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Objective To compare time to first dose of oral morphine used in the treatment of neonatal abstinence syndrome ( NAS) in a neonatal intensive care unit ( NICU) versus a special care nursery ( SCN) setting. Methods A retrospective chart review was completed of patient data from two community hospitals in a single health network. Infants born at either facility between January 2013 and August 2015 were eligible for inclusion in the study if treated for NAS with a course of oral morphine. The primary outcome was time from birth to first dose of oral morphine. Secondary outcomes included details about the morphine treatment course, length of stay, and complications from NAS. Results A total of 54 patients (19 NICU patients and 35 SCN patients) fulfilled inclusion criteria for the study. The primary outcome of median time from birth to first dose of oral morphine did not differ between the two groups (42.5 hrs [ NICU] vs 43 hrs [ SCN], p=0.53). No significant differences were found between the morphine regimens used in the two units. The median length of hospital stay (27 days [ NICU] vs 26 days [ SCN], p=0.66) and median length of NICU/ SCN stay (26 days [ NICU] vs 23 days [ SCN], p=0.75) were not statistically significantly different. Time between transfer to the NICU or SCN and administration of the first dose of oral morphine was significantly shorter in the SCN setting (28 hrs [ NICU] vs 4 hrs [ SCN], p=0.009). Conclusions This study found that infants treated for NAS had similar treatment in an NICU and an SCN. No difference was observed in time from birth to initiation of medication therapy. In addition, no differences were seen in all but one marker for quality of care including length of stay and cumulative morphine dose. Infants treated for NAS, whether in an NICU or SCN setting, can receive similar treatment and comparable outcomes. [ABSTRACT FROM AUTHOR]

Background: Inhaled medications are recommended as first-line treatment for chronic obstructive pulmonary disease (COPD) and can reduce exacerbations and hospitalizations. Low health literacy is associated with poor inhaler technique. Objective: This study examined whether handouts written specifically for patients with low health literacy are more effective in showing patients how to use their medications when compared to standard education materials. Methods: A prospective, experimental study was performed at a community-based hospital. Patients included in the study were admitted to the hospital with a diagnosis of COPD, taking at least 1 inhaled medication and identified as having low health literacy based on a Rapid Estimate of Adult Literacy in Medicine—Short Form. Low health literacy handouts were compared against the standard hospital educational materials for inhalers. Correct technique during each demonstration was evaluated using a standardized checklist. Results: Mean baseline scores for inhaler technique were 12.2 ± 2.2 steps correct for the control group and 13.4 ± 1.3 for the low health-literacy group of the 18 maximum points (P = nonsignificant). The mean change in inhaler technique score for the control group was 1.0 ± 1.8, while the mean change in inhaler technique score for the low health-literacy group was 2.1 ± 2.7 (P = .03). [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to characterize the relationship between breast feeding and postpartum smoking abstinence among women who quit smoking due to pregnancy and who were participating in a randomized clinical trial of an intervention designed to prevent postpartum relapse. Methods: A total of 251 women were enrolled in the intervention between 30 and 33 weeks postpartum and were followed through 26 weeks postpartum. Participant characteristics were assessed at the prepartum baseline visit, any breast feeding was assessed at 8 weeks postpartum, and smoking abstinence was assessed at 8 and 26 weeks postpartum. Results: Although 79.1% of participants intended to breast feed, only 40.2% reported breast feeding at 8 weeks postpartum. Characteristics associated with breast feeding at 8 weeks postpartum included Caucasian race/ethnicity, greater education, higher household income, and being married/living with a significant other. Logistic regression analysis indicated that breast feeding at 8 weeks postpartum was significantly associated with smoking abstinence at 8 weeks postpartum, odds ratio (OR) = 7.27 (95% CI = 3.27, 16.13), p < .001. Breast feeding at 8 weeks postpartum was also associated with abstinence at 26 weeks postpartum after controlling for smoking status at 8 weeks postpartum, OR = 2.64 (95% CI = 1.14, 6.10), p = .02. Discussion: Encouraging breast feeding among women who quit smoking due to pregnancy may facilitate postpartum smoking abstinence while increasing adherence to current infant feeding guidelines. [ABSTRACT FROM PUBLISHER]

