Cognitive and Behavioral Predictors of Quit Attempts and Biochemically-Validated Abstinence During Pregnancy.

Introduction: Initiating a quit attempt and achieving abstinence are distinct behaviors that have distinct correlates in general smokers. Studies predicting prenatal smoking have not addressed this. Methods: Pregnant smokers (N = 207), recruited to a cessation intervention trial, were used as an observational cohort. Women completed measures at baseline and 12-week follow-up (mid-late pregnancy). Outcomes were having made at least one quit attempt since baseline, and cotinine-validated 7-day abstinence at follow-up in attempters. Baseline predictors included demographics (age, deprivation, partner's smoking), smoking behaviors (nicotine dependence, quit attempt history, previous prenatal smoking), and smoking beliefs (self-efficacy, determination, intention to quit, nonsmoker identity, social support, pregnancy-outcome beliefs). For each outcome, variables reaching p < .1 in logistic regression analyses were entered into a multivariate model controlling for trial arm. A complete case analysis was undertaken, with missing data assumptions tested in sensitivity analyses. Results: One hundred seventy-five women (85%) completed follow-up. Intention and determination to quit (p < .001), self-efficacy, nonsmoker identity, and not having previously smoked in pregnancy (p < .05) were univariate predictors of making a quit attempt, with stronger intention to quit the only independent predictor (multivariate odds ratio [OR] = 2.41, 95% confidence interval [CI] 1.19-4.87). Only nicotine dependence predicted validated abstinence among those who made a quit attempt (multivariate OR = 0.25, 95% CI 0.10-0.60). Conclusions: Initiating a quit attempt and achieving abstinence during pregnancy were found to have different correlates. For women yet to make a quit attempt in their pregnancy, smoking beliefs may be important intervention targets, but once they are engaged in quitting, nicotine dependence appears of prime importance. Implications: This study suggests that cognitive, particularly motivational, variables predict whether pregnant smokers will make a quit attempt, but they do not predict successful abstinence in those who attempt to quit, where nicotine dependence dominates. Interventions should facilitate quit attempts by targeting motivational variables among pregnant women who continue to smoke, but should focus on managing withdrawal once a woman initiates a quit attempt.This work was supported by Cancer Research UK (CR-UK) (grant number C1345/A5809), and by a Society for the Study of Addiction (SSA) Fellowship

Increased Risk for Aplastic Anemia and Myelodysplastic Syndrome in Individuals Lacking Glutathione S-Transferase Genes

BACKGROUND: Aplastic anemia (AA) and myelodysplastic syndrome (MDS) are marrow failure states that may be associated with chromosomal instability. An absence of the glutathione S-transferase (GST) enzyme may genetically predispose individuals to AA or MDS. PROCEDURE AND RESULTS: To test this hypothesis, we determined the GSTM1 and GSTT1 genotypes in a total of 196 patients using multiplex PCR. The GSTT1 null genotype was found to be overrepresented in Caucasian, Asian, and Hispanic patients with either AA or MDS. We confirmed a difference in the expected frequency of the GSTM1 null genotype in Caucasian MDS patients. The double null GSTM1/GSTT1 genotype was also overrepresented in Caucasian AA and MDS patients. In our population, 26% of AA patients and 40% of MDS patients had a chromosomal abnormality identified by karyotype or FISH analyses for chromosomes 7 and 8. Patients with AA and the GSTT1 null genotype had an increased frequency of chromosomal abnormalities (P = 0.003). CONCLUSION: There seems to be an increased risk for AA and MDS in individuals lacking GSTT1 or both GSTM1/GSTT1

Epidemiology of musculoskeletal injury in military recruits: A systematic review and meta-analysis

Background: Injuries are a common occurrence in military recruit training, however due to differences in the capture of training exposure, injury incidence rates are rarely reported. Our aim was to determine the musculoskeletal injury epidemiology of military recruits, including a standardised injury incidence rate. Methods: Epidemiological systematic review following the PRISMA 2020 guidelines. Five online databases were searched from database inception to 5th May 2021. Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by military recruits after the year 2000 were included. We reported on the frequency, prevalence and injury incidence rate. Incidence rate per 1000 training days (Exact 95% CI) was calculated using meta-analysis to allow comparisons between studies. Observed heterogeneity (e.g., training duration) precluded pooling of results across countries. The Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies assessed study quality. Results: This review identified 41 studies comprising 451,782 recruits. Most studies (n = 26; 63%) reported the number of injured recruits, and the majority of studies (n = 27; 66%) reported the number of injuries to recruits. The prevalence of recruits with medical attention injuries or time-loss injuries was 22.8% and 31.4%, respectively. Meta-analysis revealed the injury incidence rate for recruits with a medical attention injury may be as high as 19.52 injuries per 1000 training days; and time-loss injury may be as high as 3.97 injuries per 1000 training days. Longer recruit training programs were associated with a reduced injury incidence rate (p = 0.003). The overall certainty of the evidence was low per a modified GRADE approach. Conclusion: This systematic review with meta-analysis highlights a high musculoskeletal injury prevalence and injury incidence rate within military recruits undergoing basic training with minimal improvement observed over the past 20 years. Longer training program, which may decrease the degree of overload experienced by recruit, may reduce injury incidence rates. Unfortunately, reporting standards and reporting consistency remain a barrier to generalisability. Trial registration: PROSPERO (Registration number: CRD42021251080)

Real-world uptake of a tailored, text message pregnancy smoking cessation programme (MiQuit) when offered online

