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Persistent (patent) foramen ovale (PFO): implications for safe diving	2015	Centre for Hyperbaric Oxygen Therapy, Military Hospital Brussels, Belgium, E-mail: peter.germonpre@eubs.org.	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full Diving and hyperbaric medicine Periodical, Abbrev. Diving.Hyperb.Med. Pub Date Free Form Jun Volume 45 Issue 2 Start Page 73 Other Pages 74 Notes JID: 101282742; OTO: NOTNLM; ppublish Place of Publication Australia ISSN/ISBN 1833-3516; 1833-3516 Accession Number PMID: 26165526 Language eng SubFile Editorial; IM DOI Output Language Unknown(0) PMID 26165526 Abstract Diving medicine is a peculiar specialty. There are physicians and scientists from a wide variety of disciplines with an interest in diving and who all practice 'diving medicine': the study of the complex whole-body physiological changes and interactions upon immersion and emersion. To understand these, the science of physics and molecular gas and fluid movements comes into play. The ultimate goal of practicing diving medicine is to preserve the diver's health, both during and after the dive. Good medicine starts with prevention. For most divers, underwater excursions are not a professional necessity but a hobby; avoidance of risk is generally a much better option than risk mitigation or cure. However, prevention of diving illnesses seems to be even more difficult than treating those illnesses. The papers contained in this issue of DHM are a nice mix of various aspects of PFO that divers are interested in, all of them written by specialist doctors who are avid divers themselves. However, diving medicine should also take advantage of research from the "non-diving" medicine community, and PFO is a prime example. Cardiology and neurology have studied PFO for as long, or even longer than divers have been the subjects of PFO research, and with much greater numbers and resources. Unexplained stroke has been associated with PFO, as has severe migraine with aura. As the association seems to be strong, investigating the effect of PFO closure was a logical step. Devices have been developed and perfected, allowing now for a relatively low-risk procedure to 'solve the PFO problem'. However, as with many things in science, the results have not been as spectacular as hoped for: patients still get recurrences of stroke, still have migraine attacks. The risk-benefit ratio of PFO closure for these non-diving diseases is still debated. For diving, we now face a similar problem. Let there be no doubt that PFO is a pathway through which venous gas emboli (VGE) can arterialize, given sufficiently favourable circumstances (such as: a large quantity of VGE, size of the PFO, straining or provocation manoeuvres inducing increased right atrial pressure, delayed tissue desaturation so that seeding arterial gas emboli (AGE) grow instead of shrink, and there may be other, as yet unknown factors). There is no doubt that closing a PFO, either surgically or using a catheter-delivered device, can reduce the number of VGE becoming AGE. There is also no doubt that the procedure itself carries some health risks which are, at 1% or higher risk of serious complications, an order of magnitude greater than the risk for decompression illness (DCI) in recreational diving. Scientists seek the 'truth', but the truth about how much of a risk PFO represents for divers is not likely to be discovered nor universally accepted. First of all, the exact prevalence of PFO in divers is not known. As it has been pointed out in the recent literature, a contrast echocardiography (be it transthoracic or transoesophageal) or Doppler examination is only reliable if performed according to a strict protocol, taking into account the very many pitfalls yielding false negative results. The optimal procedure for injection of contrast medium was described several years ago, but has not received enough attention. Indeed, it is our and others' experience that many divers presenting with PFO-related DCI symptoms initially are declared "PFO-negative" by eminent, experienced cardiologists! Failing a prospective study, the risks of diving with a right-to left vascular shunt can only be expressed as an 'odds ratio', which is a less accurate measure than is 'relative risk'. The DAN Europe Carotid Doppler Study, started in 2001, is nearing completion and will provide more insight into the actual risks of DCI for recreational divers. The degree of DCI risk reduction from closing a PFO is thus not only dependent on successful closure but also (mostly?) on how the diver manages his/her dive and decompress Descriptors Links Book Title Database Publisher Data Source Authors Germonpre,P. Original/Translated Title URL Date of Electronic PMCID Editors
