Electronic Nicotine Delivery Systems or E-cigarettes: American College of Preventive Medicine's Practice Statement.

INTRODUCTION: E-cigarettes or or electronic nicotine delivery systems (ENDS) have rapidly gained popularity in the U.S. Controversy exists about the safety and efficacy of ENDS. The American College of Preventive Medicine's Prevention Practice Committee undertook a consensus-based evidence review process to develop a practice statement for the American College of Preventive Medicine. METHODS: A rapid review of the literature was performed through June 2017 to identify efficacy, patient-oriented harms, and the impact on population health. RESULTS: On an individual level, limited evidence suggests that ENDS may be effective at reducing cigarette use among adult smokers intending to quit. There is insufficient evidence addressing potential long-term harms of ENDS, and limited evidence is available about short-term harms of ENDS and the impact of secondhand exposure. Although ENDS appear safer than combustible cigarettes, they are not without risk. Among youth there is no known benefit and significant concern for harm. On a population level, there may be significant harms associated with ENDS, particularly among youth nonsmokers. The long-term balance of potential benefits versus harms from the individual and population perspectives are unclear. CONCLUSIONS: The American College of Preventive Medicine developed practice recommendations that include encouraging screening for ENDS use, strategies to prevent the initiation of ENDS use in nonsmokers, particularly in youth, adoption of a harm reduction model for smokers intending to quit in those who refuse or fail to quit with evidence-based smoking-cessation methods, recommendations on policy and regulatory strategies to decrease public use of ENDS and regulation of their components, and future research needs.

Vehicle-mounted high-power microwave systems and health risk communication in a deployed environment.

Vehicle-mounted high-power microwave systems have been developed to counter the improvised explosive device threat in southwest Asia. Many service members only vaguely comprehend the nature of these devices and the nonionizing radio frequency (RF) radiation they emit. Misconceptions about the health effects of RF radiation have the potential to produce unnecessary anxiety. We report an incident in which concern for exposure to radiation from a high-power microwave device thought to be malfunctioning led to an extensive field investigation, multiple evaluations by clinicians in theater, and subsequent referrals to an Occupational Health clinic upon return from deployment. When acute exposure to RF does occur, the effects are thermally mediated and immediately perceptible--limiting the possibility of injury. Unlike ionizing radiation, RF radiation is not known to cause cancer and the adverse health effects are not cumulative. Medical officers counseling service members concerned about potential RF radiation exposure should apply established principles of risk communication, attend to real and perceived risks, and enlist the assistance of technical experts to properly characterize an exposure when appropriate.

Effects of experience and commercialisation on survival in Himalayan mountaineering: retrospective cohort study.

OBJECTIVES: To determine whether previous Himalayan experience is associated with a decreased risk of climbing death, and whether mountaineers participating in commercial expeditions differ in their risk of death relative to those participating in traditional climbs. DESIGN: Retrospective cohort study. SETTING: Expeditions in the Nepalese Himalayan peaks, from 1 January 1970 to the spring climbing season in 2010. PARTICIPANTS: 23,995 non-porters venturing above base camp on 39,038 climbs, 23,295 on 8000 m peaks. OUTCOME: Death. RESULTS: After controlling for use of standard route, peak, age, season, sex, summit success, and year of expedition, increased Himalayan experience was not associated with a change in the odds of death (odds ratio 1.00, 95% confidence interval 0.96 to 1.05, P = 0.904). Participation in a commercial climb was associated with a 37% lower odds of death relative to a traditional venture, although not significantly (0.63, 0.37 to 1.09, P = 0.100). Choice of peak was clearly associated with altered odds of death (omnibus P<0.001); year of expedition was associated with a significant trend toward reduced odds of death (0.98, 0.96 to 0.99, P = 0.011). CONCLUSIONS: No net survival benefit is associated with increased Himalayan experience or participation in a traditional (versus commercial) venture. The incremental decrease in risk associated with calendar year suggests that cumulative, collective knowledge and general innovation are more important than individual experience in improving the odds of survival.