The effectiveness of smoking cessation interventions in rural and remote populations: Systematic review and meta-analyses.

BACKGROUND: Rural and remote residents are more likely to smoke tobacco than those in major cities. However, they may experience unique systemic, provider, and individual barriers to accessing smoking cessation treatments, including distance and limited resources. Understanding the effectiveness of smoking cessation interventions in this population is important due to higher smoking-related disease burden and death compared to those in major cities. METHODS: Medline, EMBASE, Scopus, PsychINFO, and Cochrane Library were searched until 19-02/2021. Inclusion criteria were randomised controlled trials (RCTs), cluster RCTs, randomised trials, or cluster randomised trials investigating behavioural interventions and pharmacotherapies for smoking cessation in rural and remote populations compared with a control or another smoking cessation treatment; and published in English. Given there is no internationally-standardised rurality index, definitions of 'rural' and 'remote' used by authors of studies were applied to reflect their country. Exclusion criteria were studies of non-combustible smoking cessation; and studies with urban participants in the sample. Two reviewers independently screened records for eligibility, extracted data from studies utilising a modified Cochrane Effective Practice and Organisation of Care Group form, and rated methodological quality using the Quality Assessment Tool for Quantitative Studies. RESULTS: Sixteen studies were included. Meta-analysis revealed a statistically significant treatment effect of individual face-to-face counselling on smoking cessation (RR 2.35, 95% CI 1.16-4.76, I2=0%) in rural and remote populations. There was no statistically significant treatment effect for nicotine replacement therapy (RR 2.97, 95% CI 0.84-10.53, I2=47%), telephone-counselling (RR 1.69, 95% CI 0.56-5.06, I2=62%), and community-based multiple-interventions (RR:1.57, 95% CI 0.89-2.78, I2=85%). Certainty of evidence was rated very low for each meta-analysis. CONCLUSION: Despite limited resources in rural and remote settings, individual face-to-face counselling for smoking cessation appears promising. Given the limited number of studies, further research about the effectiveness of smoking cessation interventions in rural and remote populations is warranted.

Outcomes of patients with thoraco-abdominal gunshot wounds operatively managed at a district hospital in Cape Town, South Africa.

AIM: Trauma is a leading cause of morbidity and mortality in the first four decades of life. Thoracoabdominal gunshot wounds carry a significant risk of mortality. This risk of death is reduced if patients are managed in dedicated units. This study examines the outcome of these patients managed in a district level hospital. METHOD: In this retrospective review, patients with thoracoabdominal gunshot wounds were identified from operating room registry for the period of January 2015 to December 2018. Data was collected retrospectively from folders and analysed for the primary outcome of mortality. RESULTS: Sixty-eight thoracoabdominal gunshot wounds were managed operatively over the period described. Only six patients were female. The median age was 29.5 years. Fourteen patients required postoperative transfer to a level 1 trauma unit. Thirteen patients died, nine at the district hospital and four at the level 1 unit. Significant differences in organ injuries were noted in the patients that died compared to the survivors. DISCUSSION: The in-hospital mortality rate of patients managed at the district hospital was 13.2% which is comparable to international rates of 12-18%. However, the subset of patients that required postoperative transfer to a level 1 trauma unit had a high mortality rate of 28.6%. The DH is committed to managing unstable and unresponsive patients once they present. Improved mortality rates will only occur with better prehospital transport policies and by equipping the DH to manage these patients postoperatively. CONCLUSION: Management of these patients can be successful at a district hospital. However, significant obstacles exist to their optimal care, as demonstrated by the high mortality patients requiring postoperative transfer.

Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier.

