Introduction and Aims
This study aimed to compare current and ex‐smokers' sociodemographic and psychosocial characteristics, use of cessation aids and abrupt versus gradual quitting approaches.
...Design and Methods
A cross‐sectional survey of financially disadvantaged adults attending a community service organisation was conducted in New South Wales, Australia, between February 2012 and December 2013. Sociodemographic and psychosocial factors, use of cessation aids and gradual versus abrupt quit approach were assessed. χ2 tests and logistic regression compared characteristics of current and ex‐smokers.
Results
Of 905 individuals who completed the survey, 639 (71%) were current smokers and 107 (12%) were ex‐smokers. Ex‐smokers were older odds ratio (OR) = 1.03, 95% confidence interval (CI) = 1.01, 1.05, had higher odds of being female (OR = 1.67, 95% CI = 1.06, 2.65), lower odds of being financially stressed (OR = 0.87, 95% CI = 0.76, 0.99), lower odds of anxiety and depression symptoms (OR = 0.91, 95% CI = 0.84, 0.98) and lower odds of having friends and family who were smokers (ORs ranged from 0.30–0.43). Ex‐smokers had lower odds of using cessation aids and higher odds of reporting abrupt quitting during their last quit attempt (OR = 4.48, 95% CI = 2.66, 7.54).
Conclusions
Lower levels of disadvantage, less smoking in social networks, less use of cessation aids and abrupt (vs. gradual) quitting approaches were associated with being an ex‐smoker. Lower use of evidence based methods to quit by disadvantaged ex‐smokers requires further exploration. Twyman L, Bonevski B, Paul C, Bryant J, West R, Siahpush M, D'este C, Oldmeadow C, Palazzi K. What factors are associated with abstinence amongst socioeconomically disadvantaged smokers? A cross‐sectional survey of use of cessation aids and quitting approach. Drug Alcohol Rev 2017;00:000‐000
ObjectivesThis study examined sociodemographic, smoking and psychosocial characteristics associated with consent to participate in a smoking cessation trial for socially disadvantaged ...smokers.DesignBaseline data were collected prior to seeking consent for the Call it Quits, a randomised controlled trial.SettingAn Australian social and community service organisation. Sociodemographic, smoking and psychosocial characteristics were compared between smokers who agreed or declined to participate.ParticipantsOf the 584 smokers invited to participate, 431 (74%) consented and 153 (26%) declined.ResultsLogistic regression modelling indicates the ORs of participation were twice as high for those reporting ‘high’ motivation to quit compared to the ‘moderate’ motivation group, and five times higher than the ‘low’ motivation group (p=0.007). The ORs of consenting were higher for those with a preference for gradual reduction in cigarettes in quit attempts compared with ‘no preference’. The ORs were lower for those reporting ‘don't know’ regarding their enjoyment of smoking compared to ‘not at all’ enjoying smoking, and reporting that fewer of their family or friends smoked compared to ‘most or all’.ConclusionsThis study is the first to examine the characteristics of socially disadvantaged smokers who consent or decline to participate in a smoking cessation trial. Low-income smokers who are motivated to quit, are not enjoying smoking, had family or friends who smoked, and who are interested in gradual cessation approaches may be more likely to participate in a smoking cessation trial.Trial registration numberISRCTN85202510.
Local cancer relapse risk after breast conservation surgery followed by radiotherapy has fallen sharply in many countries, and is influenced by patient age and clinicopathological factors. We ...hypothesise that partial-breast radiotherapy restricted to the vicinity of the original tumour in women at lower than average risk of local relapse will improve the balance of beneficial versus adverse effects compared with whole-breast radiotherapy.