Personal exposure of primary school children to BTEX, NO(2) and ozone in Eskisehir, Turkey: relationship with indoor/outdoor concentrations and risk assessment	2014	Anadolu University, Faculty of Engineering, Department of Environmental Engineering, 26555 Eskisehir, Turkey. Electronic address: gulcindemirel7@hotmail.com.; Anadolu University, Faculty of Engineering, Department of Environmental Engineering, 26555 Eskis	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full The Science of the total environment Periodical, Abbrev. Sci.Total Environ. Pub Date Free Form 1-Mar Volume 473-474 Issue Start Page 537 Other Pages 548 Notes CI: Copyright (c) 2013; JID: 0330500; 0 (Air Pollutants); 0 (Xylenes); 3FPU23BG52 (Toluene); 66H7ZZK23N (Ozone); J64922108F (Benzene); S7G510RUBH (Nitrogen Dioxide); OTO: NOTNLM; 2013/11/11 [received]; 2013/12/08 [accepted]; 2014/01/03 [aheadofprint]; ppu Place of Publication Netherlands ISSN/ISBN 1879-1026; 0048-9697 Accession Number PMID: 24388904 Language eng SubFile Journal Article; Research Support, Non-U.S. Gov't; IM DOI 10.1016/j.scitotenv.2013.12.034 [doi] Output Language Unknown(0) PMID 24388904 Abstract Personal exposures of 65 primary school children to benzene, toluene, ethyl benzene, xylenes (BTEX), nitrogen dioxide (NO2) and ozone (O3) were measured during 24h by using organic vapor monitors and tailor-made passive samplers. Two schools were selected to represent students living in more polluted (urban) and less polluted (sub-urban) areas in the city of Eskisehir, Turkey. The pollutant concentrations were also measured in indoor and outdoor environments during the personal sampling to investigate the contribution of each micro-environment on measured personal concentrations. Socio-demographic and personal time-activity data were collected by means of questionnaires and half-hour-time resolution activity diaries. Personal exposure concentrations were found to be correlated with indoor home concentrations. Personal, indoor and outdoor concentrations of all studied pollutants except for ozone were found to be higher for the students living at the urban traffic site. Ozone, on the other hand, had higher concentrations at the sub-urban site for all three types of measurements (personal, indoor and outdoor). Analysis of the questionnaire data pointed out to environmental tobacco smoke, use of solvent based products, and petrol station nearby as factors that affect personal exposure concentrations. Cancer and non-cancer risks were estimated using the personal exposure concentrations. The mean cancer risk for the urban school children (1.7x10(-5)) was found to be higher than the sub-urban school children (0.88x10(-5)). Children living with smoking parents had higher risk levels (1.7x10(-5)) than children living with non-smoking parents (1.08x10(-5)). Overall, the risk levels were Descriptors Links Book Title Database Publisher Elsevier B.V Data Source Authors Demirel,G., Ozden,O., Dogeroglu,T., Gaga,E.O. Original/Translated Title URL Date of Electronic 20140103 PMCID Editors
Personal exposure to volatile organic compounds in the Czech Republic	2012	Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, Prague, Czech Republic.	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full Journal of exposure science & environmental epidemiology Periodical, Abbrev. J.Expo.Sci.Environ.Epidemiol. Pub Date Free Form Sep Volume 22 Issue 5 Start Page 455 Other Pages 460 Notes LR: 20131121; JID: 101262796; 0 (Air Pollutants); 0 (Benzene Derivatives); 0 (Volatile Organic Compounds); 0 (Xylenes); 3FPU23BG52 (Toluene); 6WAC1O477V (4-xylene); J64922108F (Benzene); L5I45M5G0O (ethylbenzene); O9XS864HTE (3-xylene); Z2474E14QP (2-xyle Place of Publication United States ISSN/ISBN 1559-064X; 1559-0631 Accession Number PMID: 22669500 Language eng SubFile Journal Article; Research Support, Non-U.S. Gov't; IM DOI 10.1038/jes.2012.30 [doi] Output Language Unknown(0) PMID 22669500 Abstract Personal exposures to volatile organic compounds (VOCs) were measured in the three industrial cities in the Czech Republic, Ostrava, Karvina and Havirov, while the city of Prague served as a control in a large-scale molecular epidemiological study identifying the impacts of air pollution on human health. Office workers from Ostrava and city policemen from Karvina, Havirov and Prague were monitored in the winter and summer of 2009. Only adult non-smokers