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Objective To assess differences in rates of postpartum hospitalisations among homeless women compared with non- homeless women. Design Cross- sectional secondary analysis of readmissions and emergency department (ED) utilisation among postpartum women using hierarchical regression models adjusted for age, race/ethnicity, insurance type during delivery, delivery length of stay, maternal comorbidity index score, other pregnancy complications, neonatal complications, caesarean delivery, year fixed effect and a birth hospital random effect. Setting New York statewide inpatient and emergency department databases (2009-2014). Participants 82 820 and 1 026 965 postpartum homeless and non- homeless women, respectively. Main outcome measures Postpartum readmissions (primary outcome) and postpartum ED visits (secondary outcome) within 6 weeks after discharge date from delivery hospitalisation. Results Homeless women had lower rates of both postpartum readmissions (risk- adjusted rates: 1.4% vs 1.6%; adjusted OR (aOR) 0.87, 95% CI 0.75 to 1.00, p=0.048) and ED visits than non- homeless women (risk- adjusted rates: 8.1% vs 9.5%; aOR 0.83, 95% CI 0.77 to 0.90, p<0.001). A sensitivity analysis stratifying the non- homeless population by income quartile revealed significantly lower hospitalisation rates of homeless women compared with housed women in the lowest income quartile. These results were surprising due to the trend of postpartum hospitalisation rates increasing as income levels decreased. Conclusions Two factors likely led to lower rates of hospital readmissions among homeless women. First, barriers including lack of transportation, payment or childcare could have impeded access to postpartum inpatient and emergency care. Second, given New York State's extensive safety net, discharge planning such as respite and sober living housing may have provided access to outpatient care and quality of life, preventing adverse health events. Additional research using outpatient data and patient perspectives is needed to recognise how the factors affect postpartum health among homeless women. These findings could aid in lowering readmissions of the housed postpartum population. [ABSTRACT FROM AUTHOR]

The article focuses on different studies conducted to identify factors associated with complications of pregnancy, such as maternal age, ethnicity and obesity. Particular focus is given to a linked paper by clinical senior lecturer Dr. Lucy C. Chappell and colleagues, which investigates factors associated with uncomplicated pregnancy. The article also discusses the importance of recognising that public health and primary care interventions influence the risk profile of pregnant women.

Objectives To examine contextual and individual demographical predictors of smoking and exposure to second-hand smoke (SHS) in a tobacco-cultivating rural area of southwest China. Methods A cross-sectional survey of 4070 consenting individuals aged 18 years or more was conducted in 2010. Information on demographical characteristics, tobacco smoking status and SHS exposure were obtained by a standard questionnaire. Multilevel logistic regression was used to model the variation in prevalence of smoking and SHS exposure. Results In the study population, the prevalence rates of smoking and exposure to SHS were 63.5% and 74.7% for men, and 0.6% and 71.2% for women, respectively. Men were more likely to use tobacco than women: OR 8.27, 95% CI (4.83 to 10.97). Age was inversely associated with the probability of tobacco use (OR 0.98, 95% CI 0.97 to 0.99), and exposure to SHS (OR 0.97, 95% CI 0.96 to 0.99). Individual educational level was inversely associated with smoking, but showed no association with exposure to SHS. Adults who did not grow tobacco were less likely to consume tobacco (OR 0.75, 95% CI 0.57 to 0.99) and to be exposed to SHS (OR 0.76, 95% CI 0.58 to 0.99). Living in a high-income community was associated with a low rate of current smoking (OR 0.66, 95% CI 0.57 to 0.77) and SHS exposure (OR 0.58, 95% CI 0.52 to 0.65). Conclusions Future interventions to reduce smoking and exposure to SHS in China should focus more on tobacco farmers, less-educated individuals and on poor rural communities. [ABSTRACT FROM AUTHOR]