IMPORT LOW is a multicentre, randomised, controlled, phase 3, non-inferiority trial done in 30 radiotherapy centres in the UK. Women aged 50 years or older who had undergone breast-conserving surgery for unifocal invasive ductal adenocarcinoma of grade 1–3, with a tumour size of 3 cm or less (pT1–2), none to three positive axillary nodes (pN0–1), and minimum microscopic margins of non-cancerous tissue of 2 mm or more, were recruited. Patients were randomly assigned (1:1:1) to receive 40 Gy whole-breast radiotherapy (control), 36 Gy whole-breast radiotherapy and 40 Gy to the partial breast (reduced-dose group), or 40 Gy to the partial breast only (partial-breast group) in 15 daily treatment fractions. Computer-generated random permuted blocks (mixed sizes of six and nine) were used to assign patients to groups, stratifying patients by radiotherapy treatment centre. Patients and clinicians were not masked to treatment allocation. Field-in-field intensity-modulated radiotherapy was delivered using standard tangential beams that were simply reduced in length for the partial-breast group. The primary endpoint was ipsilateral local relapse (80% power to exclude a 2·5% increase non-inferiority margin at 5 years for each experimental group; non-inferiority was shown if the upper limit of the two-sided 95% CI for the local relapse hazard ratio HR was less than 2·03), analysed by intention to treat. Safety analyses were done in all patients for whom data was available (ie, a modified intention-to-treat population). This study is registered in the ISRCTN registry, number ISRCTN12852634.
Between May 3, 2007, and Oct 5, 2010, 2018 women were recruited. Two women withdrew consent for use of their data in the analysis. 674 patients were analysed in the whole-breast radiotherapy (control) group, 673 in the reduced-dose group, and 669 in the partial-breast group. Median follow-up was 72·2 months (IQR 61·7–83·2), and 5-year estimates of local relapse cumulative incidence were 1·1% (95% CI 0·5–2·3) of patients in the control group, 0·2% (0·02–1·2) in the reduced-dose group, and 0·5% (0·2–1·4) in the partial-breast group. Estimated 5-year absolute differences in local relapse compared with the control group were −0·73% (−0·99 to 0·22) for the reduced-dose and −0·38% (−0·84 to 0·90) for the partial-breast groups. Non-inferiority can be claimed for both reduced-dose and partial-breast radiotherapy, and was confirmed by the test against the critical HR being more than 2·03 (p=0·003 for the reduced-dose group and p=0·016 for the partial-breast group, compared with the whole-breast radiotherapy group). Photographic, patient, and clinical assessments recorded similar adverse effects after reduced-dose or partial-breast radiotherapy, including two patient domains achieving statistically significantly lower adverse effects (change in breast appearance p=0·007 for partial-breast and breast harder or firmer p=0·002 for reduced-dose and p<0·0001 for partial-breast) compared with whole-breast radiotherapy.
We showed non-inferiority of partial-breast and reduced-dose radiotherapy compared with the standard whole-breast radiotherapy in terms of local relapse in a cohort of patients with early breast cancer, and equivalent or fewer late normal-tissue adverse effects were seen. This simple radiotherapy technique is implementable in radiotherapy centres worldwide.
Cancer Research UK.
This article provides a high-level overview of regulatory and legislative developments in Canada from mid-April 2020 to the end of March 2021. We reviewed statutes, regulations, case law, regulatory ...decisions, and industry practices from provincial, territorial, and federal authorities. The topics of note include the challenges related to climate change and decarbonization, the opportunities that decarbonization provides for evolving technology and mechanisms for low carbon energy through the use of hydrogen and small scale nuclear, and the regulatory gaps related thereto. We address developments in regulatory efficiency, set out how the Vavilov decision has been applied to energy regulatory decisions, discuss energy regulators' obligations to consider the honour of the Crown outside of the "duty to consult," and lastly, discuss the potential effects on project approvals and achieving reconciliation with Indigenous peoples.
Epilepsy is one of the most common chronic brain diseases and is often associated with cognitive, behavioral, or other medical conditions. The need for therapies that would prevent, ameliorate, or ...cure epilepsy and the attendant comorbidities is a priority for both epilepsy research and public health. In 2018, the National Institute of Neurological Disease and Stroke (NINDS) convened a workshop titled “Accelerating the Development of Therapies for Antiepileptogenesis and Disease Modification” that brought together preclinical and clinical investigators and industry and regulatory bodies’ representatives to discuss and propose a roadmap to accelerate the development of antiepileptogenic (AEG) and disease‐modifying (DM) new therapies. This report provides a summary of the discussions and proposals of the Preclinical Science working group. Highlights of the progress of collaborative preclinical research projects on AEG/DM of ongoing research initiatives aiming to improve infrastructure and translation to clinical trials are presented. Opportunities and challenges of preclinical epilepsy research, vis‐à‐vis clinical research, were extensively discussed, as they pertain to modeling of specific epilepsy types across etiologies and ages, the utilization of preclinical models in AG/DM studies, and the strategies and study designs, as well as on matters pertaining to transparency, data sharing, and reporting research findings. A set of suggestions on research initiatives, infrastructure, workshops, advocacy, and opportunities for expanding the borders of epilepsy research were discussed and proposed as useful initiatives that could help create a roadmap to accelerate and optimize preclinical translational AEG/DM epilepsy research.
