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Background Despite declines in overall US cigarette consumption, the menthol cigarette market share has increased in recent years. Advertising contributes to menthol initiation and use, but little has been done to characterise menthol cigarette advertising outside of the point of sale. Methods Two full-service advertising firms were used to develop a library of menthol cigarette advertisements (ads) over a 9-month period ( June 2012-February 2013) in the USA. The volume of ads, media channel (direct mail, print, online, email), estimated spend and households reached was summarised overall and by brand in 2013. Direct mail, email and print ads were coded for content and the target audience of print publications was examined. Results Over the study period, 205 menthol cigarette ads were identified with estimated expenditures exceeding US$31 million, with 70% spent on direct mail ads. Over 90% of ads promoted Camel, Marlboro and Newport menthol cigarettes. A majority (87%) of direct mail ads contained coupons or other incentives known to appeal to price-sensitive customers. Only two brands' print ads appeared during this period: Newport ads focused on themes of sociability and sexuality, and were placed in magazines targeting African-Americans and younger consumers; American Spirit print ads were placed in general interest magazines and predominantly stressed the 'natural' aspects of their brand. Discussion The tobacco industry continues to spend millions of dollars promoting menthol cigarettes through channels that preferentially target vulnerable subgroups, such as African-Americans and younger consumers. Public health campaigns to educate and combat the influence of menthol advertising are needed. [ABSTRACT FROM AUTHOR]

Background After a 1996 rearm massacre in Tasmania in which 35 people died, Australian governments united to remove semi-automatic and pump-action shotguns and rifles from civilian possession, as a key component of gun law reforms. Objective To determine whether Australia's 1996 major gun law reforms were associated with changes in rates of mass rearm homicides, total rearm deaths, firearm homicides and firearm suicides, and whether there were any apparent method substitution effects for total homicides and suicides. Design Observational study using official statistics. Negative binomial regression analysis of changes in firearm death rates and comparison of trends in pre-post gun law reform rearm-related mass killings. Setting Australia, 1979-2003. Main outcome measures Changes in trends of total firearm death rates, mass fatal shooting incidents, rates of rearm homicide, suicide and unintentional rearm deaths, and of total homicides and suicides per 100 000 population. Results In the 18 years before the gun law reforms, there were 13 mass shootings in Australia, and none in the 10.5 years afterwards. Declines in rearm-related deaths before the law reforms accelerated after the reforms for total rearm deaths (p=0.04), rearm suicides (p=0.007) and rearm homicides (p=0.15), but not for the smallest category of unintentional rearm deaths, which increased. No evidence of substitution effect for suicides or homicides was observed. The rates per 100 000 of total rearm deaths, rearm homicides and rearm suicides all at least doubled their existing rates of decline after the revised gun laws. Conclusions Australia's 1996 gun law reforms were followed by more than a decade free of fatal mass shootings, and accelerated declines in rearm deaths, particularly suicides. Total homicide rates followed the same pattern. Removing large numbers of rapid- ring firearms from civilians may be an effective way of reducing mass shootings, rearm homicides and rearm suicides. [ABSTRACT FROM AUTHOR]

The article describes the condition of acute dental infections to help general practitioners and non-specialists with its initial diagnosis and management. Information is offered on the potential diagnoses that should be excluded such as pulpitis, temporomandibular disorder and sinusitis, the symptoms and signs of spreading dental infection, important points in the management of severe dental infection, and specialist management of dental infection by dental and oral and maxillofacial surgeons.

Background: Systematic reviews (SRs) are expected to critically appraise included studies and privilege those at lowest risk of bias (RoB) in the synthesis. This study examines if and how critical appraisals inform the synthesis and interpretation of evidence in SRs. Methods: All SRs published in March–May 2012 in 14 high-ranked medical journals and a sample from the Cochrane library were systematically assessed by two reviewers to determine if and how: critical appraisal was conducted; RoB was summarised at study, domain and review levels; and RoB appraisals informed the synthesis process. Results: Of the 59 SRs studied, all except six (90%) conducted a critical appraisal of the included studies, with most using or adapting existing tools. Almost half of the SRs reported critical appraisal in a manner that did not allow readers to determine which studies included in a review were most robust. RoB assessments were not incorporated into synthesis in one-third (20) of the SRs, with their consideration more likely when reviews focused on randomised controlled trials. Common methods for incorporating critical appraisals into the synthesis process were sensitivity analysis, narrative discussion and exclusion of studies at high RoB. Nearly half of the reviews which investigated multiple outcomes and carried out study-level RoB summaries did not consider the potential for RoB to vary across outcomes. Conclusions: The conclusions of the SRs, published in major journals, are frequently uninformed by the critical appraisal process, even when conducted. This may be particularly problematic for SRs of public health topics that often draw on diverse study designs. [ABSTRACT FROM AUTHOR]

