This systematic review of prospective longitudinal primary studies sought to determine whether electronic cigarette (e-cigarette) use by teenagers who had never smoked conventional tobacco cigarettes ...(tobacco cigarettes) at baseline was associated with subsequently commencing tobacco cigarette smoking.
The review followed the principles of a systematic review and meta-analysis. A key word search identified peer-reviewed articles published between 1 January 2005 and 2 October 2019 from seven bibliographic databases and one search engine. Using pre-prepared inclusion/exclusion criteria two researchers independently screened abstracts, and subsequently, full text papers. Selected articles were quality assessed in duplicate. Data on study participants characteristics, exposure and outcome measures were recorded in an adapted Cochrane Data Extraction Form. Feasibility assessment was done to detect clinical heterogeneity and choose an approach to meta-analysis. Analysis comprised pairwise random effects meta-analyses, and sensitivity and subgroup analyses.
From the 6619 studies identified, 14 one-off primary studies in 21 articles were suitable for inclusion. The participants ages ranged from 13 to 19 years and comprised teenagers based in Europe and North America. Nine of the 14 one-off studies, with follow-up periods between 4 and 24 months, met the criteria for inclusion in a meta-analysis of the association between ever use of e-cigarettes and subsequent initiation of tobacco cigarette use. Based on primary study adjusted odds ratios, our meta-analysis calculated a 4.06 (95% confidence interval (CI): 3.00-5.48, I
68%, 9 primary studies) times higher odds of commencing tobacco cigarette smoking for teenagers who had ever used e-cigarettes at baseline, though the odds ratio were marginally lower (to 3.71 times odds, 95%CI: 2.83-4. 86, I
35%, 4 primary studies) when only the four high-quality studies were analysed.
The systematic review found that e-cigarette use was associated with commencement of tobacco cigarette smoking among teenagers in Europe and North America, identifying an important health-related harm. Given the availability and usage of e-cigarettes, this study provides added support for urgent response by policymakers to stop their use by teenagers to decrease direct harms in this susceptible population group, as well as to conserve achievements in diminishing tobacco cigarette initiation.
Neurocysticercosis: neglected but not forgotten Coyle, Christina M; Mahanty, Siddhartha; Zunt, Joseph R ...
PLoS neglected tropical diseases,
05/2012, Letnik:
6, Številka:
5
Journal Article
Background. Influenza is an important cause of morbidity and mortality among older adults. Even so, effectiveness of influenza vaccine for older adults has been reported to be lower than for younger ...adults, and the impact of frailty on vaccine effectiveness (VE) and outcomes is uncertain. We aimed to study VE against influenza hospitalization in older adults, focusing on the impact of frailty. Methods. We report VE of trivalent influenza vaccine (TIV) in people ≥65 years of age hospitalized during the 2011–2012 influenza season using a multicenter, prospective, test-negative case-control design. A validated frailty index (FI) was used to measure frailty. Results. Three hundred twenty cases and 564 controls (mean age, 80.6 and 78.7 years, respectively) were enrolled. Cases had higher baseline frailty than controls (P = .006). In the fully adjusted model, VE against influenza hospitalization was 58.0% (95% confidence interval CI, 34.2%–73.2%). The contribution of frailty was important; adjusting for frailty alone yielded a VE estimate of 58.7% (95% CI, 36.2%–73.2%). VE was 77.6% among nonfrail older adults and declined as frailty increased. Conclusions. Despite commonly held views that VE is poor in older adults, we found that TIV provided good protection against influenza hospitalization in older adults who were not frail, though VE diminished as frailty increased.
Reading the Red Bull Sublime McCARTHY, ANNE C.
PMLA : Publications of the Modern Language Association of America,
05/2017, Letnik:
132, Številka:
3
Journal Article
Recenzirano
The aesthetic of the sublime has long been associated with the language of elevation and height. Activities such as mountain climbing ofer a physical correlative to this discourse. In these cases, ...the sublime is associated with a high point or summit, and the process of descent is minimized or erased. By contrast, what I call the Red Bull sublime—named for the energy drink company that claims to “give you wings”—uses technological innovation to draw attention to the aesthetic pleasures of falling. Taking Felix Baumgartner’s 2012 space jump as its paradigmatic example, this essay elaborates the central features of the Red Bull sublime, connecting it with a Romantic tradition, represented here by Samuel Taylor Coleridge and John Keats, of peering over the edge of the abyss.
Dear Editor, While P. falciparum is commonly understood to cause an acute potentially life-threatening illness typically within one month of exposure, in its endemic sub-Saharan Africa it also causes ...chronic, often asymptomatic disease in semi-immune carriers manifesting as a low parasite burden 1. Initially diagnosed as a viral illness and discharged home, she was later called back to hospital as the lab technologist discovered malaria parasites on the routine blood smear; subsequent rapid diagnostic antigen test and formal thin and thick film confirmed ring form morphology in keeping with P. falciparum with a parasite burden of 0.65%. ...the possibility of a locally-acquired infection remains unlikely given that the patient had no close contact with travellers and lives in a cold climate.
Zika virus (ZIKV) was first isolated in Africa; decades later, caused large outbreaks in the Pacific, and is considered endemic in Asia. We aim to describe ZIKV disease epidemiology outside the ...Americas, the importance of travelers as sentinels of disease transmission, and discrepancies in travel advisories from major international health organizations.
