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Objective To extend the limited international evidence on youth in-vehicle second-hand smoke (SHS) exposure by examining trends in New Zealand, a country with a national smoke-free goal and indoors smoke-free environment legislation. Methods We tracked exposure rates and explored the associations between in-vehicle SHS exposure and smoking behaviours. In-home exposure was also examined for comparative purposes. Data were collected in annual surveys of over 25 000 year 10 school students (14-15-year olds) for a 7-year period (2006-2012). Questions covered smoking behaviour, exposure to smoking and demographics. Results Youth SHS exposure rates in-vehicle and in-home trended down slightly over time (p<0.0001 for both) with 23% exposed in-vehicle in the previous week in 2012. However, marked inequalities in exposure between ethnic groups, and by school-based socioeconomic position, persisted. The strongest association with SHS exposure was parental smoking (eg, for both parents versus neither smoking in 2012: in-vehicle SHS exposure adjusted OR: 7.4; 95% CI: 6.5 to 8.4). After adjusting for seven other factors associated with initiation, logistic regression analyses revealed statistically significant associations of in-vehicle SHS exposure with susceptibility to initiation and smoking. Conclusions The slow decline in SHS exposure in vehicles and the lack of progress in reducing relative inequalities is problematic. To accelerate progress, the New Zealand Government could follow the example of other jurisdictions and prohibit smoking in cars carrying children. Other major policy interventions, beside enhanced smoke-free environments, will also likely be required if New Zealand is to achieve its 2025 smoke-free nation goal. [ABSTRACT FROM AUTHOR]

Objective The aim of the present work was to examine adult smokers' awareness of and receptivity to an electronic nicotine delivery system (ENDS) television advert, and whether viewing the advert influenced urge to smoke and intention to try ENDS. Methods A television advert for ENDS brand blu eCigs was shown to an online convenience sample of 519 Florida adult smokers. We measured current smokers' awareness of and receptivity to the advert, and whether seeing the advert influenced their thoughts about smoking or quitting, urge to smoke and intention to try ENDS. Results were stratified by prior ENDS use. Results Approximately 62.3% of current smokers were aware of the advert. Smokers found the advert informative (73.8%), attention grabbing (67.5%) and innovative (64.5%), with prior ENDS users rating the advert more favourably than non-users. Seeing the advert elicited an urge to smoke (mean 42.1, SD=1.9) and thoughts about smoking cigarettes (75.8%) as well as quitting (74.6%). Prior END users were significantly more likely than non-users to report thinking about smoking cigarettes after seeing the advert (P<0.05). Most smokers said ENDS were ‘made for people like them' (88.6%) and they would try ENDS in the future (66.0%). Conclusions Smokers are receptive to ENDS television adverts and report intention to try ENDS after viewing the advert. Future studies should monitor ENDS advertising and examine how exposure to ENDS adverts influences smokers' use of ENDS, dual use with cigarettes and cessation behaviour. [ABSTRACT FROM AUTHOR]

Objectives This study examines the influence that smokefree workplaces, restaurants and bars have on the adoption of smokefree rules in homes and cars, and whether there is an association with adopting smokefree rules in homes and cars. Methods Bivariate probit models were used to jointly estimate the likelihood of living in a smokefree home and having a smokefree car as a function of law coverage and other variables. Household data were obtained from the nationally representative Social Climate Survey of Tobacco Control 2001, 2002 and 2004-2009; clean indoor air law data were from the American Nonsmokers' Rights Foundation Tobacco Control Laws Database. Results ‘Full coverage’ and ‘partial coverage’ smokefree legislation is associated with an increased likelihood of having voluntary home and car smokefree rules compared with ‘no coverage’. The association between ‘full coverage’ and smokefree rule in homes and cars is 5% and 4%, respectively, and the association between ‘partial coverage’ and smokefree rules in homes and cars is 3% and 4%, respectively. There is a positive association between the adoption of smokefree rules in homes and cars. Conclusions Clean indoor air laws provide the additional benefit of encouraging voluntary adoption of smokefree rules in homes and cars. [ABSTRACT FROM AUTHOR]

Background Tobacco endgame policies are increasingly advocated to end tobacco use. This study investigated public support for a total ban on tobacco sales, use and possession in Hong Kong. Methods A telephone survey was conducted among 1537 randomly selected residents in 2012 to assess their support for a total ban on tobacco sales, usage and possession. Information on sociodemographic characteristics, smoking, and second hand smoke exposure were collected. Logistic regression was used to investigate factors associated with support for a total ban. Results Most of the never smokers (75.3%), ex-smokers (63.9%), and nearly half of current smokers (48.9%) backed some form of a total ban on tobacco. A total ban on tobacco sales was the most popular option among the three groups, with over half (64.8%) of all respondents supporting a ban within 10 years. Current smoking and higher educational attainment were associated with less support for a total ban on tobacco sales. Among current smokers, having quit intentions and attempts to quit were associated with support for a total ban. Conclusions A total ban on tobacco sales was supported by most respondents. Ex-smokers and current smokers also voiced substantial support, although less than never smokers. A total ban on tobacco sales before 2022 should be the goal as it is supported by most of the respondents. Interim tobacco control measures, such as tax increases, expansion of smoking cessation services and plain packaging should be implemented to help current smokers quit and reduce smoking initiation before implementation of the ban. [ABSTRACT FROM AUTHOR]

Objective To examine how the intensity and duration of tobacco control advertising relate to adolescent smoking prevalence. Methods Australian students (aged 12-17 years) participating in a national survey conducted triennially between 1993 and 2008 (sample size range 12 314-16 611). The outcome measure was students' smoking in the previous 4 weeks collected through anonymous, self-completed surveys. For each student, monthly targeted rating points (TRPs, a measure of television advertising exposure) for tobacco control advertising was calculated for the 3 and 12 months prior to surveying. For each time period, cumulative TRPs exposure and exposure to three intensity levels (≥100 TRPs/month; ≥400 TRPs/month; ≥800 TRPs/month) over increasing durations (eg, 1 month, 2 months, etc) were calculated. Logistic regression examined associations between TRPs and adolescent smoking after controlling for demographic and policy variables. Results Past 3-month cumulative TRPs were found to have an inverse relationship with smoking prevalence. Low TRPs exposure in the past 12 months was positively associated with adolescent smoking prevalence. However, smoking prevalence reduced with cumulative exposure levels above 5800 cumulative TRPs. Additionally, exposure to ≥400 TRPs/month and ≥800 TRPs/month were associated with reduced likelihood of smoking, although the duration needed for this effect differed for the two intensity levels. When intensity was ≥400 TRPs/month, the odds of smoking only reduced with continuous exposure. When intensity was ≥800 TRPs/month, exposure at levels less than monthly was associated with reductions in smoking prevalence. Conclusions Both antismoking advertising intensity and duration are important for ensuring reductions in adolescent smoking prevalence. [ABSTRACT FROM AUTHOR]

Introduction Mentholated cigarettes are at least as dangerous to an individual's health as non-mentholated varieties. The addition of menthol to cigarettes reduces perceived harshness of smoke, which can facilitate initiation. Here, we examine correlates of menthol use, national trends in smoking menthol and non-menthol cigarettes, and brand preferences over time. Methods We estimated menthol cigarette use during 2004-2010 using annual data on persons ≥12 years old from the National Surveys on Drug Use and Health. We adjusted self-reported menthol status for selected brands that were either exclusively menthol or nonmenthol, based on sales data. Data were weighted to provide national estimates. Results Among cigarette smokers, menthol cigarette use was more common among 12-17 year olds (56.7%) and 18-25 year olds (45.0%) than among older persons (range 30.5% to 34.7%). In a multivariable analysis, menthol use was associated with being younger, female and of non-Caucasian race/ethnicity. Among all adolescents, the percentage who smoked non-menthol cigarettes decreased from 2004-2010, while menthol smoking rates remained constant; among all young adults, the percentage who smoked non-menthol cigarettes also declined, while menthol smoking rates increased. The use of Camel menthol and Marlboro menthol increased among adolescent and young adult smokers, particularly non-Hispanic Caucasians, during the study period. Conclusions Young people are heavy consumers of mentholated cigarettes. Progress in reducing youth smoking has likely been attenuated by the sale and marketing of mentholated cigarettes, including emerging varieties of established youth brands. This study should inform the Food and Drug Administration regarding the potential public health impact of a menthol ban. [ABSTRACT FROM AUTHOR]

