The effect of smoking cessation counselling in pregnant women: a meta-analysis of randomised controlled trials

BACKGROUND

Pregnant smokers are often prescribed counselling as part of multicomponent cessation interventions. However, the isolated effect of counselling in this population remains unclear, and individual randomised controlled trials (RCTs) are inconclusive.

OBJECTIVE

To conduct a meta-analysis of RCTs examining counselling in pregnant smokers.

SEARCH STRATEGY

We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline and PsycINFO databases for RCTs evaluating smoking cessation counselling.

SELECTION CRITERIA

We included RCTs conducted in pregnant women in which the effect of counselling could be isolated and those that reported biochemically validated abstinence at 6 or 12 months after the target quit date.

DATA COLLECTION AND ANALYSIS

Overall estimates were derived using random effects meta-analysis models.

MAIN RESULTS

Our search identified eight RCTs (n = 3290 women), all of which examined abstinence at 6 months. The proportion of women that remained abstinent at the end of follow up was modest, ranging from 4 to 24% among those randomised to counselling and from 2 to 21% among control women. The absolute difference in abstinence reached a maximum of only 4%. Summary estimates are inconclusive because of wide confidence intervals, albeit with little evidence to suggest that counselling is efficacious at promoting abstinence (odds ratio 1.08, 95% confidence interval 0.84-1.40). There was no evidence to suggest that efficacy differed by counselling type.

CONCLUSIONS

Available data from RCTs examining the isolated effect of smoking cessation counselling in pregnant women are limited but sufficient to rule out large treatment effects. Future RCTs should examine pharmacological therapies in this population.

Comparative in vitro susceptibility of clinical isolates of Candida paparsilosis complex and other Candida species to caspofungin and anidulafungin by Etest

In vitro susceptibility of 141 clinical isolates of Candida species to caspofungin and anidulafungin is reported. the Etest was performed according to recommended procedure and minimum inhibitory concentrations (MICs) were read after 24 h of incubation at 35 °C. Applying a breakpoint of <2 mg/ml, all Candida spp. isolates, except those belonging to C. parapsilosis complex, were susceptible. The geometric mean for caspofungin and anidulafungin for different Candida spp. were as follows: Candida parapsilosis, 0.438 and 3.355 μg/ml; Candida orthopsilosis, 0.210 and 1.456 μg/ml; Candida albicans, 0.049 and 0.007 μg/ml; Candida dubliniensis, 0.077 and 0.009 μg/ml; Candida tropicalis, 0.061 and 0.027 μg/ml; Candida glabrata, 0.120 and 0.032 μg/ml; and Candida krusei, 0.288 and 0.052 μg/ml, respectively. Anidulafungin was significantly more active than caspofungin (p <0.001) except for C. parapsilosis complex spp. isolates. In conclusion, our Etest MICs compared well with epidemiological cutoff values derived from a large number of Candida spp. isolates tested by CLSI method in previous studies. However, considering the differences in MICs of the two echinocandins for C. parapsilosis complex isolates, the Etest needs further evaluation for its suitability.

First isolations in India of Candida nivariensis, a globally emerging opportunistic pathogen

We randomly screened 363 yeast isolates during 2008 for their ability to form white colonies on CHROM agar Candida medium. Two of these isolates (0.5%) were identified as Candida nivariensis based on detailed phenotypic characterization and DNA sequencing. One was recovered from the sputum of an HIV-positive patient with a pneumonic lesion and the second from the blood of a diabetic with oropharyngeal lesions. Direct DNA sequencing of the D1/D2 region of 28S rRNA gene and/or the internal transcribed spacer (ITS) regions of rDNA confirmed that both of the isolates were C. nivariensis. The carbohydrate assimilation profiles with the ID 32 C and VITEK 2 yeast identification systems revealed only glucose assimilation. In vitro antifungal susceptibility profiles by broth microdilution and Etest methods revealed susceptibility of both isolates to fluconazole, itraconazole, voriconazole, amphotericin B and 5-flucytosine, with low MICs for posaconazole and caspofungin. These results document the occurrence of Candida nivariensis for the first time in India and focus on its potential as an opportunistic human pathogen.

Sprouty-2 controls c-Met expression and metastatic potential of colon cancer cells: sprouty/c-Met upregulation in human colonic adenocarcinomas

Sprouty negatively regulates receptor tyrosine kinase signals by inhibiting Ras/ERK pathways. Sprouty is down-regulated in breast, prostate and liver cancers and appears to function as a tumor suppressor. The role of Sprouty in colonic neoplasia, however, has not been investigated. Sprouty-2 protein and mRNA transcripts were significantly up-regulated in human colonic adenocarcinomas. Strikingly, the c-Met receptor was also upregulated in tumors with increased sprouty-2. To delineate a potential causal relationship between sprouty-2 and c-Met, K-ras mutant HCT-116 colon cancer cells were transduced with purified TAT-sprouty-2 protein or stably transfected with full-length human sprouty-2 gene. Sprouty-2 up-regulation significantly increased cell proliferation by accelerating cell cycle transition. Sprouty-2 transfectants demonstrated strong up-regulation of c-Met protein and mRNA transcripts and hepatocyte growth factor stimulated ERK and Akt phosphorylation and enhanced cell migration and invasion. In contrast, knockdown of c-Met by siRNA significantly decreased cell proliferation, migration and invasion in sprouty-2 transfectants. Further, knockdown of sprouty-2 by siRNA in parental HT-29 and LS-174T colon cancer cells also decreased cell invasion. Sprouty-2 transfectants formed significantly larger tumor xenografts and demonstrated increased proliferation and angiogenesis and suppressed apoptosis. Sprouty-2 tumors metastasized to liver from cecal orthotopic implants suggesting sprouty-2 might also enhance metastatic signals. Thus in colon cancer sprouty functions as an oncogene and its effects are mediated in part by c-Met up-regulation.

