The association between treatment adherence to nicotine patches and smoking cessation in pregnancy

Background: In non-pregnant “quitters,” adherence to nicotine replacement therapy (NRT) increases smoking cessation. We investigated relationships between adherence to placebo or NRT patches and cessation in pregnancy, including an assessment of reverse causation and whether any adherence: cessation relationship is moderated when using nicotine or placebo patches. Methods: Using data from 1050 pregnant trial participants, regression models investigated associations between maternal characteristics, adherence and smoking cessation. Results: Adherence during the first month was associated with lower baseline cotinine concentrations (β −0.08, 95% confidence interval [CI] −0.15 to −0.01) and randomization to NRT (β 2.59, 95%CI 1.50 to 3.68). Adherence during both treatment months was associated with being randomized to NRT (β 0.51, 95% CI 0.29 to 0.72) and inversely associated with higher nicotine dependence. Adherence with either NRT or placebo was associated with cessation at 1 month (odds ratio [OR] 1.11, 95% CI 1.08 to 1.13) and delivery (OR 1.06, 95% CI 1.03 to 1.09), but no such association was observed in the subgroup where reverse causation was not possible. Amongst all women, greater adherence to nicotine patches was associated with increased cessation (OR 2.47, 95% CI 1.32 to 4.63) but greater adherence to placebo was not (OR 0.98, 95% CI: 0.44 to 2.18). Conclusion: Women who were more adherent to NRT were more likely to achieve abstinence; more nicotine dependent women probably showed lower adherence to NRT because they relapsed to smoking more quickly. The interaction between nicotine-containing patches and adherence for cessation suggests that the association between adherence with nicotine patches and cessation may be partly causal

Systematic review and meta-analysis to assess the safety of Buproprion and Varenicline in pregnancy

Introduction: Smoking in pregnancy is a substantial public health issue, but, apart from nicotine replacement therapy (NRT), pharmacological therapies are not generally used to promote cessation. Bupropion and varenicline are effective cessation methods in non-pregnant smokers and this systematic review investigates their safety in pregnancy. Methods: We searched MEDLINE, EMBASE, CINAHL and PsychINFO databases for studies of any design reporting pregnancy outcomes after bupropion or varenicline exposure. We included studies of bupropion used for smoking cessation, depression, or where the indication was unspecified. Depending on study design, quality was assessed using the Newcastle-Ottawa Scale or Cochrane Risk of Bias Tool. Most findings are reported narratively but meta-analyses were used to produce pooled estimates for the proportion of live births with congenital malformations and of the mean birthweight and gestational age at delivery following bupropion exposure. Results: 18 studies were included: two randomised controlled trials, eleven cohorts, two case-control studies and three case reports. Study quality was variable. Gestational safety outcomes were reported in 14 bupropion and four varenicline studies. Meaningful meta-analysis was only possible for bupropion exposure, for which the pooled estimated proportion of congenital malformations amongst live-born infants was 1.0% (95% CI= 0.0-3.0%, I2= 80.9%, 4 studies) and the mean birthweight and mean gestational age at delivery was 3305.9g (95% CI= 3173.2-3438.7g, I2= 77.6%, 5 studies) and 39.2 weeks (95% CI= 38.8-39.6, I2= 69.9%, 5 studies) respectively. Conclusions: There was no strong evidence that either major positive or negative outcomes were associated with gestational use of bupropion or varenicline. PROSPERO registration number CRD42017067064. Implications: We believe this to be the first systematic review investigating the safety of bupropion and varenicline in pregnancy. Meta-analysis of outcomes following bupropion exposure in pregnancy suggests that there are no major positive or negative impacts on the rate of congenital abnormalities, birthweight or premature birth. Overall, we found no evidence that either of these treatments might be harmful in pregnancy, and no strong evidence to suggest safety, but available evidence is of poor quality

Systematic review and meta-analysis to assess the safety of Buproprion and Varenicline in pregnancy

