Maternal Smoking and Hospital Treatment During Pregnancy

IntroductionPrevious research suggests that young maternal age, smoking, hospitalization during a previous pregnancy, and poor self-rated health could be risk factors for prenatal hospitalization.MethodsThe objective of this retrospective observational register study was to investigate if maternal smoking during pregnancy is associated with mother’s need for hospital treatment during pregnancy. The study population consists of all singleton pregnancies (n = 961 127) in 1999–2015 in Finland. Information on maternal smoking was received from the Medical Birth Register in three classes: nonsmoker, quit smoking in the first trimester, and continued smoking throughout the pregnancy. These data were linked with the Hospital Discharge Register data and analyzed according to ICD-10 chapters.Results10.7% of women continued to smoke after the first trimester. After adjusting for confounding factors women in both smoking groups had more hospital treatment compared with nonsmokers. Especially outpatient treatment was more common among mothers who continued to smoke compared to those who quit smoking in the first trimester in several ICD-10 chapters. Compared to non-smokers, aOR for mental and behavioral disorders (F00–F99) was 2.14 (95% confidence interval 2.00–2.30) in the quit smoking group and 3.88 (3.71–4.06) in the continued smoking group. Similarly, aOR for respiratory diseases (J00–J99) was 1.26 (1.15–1.39) and 1.61 (1.52–1.71), respectively and aOR for genitourinary diseases (N00–N99) was 1.10 (1.03–1.17) and 1.29 (1.23–1.35), respectively. Some similar findings were made also in inpatient care. Some similar findings were made also in inpatient care.ConclusionsWomen who smoke during pregnancy seem to require more hospital care for various reasons. These findings emphasize the importance of actions for smoking cessation during pregnancy and women should be encouraged to quit as early as possible.ImplicationsMaternal smoking during pregnancy is associated with greater rates of both outpatient and inpatient hospital care during pregnancy. Women who quit smoking had a similar risk for hospital care during pregnancy with nonsmokers in certain diagnosis chapters, which is very motivational and could be used as an informational tool in prenatal clinics to encourage smoking cessation as it is never too late to quit smoking during pregnancy.</div

Self-rated health as an indicator of ideal cardiovascular health among working-aged women

Objective: The aim of this study was to assess the relationship between self-rated health (SRH) and the American Heart Association's (AHA) concept of ideal cardiovascular health (CVH) among female municipal employees. Studies about the association are scarce, even though AHA recommends to use SRH status surveys in clinical practice and research settings of CVH.Design: Cross-sectional study conducted in 2014.Setting: SRH was assessed with a one-item question and the data of seven ideal CVH measurements (nonsmoking, body mass index <25.0 kg/m(2), healthy diet, physical activity at goal, blood pressure <120/80 mmHg, cholesterol <5.18 mmol/l and glucose (HbA1c < 6.0%)) was gathered with a physical examination, laboratory tests, medical history and self-administrated questionnaires.Subjects: A total of 725 female subjects from 10 work units of the city of Pori, Finland.Main outcome measures: SRH and ideal CVH.Results: Of the study subjects, 28.8% reported ill-health (poor/fair SRH). The sum of ideal CVH metrics was positively associated with good SRH driven by favorable health behaviors (nonsmoking, normal body mass index, healthy diet and physical activity). A linear decrease in the prevalence of 0-2 ideal CVH metrics, and a linear increase in 5-7 metrics was associated with better SRH. Nonsmoking and normal weight were the most potent indicators of good SRH in multivariate analysis.Conclusions: Most of the subjects with 0-3 of the seven CVH metrics at ideal level were dissatisfied with their health. Since unhealthy lifestyle factors accumulate mainly to people feeling ill-health, the value of SRH is worth recognizing especially in primary health care

Body surface area and glucose tolerance - The smaller the person, the greater the 2-hour plasma glucose