participated in the study (N=160). Radiello-diffusive passive samplers were used to measure the exposure to benzene, toluene, ethylbenzene, meta- plus para-xylene and ortho-xylene (BTEX). All participants completed a personal questionnaire and a time-location-activity diary (TLAD). The average personal BTEX exposure levels in both seasons were 7.2/34.3/4.4/16.1 mug/m(3), respectively. The benzene levels were highest in winter in Karvina, Ostrava and Prague: 8.5, 7.2 and 5.3 mug/m(3), respectively. The personal exposures to BTEX were higher than the corresponding stationary monitoring levels detected in the individual localities (P Descriptors Links Book Title Database Publisher Data Source Authors Svecova,V., Topinka,J., Solansky,I., Sram,R.J. Original/Translated Title URL Date of Electronic 20120606 PMCID Editors
Personal tobacco pack display before and after the introduction of plain packaging with larger pictorial health warnings in Australia: an observational study of outdoor cafe strips	2014	Cancer Council Victoria, Melbourne, Vic., Australia.	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full Addiction (Abingdon, England) Periodical, Abbrev. Addiction Pub Date Free Form Apr Volume 109 Issue 4 Start Page 653 Other Pages 662 Notes CI: (c) 2014; JID: 9304118; CIN: Addiction. 2014 May;109(5):704-5. PMID: 24720825; OTO: NOTNLM; 2013/07/16 [received]; 2013/10/13 [revised]; 2013/12/17 [accepted]; 2014/02/25 [aheadofprint]; ppublish Place of Publication England ISSN/ISBN 1360-0443; 0965-2140 Accession Number PMID: 24428427 Language eng SubFile Journal Article; Observational Study; Research Support, Non-U.S. Gov't; IM DOI 10.1111/add.12466 [doi] Output Language Unknown(0) PMID 24428427 Abstract AIMS: We tested whether prevalence of cigarette pack display and smoking at outdoor venues and pack orientation changed following the introduction of plain packaging and larger pictorial health warnings in Australia. METHODS: Between October and April 2011-12 (pre-plain packaging, pre-PP) and 2012-13 (post-plain packaging, post-PP), we counted patrons, smokers and tobacco packs at cafes, restaurants and bars with outdoor seating. Pack type (fully branded, plain or unknown) and orientation were noted. Rates of pack display, smoking and pack orientation were analysed using multi-level Poisson regression. RESULTS: Pack display declined by 15% [adjusted incident rate ratio (IRR) = 0.85, 95% confidence interval (CI) = 0.79-0.91, P Descriptors Links Book Title Database Publisher Society for the Study of Addiction Data Source Authors Zacher,M., Bayly,M., Brennan,E., Dono,J., Miller,C., Durkin,S., Scollo,M., Wakefield,M. Original/Translated Title URL Date of Electronic 20140225 PMCID Editors
Personal, indoor, and outdoor exposure to VOCs in the immediate vicinity of a local airport	2011	New Jersey Meadowlands Commission, Meadowlands Environmental Research Institute, 1 DeKorte Park Plaza, Lyndhurst, NJ 07071, USA.	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full Environmental monitoring and assessment Periodical, Abbrev. Environ.Monit.Assess. Pub Date Free Form Feb Volume 173 Issue 4-Jan Start Page 555 Other Pages 567 Notes LR: 20131121; JID: 8508350; 0 (Air Pollutants); 0 (Benzene Derivatives); 0 (Xylenes); 3FPU23BG52 (Toluene); 6WAC1O477V (4-xylene); J64922108F (Benzene); L5I45M5G0O (ethylbenzene); Z2474E14QP (2-xylene); 2009/05/05 [received]; 2010/02/11 [accepted]; 2010/0 Place of Publication Netherlands ISSN/ISBN 1573-2959; 0167-6369 Accession Number PMID: 20237839 Language eng SubFile Journal Article; Research Support, Non-U.S. Gov't; IM DOI 10.1007/s10661-010-1404-9 [doi] Output Language Unknown(0) PMID 20237839 Abstract This study measures the effect of emissions from an airport on the air quality of surrounding neighborhoods. The ambient concentrations of benzene, toluene, ethylbenzene, and o-, m-, and p-xylene (BTEX) were measured using passive samplers at 15 households located close to the airport (indoor, outdoor, and personal), at the end of airport runways and an out-of-neighborhood location. Measurements occurred over a 48-h period during summer 2006 and winter 2006-2007. The average concentrations were 0.84, 3.21, 0.30, 0.99, and 0.34 mug/m3 at the airport runways and 0.84, 3.76, 0.39, 1.22, and 0.39 mug/m3 in the neighborhood for benzene, toluene, ethylbenzene, m-, p-, and o-xylene. The average neighborhood concentrations were not significantly different to those measured at the airport runways and were higher than the out-of-neighborhood location (0.48, 1.09, 0.15, 0.78, and 0.43 mug/m3, each BTEX). B/T ratios were