Aim To evaluate retailer’s compliance and consumer’s perceptions of and experiences with the point-of-sale (POS) tobacco display ban in Norway, implemented 1 January 2010. Methods Retailer compliance was measured using audit surveys. Consumer’s perceptions of the ban were assessed in three web surveys: one conducted before and two after implementation of the ban. The sample for each of these consisted of about 900 people aged 15-54 years and an extra sample of smokers and snus users. 10 focus group interviews with male and female daily, occasional and former smokers aged 16-50 years (N¼62) were also conducted, before and after implementation of the ban. Results Immediately following implementation of the POS display ban, compliance was 97% for cigarettes and rolling tobacco and 98% for snus. Preimplementation, young people were tempted by tobacco products when seeing them in the shop more often than older people. Postimplementation, young people also more often found it difficult to choose brand. The POS tobacco display ban was supported by a majority of the population, and by one out of three daily smokers. The removal of POS tobacco displays was perceived as a barrier for young people’s access to tobacco products, as affecting attachment to cigarette brands and as contributing to tobacco denormalisation. Conclusions Retailer’s compliance with the POS display ban in Norway was high, and the ban was well supported in the population. Consumers believed that the ban could contribute to preventing smoking initiation among young people and to some extent also support cessation efforts. [ABSTRACT FROM AUTHOR]

Objective To examine the cross-sectional association between illicit sales of tobacco to minors, Washington DC tobacco outlet advertising practices, retail store type, the demographic make-up of the area surrounding each outlet, and the proximity of each outlet to high schools, recreational parks and public housing. Participants Seven hundred and fifty tobacco outlets in the DC area, n=347 of which were randomly selected for inspection by the Synar Inspection Program in 2009-2010. Main outcome measures The presence of tobacco advertisements on the interior and exterior of each outlet, and illicit tobacco sales to Synar Inspection Program youth volunteers. Results The presence of tobacco advertisements on the exterior of gas stations was much greater than on other retail store types (OR=6.68; 95% CI 4.05 to 11.01), as was the absence of any advertisements at bars or restaurants that sold tobacco (OR=0.33; 95% CI 0.22 to 0.52). Exterior tobacco advertisements were also more likely in predominantly African-American areas of the city (OR=3.11; 95% CI 2.28 to 4.25), and particularly likely on storefronts located closer to parks (OR=1.87; 95% CI 1.06 to 3.28). Illicit sales to minors were more common at gas stations (OR=3.01; 95% CI 1.5 to 6.3), outlets that displayed exterior tobacco advertisements closer to parks (OR=3.36; 95% CI 1.38 to 8.21), and outlets located closer to high schools in majority African- American block groups (OR=1.29; 95% CI 1.07 to 1.58). Conclusions Findings demonstrate that while illicit tobacco sales to minors are occurring at acceptably low rates by Synar standards, illicit sales vary considerably by retail store type, advertising approach and proximity to high schools, parks and African-American residential areas. Future work may help inform regulatory efforts to reduce youth access at the neighbourhood, city, state and national levels. [ABSTRACT FROM AUTHOR]

Background: In the 20 years since the three Baltic States, Estonia, Latvia and Lithuania, have been independent, they have converged progressively with a Western neighbours, politically economically and socially. In contrast, the health gap has widened. Methods: Trends in life expectancy in the three Baltic States were compared with Finland and were decomposed by age for the years 1994, 1999, 2004 and 2009 and by cause of death for year 2009. 1994 was when life expectancy fell to its lowest level since the three countries regained independence. Results: From the mid-1980s to the mid-1990s, the gap in life expectancy between the three Baltic States and Finland widened, especially for men. It then narrowed progressively, except Lithuania where it widened again after 1999. Decomposition by age reveals that the narrowing gap has been driven largely by reduced mortality at working ages, partly counteracted by a relative failure to improve at older ages, especially in Lithuania. Decomposition by cause of death identifies diseases of the circulatory system as the largest contributor to the gap, with the contribution largest at older ages. However, cancer deaths, especially among men, are also important as are deaths from external causes among younger men. Conclusions: Although the gaps in life expectancy between the Baltic States and Finland have reduced, improvements, especially in Latvia and Lithuania, have been fragile. There is a clear need to act on the leading causes of the persisting gap with Finland, in particular through action on hazardous drinking and other risk factors for cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background Smoking in movies is associated with adolescent smoking worldwide. To date, studies of the association mostly are restricted to the exposure to smoking images viewed by 9-15-year-olds. The association among older adolescents is rarely examined. In addition, the reciprocal effect of smoking behaviour on subsequent reported exposure to smoking in movies has not been reported. Methods Data were from the Minnesota Adolescent Community Cohort Study collected every 6 months from 2000 to 2007 when participants were between the ages of 12 and 18 (n=4745). We estimated the prospective effect of the perceived prevalence of smoking in movies (four levels, from never to most of the time) on smoking stage (SS) measured 6 months later (six stages, from never-smoker to established smoker) and the reciprocal prospective association between the two factors. Estimates were adjusted for demographic factors. Results The perceived prevalence of smoking in movies measured between ages 13½ and 15½ consistently predicted subsequent SS. The association was inconsistent after the age of 15½. SS did not consistently predict subsequent perception of the prevalence of smoking in movies. Conclusions Perceived exposure to movie smoking primarily influenced teenagers' smoking behaviour at younger ages. If future studies confirm this finding, developing and evaluating interventions to improve young teenagers' resistance to these images may complement policies to reduce smoking in movies to reduce prevalence of adolescent smoking. [ABSTRACT FROM AUTHOR]