This descriptive analysis using GeoSentinel Surveillance Network records involves sixty-four travel and tropical medicine clinics in 29 countries. Ill returned travelers with a confirmed or probable diagnosis of ZIKV disease acquired in Africa, Asia and the Pacific seen between 1 January 2012 and 31 December 2016 are included, and the frequencies of demographic, trip, and diagnostic characteristics described. ZIKV was acquired in Asia (18), the Pacific (10) and Africa (1). For five countries (Indonesia, Philippines, Thailand, Vietnam, Cameroon), GeoSentinel patients were sentinel markers of recent Zika activity. Additionally, the first confirmed ZIKV infection acquired in Kiribati was reported to GeoSentinel (2015), and a probable case was reported from Timor Leste (April 2016), representing the only case known to date. Review of Zika situation updates from major international health authorities for country risk classifications shows heterogeneity in ZIKV country travel advisories.
Travelers are integral to the global spread of ZIKV, serving as sentinel markers of disease activity. Although GeoSentinel data are collected by specialized clinics and do not capture all imported cases, we show that surveillance of imported infections by returned travelers augments local surveillance system data regarding ZIKV epidemiology and can assist with risk categorization by international authorities. However, travel advisories are variable due to risk uncertainties.
Tuberculosis (TB) continues to be a global public health concern. Due to the presence of multiple risk factors such as poor housing conditions and food insecurity in Canadian Indigenous communities, ...this population is at particularly high risk of TB infection. Given the challenges of screening for latent TB infection (LTBI) in remote communities, a synthesis of the existing literature regarding current screening strategies among high-risk groups in low-incidence countries is warranted, in order to provide an evidence base for the optimization of paediatric LTBI screening practices in the Canadian Indigenous context.
A literature search of the Embase and Medline databases was conducted, and studies pertaining the evaluation of screening strategies or screening tools for LTBI in paediatric high-risk groups in low-incidence countries were included. Studies focusing on LTBI screening in Indigenous communities were also included, regardless of whether they focused on a paediatric population. Their results were summarized and discussed in the context of their relevance to screening strategies suitable to the Canadian Indigenous setting. Grey literature sources such as government reports or policy briefs were also consulted.
The initial literature search returned 327 studies, with 266 being excluded after abstract screening, and 36 studies being included in the final review (original research studies: n = 25, review papers or policy recommendations: n = 11). In the examined studies, case identification and cost-effectiveness of universal screening were low in low-incidence countries. Therefore, studies generally recommended targeted screening of high-risk groups in low-incidence countries, however, there remains a lack of consensus regarding cut-offs for the incidence-based screening of high-risk communities, as well as regarding the utility and prioritization of individual risk-factor-based screening of high-risk groups. The utility of the TST compared to IGRAs for LTBI detection in the pediatric population also remains contested.
Relevant strategies for targeted screening in the Canadian Indigenous context include community-level incidence-based screening (screening based on geographic location within high-incidence communities), as well as individual risk-factor-based screening, taking into account pertinent risk factors in Indigenous settings, such as poor housing conditions, malnutrition, contact with an active case, or the presence of relevant co-morbidities, such as renal disease.
Awful parenthesis McCarthy, Anne C
Awful parenthesis,
2018, 20180413, 2018, 2018-04-13
eBook
Examining various aesthetics of suspension in the works of nineteenth-century poets such as Coleridge, Shelley, Tennyson, and Christina Rossetti, Anne C. McCarthy shares important insights into the ...cultural fascination with the sublime.
Medical Education 2010: 44: 683–689
Objectives The purpose of this study was to explore the complexities (including harms and benefits) of international health electives (IHEs) involving medical ...trainees. This exploration contributes to the ongoing debate about the goals and implications of IHEs for medical trainees.
Methods This qualitative study used anonymous, one‐to‐one, semi‐structured interviews. All participants had previous international health experiences. Between September 2007 and March 2008, we interviewed a convenience sample of health care professionals (n = 10) and medical trainees (n = 10). Using a modified grounded theory methodology, we carried out cycles of data analysis in conjunction with data collection in an iterative and constant comparison process. The study’s thematic structure was finalised when theme saturation was achieved.
Results Participants described IHEs in both negative and positive terms. IHEs were described as unsustained short‐term contributions that lacked clear educational objectives and failed to address local community needs. Ethical dilemmas were described as IHE challenges. Participants reflected that many IHEs included aspects of medical tourism and the majority of participants described the IHE in negative terms. However, a few participants acknowledged the benefits of the IHE. Specifically, it was seen as an introduction to a career in global health and as a potential foundation for more sustainable projects with positive host community impacts. Finally, despite similar understandings among participants, self‐awareness of medical tourism was low.
Conclusions International health electives may include potential harms and benefits for both the trainee and the host community. Educational institutions should encourage and support structured IHEs for trainee participation. We recommend that faculties of medicine and global health educators establish pre‐departure training courses for trainees and that IHE opportunities have sufficient structures in place to mitigate the negative effects of medical tourism. We also recommend that trainees be provided with opportunities to conduct self‐reflection and critically assess their IHE experiences.
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