used as a tracer for emission sources and the average B/T ratio at the airport and outdoors were 0.20 and 0.23 for the summer and 0.40 and 0.42 for the winter, suggesting that both areas are affected by the same emission source. Personal exposure was closely related to levels in the indoor environment where subjects spent most of their time. Indoor/outdoor (I/O) ratios for BTEX ranged from 1.13 to 2.60 and 1.41 to 3.02 for summer and winter. The seasonal differences in I/O ratios reflected residential ventilation patterns, resulting in increased indoor concentrations of volatile organic compounds during winter. Descriptors Links Book Title Database Publisher Data Source Authors Jung,K.H., Artigas,F., Shin,J.Y. Original/Translated Title URL Date of Electronic 20100317 PMCID Editors
pH affects ammonium, nitrate and proton fluxes in the apical region of conifer and soybean roots	2010	Centre for Forest Biology, University of Victoria, P.O. Box 3020 STN CSC, Victoria, BC, Canada, V8W 3N5. bhawkins@uvic.ca	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full Physiologia Plantarum Periodical, Abbrev. Physiol.Plant. Pub Date Free Form Feb Volume 138 Issue 2 Start Page 238 Other Pages 247 Notes LR: 20151119; JID: 1256322; 0 (Nitrates); 0 (Protons); 0 (Quaternary Ammonium Compounds); 0 (Soil); N762921K75 (Nitrogen); 2009/10/27 [aheadofprint]; ppublish Place of Publication Denmark ISSN/ISBN 1399-3054; 0031-9317 Accession Number PMID: 19947965 Language eng SubFile Journal Article; Research Support, Non-U.S. Gov't; IM DOI 10.1111/j.1399-3054.2009.01317.x [doi] Output Language Unknown(0) PMID 19947965 Abstract The effect of pH on nitrate and ammonium uptake in the high-affinity transport system and low-affinity transport system ranges was compared in two conifers and one crop species. Many conifers grow on acidic soils, thus their preference for ammonium vs nitrate uptake can differ from that of crop plants, and the effect of pH on nitrogen (N) uptake may differ. Proton, ammonium and nitrate net fluxes were measured at seedling root tips and 5, 10, 20 and 30 mm from the tips using a non-invasive microelectrode ion flux measurement system in solutions of 50 or 1500 microM NH(4)NO(3) at pH 4 and 7. In Glycine max and Pinus contorta, efflux of protons was observed at pH 7 while pH 4 resulted in net proton uptake in some root regions. Pseudotsuga menziesii roots consistently showed proton efflux behind the root tip, and thus appear better adapted to maintain proton efflux in acid soils. P. menziesii's ability to maintain ammonium uptake at low pH may relate to its ability to maintain proton efflux. In all three species, net nitrate uptake was greatest at neutral pH. Net ammonium uptake in G. max and net nitrate uptake in P. menziesii were greatly reduced at pH 4, particularly at high N concentration, thus N concentration should be considered when determining optimum pH for N uptake. In P. menziesii and G. max, net N uptake was greater in 1500 than 50 microM NH(4)NO(3) solution, but flux profiles of all ions varied among species. Descriptors Hydrogen-Ion Concentration, Nitrates/metabolism, Nitrogen/metabolism, Pinus/metabolism, Plant Roots/metabolism, Protons, Pseudotsuga/metabolism, Quaternary Ammonium Compounds/metabolism, Seedlings/metabolism, Soil/analysis, Soybeans/metabolism Links Book Title Database Publisher Data Source Authors Hawkins,B. J., Robbins,S. Original/Translated Title URL Date of Electronic 20091027 PMCID Editors
Pharmacognostical studies on the folk medicine 'Bong Seon Wha Dae'	2003	Park, J.H., College of Pharmacy, Pusan National University, Pusan 609-735, South Korea	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full Korean Journal of Pharmacognosy Periodical, Abbrev. Korean J.Pharmacogn. Pub Date Free Form 2003/09 Volume 34 Issue 3 Start Page 193 Other Pages 196 Notes Place of Publication ISSN/ISBN 0253-3073 Accession Number Language SubFile DOI Output Language Unknown(0) PMID Abstract Korean folk medicine 'Bong Seon Wha Dae' has been used to cure constipation and acute gastritis by meat. The botanical origin of the crude drug has not been studied pharmacogostically. To clarify the botanical origin of 'Bong Seon Wha Dae', the morphological and anatomical characteristics of Impatiens species growing in Korea, i.e. I. balsamina L., I. noli-tangere L., I. textori Miq. and I. textori Miq. for. pallenscens Hara were studied. As a result, 'Bong Seon Wha Dae' was proved to be the stem of I. balsamina L. Descriptors bong seon wha dae, Impatiens balsamina extract, plant extract, unclassified drug, article, Balsaminaceae, constipation, gastritis, herbal medicine, Impatiens, impatiens noli tangere, Impatiens textori, medicinal plant, pharmacognosy, plant stem, traditional medicine Links Book Title Database Embase Publisher Data Source Embase Authors Park,J. H., Kim,J. M., Do,W. I. Original/Translated Title URL Date of Electronic PMCID Editors
