Comparisons between young adult waterpipe smokers and nonsmokers' reactions to pictorial health warning labels in Lebanon: a randomized crossover experimental study

This study compares the impact of pictorial health warning labels (HWLs) and their placements on waterpipe parts (device, tobacco and charcoal packages) on health communication outcomes between waterpipe smokers and nonsmokers in Lebanon. An online randomized crossover experimental study was conducted among young adults (n = 403, August 2021) who observed three conditions of HWLs: pictorial HWLs on the tobacco package, pictorial HWLs on all waterpipe's parts and text-only HWL on the tobacco package in random order. Participants completed post-exposure assessments of health communication outcomes after each image. Using linear mixed models, we examined the differences in the effect of HWL conditions on several outcomes (i.e. warning reactions) between waterpipe smokers and nonsmokers, controlling for confounders (i.e. age, sex). Nonsmokers reported greater attention (β = 0.54 [95% confidence interval: 0.25-0.82]), cognitive elaboration (0.31 [0.05-0.58]) and social interaction (0.41 [0.18-0.65]) for pictorial HWLs on the tobacco packages than text-only compared with smokers. Pictorial HWLs on three parts versus one part elicited higher cognitive reactions and perceived message effectiveness in nonsmokers compared with waterpipe smokers. These findings provide valuable information for policymakers about the potential of implementing HWLs specific to waterpipes to prevent their use among young adults and limit tobacco-related morbidity and mortality in Lebanon.

Implementing pictorial health warning labels on waterpipe tobacco products: a qualitative study

Background

Waterpipe smoking rates in Lebanon are among the highest in the in the world. Research has documented the effectiveness of introducing pictorial health warning labels (PHWLs) in curbing waterpipe smoking. Seventeen years after ratification of the WHO Framework Convention on Tobacco Control and twelve years post adoption of a tobacco control law, PHWLs have not yet been implemented in Lebanon. This study aims to gain insight into stakeholders opinions and recommendations for adopting and implementing PHWLs on WP products within the current tobacco control policy environment.

Methods

We conducted 13 online interviews with policymakers, media, owners of establishments that serve waterpipe, as well as international and local NGO representatives whose mandate is tobacco control. During the interview process, key informants were shown PHWLs on waterpipe tobacco products and asked about feasibility of implementation and enforcement. National documents and legislations related to PHWLs were obtained from public record. We conducted content analysis on the documents. Interviews were transcribed, coded, and analyzed thematically.

Results

The majority of the key informants agreed on who is responsible for enforcement of PHWLs and on the contextual obstacles to enforcement. Main barriers to implement PHWLs on WP products were: 1) the fact that the WP is a multi-component tobacco use method that will require including all WP components (charcoal, tobacco, device); 2) WP usually is used in several locations (e.g., home, restaurants); and 3) WP is sold via multiple sources (supermarkets, tobacco shop, etc). Stakeholders recommended some solutions to address barriers to implementation.

Conclusions

Stakeholders responsible for implementation of PHWLs need to take into consideration contextual barriers as well as the particularities of waterpipe tobacco smoking in terms of multiple components used to smoke, locations of consumption, and sources where it is sold.

Key messages

• Implementing PHWLs on waterpipe tobacco products requires distinct understanding of policy environment and context.

• Implementing PHWLs on waterpipe tobacco products needs to address the complex nature of waterpipe smoking as a multi-component tobacco use method .

Intraoperative indocyanine green videoangiography to guide decision making regarding need for vessel bypass: A case report and technical note

Background:

Indocyanine green (ICG) videoangiography is an intraoperative technique recently used in vascular neurosurgery to assess the presence or absence of blood flow during critical times of a procedure. These include, but are not limited to, detecting whether daughter branches or perforators are patent after placing a vascular clip or determining whether an aneurysm has been completely isolated from the cerebral circulation after clipping. We present a case of a less-commonly reported application of ICG videoangiography involving the selection of a vessel to act as the bypass recipient once the need is identified during the surgical treatment of a complex intracranial aneurysm.

