Prevalence of second-hand tobacco smoke in relation to smoke-free legislation in the European Union

Background

Second-hand smoke (SHS) is still an important public health problem. With joining the Framework Convention on Tobacco Control (FCTC), all parties acknowledged the health risks of SHS and agreed to implement policies to protect their populations from SHS in public places. The aim of this study was to explore the SHS exposure in restaurants and bars as well as its associations with smoke-free legislation in the European Union.

Methods

Data of Eurobarometer surveys 2014 and 2017 were used to estimate prevalence of SHS exposure. We also extracted data on individual confounders such as smoking status, gender, sex, age and information on social economic status. Additionally, we collected data on country specific data on smoking regulations in restaurants and bars from the Tobacco Control Scale to analyse associations with SHS exposure using multilevel logistic regression. Smoking regulations were categorized into the following three categories: partial ban, comprehensive ban with minor exceptions, and complete ban.

Results

Preliminary results on the prevalence of SHS in restaurants showed a decrease from 11.8% (95% confidence intervals (CI) 11.2-12.5) in 2014 to 8.8% (95% CI 8.3-9.3) in 2017. The crude multilevel model controlling only for smoking prevalence resulted in an odds ratio of 0.39 (95% CI 0.19-0.77) for comprehensive ban with minor exceptions and 0.28 (95% CI 0.16-0.50) for complete ban versus partial ban. Odds ratios remained at significant levels when controlling for all available confounders.

Conclusions

Between 2014 and 2017, SHS exposure in restaurants decreased significantly. Furthermore, strong associations with smoking regulations were observed suggesting a high compliance. Many tobacco control policies have been introduced during the last years but several countries need to strengthen their smoke-free tobacco control policies to further reduce SHS exposure preventing death, disease and disability.

Key messages

SHS exposure remains a significant public health challenge. The implementation of effective measures could be strengthened through a convergence of tobacco control strategies and policies among European Union member states.

Anticipatory behaviour in animals: A critical review

A number of studies have investigated anticipatory behaviour in animals as a measure of sensitivity to reward or as an expression of emotional state. A common feature of many studies is that they base inferences on seemingly arbitrary measures, for example, the frequency of behavioural transitions (ie number of times an animal switches between different behaviours). This paper critically reviews the literature and discusses various hypotheses for why specific behavioural responses occur in the anticipatory period between the signal and reward in conditioned animals. We argue that the specific behaviours shown may be the result of superstitious learning and thus highly variable, leaving behavioural transitions as the only response that can be scored consistently, and that sometimes these responses may relate more to frustration than to a positive emotional state. Finally, we propose new research approaches to avoid potential confounds and improve future studies on this topic.

Challenges Calibrating Hydrology for Groundwater-Fed Wetlands: a Headwater Wetland Case Study

This study aims to adapt the Soil and Watershed Assessment Tool (SWAT), a ubiquitously used watershed model, for ground-water dominated surface waterbodies by accounting for recharge from the aquifers. Using measured flow to a headwater slope wetland in Alabama's coastal plain region as a case study, we present challenges and relatively simple approaches in using the SWAT model to predict flows from the draining watershed and relatively simple approaches to model groundwater upwelling. SWAT-simulated flow at the study watershed was limited by precipitation, and consequently, simulated flows were several times smaller in magnitude than observed flows. Thus, our first approach involved a separate stormflow and baseflow calibration which included the use of a regression relationship between observed and simulated baseflow (E NASH = 0.67). Our next approach involved adapting SWAT to simulate upwelling groundwater discharge instead of deep aquifer losses by constraining the range of deep losses, β deep parameter, to negative values (E NASH = 0.75). Finally, we also investigated the use of artificial neural networks (ANN) in conjunction with SWAT to further improve calibration performance. This approach used SWAT-calibrated flow, evapotranspiration, and precipitation as inputs to ANN (E NASH = 0.88). The methods investigated in this study can be used to navigate similar flow calibration challenges in other groundwater dominant watersheds which can be very useful tool for managers and modelers alike.

P4404Prognostic value of novel nocturnal oxygen saturation metrics in patients with obstructive sleep apnoea and high cardiovascular event risk

Aim

To determine prognostic value of novel oximetry-derived metrics in patients with obstructive sleep apnoea (OSA) and high cardiovascular (CV) event risk.

Methods and results

Ancillary study of the Sleep Apnoea CV Endpoints (SAVE) randomised controlled trial, which investigated the effects of CPAP treatment on secondary CV event outcomes in 2687 participants with moderate-severe OSA and established CV disease. Associations between baseline characteristics, standard sleep and pulse oximetry-derived metrics, and CV outcomes were determined in Cox proportional hazards regression models stratified for treatment allocation. Metrics evaluated included: oxygen desaturation index, time below 90% oxygen saturation (SpO2), average SpO2across recordings (mean SpO2), across episodic desaturation events (desaturation SpO2), and baseline interpolated through episodic desaturation events (baseline SpO2); duration and desaturation/resaturation time ratio of episodic desaturation events; and mean and standard deviation of pulse rate. No SpO2 metric was associated with the composite outcome. Mean and baseline SpO2 were negatively associated with heart failure (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.69–0.95; P=0.009 and 0.78, 0.67–0.90; P=0.001, respectively) and myocardial infarction risk (0.86, 0.77–0.95; P=0.003 and 0.81, 0.73–0.90; P<0.001, respectively) and marginally positively associated with stroke risk (1.09, 1.00–1.20; P=0.065 and 1.13, 1.02–1.26; P=0.020, respectively). Desaturation duration and desaturation/resaturation time ratio, with established risk factors, predicted heart failure (area under the receiver-operating-characteristic curve 0.86, 95% CI 0.79–0.93).