Objectives. We evaluated the influence of financial strain on smoking cessation among Latino, African American, and Caucasian smokers of predominantly low socioeconomic status. Methods. Smokers enrolled in a smoking cessation study (N=424) were followed from1 week prequit through 26 weeks postquit. We conducted a logistic regression analysis to evaluate the association between baseline financial strain and smoking abstinence at 26 weeks postquit after control for age, gender, race/ ethnicity, educational level, annual household income, marital status, number of cigarettes smoked per day, and time to first cigarette of the day. Results. Greater financial strain at baseline was significantly associated with reduced odds of abstinence at 26 weeks postquit among those who completed the study (odds ratio [OR]=0.77; 95% confidence interval [CI]=0.62, 0.94; P=.01). There was a significant association as well in analyses that included those who completed the study in addition to those lost to follow-up who were categorized as smokers (OR=0.78; 95% CI=0.64, 0.96; P=.02). Conclusions. Greater financial strain predicted lower cessation rates among racially/ethnically diverse smokers. Our findings highlight the impact of economic concerns on smoking cessation and the need to address financial strain in smoking cessation interventions. (Am J Public Health. 2010;100:702706. doi: 10.2105/AJPH.2009.172676) [ABSTRACT FROM AUTHOR]

Introduction:: Postpartum relapse rates are high among women who spontaneously quit smoking during pregnancy. This randomized clinical trial tested a Motivation and Problem-Solving (MAPS) treatment for reducing postpartum relapse among diverse low-income women who quit smoking during pregnancy (N = 251; 32% Black, 30% Latino, and 36% White; 55% <$30,000/year household income). [ABSTRACT FROM PUBLISHER]

Introduction:: Much of the existing research on smoking outcome expectancies has been guided by the Smoking Consequences Questionnaire (SCQ ). Although the original version of the SCQ has been modified over time for use in different populations, none of the existing versions have been evaluated for use among Spanish-speaking Latino smokers in the United States. [ABSTRACT FROM PUBLISHER]

Introduction:: Although recent research indicates that many Latino smokers are nondaily smokers or daily smokers who smoke at a low level (≤5 cigarettes/day), almost no research has investigated the characteristics of low-level smokers because such individuals are typically excluded from clinical trial research. [ABSTRACT FROM PUBLISHER]

Genetic anticipation is the increased incidence, earlier onset, or increased severity of a disease in successive generations. Before the biological basis of anticipation had been demonstrated, the phenomenon was thought to be due to sampling bias, epigenetic effects, gene conversion, or recombinant events. Since then, the biologic basis for anticipation in a number of neurodegenerative disorders has been shown to be attributable to trinucleotide repeat instability, with expansion of repeats clearly correlated with an earlier age of onset. Recently, telomere shortening has been suggested as the mechanism for anticipation in the autosomal dominant form of dyskeratosis congenita, attributable to mutations in the TERC gene, leading to dysfunctional telomeres (Vulliamy et al. ). However, the pattern of anticipation has been observed in other disorders, including cancers, for which no genetic defect has been identified. In this study, we assess the apparent generation effect on cancer incidence in ten extended families with P53 germline mutation, identified through probands diagnosed with childhood sarcoma. The probands were from two sets of systematically ascertained sarcoma patients treated at the University of Texas M. D. Anderson Cancer Center between 1944 and 1982. From those overall studies, we have identified ten kindreds having germline P53 mutations in more than one generation. We compared the cancer incidence in members of successive generations of these families with P53 mutations (carriers) and with no P53 mutations (noncarriers). In carriers, cancer incidence increased in succeeding generations; there was no evidence for this effect in noncarriers; however, the noncarrier population was too small to rule it out. The apparent lack of increase in incidence in noncarriers argues against a cohort effect explaining the increase in carriers. [ABSTRACT FROM AUTHOR]

A response by Lorraine R. Reitzel and colleagues to a letter to the editor about their article "Low-Level Smoking Among Spanish-Speaking Latino Smokers: Relationships With Demographics, Tobacco Dependence, Withdrawal, and Cessation" is presented.