Introduction: Smoking in pregnancy is a substantial public health issue, but, apart from nicotine replacement therapy (NRT), pharmacological therapies are not generally used to promote cessation. Bupropion and varenicline are effective cessation methods in non-pregnant smokers and this systematic review investigates their safety in pregnancy. Methods: We searched MEDLINE, EMBASE, CINAHL and PsychINFO databases for studies of any design reporting pregnancy outcomes after bupropion or varenicline exposure. We included studies of bupropion used for smoking cessation, depression, or where the indication was unspecified. Depending on study design, quality was assessed using the Newcastle-Ottawa Scale or Cochrane Risk of Bias Tool. Most findings are reported narratively but meta-analyses were used to produce pooled estimates for the proportion of live births with congenital malformations and of the mean birthweight and gestational age at delivery following bupropion exposure. Results: 18 studies were included: two randomised controlled trials, eleven cohorts, two case-control studies and three case reports. Study quality was variable. Gestational safety outcomes were reported in 14 bupropion and four varenicline studies. Meaningful meta-analysis was only possible for bupropion exposure, for which the pooled estimated proportion of congenital malformations amongst live-born infants was 1.0% (95% CI= 0.0-3.0%, I2= 80.9%, 4 studies) and the mean birthweight and mean gestational age at delivery was 3305.9g (95% CI= 3173.2-3438.7g, I2= 77.6%, 5 studies) and 39.2 weeks (95% CI= 38.8-39.6, I2= 69.9%, 5 studies) respectively. Conclusions: There was no strong evidence that either major positive or negative outcomes were associated with gestational use of bupropion or varenicline. PROSPERO registration number CRD42017067064. Implications: We believe this to be the first systematic review investigating the safety of bupropion and varenicline in pregnancy. Meta-analysis of outcomes following bupropion exposure in pregnancy suggests that there are no major positive or negative impacts on the rate of congenital abnormalities, birthweight or premature birth. Overall, we found no evidence that either of these treatments might be harmful in pregnancy, and no strong evidence to suggest safety, but available evidence is of poor quality

Factors associated with the effectiveness and reach of NHS Stop Smoking Services for pregnant women in England

Background The UK National Health Service provides Stop Smoking Services for pregnant women (SSSP) but there is a lack of evidence concerning how these are best organised. This study investigates influences on services’ effectiveness and also on their propensity to engage pregnant smokers with support in stopping smoking. Methods Survey data collected from 121/141 (86%) of SSSP were augmented with data from Hospital Episode Statistics and the 2011 UK National Census. ‘Reach’ or propensity to engage smokers with support was defined as the percentage of pregnant smokers setting a quit date with SSSP support, and ‘Effectiveness’ as the percentage of women who set a quit date who also reported abstinence at four weeks later. A bivariate (i.e. two outcome variable) response Markov Chain Monte Carlo model was used to identify service-level factors associated with the Reach and Effectiveness of SSSP. Results Beta coefficients represent a percentage change in Reach and Effectiveness by the covariate. Providing the majority of one-to-one contacts in a clinic rather than at home increased both Reach (%) (β: 6.97, 95% CI: 3.34, 10.60) and Effectiveness (%) (β: 7.37, 95% CI: 3.03, 11.70). Reach of SSSP was also increased when the population served was more deprived (β for increase in Reach with a one unit increase in IMD score: 0.55, 95% CI: 0.25, 0.85), had a lower proportion of people with dependent children (β: -2.52, 95% CI: -3.82, −1.22), and a lower proportion of people in managerial or professional occupations (β: -0.31, 95% CI: -0.59, −0.03). The Effectiveness of SSSP was decreased in those areas that had a greater percentage of people >16 years with no educational qualifications (β: -0.51, 95% CI: -0.95, −0.07). Conclusions To engage pregnant smokers and to encourage them to quit, it may be more efficient for SSSP support to be focussed around clinics, rather than women’s homes. Reach of SSSP is inversely associated with disadvantage and efforts should be made to contact these women as they are less likely to achieve abstinence in the short and longer term

Comparison of cotinine levels in pregnant women while smoking and when using nicotine replacement therapy