Objectives To examine the longitudinal relationship between exposure and receptivity to tobacco advertisements and progression towards tobacco use among adolescents in India. Design and setting A 2-year longitudinal group-randomised trial, Mobilizing Youth for Tobacco Related Initiatives (MYTRI), was undertaken from 2004 to 2006 in 32 schools in Delhi and Chennai. Among the control schools (n=16), mixed-effects regression models were used to assess the objectives. Subjects Students who were non-susceptible, never users of tobacco (n=2782) at baseline (2004) in the control schools of Project MYTRI, who progressed academically and were followed up at endline (2006). Main outcome measures Progression towards tobacco use (on tobacco uptake continuum). Results Bivariate results suggest that exposure to tobacco advertisements at baseline was associated in a dose-dependent manner with progression at endline. Students exposed at more than four places were 1.5 times (95% CI 1.12 to 1.94; p<0.05) more likely to progress towards tobacco use at endline versus those not exposed. Among boys, those exposed at more than four places were 1.7 times more likely to progress (95% CI 1.14 to 2.62; p<0.05). These significant results disappeared in multivariate analysis, when other psychosocial risk factors for tobacco use were controlled. In both bivariate and multivariate analyses, the risk of progression at endline was more than two times higher (95% CI 1.28 to 4.32; p<0.05) among boys who were highly receptive versus non-receptive boys. The same relationship did not hold among girls. Conclusion High receptivity to tobacco advertising predicts future progression to tobacco use among boys in India. Suggestive evidence exists of a causal relationship between tobacco marketing and adolescent tobacco use. [ABSTRACT FROM AUTHOR]

Objectives To assess the determinants of smoking behaviour and to estimate the impact of tobacco consumption on the consumption of other commodities by Cambodian households. Methods To assess the determinants of smoking in Cambodia, the authors used a logistic regression model that estimated the probability of an individual smoking, given a set of socioeconomic and demographic characteristics. A Seemingly Unrelated Regression method was used to assess the impact of tobacco consumption on the consumption of other commodities. The nationally representative 2004 Cambodia Socio- Economic Survey, collected by the National Institute of Statistics of the Ministry of Planning in Cambodia, was used for the analysis. Results Smoking in Cambodia is influenced by a variety of factors such as gender, marital status, age, ethnicity, literacy, health status and perceptions about the health consequences of tobacco use. The authors found that spending on tobacco crowds out expenditures on education and clothing at the national level and expenditures on food for low- and middle-income households. Conclusions The first analysis of the study showed that increased education is associated with lower daily smoking, and the second analysis revealed that expenditures on tobacco crowds out expenditures on education. Combining these two results points to a vicious circle where low education means higher likelihood of smoking, which in turn results in lower spending on education. Such budget allocation clearly has negative intergenerational consequences. [ABSTRACT FROM AUTHOR]

Objective To examine tobacco industry marketing of menthol cigarettes and to determine what the tobacco industry knew about consumer perceptions of menthol. Methods A snowball sampling design was used to systematically search the Legacy Tobacco Documents Library (LTDL) (http://legacy.library.ucsf.edu) between 28 February and 27 April 2010. Of the approximately 11 million documents available in the LTDL, the iterative searches returned tens of thousands of results from the major US tobacco companies and affiliated organisations. A collection of 953 documents from the 1930s to the first decade of the 21st century relevant to 1 or more of the research questions were qualitatively analysed, as follows: (1) are/were menthol cigarettes marketed with health reassurance messages? (2) What other messages come from menthol cigarette advertising? (3) How do smokers view menthol cigarettes? (4) Were menthol cigarettes marketed to specific populations? Results Menthol cigarettes were marketed as, and are perceived by consumers to be, healthier than non-menthol cigarettes. Menthol cigarettes are also marketed to specific social and demographic groups, including AfricaneAmericans, young people and women, and are perceived by consumers to signal social group belonging. Conclusions The tobacco industry knew consumers perceived menthol as healthier than non-menthol cigarettes, and this was the intent behind marketing. Marketing emphasising menthol attracts consumers who may not otherwise progress to regular smoking, including young, inexperienced users and those who find 'regular' cigarettes undesirable. Such marketing may also appeal to health-concerned smokers who might otherwise quit. [ABSTRACT FROM AUTHOR]

