Maternal smoking and the risk of still birth: systematic review and meta-analysis

BACKGROUND: Smoking in pregnancy is known to be associated with a range of adverse pregnancy outcomes, yet there is a high prevalence of smoking among pregnant women in many countries, and it remains a major public health concern. We have conducted a systematic review and meta-analysis to provide contemporary estimates of the association between maternal smoking in pregnancy and the risk of stillbirth. METHODS: We searched four databases namely MEDLINE, EMBASE, Psych Info and Web of Science for all relevant original studies published until 31(st) December 2012. We included observational studies that measured the association between maternal smoking during pregnancy and the risk of stillbirth. RESULTS: 1766 studies were screened for title analysis, of which 34 papers (21 cohorts, 8 case controls and 5 cross sectional studies) met the inclusion criteria. In meta-analysis smoking during pregnancy was significantly associated with a 47% increase in the odds of stillbirth (OR 1.47, 95% CI 1.37, 1.57, p  <  0.0001). In subgroup analysis, smoking 1-9 cig/day and ≥10 cig/day was associated with an 9% and 52% increase in the odds of stillbirth respectively. Subsequently, studies defining stillbirth at ≥ 20 weeks demonstrated a 43% increase in odds for smoking mothers compared to mothers who do not smoke, (OR 1.43, 95% CI 1.32, 1.54, p  <  0.0001), whereas studies with stillbirth defined at ≥ 24 weeks and ≥ 28 weeks showed 58% and 33% increase in the odds of stillbirth respectively. CONCLUSION: Our review confirms a dose-response effect of maternal smoking in pregnancy on risk of stillbirth. To minimise the risk of stillbirth, reducing current smoking prevalence in pregnancy should continue to be a key public health high priority

Effects of Drilling Small Diameter Exhaust Shafts in a Gassy Longwall Operation

As the title indicates, this paper deals with the ventilation of a gassy longwall mine through the use of small diameter exhaust shafts. Extensive background information is provided to show the evolution of the mine\u27s ventilation system to correspond with changes in longwall mining techniques, particularly increases in face width. A description of the blind drilled shaft techniques, which proved to be the most economical ventilation choice for US Steel No. 50 Mine, is also included

Smoking in pregnancy: who makes quit attempts whilst pregnant and what types of cessation support do they prefer?

Background Smoking in pregnancy is strongly associated with adverse pregnancy and birth outcomes. In England, 26% of women smoke at some point during pregnancy, and 12% smoke throughout. Reducing smoking during pregnancy is therefore an NHS priority. Despite this, little is known about women who make a quit attempt during pregnancy. This study examined sociodemographic and psychological characteristics associated with making a quit attempt during pregnancy, and explored preferences for cessation support. Methods Cross-sectional, baseline data collected as part of the Pregnancy Lifestyle Survey cohort was analysed. Self-reported current or recent ex-smokers (smoked within 3 months of pregnancy) completed a questionnaire between 8-26 weeks gestation. Logistic regression analysis was used to examine characteristics associated with making a quit attempt. Descriptive statistics were used to investigate interest in accessing different forms of cessation support. Results Of the 850 participants, 57% were self-reported current smokers. Cigarettes smoked per day, smoking beliefs, previous pregnancy and a planned pregnancy were found to be significantly associated with whether women made a quit attempt whilst pregnant. Primiparous women were more than twice as likely (OR 2.20: 95% CI 1.33-3.66) to have made a quit attempt than multiparous women, and those who smoked ≥11 cigarettes per day were 72% less likely to have made a quit attempt than those who smoked ≤5 cigarettes per day (OR 0.28: 95% CI 0.16-0.48). Over 70% of women who had made a quit attempt were interested in accessing health professional led support and self-help materials. Conclusions Understanding the characteristics of women who make a quit attempt whilst pregnant and their cessation support preferences could inform future smoking cessation service design, and improve uptake of support services by allowing healthcare providers to target the women most likely to make a quit attempt, and provide support tailored specifically to meet their needs

Performance standards and quality measures for health services administration

his projects goal is to develop a plan for improving services to customers of the Health Services Administrative Team of the South Carolina Department of Health and Environmental Control

Understanding pregnant smokers’ adherence to nicotine replacement therapy during a quit attempt: a qualitative study