Background This analysis estimates the association between smoking-related knowledge and smoking behaviour in a Chinese context. To identify the specific knowledge most directly related to smoking status, we used a novel latent variable analysis approach to adjust for the high correlations between different measures of knowledge about tobacco smoking. Method Data are from the Global Adult Tobacco China Survey, a nationally representative sample of 13 354 household-dwelling individuals 15 years of age or older. Multinomial logistic regressions estimated the association between smoking status (ie, never smoked, current smoker or past smoker) and four smoking-related beliefs: whether or not smoking causes lung cancer, heart attack and stroke, and whether or not low-tar cigarettes are less harmful. A latent variable approach reassessed these associations while taking into account the general level of knowledge about smoking. Results After demographic variables and general knowledge about smoking had been controlled for, the belief that low-tar cigarettes are not less harmful was more prevalent in persons who had never smoked than in current smokers (OR=1.3 (95% CI 1.0 to 1.7) in men and OR=2.8 (95% CI 1.3 to 5.9) in women); this association was even stronger when past smokers and current smokers were compared (OR=2.1 (95% CI 1.5 to 3.0) in men and OR=5.0 (95% CI 1.3 to 20.1) in women). Conclusions Compared with those who have never smoked and those who have ceased smoking, current smokers in China are more likely to believe that low-tar cigarettes are less harmful than regular cigarettes. [ABSTRACT FROM AUTHOR]

Background On 11 January 2009, Taiwan expanded its smoke-free legislation to all indoor public places and workplaces. This study examined the impact of this policy on secondhand smoke (SHS) exposure in adult non-smokers, across gender and socioeconomic status groups (SES). Methods An annual sample of about 13 000-14 000 non-smokers was drawn from cross-sectional nationwide data of Taiwan Adult Tobacco Behavior Surveys during 2005-2011. Logistic regressions were used to analyse the aggregate data to estimate the association between the 2009 smoke-free legislation and SHS exposures in homes and workplaces. Interaction terms were used to examine the impact of the 2009 smoke-free policy on reducing differences in SHS exposure across gender, education and income groups. Results The 2009 policy reduced the odds of SHS exposure in homes in 2009 (OR=0.76, 95% CI 0.68 to 0.84) and in workplaces (year 2009: OR=0.49, 95% CI 0.39 to 0.62; year 2010: OR=0.79, 95% CI 0.66 to 0.95). The model with interaction terms showed that men were more likely than women to be exposed to workplace SHS (OR=2.02, 95% CI 1.80 to 2.27) but were less likely to be exposed to home SHS (OR=0.79, 95% CI 0.73 to 0.86). SHS exposure in homes was significantly related to lower socioeconomic status, but the 2009 smoke-free policy reduced the difference in SHS exposure across education levels. Conclusions The 2009 smoke-free policy reduced the SHS exposure for non-smokers. However, this impact on home SHS did not persist after 2009, and the effect of protection was unequal across gender and SES groups. Thus, further enforcement of smoking restrictions would be needed to reduce the risk of SHS exposure and improve protection against SHS risk among parts of the population with lower socioeconomic status. [ABSTRACT FROM AUTHOR]

Introduction There is anecdotal evidence that health messages interpreted from waterpipe tobacco smoking (WTS) research are inconsistent, such as comparing the health effects of one WTS session with that of 100 cigarettes. This study aimed to identify key health themes about WTS discussed by online news media, and how numerical cigarette–waterpipe equivalence (CWE) was being interpreted. Methods We identified 1065 online news articles published between March 2011 and September 2012 using the ‘Google Alerts' service. We screened for health themes, assessed statements mentioning CWE and reported differences between countries. We used logistic regression to identify factors associated with articles incorrectly reporting a CWE equal to or greater than 100 cigarettes, in the absence of any comparative parameter (‘CWE ≥100 cigarettes'). Results Commonly mentioned health themes were the presence of tobacco (67%) and being as bad as cigarettes (49%), and we report on differences between countries. While 10.8% of all news articles contained at least one positive health theme, 22.9% contained a statement about a CWE. Most of these (18.6% total) were incorrectly a CWE ≥100 cigarettes, a quarter of which were made by healthcare professionals/organisations. Compared with the Middle East, articles from the USA and the UK were the most significant predictors to contain a CWE ≥100 cigarettes statement. Conclusions Those wishing to write or publish information related to WTS may wish to avoid comparing WTS to cigarettes using numerical values as this is a major source of confusion. Future research is needed to address the impact of the media on the attitudes, initiation and cessation rates of waterpipe smokers. [ABSTRACT FROM AUTHOR]

Purpose The news media plays an important role in agenda setting and framing of stories about tobacco control. The purpose of this study was to examine newspaper, newswire and television coverage of tobacco issues in the USA over a 7-year period. Methods Analyses of 2004-2010 news media surveillance system data from the US Centers for Disease Control and Prevention's Office on Smoking and Health, based on content analysis and quantitative methods. Information on extent of news coverage, and types of tobacco-related themes, were examined from articles in 10 newspapers and 2 major newswires, as well as transcripts from 6 national television networks. Results The overall extent of newspaper, newswire and television stories about tobacco, and level of coverage by specific media outlets, varied over time, especially for newspapers. Nevertheless, there was an average of 3 newspaper stories, 4 newswire stories, and 1 television tobacco-related story each day. Television stories were more likely to contain cessation/addiction or health effects/statistics themes and less likely to contain secondhand smoke or policy/regulation themes than newspaper/newswire stories. There was more variation in the choice of tobacco theme among individual newspapers/newswires than television media outlets. Conclusions News coverage of tobacco in the USA was relatively constant from 2004 to 2010. Audiences were more likely to be exposed to different tobacco themes in newspapers/newswires than on television. Tracking information about tobacco news stories can be used by advocates, programs and others for planning and evaluation, and by researchers for hypothesis generation. [ABSTRACT FROM AUTHOR]

The human–computer interaction research community has long been interested in the role of age in the use of computing devices. The current availability of large high-resolution displays and a growing community of older adults who use computers on a regular basis are examples of a changing landscape of users and devices that calls for a reevaluation of what we know about age and computers. This article presents two studies comparing the performance of young and older adults in reading tasks. In our studies, older adults outperformed young adults in terms of reading times and reading comprehension regardless of medium (paper or computer display). In addition, the overlap of confidence intervals for reading times and comprehension by medium suggests participants performed equally well regardless of medium. Both findings are in contrast to results from similar studies from the 1980s and 1990s. [ABSTRACT FROM PUBLISHER]