BACKGROUND: Nicotine replacement therapy (NRT) helps smokers quit smoking, but trials indicate that there is no evidence that it is effective during pregnancy. As metabolism increases during pregnancy, NRT may deliver insufficient nicotine to alleviate withdrawal symptoms. There is mixed evidence as to what levels of cotinine are reached from nicotine exposure during pregnancy while using NRT compared with smoking. METHODS: We analyzed data on 33 pregnant participants from the NRT arm of a randomized control trial who had stopped smoking and were still using 15mg/16hr nicotine patches 1 month after quitting. Salivary cotinine levels when smoking at baseline were compared with levels on NRT at 1 month using the Wilcoxon test. RESULTS: Cotinine levels were a median of 98.5ng/ml while smoking and 62.8ng/ml while using NRT and remaining abstinent (p = .045). Participants with the highest cotinine measurements when smoking also tended to have the steepest reduction in cotinine levels while using NRT. This was most noticeable among participants with baseline cotinine levels more than 150ng/ml (n = 9) who had a greater reduction in median cotinine levels (median difference ?134.8ng /ml [95% CI = ?144.5 to ?125.9]) than those with a baseline cotinine level under 150ng/ml (n = 24; median difference ?27.9ng/ml [95% CI = ?49.35 to ?1.75]). CONCLUSIONS: In a pragmatic trial that replicated clinical practice, cotinine levels generated using NRT during pregnancy were lower than levels achieved from smoking. Although the sample size of this study was small, our findings are significant and are consistent with the hypothesis that NRT patches deliver an inadequate dose of nicotine to aid smoking cessation during pregnancy

Is the apparently protective effect of maternal nicotine replacement therapy (NRT) used in pregnancy on infant development explained by smoking cessation?: secondary analyses of a randomised controlled trial.

Objective: To investigate relationships between maternal smoking status in pregnancy and infant development. The largest RCT of nicotine replacement therapy (NRT) for smoking cessation in pregnancy, the Smoking and Nicotine in Pregnancy (SNAP) trial, found that at one month after randomisation, smoking cessation rates were doubled in the NRT group compared to the placebo group. At delivery, there was no significant difference in cessation rates between groups. Surprisingly, infants born to women randomised to NRT were more likely to have unimpaired development at 2 years. We hypothesized that this apparently protective effect was due to smoking cessation caused by NRT and so, investigate this relationship using the same cohort.Design: Secondary analysis of a randomised controlled trial.Setting: Seven antenatal hospitals in the Midlands and North-West England.Participants: Eight hundred and eighty-four (884) pregnant smokers randomised to receive either NRT patches or visually-identical placebo in the SNAP trial. Participants’ smoking behaviour were recorded at randomisation, one month after their target quit date and at delivery.Methods: Using logistic regression models, we investigated associations between participants’ smoking measures and infant development (assessed using the Ages and Stages questionnaire) at 2 years.Main outcome measures: 2-year infant development. Results: Developmental impairment was reported for 12.7% of study 2 year olds. Maternal heaviness of smoking at randomisation (odds ratio [OR]: 1.26, 95% confidence interval [95% CI]: 0.82-1.96, p = 0.091), validated smoking abstinence recorded at one month after a quit date (OR: 1.02, 95% CI: 0.60-1.74, p = 0.914) and validated smoking abstinence recorded at one month after a quit date and at the end of pregnancy (OR: 1.52, 95% CI: 0.81-2.85, p = 0.795) were not independently associated with infant developmental impairment at 2 years.Conclusion: We found no evidence that NRT treatment improved infants' developmental outcomes through smoking cessation

Estimating the healthcare costs of children born to pregnant smokers in England: cohort study using primary and secondary healthcare data