Background: Pregnant smokers may be offered nicotine replacement therapy (NRT) alongside behavioral support to assist with a quit attempt. Yet trials of NRT have found adherence to be low among pregnant women, and this has made it difficult to determine the efficacy of NRT. The aim of this study is to understand the experience of pregnant women who use NRT but discontinue this early or do not use the medication as recommended. Methods: Semi-structured telephone interviews were conducted with 14 pregnant smokers who had recently been prescribed NRT, but self-reported poor NRT adherence or discontinuing treatment prematurely. Data were transcribed and analyzed using inductive thematic analysis. Results: There were four main themes identified; expectations of NRT, experience of using NRT, safety concerns and experience of using e-cigarettes. Some women intentionally used NRT to substitute a proportion of their cigarette intake and smoked alongside. Most women smoked while using NRT. Women who underutilized NRT did so as they experienced side effects, or were concerned that using NRT instead of smoking could actually increase their nicotine exposure and potential for increased nicotine dependence or fetal harm. Most women spoke about the use of e-cigarettes as a smoking cessation method but only a few had actually experienced using them during pregnancy. Conclusion: Many women underused NRT but simultaneously smoked. Challenging negative perceptions about NRT and educating women further about the risks of smoking may encourage them to use NRT products as recommended.Implications: These findings add to the research surrounding the efficacy of NRT during pregnancy by providing insight into how pregnant women use NRT during a quit attempt and how this may influence adherence. It may assist health professionals to support pregnant smokers by increasing their understanding about the differing ways in which women use NRT and help them address concerns women may have about the safety of NRT

Changes in the rate of nicotine metabolism across pregnancy: a longitudinal study

Aims: Increased nicotine metabolism during pregnancy could explain why nicotine replacement therapy (NRT) appears to be less effective on smoking cessation in pregnancy than in non-pregnant smokers, but little is known about nicotine metabolism across pregnancy. This study was conducted to determine when changes in nicotine metabolism occur during pregnancy and to describe the magnitude of these changes. Design: Longitudinal cohort study of pregnant smokers' nicotine metabolite ratio (NMR). Setting and Participants: 101 pregnant smokers recruited from hospital antenatal clinics in Nottingham, UK were asked to provide saliva samples at 8–14 weeks (n = 98), 18–22 weeks (n = 65), 32–36 weeks gestation (n = 47), 4 weeks postpartum (n = 44) and 12 weeks postpartum (n = 47). Measurements: Nicotine metabolite ratio (NMR) was measured using the ratio of cotinine to its primary metabolite trans-3'-hydroxycotinine. Multi-level modelling was used to detect any overall difference in NMR between time points. The 12 week postpartum NMR was compared with the NMRs collected antenatally and 4 weeks postpartum. Findings: NMR changed over time (p = 0.0006). Compared with NMR at 12 weeks postpartum, NMR was significantly higher at 18–22 weeks (26% higher, 95% CI 12% to 38%) and 32–36 weeks (23% higher, 95% CI 9% to 35%). There was no significant difference between the 8-14 weeks gestation or 4 weeks postpartum NMR and 12 weeks postpartum. Conclusions: Nicotine metabolism appears to be faster during pregnancy; this faster metabolism is apparent from 18 to 22 weeks of pregnancy and appears to fall by 4 weeks after childbirth

Screening for atrial fibrillation – a cross-sectional survey of healthcare professionals in primary care

Introduction: Screening for atrial fibrillation (AF) in primary care has been recommended; however, the views of healthcare professionals (HCPs) are not known. This study aimed to determine the opinions of HCP about the feasibility of implementing screening within a primary care setting. Methods: A cross-sectional mixed methods census survey of 418 HCPs from 59 inner-city practices (Nottingham, UK) was conducted between October-December 2014. Postal and web-surveys ascertained data on existing methods, knowledge, skills, attitudes, barriers and facilitators to AF screening using Likert scale and open-ended questions. Responses, categorized according to HCP group, were summarized using proportions, adjusting for clustering by practice, with 95% C.Is and free-text responses using thematic analysis. Results: At least one General Practitioner (GP) responded from 48 (81%) practices. There were 212/418 (51%) respondents; 118/229 GPs, 67/129 nurses [50 practice nurses; 17 Nurse Practitioners (NPs)], 27/60 healthcare assistants (HCAs). 39/48 (81%) practices had an ECG machine and diagnosed AF in-house. Non-GP HCPs reported having less knowledge about ECG interpretation, diagnosing and treating AF than GPs. A greater proportion of non-GP HCPs reported they would benefit from ECG training specifically for AF diagnosis than GPs [proportion (95% CI) GPs: 11.9% (6.8–20.0); HCAs: 37.0% (21.7–55.5); nurses: 44.0% (30.0–59.0); NPs 41.2% (21.9–63.7)]. Barriers included time, workload and capacity to undertake screening activities, although training to diagnose and manage AF was a required facilitator. Conclusion: Inner-city general practices were found to have adequate access to resources for AF screening. There is enthusiasm by non-GP HCPs to up-skill in the diagnosis and management of AF and they may have a role in future AF screening. However, organisational barriers, such as lack of time, staff and capacity, should be overcome for AF screening to be feasibly implemented within primary care