Case Description:

A 51-year-old male presented with a ruptured dissecting superior cerebellar artery (SCA) aneurysm that had two branches arising from the dome. Due to the difficult morphology of this aneurysm, a superficial temporal artery to SCA bypass was planned. We used ICG videoangiography to identify the branch that had insufficient retrograde flow via collateral circulation, to which the bypass was performed, followed by the isolation of the aneurysm from the cerebral circulation using permanent surgical clips.

Conclusion:

Our case represents a possible use of ICG videoangiography during the operative treatment of a difficult aneurysm. Our patient suffered no infarcts postoperatively. In the correct clinical context, this method represents a possible treatment option for complex aneurysms requiring a bypass.

Mesocortical dopamine depletion and anxiety-related behavior in the rat: sex and hemisphere differences

The mesocortical dopamine (DA) system of the rat plays an important role in prefrontal cortex (PFC) regulation of stress and emotion and exhibits functional hemispheric asymmetry for such processing. Since few studies examine sex differences in this context, we compared the effects of left vs. right unilateral PFC DA depletion in males and females in several behavioral situations associated with anxiety or aversion. Adult rats received unilateral injections of 6-hydroxydopamine (6-OHDA) or vehicle in the ventromedial (vm) PFC. Behavioral tests included a predator odor burying test, elevated plus maze and sucrose consumption with simple taste aversion. Tissue analysis confirmed that vmPFCs injected with 6-OHDA were depleted of DA (75-85%) compared to controls. Burying behavior and sucrose consumption were affected only by left lesions, similarly in both sexes. However, risk assessment behaviors were affected by right lesions in opposite directions in males and females. Behaviors modified preferentially by the left cortex thus showed less evidence of sex differences than those modulated by the right. While mesocortical DA depletion effects are lateralized, the nature of these effects can vary with sex and specific behavior. Such findings may be clinically significant, given the large gender differences in the incidence of mood and anxiety disorders, which also show many lateralized prefrontal abnormalities.

Clinical and economic consequences of antibiotic-impregnated cerebrospinal fluid shunt catheters

OBJECT

The authors evaluated the safety and efficacy of antibiotic-impregnated shunt catheters (AISCs) and determined the cost-benefit ratio related to the fact that AISCs increase the implant costs of a shunt procedure by approximately $400 per patient.

METHODS

The control group comprised 98 adults with chronic hydrocephalus and 22 children, who were treated without AISCs (non-AISCs). In the treatment group, AISCs (Bactiseal, Codman, Johnson & Johnson) were implanted in 171 adults and 26 children. The minimum follow-up period was 6 months.

RESULTS

Important risk factors for shunt infections (such as age, comorbidity, cause of hydrocephalus, operating time, and duration of external cerebrospinal fluid drainage prior to shunt placement) did not differ between the study and control groups. In the pediatric AISC group, the frequency of premature, shunt-treated infants and the incidence of external ventricular drainage prior to shunt insertion were actually higher than those in the non-AISC group. When using AISCs, the shunt infection rate dropped from 4 to 0.6% and from 13.6 to 3.8% in the adult and the pediatric cohort, respectively. Overall the infection rate decreased from 5.8 to 1%, which was statistically significant (p = 0.0145). The average costs of a single shunt infection were $17,300 and $13,000 in children and adults, respectively. The cost-benefit calculation assumed to have saved shunt infection-related costs of approximately $50,000 in 197 AISC-treated patients due to the reduction in shunt infection rate in this group compared with costs in the control group. Despite the incremental implant costs associated with the use of AISCs, the overall reduction in infection-related costs made the use of AISCs cost beneficial in the authors' department.

CONCLUSIONS

From clinical and economic perspectives, AISCs are seemingly a valuable addition in hydrocephalus therapy.