Background Smoking is an increasing threat to health in low-income and middle-income countries and doctors are recognised as important role models in anti-smoking campaigns. Objectives The study aimed to identify the smoking prevalence of medical doctors in Laos, their tobacco-related knowledge and attitudes, and their involvement in and capacity for tobacco prevention and control efforts. Methods This was a cross-sectional national survey by a researcher-administered, face-to-face questionnaire implemented at provincial health facilities throughout the central (including national capital), northern and southern regions of Laos in 2007. Both descriptive and inferential statistics were used. Results Of the 855 participants surveyed, 9.2% were current smokers and 18.4% were ex-smokers; smoking was least common in the central region (p<0.05) and far more prevalent in males (17.3% vs 0.4%; p<0.001). Smoking was concentrated among older doctors (p <0.001). Over 84% of current smokers wanted to quit, and 74.7% had made a recent serious attempt to do so. Doctors had excellent knowledge and positive attitudes to tobacco control, although smokers were relatively less knowledgeable and positive on some items. While 78% of doctors were engaged in cessation support, just 24% had been trained to do so, and a mere 8.8% considered themselves 'well prepared'. Conclusion The willingness of doctors to take up their tobacco control role and the lower smoking rates among younger respondents offers an important window of opportunity to consolidate their knowledge, attitudes, skills and enthusiasm as cessation advocates and supports. [ABSTRACT FROM AUTHOR]

Objective This study aimed to explore tobacco smoking in seven major cities of Latin America. Methods The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study is a cross-sectional epidemiological study of 11 550 adults between 25 and 64 years old in Barquisimeto, Venezuela; Bogota, Colombia; Buenos Aires, Argentina; Lima, Peru; Mexico City, Mexico; Quito, Ecuador; and Santiago, Chile. Tobacco smoking, including cigarettes, cigars and pipes, was surveyed among other cardiovascular risk factors. Results Santiago and Buenos Aires had the highest smoking prevalence (45.4% and 38.6%, respectively); male and female rates were similar. In other cities, men smoked more than women, most markedly in Quito (49.4% of men vs 10.5% of women). Peak male smoking prevalence occurred among the youngest two age groups (25-34 and 35-44 years old). Men and women of Buenos Aires smoked the highest number of cigarettes per day on average (15.7 and 12.4, respectively). Men initiated regular smoking earlier than women in each city (ranges 13.7-20.0 years vs 14.2-21.1 years, respectively). Exposure to secondhand tobacco smoke at workplace for more than 5 h per day was higher in Barquisimeto (28.7%), Buenos Aires (26.8%) and Santiago (21.5%). The highest prevalence of former smokers was found among men in Buenos Aires, Santiago and Lima (30.0%, 26.8% and 26.0% respectively). Conclusions Smoking prevalence was high in the seven CARMELA cities, although patterns of smoking varied among cities. A major health and economic burden is inevitable in urban Latin America unless effective comprehensive tobacco control measures recommended by the World Health Organisation Framework Convention on Tobacco Control are implemented. [ABSTRACT FROM AUTHOR]