Introduction Acute ischemic stroke (AIS) due to internal carotid artery (ICA) occlusion has a poor prognosis if treated by intravenous thrombolysis. Intra-arterial (IA) treatment is a promising alternative. However, its effectiveness is still unproven. Methods We collected all publications describing results of IA treatment in acute ICA occlusions. All studies with 10 patients or more providing data on clinical outcome were included. We pooled the results by occlusion site (intracranial, extracranial or tandem occlusions) and treatment method, using recanalization, symptomatic intracranial hemorrhage, mortality and favorable clinical outcome (defined as modified Rankin Scale score 0-2) as outcome measures. Results 32 studies totaling 1107 patients were included. In the population with intracranial ICA occlusion, recanalization (69% vs 38%, p<0.001) and favorable outcome (34% vs 12%, p<0.001) rates were significantly higher for mechanical thrombectomy than for IA thrombolysis. In the population with extracranial ICA occlusion, stenting resulted in a higher recanalization rate (87% vs 48%, p=0.001) and favorable outcome rate (68% vs 15%, p<0.001) and lower mortality (18% vs 41%, p=0.048) than IA thrombolysis. In the tandem occlusion population, a statistically significant lower death rate was found for the group treated with IA thrombolysis only compared with the groups with any mechanical treatment of the intracranial occlusion (0% vs 34%, p=0.002 and 0% vs 33%, p=0.001). Conclusions This review shows that, for patients with AIS due to an extracranial and/or intracranial ICA occlusion, stenting and mechanical thrombectomy are associated with higher recanalization rates and improved functional outcomes compared with IA thrombolysis. [ABSTRACT FROM AUTHOR]

Background and purpose: Dissections and dissecting aneurysms involving the basilar artery (BA) are rare lesions with a poor prognosis, and controversies exist on treatment strategy. We describe the clinical presentation, radiologic features, and clinical outcomes of 11 consecutive patients with these lesions, treated using stent alone placement. Materials and methods 11 patients were studied (10 men, one woman), with a mean age of 51 years (range 30-68 years). Clinical and angiographic data were reviewed retrospectively. Results It was technically feasible to place stents in all 11 cases, and a multiple stents technique was used in nine patients. Procedure related posterior circulation ischemic complications occurred in two cases. One patient presenting with locked-in syndrome died of a pulmonary embolism 3 months after treatment although the clinical condition was gradually improving after stent placement. In the other eight cases, improvement in initial symptoms or a stable condition was observed on follow-up at 1-48 months. Angiographic follow-up was obtained in nine cases using DSA (n=8) or CT angiography (n=1). Successful occlusion of the aneurysm or dissection sac was noted in two cases, BA occlusion in one case, disappearance of double lumen sign in one case, and delayed retention of contrast medium in one case. For the remaining four patients there was no change in the configuration of the lesions on follow-up angiographic results. Conclusions Stent alone treatment as a potential and disputable alternative therapeutic option for the treatment of BA dissection and dissecting aneurysms, although technically feasible, was effective in only certain lesions, and this treatment carries substantial risks of complications and a high failure rate. The true effect of this strategy is questionable. A study involving larger populations and a longer follow-up is necessary to evaluate the efficacy of this treatment modality. [ABSTRACT FROM AUTHOR]

A reprint of the article "Nicotine and health" which was published in a 2014 issue of "Drug and Therapeutics Bulletin" is presented. It discusses the pharmacological effects of nicotine, described to be the primary addictive agent in tobacco products. Topics mentioned include nicotine and its pharmacology, the negative effects of nicotine, and harm reduction with nicotine replacement therapy (NRT). Also cited are the postulated positive effects of nicotine claimed by people who smoke.

Carpal tunnel syndrome is the most commonly diagnosed compression neuropathy of the upper limb. Patients may present to general practitioners, physiotherapists, hand therapists, or surgeons with a variety of symptoms. Several studies have examined the epidemiology, diagnosis, and treatment of carpal tunnel syndrome. We review these resources to provide an evidence based guide to the diagnosis and treatment of carpal tunnel syndrome. INSETS: Box 1 Symptoms and signs of carpal tunnel syndrome;Box 2 Differential diagnoses for carpal tunnel syndrome;Box 3 When should I refer?. [ABSTRACT FROM AUTHOR]

Introduction Venous malformations frequently occur in the head and neck, and they can require treatment for a variety of reasons. Among multiple therapeutic approaches employed, percutaneous sclerotherapy has become one of the most commonly used treatments, with numerous sclerosants successfully utilized. Ethanolamine oleate has approval from the Food and Drug Administration for sclerosis of esophageal varices, and is used by some practitioners for the treatment of venous malformations. This study reports single center results of percutaneous sclerotherapy with ethanolamine oleate to treat venous malformations of the head and neck. Materials and methods Prospectively maintained procedural records were retrospectively reviewed to identify all patients with venous malformations who underwent percutaneous sclerotherapy. The Mulliken and Glowacki classification was used to diagnose venous malformations. Medical records and images were reviewed to record demographic information, lesion characteristics, treatment sessions, and clinical and imaging response. Quantitative volumetric analysis was conducted to augment commonly used poorly reproducible subjective outcome measures. Response was assessed after each session and completion of all percutaneous treatment. A χ2 analysis was performed to evaluate the effects of the above described characteristics on outcomes. Results 52 interventions were performed for lesions in 26 patients. No complications occurred following any procedures. Response to individual sessions was categorized as excellent following two (3.8%) sessions, good following 45 (86.5%), and fair following four (7.7%) session. No sessions resulted in poor responses. Final results were excellent in two patients (7.7%), good in 22 (84.6%), and fair in two (7.7%). Average lesion volume reduction was 39% following each session, and 61% after treatment completion. Periorbital lesions were significantly less likely than lesions located elsewhere to have good or excellent outcomes. No other lesion or demographic features affected outcomes. Conclusions Percutaneous sclerotherapy with ethanolamine oleate appears to be safe and effective for the treatment of venous malformations and should be considered when treating these complex lesions. The efficacy of this agent appears to match or exceed that of other sclerosants used for such treatment, and further investigation in prospective controlled research is warranted. [ABSTRACT FROM AUTHOR]