The 2014-2016 Ebola virus disease (EVD) outbreak in Liberia highlighted the importance of robust preparedness measures for a well-coordinated response; the initially delayed response contributed to ...the steep incidence of cases, infections among health care workers, and a collapse of the health care system. To strengthen local capacity and combat disease transmission, various healthcare worker (HCW) trainings, including the Ebola treatment unit (ETU) training, safe & quality services (SQS) training and rapid response team (RRT), were developed and implemented between 2014 and 2017.
Data from the ETU, SQS and RRT trainings were analyzed to determine knowledge and confidence gained.
The ETU, SQS and RRT training were completed by a total of 21,248 participants. There were improvements in knowledge and confidence, an associated reduction in HCWs infection and reduced response time to subsequent public health events.
No infections were reported by healthcare workers in Liberia since the completion of these training programs. HCW training programmes initiated during and post disease outbreak can boost public trust in the health system while providing an entry point for establishing an Epidemic Preparedness and Response (EPR) framework in resource-limited settings.
Agricultural producers grapple with low farm yields and declining ecosystem services within their landscapes. In several instances, agricultural production systems may be considered largely ...unsustainable in socioeconomic and ecological (resource conservation and use and impact on nature) terms. Novel technological and management options that can serve as vehicles to promote the provision of multiple benefits, including the improvement of smallholder livelihoods, are needed. We call for a paradigm shift to allow designing and implementing agricultural systems that are not only efficient (serving as a means to promote development based on the concept of creating more goods and services while using fewer resources and creating less waste) but can also be considered synergistic (symbiotic relationship between socio-ecological systems) by simultaneously contributing to major objectives of economic, ecological, and social (equity) improvement of agro-ecosystems. These transformations require strategic approaches that are supported by participatory system-level research, experimentation, and innovation. Using data from several studies, we here provide evidence for technological and management options that could be optimized, promoted, and adopted to enable agricultural systems to be efficient, effective, and, indeed, sustainable. Specifically, we present results from a study conducted in Colombia, which demonstrated that, in rice systems, improved water management practices such as Alternate Wetting and Drying (AWD) reduce methane emissions (~70%). We also show how women can play a key role in AWD adoption. For livestock systems, we present in vitro evidence showing that the use of alternative feed options such as cassava leaves contributes to livestock feed supplementation and could represent a cost-effective approach for reducing enteric methane emissions (22% to 55%). We argue that to design and benefit from sustainable agricultural systems, there is a need for better targeting of interventions that are co-designed, co-evaluated, and co-promoted, with farmers as allies of transformational change (as done in the climate-smart villages), not as recipients of external knowledge. Moreover, for inclusive sustainability that harnesses existing knowledge and influences decision-making processes across scales, there is a need for constant, efficient, effective, and real trans-disciplinary communication and collaboration.
Many livestock farms lack the amount of land required to apply manure based on crop nutrient needs. Due to recent increases
in fertilizer prices, a potential option would be for crop farmers to ...replace some commercial fertilizer with manure, which
could efficiently utilize manure nutrients without degrading water quality. This study surveyed farmers in Missouri and Iowa
to determine factors affecting crop farmers' application of manure. Results indicate that about 19% of crop farmers currently
apply manure. Those who apply tend to be younger and are both concerned with water quality and believe manure application
can improve water quality. Farmers with lower off-farm income are also more likely to apply manure. Iowa farmers are more
likely to apply manure than Missouri farmers. Those who perceive high transportation costs and those experiencing discomfort
with the smell of manure are less likely to apply manure.
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