Tobacco packaging design for reducing tobacco use

Background  Tobacco use is the largest single preventable cause of death and disease worldwide. Standardised tobacco packaging is an intervention intended to reduce the promotional appeal of packs and can be defined as packaging with a uniform colour (and in some cases shape and size) with no logos or branding, apart from health warnings and other government-mandated information, and the brand name in a prescribed uniform font, colour and size. Australia was the first country to implement standardised tobacco packaging between October and December 2012, France implemented standardised tobacco packaging on 1 January 2017 and several other countries are implementing, or intending to implement, standardised tobacco packaging.  Objectives  To assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction.  Search methods  We searched MEDLINE, Embase, PsycINFO and six other databases from 1980 to January 2016. We checked bibliographies and contacted study authors to identify additional peer-reviewed studies.  Selection criteria  Primary outcomes included changes in tobacco use prevalence incorporating tobacco use uptake, cessation, consumption and relapse prevention. Secondary outcomes covered intermediate outcomes that can be measured and are relevant to tobacco use uptake, cessation or reduction. We considered multiple study designs: randomised controlled trials, quasi-experimental and experimental studies, observational cross-sectional and cohort studies. The review focused on all populations and people of any age; to be included, studies had to be published in peer-reviewed journals. We examined studies that assessed the impact of changes in tobacco packaging such as colour, design, size and type of health warnings on the packs in relation to branded packaging. In experiments, the control condition was branded tobacco packaging but could include variations of standardised packaging.  Data collection and analysis  Screening and data extraction followed standard Cochrane methods. We used different 'Risk of bias' domains for different study types. We have summarised findings narratively.  Main results  Fifty-one studies met our inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between- and within-participant experimental studies, cohort and cross-sectional studies, and time-series analyses. Few studies assessed behavioural outcomes in youth and non-smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross-sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non-behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall we judged most studies to be at high or unclear risk of bias in at least one domain. The one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 percentage point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. Findings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. One national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post-implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. Studies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye-tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non-behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. We found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse-tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack.  Authors' conclusions  The available evidence suggests that standardised packaging may reduce smoking prevalence. Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect. A reduction in smoking behaviour is supported by routinely collected data by the Australian government. Data on the effects of standardised packaging on non-behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence. As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake. We did not find any evidence suggesting standardised packaging may increase tobacco use

Acute effects of glucagon-like peptide-1, GLP-1_{9-36 amide}, and exenatide on mesenteric blood flow, cardiovascular parameters, and biomarkers in healthy volunteers

Glucagon-like peptide-1 (GLP-1, GLP-17-36amide) and its sister peptide glucagon-like peptide 2 (GLP-2) influence numerous intestinal functions and GLP-2 greatly increases intestinal blood flow. We hypothesized that GLP-1 also stimulates intestinal blood flow and that this would impact on the overall digestive and cardiovascular effects of the hormone. To investigate the influence of GLP-1 receptor agonism on mesenteric and renal blood flow and cardiovascular parameters, we carried out a double-blinded randomized clinical trial. A total of eight healthy volunteers received high physiological subcutaneous injections of GLP-1, GLP-19-36 amide (bioactive metabolite), exenatide (stable GLP-1 agonist), or saline on four separate days. Blood flow in mesenteric, celiac, and renal arteries was measured by Doppler ultrasound. Blood pressure, heart rate, cardiac output, and stroke volume were measured continuously using an integrated system. Plasma was analyzed for glucose, GLP-1 (intact and total), exenatide and Pancreatic polypeptide (PP), and serum for insulin and C-peptide. Neither GLP-1, GLP-19-36 amide, exenatide nor saline elicited any changes in blood flow parameters in the mesenteric or renal arteries. GLP-1 significantly increased heart rate (two-way ANOVA, injection [P = 0.0162], time [P = 0.0038], and injection × time [P = 0.082]; Tukey post hoc GLP-1 vs. saline and GLP-19-36amide [P < 0.011]), and tended to increase cardiac output and decrease stroke volume compared to GLP-19-36 amide and saline. Blood pressures were not affected. As expected, glucose levels fell and insulin secretion increased after infusion of both GLP-1 and exenatide.Lasse Bremholm, Ulrik B Andersen, Mads Hornum, Linda Hilsted, Simon Veedfald, Bolette Hartmann and Jens Juul Hols