BACKGROUND: Despite a long history of discrimination and persisting racial disparities in smoking prevalence, little research exists on the relationship between discrimination and smoking in South Africa. METHODS: This analysis examined chronic (day-to-day) and acute (lifetime) experiences of racial and non-racial (eg, age, gender or physical appearance) discrimination and smoking status among respondents to the South Africa Stress and Health study. Logistic regression models were constructed using SAS-Callable SUDAAN. RESULTS: Both chronic racial discrimination (RR=1.45, 95% CI 1.14 to 1.85) and chronic non-racial discrimination (RR=1.69, 95% CI 1.37 to 2.08) predicted a higher risk of smoking, but neither type of acute discrimination did. Total (sum of racial and non-racial) chronic discrimination (RR=1.46, 95% CI 1.20 to 1.78) and total acute discrimination (RR=1.28, 95% CI 1.01 to 1.60) predicted a higher risk of current smoking. CONCLUSIONS: Racial and non-racial discrimination may be related to South African adults' smoking behaviour, but this relationship likely varies by the timing and frequency of these experiences. Future research should use longitudinal data to identify the temporal ordering of the relationships studied, include areas outside of South Africa to increase generalisability and consider the implications of these findings for smoking cessation approaches in South Africa. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Those with any psychiatric diagnosis have substantially greater rates of smoking and are less likely to quit smoking than those with no diagnosis. Using nationally representative data, we sought to provide estimates of smoking and longitudinal cessation rates by specific psychiatric diagnoses and mental health service use. DESIGN AND PARTICIPANTS: Data were analysed from a two-wave cohort survey of a US nationally representative sample (non-institutionalised adults): the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002, n=43 093; 2004-2005, n=34 653). MAIN OUTCOME MEASURES: We examined smoking rates (lifetime, past year and past year heavy) and cross-sectional quit rates among those with any lifetime or past year psychiatric diagnosis (DSM-IV). Importantly, we examined longitudinal quit rates and conducted analyses by gender and age categories. RESULTS: Those with any current psychiatric diagnosis had 3.23 (95% CI 3.11 to 3.35) times greater odds of currently smoking than those with no diagnosis, and were 25% less likely to have quit by follow-up (95% CI 20% to 30%). Prevalence varied by specific diagnoses (32.4% to 66.7%) as did cessation rates (10.3% to 17.9%). Comorbid disorders were associated with higher proportions of heavy smoking. Treatment use was associated with greater prevalence of smoking and lower likelihood of cessation. CONCLUSIONS: Those with psychiatric diagnoses remained much more likely to smoke and less likely to quit, with rates varying by specific diagnosis. Our findings highlight the need to improve our ability to address smoking and psychiatric comorbidity both within and outside of healthcare settings. Such advancements will be vital to reducing mental illness-related disparities in smoking and continuing to decrease tobacco use globally. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe relationships between tobacco-related environments and disparities in smoking by sexual orientation. METHODS: We examined three aspects of state-level tobacco environments, which were derived from the ImpacTeen State Level Tobacco Control Policy and Prevalence Database: (1) tobacco price and tax data and tobacco control funding; (2) tobacco control policies and (3) tobacco prevalence and norms data. This information was linked to individual-level data on sexual orientation, tobacco use and nicotine dependence in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N=34 653; 577 LGB respondents), a cross-sectional, nationally representative survey of adults in the USA. RESULTS: Lesbian, gay and bisexual (LGB) adults in states with more restrictive tobacco environments were less likely to have ever smoked (AOR=0.78, 95% CI 0.62 to 1.00) and to currently smoke (AOR=0.77, 95% CI 0.60 to 0.99) than LGB adults in more permissive tobacco environments. Further, sexual orientation disparities in past and current smoking, as well as in current nicotine dependence, were lower in states with the most restrictive tobacco environments. Results were robust to adjustment for confounders at the individual and state levels. CONCLUSIONS: Restrictive state-level tobacco environments are correlates of smoking behaviours among LGB adults in the USA; such environments could potentially reduce social inequalities in smoking based on sexual orientation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Dysfunctional reward processing is present in individuals with schizophrenia-spectrum disorders (SSD) and may confer vulnerability to addiction. Our objective was to identify a deficit in patients with SSD on response to rewarding stimuli and determine whether this deficit predicts cannabis use. METHODS: We divided a group of patients with SSD and nonpsychotic controls into cannabis users and nonusers. Response to emotional and cannabis-associated visual stimuli was assessed using self-report, event-related potentials (using the late positive potential [LPP]), facial electromyography and skin-conductance response. RESULTS: Our sample comprised 35 patients with SSD and 35 nonpsychotic controls. Compared with controls, the patients with SSD showed blunted LPP response to pleasant stimuli (p = 0.003). Across measures, cannabis-using controls showed greater response to pleasant stimuli than to cannabis stimuli whereas cannabis-using patients showed little bias toward pleasant stimuli. Reduced LPP response to pleasant stimuli was predictive of more frequent subsequent cannabis use (β = -0.24, p = 0.034). LIMITATIONS: It is not clear if the deficit associated with cannabis use is specific to rewarding stimuli or nonspecific to any kind of emotionally salient stimuli. CONCLUSION: The LPP captures a reward-processing deficit in patients with SSD and shows potential as a biomarker for identifying patients at risk of heavy cannabis use. [ABSTRACT FROM AUTHOR]

Background Decisions about which antismoking advertisements should be aired are often guided by audience ratings of perceived effectiveness (PE). Given that the usefulness of PE measures depends on their ability to predict the likelihood that a message will have a positive impact on outcomes such as behaviour change, in the current study we used pre-exposure, postexposure and follow-up measures to test the association between PE and subsequent changes in quitting intentions and smoking behaviours. Methods Daily smokers (N=231; 18 years and older) completed baseline measures of quitting intentions before watching an antismoking advertisement. Immediately following exposure, intentions were measured again and PE was measured using six items that factored into two scales: ad-directed PE (ADPE) and personalised PE (PPE). A follow-up telephone survey conducted within 3 weeks of exposure measured behaviour change (reduced cigarette consumption or quit attempts). Results From pre-exposure to postexposure, 18% of smokers showed a positive change in their intentions. Controlling for baseline intentions, PPE independently predicted intention change (OR=2.57, p=0.004). At follow-up, 26% of smokers reported that they had changed their behaviour. PPE scores also predicted the likelihood of behaviour change (OR=1.93, p=0.009). Conclusions Audience ratings of PPE, but not ADPE, were found to predict subsequent intention and behaviour change. These findings increase confidence in the use of PE measures to pretest and evaluate antismoking television advertisements, particularly when these measures tap the extent to which a smoker has been personally affected by the message. [ABSTRACT FROM AUTHOR]

Objective The aim of this research was to compare the risk of all-cause mortality and mortality from all cancers combined, lung cancer, respiratory diseases, cardiovascular diseases and diabetes mellitus between normal-weight smokers and overweight or obese ex-smokers. Methods Data were from 1997 to 2004 National Health Interview Survey (with response rates ranging from 70% to 80%) which were linked to records in the National Death Index. Mortality follow-up was through 31 December 2006. The sample was limited to normal-weight smokers and overweight/obese ex-smokers 25 years of age and older (n=52 819). HR from Cox regression was computed to represent mortality effect. Results Results showed that in both women and men, normal-weight smokers, relative to overweight or obese ex-smokers, had a higher risk of mortality from all causes combined, all cancers combined, lung cancer, cardiovascular and respiratory diseases. Among women, there was no difference in mortality risk from diabetes mellitus between normal-weight smokers and overweight or obese ex-smokers. Among men, there was some evidence that the risk of mortality was higher in obese ex-smokers than normal-weight smokers. Conclusions This article concludes that, overall, mortality risk is smaller in overweight or obese ex-smokers than normal-weight smokers. Smoking cessation interventions can tailor messages that highlight the greater reduction in mortality associated with quitting, compared with potential weight gain. [ABSTRACT FROM AUTHOR]