Background: Prenatal smoking is a major public health concern and uptake of NHS cessation support is low in this group. Text message-based self-help is a promising intervention for this population but little is known about its likely real-world uptake, an essential parameter for estimating public health impact. Aims were to explore uptake (including cost) of a tailored, theory-guided, text message intervention for pregnant smokers (‘MiQuit’) when offered online. Methods: Links to a website providing MiQuit activation information (texting a shortcode) were advertised online on a cost-per-click basis for two commercial websites (Google AdWords, Facebook Ads) and free of charge for two smoking in pregnancy webpages (National Childbirth Trust, NHS Choices). Activations per advert click, per advert exposure and cost per activation were calculated. Findings: Low-visibility links on free-of-charge webpages generated few activations. For the commercial websites, cost per click was lower with Facebook but a higher proportion of Google advert clickers activated support (5.2% of 812 Google, 2.2% of 1889 Facebook), making their cost per activation very similar (£23.86 Google, £23.81 Facebook). Compared to participants of a prior MiQuit trial, those activating support online appeared more motivated (intended to quit smoking sooner) and those activating support via Google were earlier in pregnancy, with a sharp peak at 4-5 weeks gestation. Incremental costs per quitter were £746.19 (95% CI -£1,886.654 to £4,595.08) at the end of pregnancy and -£76.22 (-£2,790.33 to £3,844.02) when extended to mother’s lifetime. Discussion: Online advertisements are a feasible, potentially cost-saving method for engaging pregnant smokers in cessation support

Real-world uptake of a tailored, text message pregnancy smoking cessation programme (MiQuit) when offered online

Background: Prenatal smoking is a major public health concern and uptake of NHS cessation support is low in this group. Text message-based self-help is a promising intervention for this population but little is known about its likely real-world uptake, an essential parameter for estimating public health impact. Aims were to explore uptake (including cost) of a tailored, theory-guided, text message intervention for pregnant smokers (‘MiQuit’) when offered online. Methods: Links to a website providing MiQuit activation information (texting a shortcode) were advertised online on a cost-per-click basis for two commercial websites (Google AdWords, Facebook Ads) and free of charge for two smoking in pregnancy webpages (National Childbirth Trust, NHS Choices). Activations per advert click, per advert exposure and cost per activation were calculated. Findings: Low-visibility links on free-of-charge webpages generated few activations. For the commercial websites, cost per click was lower with Facebook but a higher proportion of Google advert clickers activated support (5.2% of 812 Google, 2.2% of 1889 Facebook), making their cost per activation very similar (£23.86 Google, £23.81 Facebook). Compared to participants of a prior MiQuit trial, those activating support online appeared more motivated (intended to quit smoking sooner) and those activating support via Google were earlier in pregnancy, with a sharp peak at 4-5 weeks gestation. Incremental costs per quitter were £746.19 (95% CI -£1,886.654 to £4,595.08) at the end of pregnancy and -£76.22 (-£2,790.33 to £3,844.02) when extended to mother’s lifetime. Discussion: Online advertisements are a feasible, potentially cost-saving method for engaging pregnant smokers in cessation support

Factors influencing the provision of End of Life care for adolescents and young adults with advanced cancer: a scoping review protocol

The objective of this review is to locate and describe literature relating to EoL care provision to adolescents and young adults with cancer. The specific areas of investigation will include: - Care service provision in adolescents and young adults with cancer during the EoL phase of care - Experiences and perceptions of adolescents and young adults with cancer during the EoL phase of care - Experience and perceptions of the health professionals and family members involved in their care. - Practices/intervention

Factors influencing the provision of end-of-life care for adolescents and young adults with advanced cancer: a scoping review

Background There is international recognition that cancer in young people is on the rise and that improvements in outcomes for young people lag well behind advances achieved for both children and older adults over the past 30 years. Cancer is the third leading cause of death in adolescents and young adults; however, little is known about how the end of life unfolds for those who die of the progressive disease. Objective This scoping review sought to locate and describe literature relating to end of life care for adolescents and young adults with cancer

B Cells Regulate Neutrophilia during Mycobacterium tuberculosis Infection and BCG Vaccination by Modulating the Interleukin-17 Response

We have previously demonstrated that B cells can shape the immune response to Mycobacterium tuberculosis, including the level of neutrophil infiltration and granulomatous inflammation at the site of infection. The present study examined the mechanisms by which B cells regulate the host neutrophilic response upon exposure to mycobacteria and how neutrophilia may influence vaccine efficacy. To address these questions, a murine aerosol infection tuberculosis (TB) model and an intradermal (ID) ear BCG immunization mouse model, involving both the μMT strain and B cell-depleted C57BL/6 mice, were used. IL (interleukin)-17 neutralization and neutrophil depletion experiments using these systems provide evidence that B cells can regulate neutrophilia by modulating the IL-17 response during M. tuberculosis infection and BCG immunization. Exuberant neutrophilia at the site of immunization in B cell-deficient mice adversely affects dendritic cell (DC) migration to the draining lymph nodes and attenuates the development of the vaccine-induced Th1 response. The results suggest that B cells are required for the development of optimal protective anti-TB immunity upon BCG vaccination by regulating the IL-17/neutrophilic response. Administration of sera derived from M. tuberculosis-infected C57BL/6 wild-type mice reverses the lung neutrophilia phenotype in tuberculous μMT mice. Together, these observations provide insight into the mechanisms by which B cells and humoral immunity modulate vaccine-induced Th1 response and regulate neutrophila during M. tuberculosis infection and BCG immunization. © 2013 Kozakiewicz et al