Objective To assess the impact of a tobacco control law adopted in Albania in 2007 and to estimate the share of illicit cigarettes on the market. Design Comparative analysis of two waves of a nationally representative household survey, one conducted before the new law went into effect and the other after 2 years. Official sales data were contrasted with the consumption estimate based on the survey. Main outcome measures Smoking prevalence, quit attempts, exposure to cigarette advertising, exposure to second-hand smoke, total cigarette consumption, share of illicit packs among packs possessed by smokers. Results Despite the adoption of strong smoke-free policies and adverting restrictions, smoking prevalence in Albania has risen. The increase in prevalence has been driven by higher smoking rates among females (18.9% in 2007 vs 29.3% in 2009) and young adults (23.2% in 2007 vs 38.5% in 2009 among 18-19 year olds). Self-reported exposure to second-hand smoke and cigarette advertising have been reduced since 2007. The majority of respondents are still exposed to second-hand smoke and more than half are exposed to tobacco advertising. Nevertheless, there are signs that the consumption of illicit cigarettes is declining. Conclusions The impacts of smoke-free policies and an advertising ban have been limited due to lack of enforcement and failure to adopt a comprehensive set of tobacco control measures. These measures should include sizeable and regular tobacco tax increases in excess of the general level of inflation and income growth. The decline in the share of illicit cigarettes should improve the effectiveness of the cigarette tax policy. [ABSTRACT FROM AUTHOR]

Objective To explore social and behavioural impacts of English smoke-free legislation (SFL) in different ethnic groups. Design A longitudinal, qualitative panel study of smokers using in-depth interviews conducted before and after introduction of SFL. Participants A purposive sample of 32 smokers selected from three ethnic groups in deprived London neighbourhoods with approximately equal numbers of younger and older, male and female respondents. Results SFL has had positive impacts with half smoking less and three quitting. Although there were no apparent differences in smoking and quitting behaviours between groups, there were notable differences in the social impacts of SFL. The greatest negative impacts were in smokers over 60 years, potentially increasing their social isolation, and on young Somali women whose smoking was driven more underground. In contrast, most other young adult smokers felt relatively unaffected by SFL, describing unexpected social benefits. Although there was high compliance, reports of illegal smoking were more frequent among young, ethnic minority smokers, with descriptions of venues involved suggesting they are ethnically distinct and well hidden. Half of respondents reported stopping smoking in their own homes after SFL, but almost all were Somali or Turkish. White respondents tended to report increases in home smoking. Discussion Although our study suggests that SFL can lead to reductions in tobacco consumption, it also shows that impacts vary by ethnicity, age and sex. This study highlights the importance of understanding the meaning of smoking in different social contexts so future tobacco control interventions can be developed to reduce health and social inequalities. [ABSTRACT FROM AUTHOR]

AIM: To investigate the impact of newspaper use in a year of increased coverage of litigation against the tobacco industry on youths' beliefs about the health risks of ‘light’ cigarettes, and examine relations between inaccurate beliefs about ‘lights’, perceptions of risk and intentions to quit smoking. PARTICIPANTS: The data come from the 2004 National Annenberg Survey of Youth, a representative random digit dial telephone survey of youths aged 14–22 years in the USA (n=1501; current smokers, n=305; ‘lights’ smokers, n=112). DESIGN: All youths were asked about newspaper use and beliefs regarding ‘light’ cigarettes (riskiness, addictiveness, ease of quitting). Smokers reported on risk perceptions and quitting intentions. We also examined changes in newspaper coverage related to ‘lights’ from January 2001 to April 2004. RESULTS: Newspaper coverage related to ‘lights’ increased in the first months of 2003, and continued into 2004. Logistic regression analyses suggest that ‘lights’ smokers with lower levels of newspaper use were most likely to hold inaccurate beliefs about ‘lights’ (OR=5.93, 95% CI 1.48 to 23.77). Smokers of ‘lights’ with inaccurate beliefs were less likely to perceive their smoking as risky (OR=0.29, 95% CI 0.11 to 0.87), and smokers with inaccurate beliefs were less likely to have strong quitting intentions (OR=0.52, 95% CI 0.28 to 0.96). CONCLUSIONS: Inaccurate beliefs about the risks of ‘lights’ were negatively related to youth smokers' perceptions of risk and intentions to quit smoking. News coverage surrounding the tobacco industry's failure to disclose these risks might help reduce these inaccurate, and potentially dangerous, beliefs. [ABSTRACT FROM AUTHOR]

The article focuses on cystic fibrosis. It introduces papers published in the October 1, 2001 issue of the journal "Thorax," which are related to prognosis or treatment for cystic fibrosis (CF) in the past two decades. The author states that the upward trend in the expected duration of life for patients with CF may have lost its momentum. The U.S. and Canadian national CF registries show estimated median survival age increasing to around 32 years in 1989 and 1996, respectively, but in subsequent years no further improvement is seen. Although the timing of a plateau in median survival age may differ, consistent patterns are seen in several other population-based studies.