Pharmacological activity of three fractions obtained by smoking cannabis through a water pipe	1976	Dept. Psychobiol., Esc. Paulista Med., Sao Paulo	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full Bulletin on narcotics Periodical, Abbrev. Bull.Narc. Pub Date Free Form 1976/ Volume 28 Issue 2 Start Page 49 Other Pages 56 Notes Place of Publication ISSN/ISBN 0007-523X Accession Number Language SubFile DOI Output Language Unknown(0) PMID Abstract Descriptors cannabinol, cannabis, dronabinol, placebo, catatonia, cornea reflex, drug comparison, drug screening, intraperitoneal drug administration, motor activity, mouse, rabbit, sleep time, theoretical study Links Book Title Database Embase; MEDLINE Publisher Data Source Embase Authors Savaki,H. E., Cunha,J., Carlini,E. A., Kephalas,T. A. Original/Translated Title URL Date of Electronic PMCID Editors
Pharmacological interventions for promoting smoking cessation during pregnancy	2015	Division of Primary Care, University of Nottingham, D1411, Medical School, Queen's Medical Centre, Nottingham, UK, NG7 2UH.	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full The Cochrane database of systematic reviews Periodical, Abbrev. Cochrane Database Syst.Rev. Pub Date Free Form 22-Dec Volume (12):CD010078. doi Issue 12 Start Page CD010078 Other Pages Notes LR: 20160602; GR: Department of Health/United Kingdom; JID: 100909747; 0 (Nicotinic Agonists); 01ZG3TPX31 (Bupropion); W6HS99O8ZO (Varenicline); epublish Place of Publication England ISSN/ISBN 1469-493X; 1361-6137 Accession Number PMID: 26690977 Language eng SubFile Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review; IM DOI 10.1002/14651858.CD010078.pub2 [doi] Output Language Unknown(0) PMID 26690977 Abstract BACKGROUND: Smoking in pregnancy is a public health problem. When used by non-pregnant smokers, pharmacotherapies (nicotine replacement therapy (NRT), bupropion and varenicline) are effective for smoking cessation, however, their efficacy and safety in pregnancy remains unknown. Electronic Nicotine Delivery Systems (ENDS), or e-cigarettes, are becoming widely used but their efficacy and safety when used for smoking cessation in pregnancy are also unknown. OBJECTIVES: To determine the efficacy and safety of smoking cessation pharmacotherapies (including NRT, varenicline and bupropion), other medications, or ENDS when used for smoking cessation in pregnancy. SEARCH METHODS: We searched the Pregnancy and Childbirth Group's Trials Register (11 July 2015), checked references of retrieved studies, and contacted authors. SELECTION CRITERIA: Randomised controlled trials (RCTs) conducted in pregnant women with designs that permit the independent effects of any type of pharmacotherapy or ENDS on smoking cessation to be ascertained were eligible for inclusion.The following RCT designs are included.Placebo-RCTs: any form of NRT, other pharmacotherapy, or ENDS, with or without behavioural support/cognitive behaviour therapy (CBT), or brief advice, compared with an identical placebo and behavioural support of similar intensity.RCTs providing a comparison between i) any form of NRT, other pharmacotherapy, or ENDS added to behavioural support/CBT, or brief advice and ii) behavioural support of similar (ideally identical) intensity.Parallel- or cluster-randomised trials were eligible for inclusion. Quasi-randomised, cross-over and within-participant designs were not, due to the potential biases associated with these designs. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias and also independently extracted data and cross checked individual outcomes of this process to ensure accuracy. The primary efficacy outcome was smoking cessation in later pregnancy (in all but one trial, at or around delivery); safety was assessed by 11 outcomes (principally birth outcomes) that indicated neonatal and infant well-being; and we also collated data on adherence with trial treatments. MAIN RESULTS: This review includes a total of nine trials which enrolled 2210 pregnant smokers: eight trials of NRT and one trial of bupropion as adjuncts to behavioural support/CBT. The risk of bias was generally low across trials with virtually all domains of the 'Risk of bias' assessment tool being satisfied for the majority of studies. We found