Conclusions

Higher mean and baseline SpO2 were associated with reduced risk of heart failure and myocardial infarction, and small increases in stroke rate. Desaturation shape may have predictive utility for future CV events.

Clinical trial registration: clinicaltrials (NCT00738179).

Changes in newspaper coverage of mental illness from 2008 to 2016 in England

AIMS

Since 2008 England's anti-stigma programme Time to Change has lobbied media outlets about stigmatising coverage and worked with them to promote accurate and non-stigmatising coverage. While this may have an impact on coverage and hence attitudes, it is also possible that coverage can change in response to improving attitudes, through the creation of a market demand for less stigmatising coverage. This study evaluates English newspaper coverage of mental health topics between 2008 and 2016.

METHOD

Articles covering mental health in 27 newspapers were retrieved using keyword searches on two randomly chosen days each month in 2008-2016, excluding 2012 and 2015 due to restricted resources. Content analysis used a structured coding framework. Univariate logistic regression models were used to estimate the odds of each hypothesised element occurring in 2016 compared with 2008 and Wald tests to assess the overall statistical significance of the year variable as the predictor.

RESULTS

The sample retrieved almost doubled between 2008 (n = 882) and 2016 (n = 1738). We found a significant increase in the proportion of anti-stigmatising articles (odds ratio (OR) 2.26 (95% confidence interval (CI) 1.86-2.74)) and a significant decrease in stigmatising articles (OR 0.62 (95% CI 0.51-0.75)). Reports on all diagnoses except for schizophrenia were more often anti-stigmatising than stigmatising.

CONCLUSIONS

This is the first clear evidence of improvement in coverage since the start of Time to Change. However, coverage of schizophrenia may be less affected by this positive shift than that of other diagnoses. The increase in the level of coverage identified in 2016 requires further investigation, as it may also influence public conceptualisation of what constitutes mental illness, attitudes to mental illness in general and/or specific diagnoses. While most anti-stigma programmes are not diagnosis specific, we suggest their evaluation would benefit from a diagnosis specific approach to allow fuller interpretation of their effects. This could include media analysis driven by hypotheses based on diagnoses to ascertain whether variations by diagnosis over time occur both in the nature and in the proportion of coverage.

Population differentiation between Australian and Chinese Helicoverpa armigera occurs in distinct blocks on the Z-chromosome

Over the last 40 years, many types of population genetic markers have been used to assess the population structure of the pest moth species Helicoverpa armigera. While this species is highly vagile, there is evidence of inter-continental population structure. Here, we examine Z-chromosome molecular markers within and between Chinese and Australian populations. Using 1352 polymorphic sites from 40 Z-linked loci, we compared two Chinese populations of moths separated by 700 km and found virtually no population structure (n = 41 and n = 54, with <1% of variation discriminating between populations). The levels of nucleotide diversity within these populations were consistent with previous estimates from introns in Z-linked genes of Australian samples (π = 0.028 vs. 0.03). Furthermore, all loci surveyed in these Chinese populations showed a skew toward rare variants, with ten loci having a significant Tajima's D statistic, suggesting that this species could have undergone a population expansion. Eight of the 40 loci had been examined in a previous study of Australian moths, of which six revealed very little inter-continental population structure. However, the two markers associated with the Cyp303a1 locus that has previously been proposed to be a target of a selective sweep, exhibited allele structuring between countries. Using a separate dataset of 19 Australian and four Chinese moths, we scanned the molecular variation distributed across the entire Z-chromosome and found distinct blocks of differentiation that include the region containing Cyp303a1. We recommend some of these loci join those associated with insecticide resistance to form a set of genes best suited to analyzing population structure in this global pest.

