Behaviour change interventions to reduce second-hand smoke (SHS) exposure at home in pregnant women - A systematic review and intervention appraisal

Abstract Background Second-hand smoke (SHS) exposure during pregnancy is associated with poor pregnancy and foetal outcomes. Theory-based behaviour change interventions (BCI) have been used successfully to change smoking related behaviours and offer the potential to reduce exposure of SHS in pregnant women. Systematic reviews conducted so far do not evaluate the generalisability and scalability of interventions. The objectives of this review were to (1) report the BCIs for reduction in home exposure to SHS for pregnant women; and (2) critically appraise intervention-reporting, generalisability, feasibility and scalability of the BCIs employed. Methods Standard methods following PRISMA guidelines were employed. Eight databases were searched from 2000 to 2015 in English. The studies included used BCIs on pregnant women to reduce their home SHS exposure by targeting husbands/partners. The Workgroup for Intervention Development and Evaluation Research (WIDER) guidelines were used to assess intervention reporting. Generalisability, feasibility and scalability were assessed against criteria described by Bonell and Milat. Results Of 3479 papers identified, six studies met the inclusion criteria. These studies found that BCIs led to increased knowledge about SHS harms, reduction or husbands quitting smoking, and increased susceptibility and change in level of actions to reduce SHS at home. Two studies reported objective exposure measures, and one reported objective health outcomes. The studies partially followed WIDER guidelines for reporting, and none met all generalisability, feasibility and scalability criteria. Conclusions There is a dearth of literature in this area and the quality of studies reviewed was moderate to low. The BCIs appear effective in reducing SHS, however, weak study methodology (self-reported exposure, lack of objective outcome assessment, short follow-up, absence of control group) preclude firm conclusion. Some components of the WIDER checklist were followed for BCI reporting, scalability and feasibility of the studies were not described. More rigorous studies using biochemical and clinical measures for exposures and health outcomes in varied study settings are required. Studies should report interventions in detail using WIDER checklist and assess them for generalisability, feasibility and scalability. Trial registration CRD40125026666

In vitro and in vivo evaluation of guar gum matrix tablets for oral controlled release of water-soluble diltiazem hydrochloride

The objective of the study was to develop guar gum matrix tablets for oral controlled release of water-soluble diltiazem hydrochloride. Matrix tablets of diltiazem hydrochloride, using various viscosity grades of guar gum in 2 proportions, were prepared by wet granulation method and subjected to in vitro drug release studies. Diltiazem hydrochloride matrix tablets containing either 30% wt/wt lowviscosity (LM1), 40% wt/wt medium-viscosity (MM2), or 50% wt/wt high-viscosity (HM2) guar gum showed controlled release. The drug release from all guar gum matrix tablets followed first-order kinetics via Fickian-diffusion. Further, the results of in vitro drug release studies in simulated gastrointestinal and colonic fluids showed that HM2 tablets provided controlled release comparable with marketed sustained release diltiazem hydrochloride tablets (D-SR tablets). Guar gum matrix tablets HM2 showed no change in physical appearance, drug content, or in dissolution pattern after storage at 40°C/relative humidity 75% for 6 months. When subjectd to in vivo pharmacokinetic evaluation in healthy volunteers, the HM2 tablets provided a slow and prolonged drug release when compared with D-SR tablets. Based on the results of in vitro and in vivo studies it was concluded that that guar gum matrix tablets provided oral controlled release of water-soluble diltiazem hydrochloride

Eltrombopag before procedures in patients with cirrhosis and thrombocytopenia

Eltrombopag is an oral thrombopoietin-receptor agonist. This study evaluated the efficacy of eltrombopag for increasing platelet counts and reducing the need for platelet transfusions in patients with thrombocytopenia and chronic liver disease who are undergoing an elective invasive procedure

Supporting food security in the 21st century through resource-conserving increases in agricultural production

<p>Abstract</p> <p>The Green Revolution was accomplished under a set of demographic, economic, climatic and other conditions in the 20th century that have been changing and will surely be different and more difficult in the decades ahead. The suitability and sustainability of any given agricultural technology depends on factors like resource availability and productivity, energy costs, and environmental constraints. The achievements of Green Revolution technologies in the 1960s and 1970s came at a critical time of impending food shortages, and the world’s people would be worse off without them. However, the rate of yield improvement for cereal production has been slowing since the mid-1980s.</p> <p>Looking ahead at the foreseeable circumstances under which 21st century agricultural producers must try to assure food security, there will be need for technologies that are less dependent on resources that are becoming relatively scarcer, like arable land and water, or becoming relatively more costly, like energy and petrochemical-based inputs. This paper considers agroecologically-based innovations that reduce farmers’ dependence on external inputs, relying more on endogenous processes and existing potentials in plants and soil systems. Such resource-conserving production represents a different approach to meeting food security goals.</p> <p>While these innovations are not yet fully understood and are still being researched, there are good agronomic reasons to account for their effectiveness, and scientific validations are accumulating. Enough successes have been recorded from making changes in the management of plants, soil, water and nutrients that more attention from researchers, policy-makers and practitioners is warranted, especially given the need to adapt to, and to mitigate the effects of, climate change. The same agroecological concepts and management methods that are enhancing factor productivity in rice production are giving similar results with other crops such as wheat, finger millet, sugarcane, mustard, and tef.</p> <p>Genetic potentials are the starting point for any and all agricultural production, and current efforts to improve food security and nutrition through plant breeding efforts should continue. However, future research and production strategies could beneficially seek to capitalize on biological processes and potentials existing within crops and in their supporting soil systems, rather than focusing so predominantly on making modifications in genetic factors. Scientific advances in the domains of microbiology, soil ecology and epigenetics could foreseeably assist farmers in meeting production and income goals with resource-economizing methods. It remains to be seen to what extent agroecologically-informed methods can help farmers meet expected agricultural production requirements to ensure global food security, but this direction deserves more attention and support.</p