Bayesian Atlas Estimation for the Variability Analysis of Shape Complexes

International audienceIn this paper we propose a Bayesian framework for multi-object atlas estimation based on the metric of currents which permits to deal with both curves and surfaces without relying on point correspondence. This approach aims to study brain morphometry as a whole and not as a set of different components, focusing mainly on the shape and relative position of different anatomical structures which is fundamental in neuro-anatomical studies. We propose a generic algorithm to estimate templates of sets of curves (fiber bundles) and closed surfaces (sub-cortical structures) which have the same " form " (topology) of the shapes present in the population. This atlas construction method is based on a Bayesian framework which brings to two main improvements with respect to previous shape based methods. First, it allows to estimate from the data set a parameter specific to each object which was previously fixed by the user: the trade-off between data-term and regularity of deformations. In a multi-object analysis these parameters balance the contributions of the different objects and the need for an automatic estimation is even more crucial. Second, the covariance matrix of the deformation parameters is estimated during the atlas construction in a way which is less sensitive to the outliers of the population

Conceptual dialogues as a task format in teacher education and the reflection of their potential for inclusive Sachunterricht

Im Rahmen des Beitrags werden Konzeptdialoge als Aufgabenformate für die Entwicklung gemeinsamer fachlich tragfähiger Erklärungen in einer heterogenen Lerngruppe zu einem naturwissenschaftlich-technischen Phänomen sowie als Erhebungsmethode zur Erfassung von Vorstellungen und Präkonzepten von Schüler*innen für den inklusiven Sachunterricht vorgestellt. Fortführend werden Konzeptdialoge sowohl als Aufgabenformate als auch als Erhebungsmethode für den Einsatz in der ersten Phase der Lehrer*innenbildung, angelehnt an die Reflexion Masterstudierender in einem modulbezogenen Projekt mit Konzeptdialogen zum Phänomen Kuchenbacken, diskutiert. (DIPF/Orig.)In this article, concept dialogues are presented as task formats for the development of common, professionally viable explanations in a heterogeneous learning group about a scientific-technical phenomenon, as well as a survey method for recording students\u27 conceptions and pre-conceptions for inclusive Sachunterricht. Further, conceptual dialogues are discussed both as task formats and as a data collection method for use in the first phase of teacher education, based on the reflections of Master\u27s students in a module-related project with conceptual dialogues on the phenomenon of baking cakes. (DIPF/Orig.

Towards joint morphometry of white matter tracts and gray matter surfaces

Organization for Human Brain Mapping 2013International audienceMorphological studies of anatomical structures play an important role in neuroimaging. For example in the analysis of the circuits connecting sub-cortical areas to the cortical surface one would like to study together gray matter surfaces and white matter tracts (fiber bundles). To the best of our knowledge, there is no generic method to study these objects together. Atlas construction is based on the joint estimate of a common ''mean shape'' (template) and of its deformation towards each shape of the population. The atlas shows the invariants of the population and their variability. We propose a new atlas construction method based on currents [1] which permits to deal with curves and surfaces together. We extend to curves the methodology proposed in [3] for surfaces. This allows to fix a topologically correct representation of the bundle templates. We are therefore able to compare the templates directly with the shapes of the population and to study the relative positions of different objects. Moreover every deformation is based on one single diffeomorphism of the whole 3D space which preserves the spatial organization of the objects making possible a joint analysis of multiple objects

Vigencia de la semiótica

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Unified analysis of shape and structural connectivity of neural pathways