Background and aims: Little is known about the long term economic consequences of smoking during pregnancy. We estimated the association between smoking in pregnancy and the costs of delivering healthcare to infants and children in England, and investigated which aspects of care are the key drivers of these costs. Methods: We used Hospital Episode Statistics (HES) linked with Clinical Practice Research Datalink (CPRD) data in England from January 2003 until January 2015 in children with longitudinal data for at least one, five and ten years after birth. Poisson regression provided rate ratios (RR) and 95% confidence intervals (CIs) comparing healthcare episode rates between those exposed and not exposed to smoking during pregnancy. Linear regression was used to compare estimated costs between groups (£ sterling, 2015 prices) and generalized linear multivariable (GLM) models adjusted for potentially moderating factors. Results: A total of 93,152 singleton pregnancies with the required data were identified. Maternal smoking in pregnancy was associated with higher primary care, prescription and hospital inpatient episode rates, but lower outpatient visit and diagnostic test rates. Adjusting for year of birth, socio-economic deprivation, parity, sex of child and delivery method showed that maternal smoking in pregnancy was associated with increased child healthcare costs at 1 year (average cost difference for children of smokers, f3: £91.18, 95%CI: £47.52-£134.83) and 5 years of age (f3: £221.80, 95%CI: £17.78-£425.83), but not at 10 years of age (f3: £365.94, 95%CI: -£192.72-£924.60). Conclusion: In England, maternal smoking in pregnancy is associated with increased child healthcare costs over the first five years of life; these costs are primarily driven by greater hospital inpatient care

Loveridge's Angolan geckos, Afroedura karroica bogerti and Pachydactylus scutatus angolensis (Sauria, Gekkonidae) : new distribution records, comments on type localities and taxonomic status

Loveridge described two new geckos from Angola, Afroedura karroica bogerti and Pachydactylus scutatus angolensis. The descriptions of both species have vague and confusing type localities and refinements are suggested based on early expedition reports and historical accounts from the region. Numerous new distribution records are reported for both species from expeditions undertaken from 1956–2016 by the authors or their colleagues. The taxonomic status of both species has changed, but new material from diverse habitats, altitudes and geological substrates indicates that further taxonomic adjustments are likely in order to reflect additional cryptic diversity.Steve Boyes and John Hilton of the Wild Bird Trust, administers of the National Geographic Okavango Wilderness Project (National Geographic Society grant number EC0715–15) during which WRB, WC, NB, PVP & LV participated in the biodiversity surveys of the headwaters of the Cuito and Cuanavale Rivers (2015–2016).http://zse.pensoft.nethb2017Zoology and Entomolog

Electrical transport mechanisms of Neodymium-doped rare-earth semiconductors

This study reports the electrical properties of Nd-doped cerium oxide (CeO2) films synthesized by microwave assisted hydrothermal using a two-point probe technique. Positron annihilation lifetime spectroscopy studies evidenced that, as the Nd content rises, a structural disorder occurs. This is caused by an increase in oxygen vacancies surrounded with Nd (defective clusters), with the mean lifetime components ranging between 290 and 300 ps. Particle size estimation showed values from 8.6 to 28.9 nm. Along with the increase of neodymium impurities, also the conductivity increases, due to the hopping conduction mechanism between defective species. This gives rise to a response time of only 6 s, turning these materials candidates to realize gas sensor devices. Ab initio investigations showed that the improved electric conduction is boosted mostly by the reduced Nd2+ than the Ce3+, where the oxygen vacancies play a fundamental role.Fil: Vaz, Isabela C. F.. Federal University of Itajubá; BrasilFil: Macchi, Carlos Eugenio. Universidad Nacional del Centro de la Provincia de Buenos Aires; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Somoza, Alberto Horacio. Universidad Nacional del Centro de la Provincia de Buenos Aires; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rocha, Leandro S. R.. Universidade Federal do São Carlos; BrasilFil: Longo, Elson. Universidade Federal do São Carlos; BrasilFil: Cabral, Luis. Universidade Estadual de Campinas; BrasilFil: da Silva, Edison Z.. Universidade Estadual de Campinas; BrasilFil: Simões, Alexandre Zirpoli. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Zonta, Giulia. Università di Ferrara; ItaliaFil: Malagu, Cesare. Università di Ferrara; ItaliaFil: Desimone, Paula Mariela. Universidad Nacional de Mar del Plata; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; ArgentinaFil: Ponce, Miguel Adolfo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; Argentina. Universidad Nacional de Mar del Plata; ArgentinaFil: Moura, Francisco. Federal University of Itajubá; Brasi