Objective Evidence shows that smoking tobacco using a waterpipe is significantly associated with diseases. Despite this, waterpipe use seems to be increasing worldwide, though nationally representative data are not widely available. The Global Adult Tobacco Survey (GATS) provides an opportunity to measure various indicators of waterpipe use from nationally representative surveys. Methods Data were obtained for adults 15 years of age or older from 13 countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam) who completed GATS from 2008-2010. The GATS questionnaire collected data on current waterpipe use, including daily/less than daily prevalence and number of sessions per day/week. An optional waterpipe module measured former use, age of initiation, and level of consumption during a session. Results GATS was successful in producing nationally representative data on waterpipe use from 13 countries, many of which for the first time. The prevalence of waterpipe use among men was highest in Vietnam (13.0%) and Egypt (6.2%); among women, waterpipe use was highest in Russia (3.2%) and Ukraine (1.1%). While over 90% of adults in Ukraine thought smoking tobacco causes serious illness, only 31.4% thought smoking tobacco using a waterpipe causes serious illness. Conclusions GATS data provide the ability to analyse waterpipe use within a country and across countries. Monitoring of waterpipe use at a national level will better enable countries to target tobacco control interventions such as education campaigns about the negative health effects of waterpipe use. [ABSTRACT FROM AUTHOR]

Objectives Comprehensive smokefree laws, as recommended by the WHO Framework Convention of Tobacco Control (WHO FCTC), are the most effective tool to protect the population from secondhand smoke (SHS) and to ensure healthy environments. Studies evaluating how laws govern SHS protection are scarce. This study assessed the level of protection from SHS of laws from countries belonging to the WHO European Region. Methods A new methodology system was developed to evaluate the smokefree legislation according to the principles provided by the WHO guidelines for the correct implementation of Article 8 of the FCTC. For each law, six main sectors and 28 facilities were evaluated. Results Overall 68 laws from 48 countries from the WHO European Region were reviewed. 'Education' and 'Public transport' were the most protected sectors from SHS. Many WHO European laws do not provide protection from SHS across all public sectors. For example, 48.5% of general health facilities and 71.2% of restaurants are unprotected from SHS. The level of protection provided in the 28 facilities studied was low; many WHO European laws still allow smoking under certain conditions, permitting smoking in designated and/or ventilated areas. Conclusions Nine years after the adoption of the WHO FCTC there are still legal formulas in which smoking is allowed in several facilities, through the inclusion of separated areas, ventilated areas and other conditions. Tobacco control efforts still face the challenge of eradicating the legal clauses that prevent 100% smokefree environments. [ABSTRACT FROM AUTHOR]

Background Despite efforts to reduce exposure to secondhand smoke (SHS), only 5% of the world's population enjoy smoke-free restaurants and bars. Methods Lifetime excess risk (LER) of cancer death, ischaemic heart disease (IHD) death and asthma initiation among non-smoking restaurant and bar servers and patrons in Minnesota and the US were estimated using weighted field measurements of SHS constituents in Minnesota, existing data on tobacco use and multiple dose-response models. Results A continuous approach estimated a LER of lung cancer death (LCD) of 18×10−6 (95% CI 13 to 23×10−6 ) for patrons visiting only designated non-smoking sections, 80×10−6 (95% CI 66 to 95×10−6 ) for patrons visiting only smoking venues/sections and 802×10−6 (95% CI 658 to 936×10−6 ) for servers in smoking-permitted venues. An attributable-risk (exposed/ non-exposed) approach estimated a similar LER of LCD, a LER of IHD death about 10−2 for non-smokers with average SHS exposure from all sources and a LER of asthma initiation about 5% for servers with SHS exposure at work only. These risks correspond to 214 LCDs and 3001 IHD deaths among the general non-smoking population and 1420 new asthma cases among non-smoking servers in the US each year due to SHS exposure in restaurants and bars alone. Conclusions Health risks for patrons and servers from SHS exposure in restaurants and bars alone are well above the acceptable level. Restaurants and bars should be a priority for governments' effort to create smoke-free environments and should not be exempt from smoking bans. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between duration and place of second-hand smoke (SHS) exposure and psychological distress in adolescents. Methods A cross-sectional study conducted in 2008 and 2009 in a representative sample of 4th-year students of secondary education (mean age 15.7 years) in the region of Madrid, Spain. The 2215 students who were not smokers were selected for the analysis. Duration of SHS exposure within and outside the home was obtained by self-report. Psychological distress was defined as a score ≥3 points in the General Health Questionnaire (GHQ-12). The analyses were made using logistic regression adjusted for demographic variables, lifestyles and family characteristics. Results Among non-smoking adolescents, 27.8% (95% CI 25.5 to 30.0) were exposed to SHS in the home, and 33.6% (95% CI 31.3 to 36.0) outside the home. Compared with those with no SHS exposure in the home, the multivariate OR for psychological distress was 1.23 (95% CI 0.92 to 1.64) in individuals with SHS exposure <1 h/day, 2.07 (95% CI 1.30 to 3.28) for exposure 1-3 h/day, and 2.24 (95% CI 1.45 to 3.47) for exposure >3 h/day (p for linear trend <0.001). No association was observed between SHS exposure outside the home and psychological distress. Conclusions In non-smoking adolescents, duration of exposure to SHS in the home had a positive dose-response relationship with the frequency of psychological distress. However SHS exposure outside the home did not show an association with mental health. [ABSTRACT FROM AUTHOR]

Background The implementation of comprehensive smoke-free laws has been associated with reductions in second-hand smoke exposure at home in several high income countries. There is little information on whether these benefits extend to low income and middle income countries with a growing tobacco-related disease burden such as India. Methods State and individual-level analysis of cross-sectional data from the Global Adult Tobacco Survey India, 2009/2010. Associations between working in a smoke-free indoor environment and living in a smoke-free home were examined using correlation at the state level, and multivariate logistic regression at the individual level. Results The percentage of respondents employed indoors (outside the home) working in smoke-free environments who lived in a smoke-free home was 64.0% compared with 41.7% of those who worked where smoking occurred. Indian states with higher proportions of smoke-free workplaces had higher proportions of smoke-free homes (rs=0.54, p<0.005). In the individual-level analysis, working in a smoke-free workplace was associated with a significantly higher likelihood of living in a smoke-free home (adjusted OR=2.07; 95% CI 1.64 to 2.52) after adjustment for potential confounders. Conclusions Implementation of smoke-free legislation in India was associated with a higher proportion of adults reporting a smoke-free home. These findings further strengthen the case for accelerated implementation of Article 8 of the Framework Convention on Tobacco Control (FCTC) in low and middle income countries. [ABSTRACT FROM AUTHOR]

Background and aim In recent years, new non-traditional, potentially reduced exposure products (PREPs), claiming to contain fewer harmful chemicals than the traditional products, have been introduced in the market. Little is known about socioeconomic, demographic and smoking-related determinants of the likelihood of using these products among smokers. The aim of this study was to examine these determinants. Methods Data from the 2006-2007 Tobacco Use Supplement to the Current Population Survey was used. We limited the analysis to current smokers (n=40 724). Multivariate logistic regression analyses were conducted to estimate the association between covariates and the probability of the use of PREPs. Results We found that younger age, lower education, higher nicotine addiction and having an intention to quit are associated with higher likelihood of the use of PREPs. The likelihood of using these products was found to be higher among respondents who are unemployed or have a service, production, sales or farming occupation than those with a professional occupation. Smokers living in the midwest, south or west, were found to have a greater likelihood of the use of PREPs than those living in the northeast. Conclusions Because there is little evidence to suggest that PREPs are less harmful that other tobacco products, their marketing as harm-minimising products should be regulated. Smokers, in particular those who are younger, have a lower socioeconomic status, and are more nicotine-dependent, should be the target of educational programmes that reveal the actual harm of PREPs. [ABSTRACT FROM AUTHOR]