A Coordinated Approach to Lung Cancer Screening in Canada

Background and context: Lung cancer screening with low-dose computed tomography is recommended by the Canadian Task Force on Preventive Health Care for individuals at high risk. While no organized lung cancer screening programs currently exist, several Canadian jurisdictions have begun to plan for program implementation with pilot programs, studies, or business cases. Aim: The Canadian Partnership Against Cancer (the Partnership) has supported lung cancer screening activities by initiating a series of projects to promote lung health in Canada. Strategy/Tactics: The Partnership responded to emerging evidence on lung cancer screening with the establishment of the Pan-Canadian Lung Cancer Screening Network (PLCSN) in 2012. The PLCSN brings together key stakeholders from across Canada to promote pan-Canadian collaboration and serves as a national platform for knowledge exchange. Program/Policy process: One of the first priorities of the PLCSN was the development of a consensus statement-based Lung Cancer Screening Framework for Canada in 2014. The Framework outlines key considerations for lung cancer screening programs, including screening eligibility, radiologic testing, pathology quality and reporting, diagnostic treatment and follow-up, and the inclusion of smoking cessation interventions. As the development of the Framework drew to completion, the second priority of the PLCSN was the development of national quality indicators for lung cancer screening. An initial set of ten national-level lung cancer screening quality indicators was developed for national reporting. Most recently, the PLCSN developed a list of five quality-related lung cancer screening questions that should be explored in advance of the widespread implementation of lung cancer screening programs. These considerations included eligibility, enrollment, smoking cessation, nodule management and the effect of lung cancer screening programs on projected lung cancer mortality. Other Partnership initiatives to promote lung health include health economic modeling for lung cancer screening and collecting data on evidence-based smoking cessation programs. Outcomes: These initiatives have aligned pan-Canadian lung cancer screening efforts to facilitate knowledge sharing and resource efficiency, standardization of data collection and reporting, and acceleration of lung cancer screening in Canada. As of January 2018, four provinces have completed business cases, one province has implemented a pilot study, and three trials are ongoing across the country. Partnership initiatives and resources were used by several jurisdictions to inform the development of lung health activities. What was learned: By initiating these activities in advance of organized lung cancer screening programs, the Partnership has contributed to the evidence base on best practices in lung cancer screening that will be necessary for successful program implementation.

Power outages and refrigerated medicines: The need for better guidelines, awareness and planning

WHAT IS KNOWN AND OBJECTIVE

Vaccines and other pharmaceuticals are essential medical supplies that require continuous storage at specific temperatures to maintain viability. Power outages can lead to a break in the cold chain, resulting in the degradation of essential medicines.

COMMENT

After a power outage, the stability of vaccines and other medicines can be difficult to ascertain. Many public health guidelines therefore recommend discarding potentially compromised pharmaceuticals unless the cold chain can be guaranteed-a costly endeavour. There are government guidelines aimed at minimizing exposure to high temperatures in the event of a power outage; however, the usefulness of these guidelines is uncertain.

WHAT IS NEW AND CONCLUSION

The actual cost of vaccine and pharmaceutical loss due to a break in the cold chain is poorly studied and requires further research. Additional recommendations regarding the stability of specific medicines would also be a valuable resource.

Assay to Detect Inhibitory Substances in Serum of Patients with Acute Liver Failure

Patients with acute liver failure accumulate toxic substances in the circulation which may impair recovery of hepatic function. The aim of this study was to test an in vitro assay to detect inhibitory substances in the serum of patients with acute liver failure. Human liver-derived HepG2 cells were incubated for 24h in 96 well plates (30,000 cells/well) with sera (10%) from 24 patients with acute liver failure due to paracetamol overdose or NANB hepatitis and 11 normal controls. DNA synthesis was determined from the incorporation of 3H-thymidine and cell viability by the metabolism of the tetrazolium dye MTS. HepG2 cells exposed to acute liver failure sera incorporated significantly less 3H-thymidine (median 30% of control, range 0.2–169%) than normal sera (100%, 76–133%, p=0.002). Cell viability was also reduced (75%, 33–112% vs 100%, 96–105%, p<0.00l). There was no correlation between these values and patient outcome or levels of plasma TNF-α or serum interferon-γ. The assay detected inhibitory substances in sera of patients with acute liver failure and could be used to monitor the use of liver support systems.

Exploring the current and future role of the pharmacists in osteoporosis screening and management in Malaysia

Background Several studies have found that pharmacists can assist in screening and prevention of osteoporosis by referring patients for bone mineral density scans and counselling on lifestyle changes. In Malaysia, screening osteoporosis in all elderly women is not mandatory due to its cost. One approach to address this gap is to develop a pharmacist-led osteoporosis screening and prevention program. However, there is a paucity of data on the perspectives of Malaysian pharmacists in this area. Objective To explore the perspective of stakeholders (policy makers, doctors, pharmacists, nurses and patients) towards the role of pharmacists in osteoporosis screening and management. Setting A primary care clinic located within a teaching hospital in Kuala Lumpur, Malaysia. Method Patients (n = 20), nurses (n = 10), pharmacists (n = 11), doctors (n = 10) and policy makers (n = 5) were individually interviewed using a semi-structured topic guide. Purposive sampling was used. Interviews were transcribed verbatim and analysed using thematic analysis. Main outcome measure Perspective of stakeholders on the current and future role of pharmacists. Results All participants perceived pharmacists to be suppliers of medication, although there was some recognition of roles in providing medication advice. Nonetheless, these stakeholders were eager for pharmacists to expand their non-dispensing roles towards counselling, creating awareness and screening of osteoporosis. Interviewed pharmacists referred to their current role as 'robotic dispensers' and unanimously agreed to spread out to osteoporosis management role. Conclusion Under stakeholders there is a willingness to expand the role of pharmacists in Malaysia to non-dispensing roles, particularly in osteoporosis screening and management.