Multilocus analysis of honeyeaters (Aves: Meliphagidae) highlights spatio-temporal heterogeneity in the influence of biogeographic barriers in the Australian monsoonal zone

Multilocus studies in phylogenetics and comparative phylogeography have the power to explore a broader spectrum of evolutionary questions than either discipline has alone. To examine the origins of sympatry in a group of closely related birds of mostly mesic eucalypt woodlands in Australia, we reconstructed the relationships among species of Entomyzon and Melithreptus honeyeaters (Aves: Passeriformes: Meliphagidae) using a mitochondrial marker, ND2, and six non-coding nuclear loci (total 4719 base pairs). By sampling across the geographical range of each species, we studied not only their phylogenetic relationships to each other but also the spatial distribution of their genetic diversity. We tested several biogeographic hypotheses concerning the role of Pleistocene environmental change in Australia. Phylogenetic gene trees support the current understanding of E. cyanotis as the sister to Melithreptus. Non-monophyly of M. lunatus in Australia's southern temperate woodlands highlights the need for a revision of systematics within Melithreptus. Phylogeographic analysis of the three northern species in Australia's monsoon tropics, M. gularis, M. albogularis and E. cyanotis, suggests that the roles of the Carpentarian and Torresian Barriers in shaping geographic structure in each of the species have been more complex and temporally dynamic than earlier morphology-based arguments of vicariance had suggested. We discuss their roles as ecological filters as well as barriers.

Polymyalgia rheumatica prevalence in a population-based sample

OBJECTIVE

To determine polymyalgia rheumatica (PMR) prevalence using population-based administrative data, and to estimate the error associated with case ascertainment approaches when using these databases.

METHODS

Cases were ascertained using physician billing and hospitalization data from the province of Manitoba (population 1.1 million). Focusing on the population age >/=45 years, we compared 3 different case definition algorithms and also used statistical methods that accounted for imperfect case ascertainment to estimate the prevalence and the properties of the ascertainment algorithms. A hierarchical Bayesian latent class regression model was developed that also allowed us to assess differences across patient demographics (sex and region of residence).

RESULTS

Using methods that account for the imperfect nature of both billing and hospitalization databases, we estimated the prevalence of PMR in women age >/=45 years to be lower in urban areas (754.5 cases/100,000; 95% credible interval [95% CrI] 674.1-850.3) compared with rural areas (1,004 cases/100,000; 95% CrI 886.3-1,143). This regional trend was also seen in men age >/=45 years, where the prevalence was estimated at 273.6 cases/100,000 (95% CrI 219.8-347.6) in urban areas and 380.7 cases/100,000 (95% CrI 311.3-468.1) in rural areas. Billing data appeared more sensitive in ascertaining cases than hospitalization data, and a large proportion of diagnoses was made by physicians other than rheumatologists.

CONCLUSION

These data suggest a higher prevalence of PMR in rural versus urban regions. Our approach demonstrates the usefulness of methods that adjust for the imperfect nature of multiple information sources, which also allow for estimation of the sensitivity of different case ascertainment approaches.

Estimating the sensitivity and specificity of Kato-Katz stool examination technique for detection of hookworms, Ascaris lumbricoides and Trichuris trichiura infections in humans in the absence of a 'gold standard'

The accuracy of the Kato-Katz technique in identifying individuals with soil-transmitted helminth (STH) infections is limited by day-to-day variation in helminth egg excretion, confusion with other parasites and the laboratory technicians' experience. We aimed to estimate the sensitivity and specificity of the Kato-Katz technique to detect infection with Ascaris lumbricoides, hookworm and Trichuris trichiura using a Bayesian approach in the absence of a 'gold standard'. Data were obtained from a longitudinal study conducted between January 2004 and December 2005 in Samar Province, the Philippines. Each participant provided between one and three stool samples over consecutive days. Stool samples were examined using the Kato-Katz technique and reported as positive or negative for STHs. In the presence of measurement error, the true status of each individual is considered as latent data. Using a Bayesian method, we calculated marginal posterior densities of sensitivity and specificity parameters from the product of the likelihood function of observed and latent data. A uniform prior distribution was used (beta distribution: alpha=1, beta=1). A total of 5624 individuals provided at least one stool sample. One, two and three stool samples were provided by 1582, 1893 and 2149 individuals, respectively. All STHs showed variation in test results from day to day. Sensitivity estimates of the Kato-Katz technique for one stool sample were 96.9% (95% Bayesian Credible Interval [BCI]: 96.1%, 97.6%), 65.2% (60.0%, 69.8%) and 91.4% (90.5%, 92.3%), for A. lumbricoides, hookworm and T. trichiura, respectively. Specificity estimates for one stool sample were 96.1% (95.5%, 96.7%), 93.8% (92.4%, 95.4%) and 94.4% (93.2%, 95.5%), for A. lumbricoides, hookworm and T. trichiura, respectively. Our results show that the Kato-Katz technique can perform with reasonable accuracy with one day's stool collection for A. lumbricoides and T. trichiura. Low sensitivity of the Kato-Katz for detection of hookworm infection may be related to rapid degeneration of delicate hookworm eggs with time.