BACKGROUND: An exclusive human milk diet (EHM) including fortification with a human milk-based fortifier has been shown to decrease the occurrence of necrotizing enterocolitis (NEC) but growth velocity may be less for infants receiving EHM compared to a bovine diet. OBJECTIVE: The objective of this study was to determine if growth is improved by earlier fortification of breast milk for preterm infants supported with a human milk based fortifier. STUDY DESIGN: A multi-center retrospective cohort study of the outcomes of infants of 500- 1250 g birth weight whose breast milk feedings were fortified at >60 mL/kg/day (late) versus <60 mL/kg/day (early) of enteral feeding volume. RESULTS: Median±IQR range for gestational age (27.6±3.4 vs 27.0±2.9 weeks, p = 0.03) and chronic lung disease (CLD: 42.6 vs 27.6%, p = 0.008) were higher, and weight gain (12.9±2.6 vs 13.3±2.6 g/kg/day, p = 0.03) was lower in the late (N = 102) vs the early (N = 292) group. Adjusted multiple linear regression analysis found that early fortification was associated with improved growth velocity for weight (p = 0.007) and head circumference (HC) (p = 0.021) and less negative changes in z-scores for weight (p = 0.022) and HC (p = 0.046) from birth to discharge. Adjusted multiple logistic regression found that early fortification was associated with decreased occurrence of CLD (p = 0.004). No other outcomes, including NEC, were associated with early versus late fortification. CONCLUSION: The study results suggested that early HM fortification appears to positively affect growth for infants whose human milk feedings are fortified with a human milk based fortifier without adverse effects. The incidence of CLD was also reduced in the early fortification group.

A unified mechanism for unconfined deflagration-to-detonation transition in terrestrial chemical systems and type Ia supernovae.

The nature of type Ia supernovae (SNIa)-thermonuclear explosions of white dwarf stars-is an open question in astrophysics. Virtually all existing theoretical models of normal, bright SNIa require the explosion to produce a detonation in order to consume all of stellar material, but the mechanism for the deflagration-to-detonation transition (DDT) remains unclear. We present a unified theory of turbulence-induced DDT that describes the mechanism and conditions for initiating detonation both in unconfined chemical and thermonuclear explosions. The model is validated by using experiments with chemical flames and numerical simulations of thermonuclear flames. We use the developed theory to determine criteria for detonation initiation in the single-degenerate Chandrasekhar-mass SNIa model and show that DDT is almost inevitable at densities of 107 to 108 grams per cubic centimeter.

Mother-adolescent conflict in African American and European American families: the role of corporal punishment, adolescent aggression, and adolescents' hostile attributions of mothers' intent.

The present study examined mothers' use of corporal punishment and adolescents' aggression as predictors of mother-youth conflict during early adolescence. Particular attention was given to the potential mediating role that adolescents' hostile attributions of intent (HAI) regarding mothers' behavior might play in connections between corporal punishment, youth aggression, and mother-adolescent conflict for European American (EA) and African American (AA) youth. Data were collected from 268 12- to 14-year-olds (154 European American; 114 African American; 133 girls; 135 boys) and their mothers over a period of 2 years. Questionnaires completed by both mothers and adolescents were used to assess maternal corporal punishment and adolescent aggression, and interviews concerning hypothetical situations were used to assess adolescent HAI in year one. In both year one and year two mother-adolescent conflict was observed in a laboratory interaction session. Data revealed that adolescent HAI mediated the link between maternal corporal punishment and mother-adolescent conflict for EA, but not AA youth. Adolescents' HAI mediated the link between adolescent aggression and mother-adolescent conflict for both EA and AA families.

Prenatal drug exposure effects on subsequent vulnerability to drug abuse.

Research has shown that both prenatal alcohol and tobacco exposure are associated with increased risk of significant adverse medical, developmental, and behavioral outcomes including substance abuse. Research on the outcomes of prenatal exposure to illicit drugs (PNDE) has also found increased physical and behavioral problems for gestationally drug-exposed children. However, a clear picture has not emerged on whether the consequences of PNDE are independent from those associated with having a substance abusing parent and whether PNDE increases vulnerability to drug abuse. Because of its typical co-occurrence with factors inherent in having a drug-abusing parent, PNDE is at least a marker of significant increased risk for a range of negative outcomes including greater vulnerability to substance abuse. Although a review of the relevant research literatures indicates that the direct consequences of PNDE appear to be generally both subtle and nonglobal, PNDE does appear to have negative developmental and behavioral outcomes, and there is evidence that it is a modest direct contributor to increased substance abuse vulnerability.