Background: The oral glucose tolerance test (OGTT) is standardized globally with a uniform glucose load of 75 g to all adults irrespective of body size. An inverse association between body height and 2-hour postload plasma glucose (2hPG) has been demonstrated. Our aim was to evaluate the relationship between body surface area (BSA) and plasma glucose values during an OGTT.Methods: An OGTT was performed on 2659 individuals at increased cardiovascular risk aged between 45 and 70 years of age, who had not previously been diagnosed with diabetes or cardiovascular disease. Their BSA was calculated according to the Mosteller formula. Study subjects were divided into five BSA levels corresponding to 12.5, 25, 25, 25, and 12.5% of the total distribution.Findings: When adjusted for age, sex, waist circumference, alcohol intake, current smoking, and leisure-time physical activity, BSA level showed an inverse linear relationship with the 2hPG in all categories of glucose tolerance (p for linearity Interpretation: Body size has a considerable impact on the findings from a standardized OGTT. Smaller persons are more likely to be diagnosed as glucose intolerant than relatively larger sized individuals.Research in context: Evidence before this study. We searched PubMed using the MeSH terms "glucose tolerance test", "body surface area", "body height", "body size", "glucose tolerance", "insulin resistance", "blood glucose" and "diabetes mellitus" on March 10, 2019 without language restrictions. We also used Cited Reference Search in Web of Science for relevant articles. The oral glucose tolerance test (OGTT) is standardized globally with a uniform glucose load of 75 g to all adults irrespective of body size. An inverse association between body height and 2-hour postload plasma glucose (2hPG) has been demonstrated. Several studies have shown that 2hPG predicts all-cause mortality better than elevated fasting glucose. However, body height or body surface area are not usually adjusted in epidemiological studies. It is well known that short adult stature is a risk factor for cardiovascular and all-cause mortality.Added value of this study. This is the first study to assess the relationship of body surface area and 2hPG in a typical primary care population at increased cardiovascular risk. Body surface area has a considerable impact on the result of a standardized OGTT. Smaller individuals are more likely to be diagnosed as glucose intolerant than relatively larger sized individuals.Implications of all the available evidence. There is a possibility that the diagnosis of type 2 diabetes made by an OGTT is a false positive result in a relatively small individual, and a false negative result in a relatively larger individual. Association of 2hPG concentrations and mortality may be influenced by body size as confounding factor. Given that the OGTT is a time and effort consuming test both for patients and laboratory personnel, validity of the OGTT for different body sizes should be reconsidered. (C) 2019 Elsevier B.V. All rights reserved.</div

The role of psychosocial risk factors in the burden of headache

Purpose: Psychosocial risk factors are common in headache patients and affect the impact of headache in multiple ways. The aim of our study was to assess how psychosocial risk factors correlate with the headache impact test-6 (HIT-6). To our knowledge this is the first study to evaluate the impact of several psychosocial factors on the HIT-6 score.Patients and methods: Our study population consisted of 469 Finnish female employees reporting headache during the past year. Psychosocial risk factors were assessed using validated, self-administered questionnaires: the generalized anxiety disorder 7-item scale (GAD-7) for anxiety, the major depression inventory (MDI) for depressive symptoms, the ENRICHD short social support instrument (ESSI) for social isolation, the cynical distrust scale for hostility and the Bergen burnout indicator (BBI-15) for work stress.Results: Exploratory factor analysis of the HIT-6 scores revealed two factors, one describing psychological and quality of life aspects affected by headache and the other describing severity of pain and functional decline. Internal consistency of the HIT-6 was 0.87 (95% CI: 0.85-0.89). Correlations between the total HIT-6 score and all measured psychosocial risk factors except for hostility were weak, but statistically significant.Conclusion: The HIT-6 questionnaire has good construct validity and it describes reliably and independently the impact of headache without interference of psychosocial factors in general working-aged female population.</p

The effects of aromatase inhibitors on lipids and thrombosis

Oestrogen is known to influence blood lipid levels and though its cardioprotective effects are less clear than once thought, there remains concern that reduction of oestrogen levels during hormonal treatment for breast cancer may have an adverse effect on cardiovascular risk. While tamoxifen has been shown to improve lipid profiles, the aromatase inhibitors have a very different mode of action and do not possess the oestrogen-agonistic effects of tamoxifen. At present, there are few data on the effects of these agents on lipid profiles. Available data are mixed, but suggest that the different aromatase inhibitors have different effects on lipid profiles. Some studies show anastrozole as generally having little effect on lipids, while others have indicated adverse effects on lipid profiles/increased hypercholesterolaemia. Letrozole has been associated with adverse effects on lipid profiles in some studies, including BIG 1-98, but short-term data from randomised trials do not show increased cardiovascular morbidity. By contrast, exemestane, which has been studied in slightly more detail, may either have little effect or may be associated with slightly improved lipid profiles. In general, the changes have been small and are likely to be of little relevance in women with advanced breast cancer, but if these agents come to be used in early breast cancer, their impact on lipid profiles may become more important. Many studies are currently underway with the aromatase inhibitors, with safety assessments including monitoring lipid levels. The results of these studies are keenly awaited

Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial

Background: Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC) counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers.Methods: Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used.Discussion: To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster randomised controlled design, we aim to provide further evidence on intervention effects, as well as on the validity and feasibility of the theoretical-domain approach. The empirical data collected within this trial will be useful in testing whether this theoretical-domain approach can improve our understanding of the implementation of TUPAC guidelines among dental providers

Assessing implementation difficulties in tobacco use prevention and cessation counselling among dental providers

