian cancer

Right Place, Right Time: Preferences of Women with Ovarian Cancer for Delivery of CAM Education

The purpose of this pilot study was to assess the feasibility of on-site complementary and alternative medicine (CAM) education sessions to maximize quality of life for women with ovarian cancer. The pilot intervention consisted of four weekly sessions, each focusing the techniques and benefits of a particular CAM topic (e.g., nutrition, massage, relaxation). Participants were recruited from the Center for Women’s Oncology at H. Lee Moffitt Cancer Center from 2010 to 2012. Eligible participants had an ovarian cancer diagnosis with a life expectancy of at least 12 months, and were 18 years or older. The Gynecologic Oncology research nurse invited women in the outpatient clinic who matched the eligibility criteria. The research nurse explained the study and provided an informed consent form and return envelope. Because ovarian cancer is not only a rare cancer but, also, most patients seen at Moffitt have recurrent or advanced disease, many women did not have an adequate ECOG score. Many women who consented had rapid changes in health status, with morbidity and mortality outpacing recruitment of the 20 needed to proceed with the four education sessions. Baseline and follow-up surveys were conducted to assess changes in QOL, knowledge, and satisfaction with the intervention. While 27 women consented and 24 women completed the baseline survey, only five women participated in the intervention. The five women who participated were all white, and at time of consenting had a mean age of 60 (SD 9.08) and an average of 102 months (SD 120.65) since diagnosis, and were all on active treatment, except for one. The intervention pilot did not encounter difficulties with regard to recruitment, but suffered problems in achieving an adequate number of women to launch the on-site sessions because of rapidly changing morbidity and significant mortality. The team recognized that a larger-scaled intervention comprised of on-site sessions was impractical and compared attendance rates with a more convenient format currently underway in the Women’s Oncology program at Moffitt. While low participation prevented an intervention analysis of scientific merit, the study data is informative with regard to barriers, facilitators, and alternative methods for sharing useful information to women with advanced ovarian cancer. The comparison strongly suggested that CAM education for women compromised by the disease and treatment associated with ovarian cancer would best be delivered in the convenient-access format that allowed remote access to live and recorded discussions of specific topics