The article discusses British National Institute for Health and Care Excellence (NICE) recommendations for the diagnosis, management, and treatment of multiple sclerosis (MS). Topics explored include the clinical indicators of MS such as double vision and balance problems, the laboratory examinations that need to be performed such as full blood count and thyroid function assessment, and the prevalence of relapse in individuals with MS.

The article discusses the prevalence and management of teenage pregnancy. Topics explored include the teenage pregnancy rate in Great Britain, social factors that contribute to teenage pregnancy such as unemployment and poverty, and the health risks faced by teenage mothers such as anaemia, depression, and premature death. The need to provide adequate care to teenage mothers to prevent medical complications is also addressed.

The article presents a clinical review of the assessment, diagnosis, and treatment of acute pancreatitis, which is defined as an inflammation of the pancreas. Topics discussed include a description of acute pancreatitis, its risk factors and possible causes, and the symptoms associated with the disease. Also discussed are the confirmation of diagnosis based on various tests, assessment of severity, and its management process which includes the process for necrotising pancreatitis.

The article discusses the importance of an efficient communication in relaying adverse drug reaction information to patients with chronic diseases. Topics discussed include the nocebo effect, the potential harm that incompetent information can bring to patients, information that might be too voluminous, with marked variations, and overlaps with commonly experienced symptoms. Suggestions to productively convey information are also presented.

To investigate the effectiveness of open peer review as a mechanism to improve the reporting of randomised trials published in biomedical journals. Design Retrospective before and after study. Setting BioMed Central series medical journals. Sample 93 primary reports of randomised trials published in BMC-series medical journals in 2012. Main outcome measures Changes to the reporting of methodological aspects of randomised trials in manuscripts after peer review, based on the CONSORT checklist, corresponding peer reviewer reports, the type of changes requested, and the extent to which authors adhered to these requests. Results Of the 93 trial reports, 38% (n=35) did not describe the method of random sequence generation, 54% (n=50) concealment of allocation sequence, 50% (n=46) whether the study was blinded, 34% (n=32) the sample size calculation, 35% (n=33) specification of primary and secondary outcomes, 55% (n=51) results for the primary outcome, and 90% (n=84) details of the trial protocol. The number of changes between manuscript versions was relatively small; most involved adding new information or altering existing information. Most changes requested by peer reviewers had a positive impact on the reporting of the final manuscript--for example, adding or clarifying randomisation and blinding (n=27), sample size (n=15), primary and secondary outcomes (n=16), results for primary or secondary outcomes (n=14), and toning down conclusions to reflect the results (n=27). Some changes requested by peer reviewers, however, had a negative impact, such as adding additional unplanned analyses (n=15). Conclusion Peer reviewers fail to detect important deficiencies in reporting of the methods and results of randomised trials. The number of these changes requested by peer reviewers was relatively small. Although most had a positive impact, some were inappropriate and could have a negative impact on reporting in the final publication. [ABSTRACT FROM AUTHOR]

The article describes the case of a 28-year-old woman with type 2 diabetes, controlled hypertension, and sleep apnoea seeking advice about weight loss. Topics discussed include the mechanisms of action of anti-obesity drugs, the pharmacological options for obesity, and the efficacy of orlistat, phentermine-extended release (ER) topiramate, and lorcaserin. Also mentioned are safety issues and drug precautions.

The article examines how breast cancer is medically treated in adjuvant and metastatic settings. Topics discussed include the advances and changes in practice since 2008, the use of targeted therapies to individualise and tailor breast cancer management according to tumour biology and molecular subtype, and the diagnosis of early breast cancer.

The article focuses on the control given to Greater Manchester over its health and social care budget on April 1, 2016. Topics mentioned include details of "Taking Charge" blueprint for the changes published by the Greater Manchester Combined Authority, changes in the provision of general practitioner services, and partnership with the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care to evaluate the devolution programme.

The article details the events that led to nutrition and immunology researcher Ranjit Kumar Chandra being accused of scientific fraud. Topics discussed include the career history of Chandra, the questions surrounding Chandra's bank accounts and financial transactions and the aspects of the nutritional study published in the 1992 issue of the periodical 'Lancet" questioned by several scientific community members which led to allegations of scientific fraud against Chandra.