Objective: To visualise the non-linear correlation between age and poor outcome at discharge in patients with aneurysmal subarachnoid haemorrhage (SAH) while adjusting for covariates, and to address the heterogeneity of this correlation depending on disease severity by a registry-based design.Methods: We extracted data from the Japanese Stroke Databank registry for patients with SAH treated via surgical clipping or endovascular coiling within 3 days of SAH onset between 2000 and 2017. Poor outcome was defined as a modified Rankin Scale Score ≥3 at discharge. Variable importance was calculated using machine learning (random forest) model. Correlations between age and poor outcome while adjusting for covariates were determined using generalised additive models in which spline-transformed age was fit to each neurological grade of World Federation of Neurological Societies (WFNS) and treatment.Results: In total, 4149 patients were included in the analysis. WFNS grade and age had the largest and second largest variable importance in predicting the outcome. The non-linear correlation between age and poor outcome was visualised after adjusting for other covariates. For grades I-III, the risk slope for unit age was relatively smaller at younger ages and larger at older ages; for grade IV, the slope was steep even in younger ages; while for grade V, it was relatively smooth, but with high risk even at younger ages.Conclusions: The clear visualisation of the non-linear correlation between age and poor outcome in this study can aid clinical decision making and help inform patients with aneurysmal SAH and their families better. [ABSTRACT FROM AUTHOR]

Objectives: Type 2 myocardial infarction (MI) is a heterogenous condition and whether there are differences between women and men is unknown. We evaluated sex differences in clinical characteristics, investigations and outcomes in patients with type 2 MI.Methods: In the Swedish Web based system for Enhancement and Development of Evidence based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry, we compared patients admitted to coronary care units with a diagnosis of type 1 or type 2 MI. Sex-stratified Cox regression models evaluated the association with all-cause death in men and women separately.Results: We included 57 264 (median age 73 years, 65% men) and 6485 (median age 78 years, 50% men) patients with type 1 and type 2 MI, respectively. No differences were observed in the proportion of men and women with type 2 MI who underwent echocardiography and coronary angiography, but women were less likely than men to have left ventricular (LV) impairment and obstructive coronary artery disease (CAD). Compared with type 1 MI, patients with type 2 MI had higher risk of death regardless of sex (men: adjusted HR 1.55 (95% CI 1.44 to 1.67); women: adjusted HR 1.34 (95% CI 1.24 to 1.45)). In those with type 2 MI, the risk of death was lower for women than men (adjusted HR 0.85 (95% CI 0.76 to 0.92) (men, reference)).Conclusions: Type 2 MI occurred in men and women equally and we found no evidence of sex bias in the selection of patients for cardiac investigations. Patients with type 2 MI had worse outcomes, but women were less likely to have obstructive CAD or severe LV impairment and were more likely to survive than men. [ABSTRACT FROM AUTHOR]

Endovascular therapies for acute childhood stroke remain controversial and little evidence exists to determine the minimum age and size cut-off for thrombectomy in children. Despite this, an increasing number of reports suggest feasibility of thrombectomy in at least some children by experienced operators. When compared with adults, technical modifications may be necessary in children owing to differences in vessel sizes, tolerance of blood loss, safety of contrast and radiation exposure, and differing stroke etiologies. We review critical considerations for neurologists and neurointerventionalists when treating pediatric stroke with endovascular therapies. We discuss technical factors that may limit feasibility of endovascular therapy, including size of the femoral and cervicocerebral arteries, which contributes to vasospasm risk. The risk of femoral vasospasm can be assessed by comparing catheter outer diameter with estimated femoral artery size, which can be estimated based on the child's height. We review evidence supporting specific strategies to mitigate cervicocerebral arterial injury, including technique (stent retrieval vs direct aspiration) and device size selection. The importance of and strategies for minimizing blood loss, radiation exposure, and contrast administration are reviewed. Attention to these technical limitations is critical to delivering the safest possible care when thrombectomy is being considered for children with acute stroke. [ABSTRACT FROM AUTHOR]

The article offers information on the maintenance fluid and salt requirement by hospitalized children. Topics discussed include maintenance need for water in parenteral fluid therapy, prevention of hyponatremia during maintenance intravenous fluid administration, and hypotonic solutions for maintenance intravenous fluid.

