The effect of peer and parental smoking on adolescent smoking initiation: Exploring potential moderators

The factors that contribute to smoking initiation among adolescents are poorly understood. The current approaches to smoking prevention may have achieved their maximum potential as evidenced by a stalling in the decline in smoking rates. To date, approaches to smoking prevention based on social and individual factors have previously met with limited success. A promising new approach will be to examine the interaction between social and individual factors and the effects of their interaction on smoking initiation. Parental and peer smoking behaviors are well-known risk factors for smoking initiation. Several theoretical models suggest that perceptual or interpretative processes may moderate the influence of factors such as these on the smoking initiation process. This study looks at age (as a proxy for adolescent development), depression and school performance as potential moderators of the impact of parental or peer smoking. This study uses a large longitudinal sample (The Teenage Attitudes and Practices Surveys -- 1989 and 1993) to explore for these relationships. Results show very limited support for the impact of potential moderated relationships, with only one of the six hypothesized interactions being supported (peer smoking and school performance). This would suggest that theoretical models which include concepts of perceptual or interpretative processes as moderating influences need to continue to evaluate their validity. Another finding of the study is a significant main effect of school performance on smoking initiation --a relationship which has not been previously reported in a national longitudinal sample. This study also found support for depression as an antecedent to smoking initiation -- a relationship whose causal direction continues to be controversial. Continued exploration of the complex relationships between these social and individual factors may allow for the development of more effective evidence-based smoking prevention programs

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease

The structural basis of allosteric regulation in proteins

Allosteric regulation of protein function occurs when the regulatory trigger, such as the binding of a small-molecule effector or inhibitor, takes place some distance from the protein’s, or protein complex’s, active site. This distance can be a few Å, or tens of Å. Many proteins are regulated in this way and exhibit a variety of allosteric mechanisms. Here we review how analyses of experimentally determined models of protein 3D structures, using either X-ray crystallography or NMR spectroscopy, have revealed some of the mechanisms involved