Unnatural rainfall fluctuation can result in such severe natural phenomena as drought and floods. This variability not only occurs in areas with unusual natural features such as land formations and drainage but can also be due to human intervention. Since rainfall data often contain zero values, evaluating rainfall change is an important undertaking, which can be estimated via the confidence intervals for the difference between delta-lognormal variances using the highest posterior density-based reference (HPD-ref) and probability-matching (HPD-pm) priors. Simulation results indicate that HPD-pm performances were better than other methods in terms of coverage rates and relative average lengths for the difference in delta-lognormal variances, even with a large difference in variances. To illustrate the efficacy of our proposed methods, we applied them to daily rainfall data sets for the lower and upper regions of northern Thailand., (© 2020 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Head‐up displays (HUDs) can provide important driving information such as speed and navigation directly to a driver within their immediate field of view, and thus improve driving experience. Specifically, a dual‐plane AR‐HUD can provide drivers with larger images with richer information, more intuitive information presentation, and enhanced navigation features. To ensure driver comfort, proper presentation format of the text on the dual‐plane HUD needs to be investigated. A human factors experiment was conducted to explore proper luminance contrast and font size of the text on a HUD. Twenty older and nine mid‐age drivers were instructed to recognize letters in fourteen levels of font size under each of eight levels of luminance contrast (ranging from 1.2:1, to 8:1) on each plane. The best test performance was observed at a luminance contrast of 7:1. We report the minimum and upper bound of 95% confidence interval of legible vertical visual angle for 99.5% of older drivers at each level of luminance contrast. While the typical legibility rule of thumb for font height vs. distance on standard displays is.007 (also known as the Bond rule), our experiment suggests that double that size (0.014) was needed to cover 99.5% of older drivers at a contrast ratio of 1.2:1 on a HUD. [ABSTRACT FROM AUTHOR]

Background and Aims: Increasing numbers of school‐based drug surveys are transitioning data collection to electronic tablets from paper‐and‐pencil, which may produce a survey mode effect and consequent discontinuity in time trends for population estimates of drug prevalence. This study tested whether (a) overall, self‐reported drug use prevalence is higher on electronic tablets versus paper‐and‐pencil surveys, (b) socio‐demographics moderate survey mode effects and (c) levels of missing data are lower for electronic tablet versus paper‐and‐pencil modes. Design A randomized controlled experiment. Setting: Results are nationally representative of students in the contiguous United States. Participants: A total of 41 866 8th, 10th and 12th grade students who participated in the 2019 Monitoring the Future school‐based survey administration. Intervention and comparator: Surveys were administered to students in a randomly selected half of schools with electronic tablets (intervention) and with paper‐and‐pencil format (comparator) for the other half. Measurements Primary outcome was the total number of positive drug use responses. Secondary outcomes were the percentage of respondents completing all drug questions, percentage of drug questions unanswered and mean number of missing drug items. Findings The relative risk (RR) for total number of positive drug use responses for electronic tablets versus paper‐and‐pencil surveys were small and their 95% confidence intervals (CI) included the value of one for reporting intervals of life‐time (RR = 1.03; 95% CI, 0.93–1.14), past 12 months (RR = 1.01; 95% CI, 0.91–1.11), past 30 days (RR = 1.05; 95% CI, 0.93–1.20) and for heavy use (RR = 1.10; 95% CI, 0.93–1.29). Multiplicative interaction tests indicated no moderation of these relative risks by race (white versus non‐white), population density, census region, public/private school, year of school participation, survey version or non‐complete drug responses. Levels of missing data were significantly lower for electronic tablets versus paper‐and‐pencil surveys. Conclusions: Adolescent drug prevalence estimates in the United States differed little across electronic tablet versus paper‐and‐pencil survey modes, and showed little to no effect modification by socio‐demographics. Levels of missing data were lower for electronic tablets. [ABSTRACT FROM AUTHOR]

The main objective of this paper is to review and analysis of the state of the art regarding triage applications (apps) for health emergencies. This research is based on a systematic review of the literature in scientific databases from 2010 to early 2021, following a prism methodology. In addition, a Google Play Store search of the triage apps found in the literature was performed for further evaluation. A total of 26 relevant papers were obtained for this study, of which 13 apps were identified. After searching for each of these apps in the Google Play Store platform, only 2 of them were obtained, and these were subsequently evaluated together with another app obtained from the link provided in the corresponding paper. In the analysis carried out, it was detected that from 2019 onwards there has been an increase in research interest in this area, since the papers obtained from this year onwards represent 38.5% of the relevant papers. This increase may be caused by the need for early selection of the most serious patients in such difficult times for the health service. According to the review carried out, an increase in mobile app research focused on Emergency Triage and a decrease in app studies for triage catastrophe have been identified. In this study it was also observed that despite the existence of many researches in this sense, only 3 apps contained in them are accessible. "TRIAGIST" does not allow the entry of an unidentified user, "Major Trauma Triage Tool" presents negative comments from users who have used it and "ESITriage" lacks updates to improve its performance. [ABSTRACT FROM AUTHOR]

Introduction: Physician scientists have both advanced medical specialist and research training and are a critical link between research and improved standards of care. Physician scientist training has existed for more than four decades in the USA, and Western European but is almost non-existent elsewhere. The aim of this study was to determine whether there is a need to develop a physician scientist training program. Methods -Medical doctor faculty in the faculty of health sciences of the University of Nairobi were categorized into physicians for those with medical specialist qualifications and physician scientists if they had in addition a research degree. The two groups were compared in terms of total number and frequency of peer reviewed publications since graduating with a medical degree, number of first author publications, and productivity before and after their research training. Data on training was extracted from the publicly available curriculum vitae on the institution's website while pubmed was used to verify the number of publications up to December 2013. Results: Of the 235 eligible faculty, 183 [78%] were physicians and 52 [22%] were physician scientists. The median number of publications in peer reviewed journals was 20 for physician scientists and 6 for physicians [p<0.001] which translated into 1.03 and 0.29 published papers per person-years, respectively [Wilcoxon rank test p<0.000]. Among the 28 faculty whose research training followed medical specialization, mean publications per year before and after research training was 0.4 compared with 2.4 [p=0.01]. Conclusion: Physician research training increases scientific productivity. [ABSTRACT FROM AUTHOR]

The rapid progression of emerging technologies like the Internet of Things (IoT) and Big Data analytics for manufacturing has driven innovation across various industries worldwide. Production data are utilized to construct a model for quality evaluation and analysis applicable to components processed by machine tools, ensuring process quality for critical components and final product quality for the machine tools. Machine tool parts often encompass several quality characteristics concurrently, categorized into three types: smaller-the-better, larger-the-better, and nominal-the-better. In this paper, an evaluation index for the nominal-the-better quality characteristic was segmented into two single-sided Six Sigma quality indexes. Furthermore, the process quality of the entire component product was assessed by n single-sided Six Sigma quality indexes. According to numerous studies, machine tool manufacturers conventionally base their decisions on small sample sizes (n), considering timeliness and costs. However, this often leads to inconsistent evaluation results due to significant sampling errors. Therefore, this paper established fuzzy testing rules using the confidence intervals of the q single-sided Six Sigma quality indices, serving as the fuzzy quality evaluation model for components of machine tools. [ABSTRACT FROM AUTHOR]

Citation data for institutes are generally provided as numbers of citations or as relative citation rates (as, for example, in the Leiden Ranking). These numbers can then be compared between the institutes. This study aims to present a new approach for the evaluation of citation data at the institutional level, based on regression models. As example data, the study includes all articles and reviews from the Web of Science for the publication year 2003 ( n = 886,416 papers). The study is based on an in-house database of the Max Planck Society. The study investigates how much the expected number of citations for a publication changes if it contains the address of an institute. The calculation of the expected values allows, on the one hand, investigating how the citation impact of the papers of an institute appears in comparison with the total of all papers. On the other hand, the expected values for several institutes can be compared with one another or with a set of randomly selected publications. Besides the institutes, the regression models include factors which can be assumed to have a general influence on citation counts (e.g., the number of authors). [ABSTRACT FROM AUTHOR]