Objective: To describe annual incidence and temporal trends (2002-2014) in incidence of long-term outcomes of adult out-of-hospital cardiac arrest (OHCA) of presumed cardiac aetiology attended by Queensland Ambulance Service (QAS) paramedics, by age, gender, geographical remoteness and socioeconomic status (SES).Methods: This is a retrospective cohort study. Cases were identified using the QAS OHCA Registry and were linked with entries in the Queensland Hospital Admitted Patient Data Collection and the Queensland Registrar General Death Registry. Population data were obtained from the Australian Bureau of Statistics to calculate incidence. Inclusion criteria were adult (18+ years) residents of Queensland who suffered OHCA of presumed cardiac aetiology and survived to hospital admission. Analyses were undertaken by three mutually exclusive outcomes: (1) survival to less than 30 days (Surv<30 days); (2) survival from 30 to 364 days (Surv30-364 days); and (3) survival to 365 days or more (Surv365+ days). Incidence rates were calculated for each year by gender, age, remoteness and SES. Temporal trends were analysed.Results: Over the 13 years there were 4393 cases for analyses. The incidence of total admitted events (9.72-10.13; p<0.01), Surv30-364 days (0.18-0.42; p<0.05) and Surv365+ days (1.94-4.02; p<0.001) increased significantly over time; no trends were observed for Surv<30 days. An increase in Surv365+ days over time was observed in all remoteness categories and most SES categories.Conclusion: Evidence suggests that implemented strategies to improve outcomes from OHCA have been successful and penetrated groups living in more remote locations and the lower socioeconomic groups. These populations still require focus. Ongoing reporting of long-term outcomes from OHCA should be undertaken using population-based incidence. [ABSTRACT FROM AUTHOR]

Rational prescribing of medicines requires evidence from clinical trials on efficacy, safety and the dose to be prescribed, based on clinical trials. Regulatory authorities assess these data and information is included in the approved summary of product characteristics. Regulatory guidelines on clinical investigation of medicinal products in the paediatric population generally propose that studies are done in defined age groups but advise that any classification of the paediatric population into age categories is to some extent arbitrary or that the age groups are intended only as a guide. The pharmaceutical companies tend to plan their studies using age groups the regulatory guidelines suggest, to avoid problems when applying for marketing authorisation. These age bands end up in the paediatric label, and consequently into national paediatric formularies. The age bands of the most commonly used age-subsets: neonates, infant/toddlers, children and adolescents, are more historical than based on physiology or normal development of children. Particularly problematic are the age bands for neonates and adolescents. The age of 12 years separating children from adolescents, and the upper limit of the adolescents set by the definition of paediatric age in healthcare, which varies according to the region, are particularly questionable. Modern pharmacometric methods (modelling and simulation) are being increasingly used in paediatric drug development and may allow assessment of growth and/or development as continuous covariables. Maybe time has come to reconsider the rational of the currently used age bands. [ABSTRACT FROM AUTHOR]

Background Intrahospital transfers have become more common as hospital staff balance patient needs with bed availability. However, this may leave patients more vulnerable to potential pathogen transmission routes via increased exposure to contaminated surfaces and contacts with individuals. Objective This study aimed to quantify the association between the number of intrahospital transfers undergone during a hospital spell and the development of a hospital- acquired infection (HAI). Methods A retrospective case-control study was conducted using data extracted from electronic health records and microbiology cultures of non- elective, medical admissions to a large urban hospital network which consists of three hospital sites between 2015 and 2018 (n=24 240). As elderly patients comprise a large proportion of hospital users and are a high- risk population for HAIs, the analysis focused on those aged 65 years or over. Logistic regression was conducted to obtain the OR for developing an HAI as a function of intrahospital transfers until onset of HAI for cases, or hospital discharge for controls, while controlling for age, gender, time at risk, Elixhauser comorbidities, hospital site of admission, specialty of the dominant healthcare professional providing care, intensive care admission, total number of procedures and discharge destination. Results Of the 24 240 spells, 2877 cases were included in the analysis. 72.2% of spells contained at least one intrahospital transfer. On multivariable analysis, each additional intrahospital transfer increased the odds of acquiring an HAI by 9% (OR=1.09; 95% CI 1.05 to 1.13). Conclusion Intrahospital transfers are associated with increased odds of developing an HAI. Strategies for minimising intrahospital transfers should be considered, and further research is needed to identify unnecessary transfers. Their reduction may diminish spread of contagious pathogens in the hospital environment. [ABSTRACT FROM AUTHOR]