International audienceAn abnormal brain development due to a neuropsychiatric disorder can influence the shape and the anatomical organization of both white and grey matter structures. An example is the syndrome of Gilles de la Tourette (GTS) which is thought to be associated with dysfunctions of the cortico-striato-pallido-thalamic circuits [6]. These anatomical complexes should be studied as a whole, analysing both the shape and the relative position of their structures.Atlas constructions permit to estimate an average shape complex of a given population, called template, and its deformations towards the shape complexes of each subject. The template represents the morphological invariants of the population whereas the deformations capture its variability.Previous works defined these deformations as single diffeomorphisms acting on the entire 3D space, so that ending points of fiber bundles could not move independently of grey matter structures [1,2,4,5]. This implicitly assumes that fiber bundles connect the same areas of grey matter structures across subjects. This assumption is not compatible with the aforementioned hypothesis about GTS [6] which relates the syndrome to atypical configurations of neural circuits. We propose a new atlas construction method which can handle both fibers and surfaces and which is based on a double diffeomorphism. This permits to analyse the morphological variations of each structure and the changes in the relative position between fiber bundles and grey matter structures, namely the variations in structural connectivity

Associations between psychosocial wellbeing and experience of gender-based violence at community, household, and intimate-partner levels among a cross-sectional cohort of young people living with and without HIV during COVID-19 in Cape Town, South Africa

Background Growing evidence indicates that gender-based violence (GBV) increased during COVID-19. We investigated self-reported impact of the pandemic on GBV at community, household and intimate partner (IPV) levels among young people and its associations with psychosocial wellbeing, i.e., COVID-related stressors and mental health. Methods Cross-sectional data were drawn from a survey with young people ages 13–24 (N = 536) living with HIV (YPLWH) and without HIV (YPLWoH), in peri-urban Cape Town, South Africa. The survey, conducted February-October 2021, examined the impact of the initial lockdown on experience and perceived changes in GBV at each level, and pandemic-related psychosocial wellbeing. Descriptive statistics and binomial and multinomial regression analyses were conducted to illustrate exposure and perceived changes in GBV since lockdown, and their association with COVID-related stress factors (e.g., social isolation, anxiety about COVID), mental health (e.g., depression, anxiety), and other risk factors (e.g., age, gender, socioeconomic status) by HIV status. Results Participants were 70% women with mean age 19 years; 40% were living with HIV. Since lockdown, YPLWoH were significantly more likely than YPLWH to perceive community violence as increasing (45% vs. 28%, p < 0.001), and to report household violence (37% vs. 23%, p = 0.006) and perceive it as increasing (56% vs. 27%, p = 0.002) (ref: decreasing violence). YPLWoH were also more likely to report IPV experience (19% vs. 15%, p = 0.41) and perception of IPV increasing (15% vs. 8%, p = 0.92). In adjusted models, COVID-related stressors and common mental health disorders were only associated with household violence. However, indicators of economic status such as living in informal housing (RRR = 2.07; 95% CI = 1.12–3.83) and food insecurity (Community violence: RRR = 1.79; 95% CI = 1.00-3.20; Household violence: RRR = 1.72; 95% CI = 1.15–2.60) emerged as significant risk factors for exposure to increased GBV particularly among YPLWoH. Conclusions Findings suggest that for young people in this setting, GBV at community and household levels was more prevalent during COVID-19 compared to IPV, especially for YPLWoH. While we found limited associations between COVID-related stressors and GBV, the perceived increases in GBV since lockdown in a setting where GBV is endemic, and the association of household violence with mental health, is a concern for future pandemic responses and should be longitudinally assessed. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-023-16945-5

Why monitor the neonatal brain-that is the important question

A key goal of neonatal neurocritical care is improved outcomes, and brain monitoring plays an essential role. The recent NEST trial(1) reported no outcome benefits using aEEG monitoring compared to clinical seizure identification among neonates treated for seizures. However, the study failed to prove the effects of monitoring on seizure treatment in the first place.Non peer reviewe