Objective: To explore the barriers associated with the adoption of the Alberta Nutrition Guidelines for Children and Youth in schools according to characteristics of the innovation (guidelines) and the organization (schools). Design: Cross-sectional telephone survey. Setting and Participants: Schools in Alberta, Canada. Principals from 357 schools. Main Outcome Measure: Barriers to adopting the nutrition guidelines. Analysis: A 19-question telephone survey, including open- and closed-ended questions, was used to obtain information regarding schools' characteristics and barriers to adopting the guidelines. Qualitative data were coded according to common themes a priori, based on constructs from the Diffusion of Innovations framework. Results: Schools reported many barriers related to the relative advantage, compatibility, and complexity of adopting the guidelines. Parents' resistance to change and cost were the key reported barriers. Lack of knowledge, student preferences, the physical location of the school, and barriers related to the provision of healthful food were also reported. Conclusions and Implications: Disseminating guidelines without providing adequate support for their implementation may not promote change within the school setting. School nutrition initiatives need to involve the parents and have access to sufficient financial and human resource support. [ABSTRACT FROM AUTHOR]

Purpose: To extend knowledge about measurement equivalence of depression measures assessed by tablet and paper-pencil administration, the present study evaluated the effect of mode of administration (MoA) on scale and item level for the Patient Health Questionnaire (PHQ-9) and the Aachen Depression Item Bank (ADIB) in elderly patients.Methods: Primary care patients (N = 193, ≥60 years) were assessed following a crossover design in Leipzig, Germany. All participants filled out the PHQ-9 and the ADIB in both MoAs under study. Effects of MoA were analyzed by intra-class correlation, mixed-effects regression, and differential item functioning (DIF). Additionally, detection rates between both MoAs were compared using receiver operating characteristics analysis compared to a diagnostic interview (SCID-I, N = 163).Results: No effect of MoA was found in the PHQ-9 on scale score or item level. Two ADIB items showed DIF according to MoA. In terms of discriminatory power, MoA did not influence detection rates of both instruments.Conclusions: In summary, our findings suggest that no severe effect of mode of administration on self-report assessments of depression should be expected. It can be concluded that tablets provide a valid way to electronically assess depressive symptoms in elderly patients. Yet changes in item presentation can influence the psychometric properties and require equivalence testing using sophisticated analyses on item level such as DIF. [ABSTRACT FROM AUTHOR]

Recent research has documented the immediate negative impact of the COVID‐19 pandemic on household and business consumption, but there is still limited investigation into the medium‐term effects in specific consumption categories. This paper addresses this gap using a vector autoregression analysis of a system of aggregated consumer final demand across Australia. We highlight the importance of studying a demand system, as opposed to investigating independent consumption categories, due to the interactive evolution of consumption during the pandemic. Modelling the paths of various consumption categories in response to shocks from one another, we find that, despite the large and abrupt shocks to consumption during the first two quarters of 2020, most categories reverted to pre‐COVID levels when restrictions were lifted. Importantly, transportation had the largest and most persistent decline. Overall, shocks to sectors other than food, alcohol and education were outside the counterfactual forecast confidence intervals estimated based on pre‐COVID information. [ABSTRACT FROM AUTHOR]

Despite the substantial personal and economic implications of end-of-life decisions, many individuals fail to document their wishes, which often leads to patient dissatisfaction and unnecessary medical spending. We conducted a randomized trial of 1,200 patients aged 55 years and older to facilitate advance directive (AD) completion and better understand why patients fail to engage in high-value planning. We found that including a physical AD form with paper letters as a nudge to decrease hassle costs increased AD completion by 9.0 percentage points (95% confidence interval [CI] = [4.2, 13.9] percentage points). The intervention was especially effective for individuals aged 70 years and older, as AD completion increased by 17.5 percentage points (95% CI = [5.7, 9.4] percentage points). When compared with the impact of costless electronic reminders, each additional AD completion from the letter interventions costs as little as US$37. Our findings suggest that simple, inexpensive interventions with paper communication as behavioral nudges can be effective, especially in older populations. [ABSTRACT FROM AUTHOR]

Refugees and asylum seekers are more prone to posttraumatic stress disorder (PTSD) than the general population. This systematic review aims to determine which psychosocial interventions effectively treat PTSD among refugees and asylum seekers in low- and middle-income countries (LMIC). Relevant papers were retrieved from the bibliographic databases. PTSD symptoms post-intervention was the primary outcome. Ten studies were selected with 1981 participants. In meta-analyses of Randomised control trials (RCTs), psychosocial interventions for PTSD (SMD −0.60, 95% CI −0.96 to −0.23; I 2 = 91%; 95% CI 75–100; nine studies, 1789 participants) were shown to be clinically effective. Also, in case of depression (SMD −0.59, 95% CI −0.95 to −0.22; I 2 = 84%; 95% CI 50–90; seven studies, 1248 participants). Eye Movement Desensitization and Reprocessing (EMDR) had the greatest effect size among psychosocial therapies for this demographic. However, the number of studies is small, and their methodological rigour is limited, thus future study should concentrate on performing more rigorous trials. [ABSTRACT FROM AUTHOR]

Introduction: Obtaining vascular access is crucial in critically ill patients. The EZ‐IO® device is easy to use and has a high insertion success rate. Therefore, the use of intraosseous vascular access (IOVA) has gradually increased. Aim: We aim to determine how IOVA was integrated into management of vascular access during out‐of‐hospital cardiac arrest (OHCA) resuscitation. Methods: Analysing the data from the OHCA French registry for events occurring between 1 January 2013 and 15 March 2021, we studied: demography, circumstances of occurrence and management including vascular access, delays and evolution. The primary outcome was the rate of IOVA implantation. Results: Among the 7156 OHCA included in the registry, we analysed the 3964 (55%) who received cardiopulmonary resuscitation. The vascular access was peripheral in 3122 (79%) cases, intraosseous in 775 (20%) cases and central in 12 (<1%) cases. The use of IOVA has increased linearly (R2 = 0.61) during the 33 successive trimesters studied representing 7% of all vascular access in 2013 and 33% in 2021 (p = 0.001). It was significantly more frequent in traumatic cardiac arrest: 12% versus 5%; p < 0.0001. The first epinephrine bolus occurred significantly later in the IOVA group, at 6 (4–10) versus 5 (3–8) min; p < 0.0001. Survival rate in the IOVA group was significantly lower, at 1% versus 7%; p < 0.0001. Conclusion: The insertion rate of IOVA significantly increased over the studied period, to reach 30% of all vascular access in the management OHCA patients. The place of the intraosseous route in the strategy of venous access during the management of prehospital cardiac arrest has yet to be determined. Summary statement: What is already known about this topic? How the intraosseous vascular access was integrated into the vascular approach during the medical resuscitation of out‐of‐hospital cardiac arrest remains unknown What this paper adds? The use of intraosseous access strongly increased (more than 400%) between 2013 and 2021, exceeding 30% of all vascular access in OHCA in 2021.The outcome of OHCA patients treated with intraosseous access was less favourable. The implications of this paper: The use of intraosseous venous access increased despite the lack of evidence supporting this practice.More studies are required to precisely determine the place of the intraosseous route and its impact on the prognosis of cardiac arrest. [ABSTRACT FROM AUTHOR]