<p>Abstract</p> <p>Background</p> <p>Tobacco use adversely affects oral health. Clinical guidelines recommend that dental providers promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented, however. To improve guideline adherence and to develop effective interventions, it is essential to understand provider behaviour and challenges to implementation. This study aimed to develop a theoretically informed measure for assessing among dental providers implementation difficulties related to tobacco use prevention and cessation (TUPAC) counselling guidelines, to evaluate those difficulties among a sample of dental providers, and to investigate a possible underlying structure of applied theoretical domains.</p> <p>Methods</p> <p>A 35-item questionnaire was developed based on key theoretical domains relevant to the implementation behaviours of healthcare providers. Specific items were drawn mostly from the literature on TUPAC counselling studies of healthcare providers. The data were collected from dentists (n = 73) and dental hygienists (n = 22) in 36 dental clinics in Finland using a web-based survey. Of 95 providers, 73 participated (76.8%). We used Cronbach's alpha to ascertain the internal consistency of the questionnaire. Mean domain scores were calculated to assess different aspects of implementation difficulties and exploratory factor analysis to assess the theoretical domain structure. The authors agreed on the labels assigned to the factors on the basis of their component domains and the broader behavioural and theoretical literature.</p> <p>Results</p> <p>Internal consistency values for theoretical domains varied from 0.50 ('emotion') to 0.71 ('environmental context and resources'). The domain environmental context and resources had the lowest mean score (21.3%; 95% confidence interval [CI], 17.2 to 25.4) and was identified as a potential implementation difficulty. The domain emotion provided the highest mean score (60%; 95% CI, 55.0 to 65.0). Three factors were extracted that explain 70.8% of the variance: motivation (47.6% of variance, α = 0.86), capability (13.3% of variance, α = 0.83), and opportunity (10.0% of variance, α = 0.71).</p> <p>Conclusions</p> <p>This study demonstrated a theoretically informed approach to identifying possible implementation difficulties in TUPAC counselling among dental providers. This approach provides a method for moving from diagnosing implementation difficulties to designing and evaluating interventions.</p

Assessing implementation difficulties in tobacco use prevention and cessation counselling among dental providers

Background: Tobacco use adversely affects oral health. Clinical guidelines recommend that dental providers promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented, however. To improve guideline adherence and to develop effective interventions, it is essential to understand provider behaviour and challenges to implementation. This study aimed to develop a theoretically informed measure for assessing among dental providers implementation difficulties related to tobacco use prevention and cessation (TUPAC) counselling guidelines, to evaluate those difficulties among a sample of dental providers, and to investigate a possible underlying structure of applied theoretical domains.Methods: A 35-item questionnaire was developed based on key theoretical domains relevant to the implementation behaviours of healthcare providers. Specific items were drawn mostly from the literature on TUPAC counselling studies of healthcare providers. The data were collected from dentists (n = 73) and dental hygienists (n = 22) in 36 dental clinics in Finland using a web-based survey. Of 95 providers, 73 participated (76.8%). We used Cronbach's alpha to ascertain the internal consistency of the questionnaire. Mean domain scores were calculated to assess different aspects of implementation difficulties and exploratory factor analysis to assess the theoretical domain structure. The authors agreed on the labels assigned to the factors on the basis of their component domains and the broader behavioural and theoretical literature.Results: Internal consistency values for theoretical domains varied from 0.50 ('emotion') to 0.71 ('environmental context and resources'). The domain environmental context and resources had the lowest mean score (21.3%; 95% confidence interval [CI], 17.2 to 25.4) and was identified as a potential implementation difficulty. The domain emotion provided the highest mean score (60%; 95% CI, 55.0 to 65.0). Three factors were extracted that explain 70.8% of the variance: motivation (47.6% of variance, alpha = 0.86), capability (13.3% of variance, alpha = 0.83), and opportunity (10.0% of variance, alpha = 0.71).Conclusions: This study demonstrated a theoretically informed approach to identifying possible implementation difficulties in TUPAC counselling among dental providers. This approach provides a method for moving from diagnosing implementation difficulties to designing and evaluating interventions

Assessment of post-competition peak blood lactate in male and female master swimmers aged 40–79 years and its relationship with swimming performance

The main purpose of this study was to measure the postcompetition blood lactate concentration ([La]b) in master swimmers of both sexes aged between 40 and 79 years in order to relate it to age and swimming performance. One hundred and eight swimmers participating in the World Master Championships were assessed for [La]b and the average rate of lactate accumulation (La’;mmol l-1 s-1) was calculated. In addition, 77 of them were also tested for anthropometric measures. When the subjects were divided into 10-year age groups, males exhibited higher [La]b than women (factorial ANOVA, P < 0.01) and a steeper decline with ageing than female subjects. Overall, mean values (SD) of [La]b were 10.8 (2.8), 10.3 (2.0), 10.3 (1.9), 8.9 (3.2) mmol l-1 in women, and 14.2 (2.5), 12.4 (2.5), 11.0 (1.6), 8.2 (2.0) mmol l-1 in men for, respectively, 40–49, 50–59, 60–69, 70–79 years’ age groups. When, however, [La]b values were normalised for a ‘‘speed index’’, which takes into account swimming speed as a percentage of world record, these sex-related differences, although still present, were considerably attenuated. Furthermore, the differences in La’ between males and females were larger in the 40–49 age group (0.34 vs 0.20 mmol l-1 s-1 for 50-m distance) than in the 70–79 age group (0.12 vs 0.14 mmol l-1 s-1 for 50-m distance). Different physiological factors, supported by the considered anthropometric measurements, are suggested to explain the results