Aim: This research aimed to determine the impact of problematic mobile phone use on negative mental health outcomes among nursing students in India, highlighting the necessity for targeted interventions and support mechanisms to enhance the overall well‐being and adaptability of future healthcare professionals. Methods: A cross‐sectional survey was conducted in three randomly selected nursing colleges in South India, employing validated and standardized tools such as the Mobile Phone Problematic Use Scale, Patient Health Questionnaire, Insomnia Severity Index Scale, Satisfaction with Life Scale and Rosenberg Self‐Esteem Scale. Results: The study included 402 nursing students with an average age of 20.47 years, revealing a 39% prevalence of severe problematic mobile phone usage. Positive correlations were observed between mobile phone problematic use and age, depression and insomnia. Additionally, strong negative correlations were found between satisfaction with life and self‐esteem. Depression and satisfaction with life served as chain mediators in the impact of self‐esteem on problematic mobile phone use, and both self‐esteem and satisfaction with life negatively predicted problematic mobile phone use. Conclusion: The study highlights a prevalent issue of problematic mobile phone use among nursing students, indicating a pressing need for timely intervention, as it correlates with depression, sleep insomnia, low self‐esteem and life dissatisfaction. Summary statement: What is already known about this topic? Over the last decade, using mobile phones has been prevalent among today's children and young people, coinciding with an increase in poor mental health in this population.Problematic mobile phone use may consist of various issues, including addiction/dependence, financial troubles, risky use (i.e. while driving) and restricted use (i.e. in prohibited places).From an epidemiological standpoint, prevalence rate estimates vary widely and there is little research and understanding regarding the aetiology of problematic and addicted mobile phone usage, particularly its progression. What this paper adds? The prevalence of severe problematic mobile phone use among nursing students is very high and needs immediate attention.There is a negative impact of mobile phone use on the mental health outcomes of nursing students.Positive life satisfaction and self‐esteem are protective variables that negatively predict problematic mobile phone use, while their influence is mediated by a chain reaction involving reduced depression, emphasizing the interconnected psychological dynamics. The implications of this paper: Further research is needed on the influencing factors of problematic mobile phone use and interventions to prevent mobile phone addiction among nursing students.The influence of mobile phone use on the mental health outcomes of nursing students can affect their clinical practice and productive life therefore the appropriate policies should be implemented.Implementation of short and rapid counselling services for the nursing students by the nurse educators should incorporate into the curriculum to achieve a better quality of nurses. [ABSTRACT FROM AUTHOR]

Aim: To assess the prevalence of non‐communicable disease risk factors among the nursing staff and educate them on prevention. Background: Nursing staff is integral to the Indian community healthcare systems. Recent studies report a high prevalence of non‐communicable diseases in Indian nursing staff. Therefore, data on the prevalence of non‐communicable disease risk factors among nursing staff are crucial for education on prevention. Design: A cross‐sectional digital survey‐based study. Method: We invited 4435 nursing staff to attend our online survey. We used a customized questionnaire for data collection, including a digitized version of the Community‐Based Assessment Checklist form. A score of >4 was considered high risk and warranted screening. Result: Among 682 nursing staff who attended, 70% had never undergone screening for non‐communicable diseases. The prevalence of non‐communicable disease risk factors was significantly higher in male nursing staff. In addition, logistic regression analysis showed that age, tobacco and alcohol use, increased waist circumference, physical inactivity and family history of non‐communicable diseases were significant risk factors among nursing staff. Conclusion: The study findings suggest that the nursing staff have suboptimal self‐health concerns on non‐communicable diseases. This situation warrants continued medical education, awareness campaigns on adopting a healthy lifestyle and health promotion. Summary statement: What is already known about this topic? The prevalence of non‐communicable diseases (NCDs) among Indian nursing staff is a growing concern, underscoring the need for comprehensive research and targeted interventions.Despite the significant health risks faced by this demographic, there is a notable lack of data on NCD risk factors specific to Indian nursing professionals. What this paper adds? This paper adds information on the prevalence of NCD risk factors chiefly among nursing staff in the Delhi National Capital Region.Male nursing staff have particularly high NCD risk factors. The implications of this paper: Findings may help develop routine screening programmes for nursing staff, continued nursing education and good, safe nursing practice. [ABSTRACT FROM AUTHOR]

Aims: This study describes the incidence of fatigue in kidney transplant recipients and analyses the relationship between physiological factors, psychological factors, situational factors and fatigue in kidney transplant recipients. Background: Fatigue, as a common symptom after kidney transplantation, is affected by many factors, but the influence of some factors on the fatigue of kidney transplant recipients is still controversial. Design: This cross‐sectional study was designed based on the theory of unpleasant symptoms. Methods: Our survey involved 307 participants attending the kidney transplant outpatient clinic of a tertiary Class A hospital (Changsha, Hunan, China). Data were collected between February and April 2021 using a structured questionnaire and electronic medical records. Data were analysed using IBM SPSS 25.0 (SPSS Inc.) Results: It was found that the incidence of fatigue in kidney transplant recipients was 53.1%. According to the binary logistic regression analysis, sleep quality, hypokalemia, anxiety, depression and education level were independent risk factors for fatigue in kidney transplant recipients. Conclusion: The incidence of fatigue in kidney transplant recipients was high and was influenced by physical, psychological and situational factors. Clinical nurses should assess fatigue levels in a timely and multidimensional manner in clinical practice and provide effective and scientific guidance about fatigue self‐coping and symptom management for kidney transplant recipients. Summary statement: What is already known about this topic? Fatigue is a common symptom of kidney transplant recipients and can impair postoperative recovery, reemployment, quality of life, social activities and physical and mental states, causing the body to be in a state of chronic energy consumption.Owing to the imperceptible physical injury upon kidney transplant recipients, fatigue is often underappreciated or even disregarded. What this paper adds? It was found that the rate of fatigue in kidney transplant recipients was high.The risk factors for fatigue in kidney transplant recipients based on the theory of unpleasant symptoms were analysed in three ways: physiological, psychological and situational. The results showed that sleep quality, duration after transplantation, serum potassium level, anxiety, depression, education level, financial burden and social support were associated with fatigue in kidney transplant recipients. The implications of this paper: Clinical nurses should conduct timely and multidimensional fatigue evaluations of kidney transplant recipients and pay more attention to those with a high level of fatigue.The findings can provide a scientific basis for kidney transplant specialist nurses to conduct targeted interventions and facilitate fatigue management for kidney transplant recipients. They can also help to develop fatigue intervention models based on the displeasure symptom theory to improve fatigue in kidney transplant recipients. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to investigate the effectiveness of the bladder stimulation technique (BST) to collect urine samples from newborns and its effects on physiological parameters and comfort of the newborn. Design: This was a randomized controlled trial conducted in a NICU. A total of 64 newborns were divided into 2 groups: 32 newborns in the experimental group and 32 newborns in the control group. Methods: Newborns in the experimental group (EG) were subjected to the BST, and in the control group (CG), urine collection was via sterile urine bags, which is routine practice. Procedural success was defined as the collection of urine samples within 3 min of beginning the stimulation technique in the experimental group and of placing the sterile urine bag in the control group. Results: The success rate of the procedure in 3 min was 62.5% in the EG and 28% in the CG (P = 0.006, absolute difference: 35%, 95% confidence interval 27% to 42%, NNT: 3). According to the comparison of the overall mean COMFORTneo scale and pain and distress subscale scores at the 1‐ and 3‐min marks, there was a significant difference between the EG and CG (p < 0.05). The mean scores in the EG were higher than those in the CG. The mean oxygen‐saturation was significantly lower in the EG than in the CG (p < 0.05), and the increase in heart rate was significantly higher in the EG (p = 0.018). Conclusions: BST is a more successful method within 3 min for collecting urine samples from newborns compared to sterile urine bags. However, the newborns' comfort levels minimally decreased at 3 min, and they had moderate pain and distress, while the BST was being implemented. This increase in physiologic parameters was statistically significant but not clinically significant. Summary statement: What is already known about this topic? Urinary tract infection is a commonly diagnosed bacterial infection in young infants with fever. However, the symptoms of this infection are non‐specific, so urine samples are needed to accurately diagnose and exclude it.There are multiple methods available for collecting urine samples, each with its own advantages and disadvantages.The bladder stimulation technique is a noninvasive and efficient method for collecting urine samples. However, few studies have examined the pain and distress effects of this technique, and these studies have reported varying results. What this paper adds? This study found that bladder stimulation techniques were more effective than sterile urine bags in collecting urine samples within 3 min from newborns.The bladder stimulation technique led to decreased saturation and comfort levels, increased heart rate, and increased pain and distress in the newborns during urine sampling; these increases in physiologic parameters were statistically significant but not clinically significant. The implications of this paper: The bladder stimulation technique is an effective noninvasive method for quickly collecting urine samples.Considering the pain and distress‐increasing properties of the technique, it may be recommended before invasive interventions (bladder catheterization and suprapubic aspiration) when urine sample collection with urine bags is not possible; it can be used in cases where urgent urine collection is required. [ABSTRACT FROM AUTHOR]

Aims: This study was conducted to examine the effect of monthly telephone message reminders after training on women's beliefs and practice behaviours regarding breast self‐examination. Methods: This randomized controlled study was conducted with 83 women aged 20–69 years living in Turkey between September 2021 and July 2022. Women were randomly assigned (1:1) to the intervention (n = 41) or control group (n = 42), both groups received online breast self‐examination training, and the intervention group received monthly reminders on their mobile phones for 3 months. Participants completed the Champion's Health Belief Model Scale and breast self‐examination practice evaluation form at baseline and 3 months after intervention. Results: After the intervention, the mean scores of the benefits and self‐efficacy subscales of Champion's Health Belief Model Scales were significantly higher in the intervention group compared to the control group, and the mean score of barriers was lower. The rate of performing breast self‐exam regularly and at the appropriate time was higher in the intervention group. The rate of forgetting to perform breast self‐examination was higher in control group. Conclusion: A monthly reminder message may be recommended to increase women's belief in breast self‐examination and increase regular practice. Summary statement: What is already known about this topic? Breast cancer is common, it is a type of cancer that progresses slowly and can be treated with early diagnosis and regular application of breast self‐examination is one of the effective non‐invasive screening methods for early diagnosis of breast cancer among women.Studies have found that forgetfulness and neglect, lack of awareness about BSE techniques and lack of knowledge are important obstacles to breast self‐examination. What this paper adds? Breast self‐examination training and then a monthly phone message reminder approach was used in women.It has been observed that the monthly telephone reminder message is an intervention that increases the belief in breast self‐examination in women, along with an increase in the rate of regular and timely examination practice and a decrease in the rate of forgetting to do so. The implications of this paper: The importance of regular phone message reminders about breast self‐examination should be included in the in‐service training given to all health professionals, especially midwives and nurses working in the delivery of primary health care services.A central message system could be developed to remind women of breast self‐examination at the national level. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effects of dyadic intervention on anxiety, depression, care burden and quality of life in informal caregivers of palliative patients with lung cancer. Background: Informal caregivers of palliative lung cancer patients bear a large number of negative emotions during the process of caring for the patients. Dyadic intervention has the potential for improving them but the overall effect is unclear. Design: A systematic review and meta‐analysis. Data sources All randomized controlled trials were retrieved from the following databases until 4 May 2023: Web of Science, Embase Ovid, PubMed, Cochrane Central Register of Randomized Controlled Trials, Weipu, Wanfang and Chinese National Knowledge Infrastructure databases. Review methods: This review was performed by Stata 12.0 and Review Manager 5.3. Results: Thirteen randomized controlled trials were in accordance with the inclusion and exclusion criteria (n = 1807). The results revealed that dyadic intervention significantly improved family caregivers' anxiety, depression and caregiver burden of palliative patients with lung cancer. There was no significant difference in quality of life between the dyadic intervention group and family caregivers who did not receive the dyadic intervention. Conclusions: Dyadic intervention positively impacts the experience of family caregivers of palliative patients with lung cancer. Summary statement: What is already known about the topic? Informal caregivers of palliative lung cancer patients bear a large number of negative emotions during the process of caring for the patients.The overall effect of dyadic intervention for informal caregivers of palliative patients with lung cancer is unclear on account of different results reported in existing studies. What this paper adds? Dyadic intervention could improve family caregivers' anxiety, depression and caregiver burden of palliative patients with lung cancer, even though it did not improve quality of life.Dyadic intervention positively impacts the experience of family caregivers of palliative patients with lung cancer. The implications of this paper: Medical personnel can provide personalized dyadic interventions based on the assessment of the palliative patient and their informal caregivers, such as providing illness understanding, symptom management and addressing psychosocial.Findings can be applied as a reference to help informal caregivers prevent potential emotional disturbance. [ABSTRACT FROM AUTHOR]

Objective: Clinical care ratios are used to quantify and benchmark the activity of allied health professionals. This study aims to review previous recommendations and identify what variables may influence them. Method: Data was collected from the core allied health professions (audiology, nutrition and dietetics, occupational therapy, physiotherapy, podiatry, prosthetics and orthotics, psychology, social work and speech pathology) across eight Australian hospitals. Data for 113 staff who were casual or from smaller professions (audiology, podiatry, prosthetics and orthotics and psychology) were excluded due to insufficient numbers for analysis. The remaining data were analysed according to profession, seniority (tiers 1, 2 and 3) and employment status (permanent versus casual staff). A two-way ANOVA was performed to assess the association of clinical care ratios with tier, profession, employment status and gender. Results: Data from 1246 staff from the five larger professions at participating hospitals were analysed. There were no interactions between profession and gender (P = 0.185) or employment status (P = 0.412). The relationship between clinical care ratio and profession was modified by tier (interaction term, P = 0.014), meaning that differences in clinical care ratios between professions depended on the tier. Conclusion: This research has confirmed that clinical care ratios are a useful tool in workload management and determining staffing levels for allied health professionals. The recommendations from this research provide a starting point that can be finessed with reference to profession, model of care, workforce structure, governance and training requirements. This will lead to increased staff wellbeing and improved patient outcomes. What is known about this topic? Clinical care ratios are a useful tool to quantify, monitor and compare workloads of allied health professionals. What does this paper add? This paper confirms that clinical care ratios are a useful workforce planning tool and that when developing roles and models of care, clinical care ratios need to be incorporated into staffing requests and considered as part of workload management tools. What are the implications for practitioners? Clinical care ratios enable the quantification and benchmarking of direct and clinical support activity components of a workload and can be used when planning new services and reviewing current services. [ABSTRACT FROM AUTHOR]

Background: The incidence of colorectal cancer (CRC) is rising in Iran, but reports vary across different regions due to diverse methods and data sources. This study aimed to conduct a systematic review and meta analysis to provide an overview of the incidence rate of CRC and its trend among Iranians in various provinces. Materials and Methods: A comprehensive literature search based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses checklist was performed using national and international databases for papers published up to December 2023. CRC incidence rates were extracted from the numbers, crude rates, and age standardized rates (ASRs). A meta analysis was conducted to calculate the incidence rate and 95% confidence intervals (CIs) in subgroups of sex and province. Results: The initial database search retrieved 1287 papers, with 47 studies meeting the inclusion criteria after further screening. Overall, the trend of CRC incidence has been increasing, although a different pattern was observed in 2008. The pooled incidence rate of CRC was 8.46 (95% CI: 7.16-9.86) per 100,000 population before the publication of the annual continuous reports of the Iranian National Cancer Registry. The latest national data (2014-2017) indicated an ASR of approximately 15 per 100,000 population. Conclusion: The incidence of CRC in Iran is lower than the global average. However, inconsistent cancer registration policies and gaps in registration have hindered the ability to establish a reliable trend of CRC incidence over time. [ABSTRACT FROM AUTHOR]