no trials investigating varenicline or ENDS. Compared to placebo and non-placebo controls, there was a difference in smoking rates observed in later pregnancy favouring use of NRT (risk ratio (RR) 1.41, 95% confidence interval (CI) 1.03 to 1.93, eight studies, 2199 women). However, subgroup analysis of placebo-RCTs provided a lower RR in favour of NRT (RR 1.28, 95% CI 0.99 to 1.66, five studies, 1926 women), whereas within the two non-placebo RCTs there was a strong positive effect of NRT, (RR 8.51, 95% CI 2.05 to 35.28, three studies, 273 women; P value for random-effects subgroup interaction test = 0.01). There were no differences between NRT and control groups in rates of miscarriage, stillbirth, premature birth, birthweight, low birthweight, admissions to neonatal intensive care, caesarean section, congenital abnormalities or neonatal death. Compared to placebo group infants, at two years of age, infants born to women who had been randomised to NRT had higher rates of 'survival without developmental impairment' (one trial). Generally, adherence with trial NRT regimens was low. Non-serious side effects observed with NRT included headache, nausea and local reactions (e.g. skin irritation from patches or foul taste from gum), but these data could not be pooled. AUTHORS' CONCLUSIONS: NRT used in pregnancy for smoking cessation increases smoking cessation rates measured in late Descriptors Links Book Title Database Publisher Data Source Authors Coleman,T., Chamberlain,C., Davey,M.A., Cooper,S.E., Leonardi-Bee,J. Original/Translated Title URL Date of Electronic 20151222 PMCID Editors
Pharmacological interventions for promoting smoking cessation during pregnancy	2012	Division of Primary Care, University of Nottingham, Nottingham, UK. tim.coleman@nottingham.ac.uk.	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full The Cochrane database of systematic reviews Periodical, Abbrev. Cochrane Database Syst.Rev. Pub Date Free Form 12-Sep Volume (9):CD010078. doi Issue 9 Start Page CD010078 Other Pages Notes LR: 20160602; GR: Department of Health/United Kingdom; JID: 100909747; UIN: Cochrane Database Syst Rev. 2015;(12):CD010078. PMID: 26690977; epublish Place of Publication England ISSN/ISBN 1469-493X; 1361-6137 Accession Number PMID: 22972148 Language eng SubFile Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review; IM DOI 10.1002/14651858.CD010078 [doi] Output Language Unknown(0) PMID 22972148 Abstract BACKGROUND: Smoking in pregnancy is a substantial public health problem. When used by non-pregnant smokers, pharmacotherapies [nicotine replacement therapy (NRT), bupropion and varenicline] are effective treatments for smoking cessation, however, their efficacy and safety in pregnancy remains unknown. OBJECTIVES: To determine the efficacy and safety of smoking cessation pharmacotherapies, including NRT, varenicline and bupropion (or any other medications) when used to support smoking cessation in pregnancy. SEARCH METHODS: We searched the Pregnancy and Childbirth Group's Trials Register (5 March 2012), checked references of retrieved studies and contacted authors in the field. SELECTION CRITERIA: Randomised controlled trials (RCTs) with designs that permit the independent effects of any type of NRT (e.g. patch, gum etc.) or any other pharmacotherapy on smoking cessation to be ascertained were eligible for inclusion. Trials must provide very similar (ideally identical) levels of behavioural support or cognitive behaviour therapy (CBT) to participants in active drug and comparator trial arms.The following RCT designs are considered acceptable.Placebo RCTs: any form of NRT or other pharmacotherapy, with or without behavioural support/CBT, or brief advice compared with placebo NRT and additional support of similar intensity.RCTs providing a comparison between i) behavioural support/CBT or brief advice and ii) any form of NRT or other pharmacotherapy added to behavioural support of similar (ideally identical) intensity.Parallel- or cluster-randomised design trials are eligible for inclusion. However, quasi-randomised, cross-over and within-participant designs are not eligible for inclusion due to the potential biases associated with these designs. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias and extracted data. Two assessors independently extracted data and cross checked individual outcomes of this process to ensure accuracy. The primary efficacy outcome was smoking cessation in later pregnancy (in all but one trial, at or around delivery); safety was assessed by seven birth outcomes that indicated neonatal well being and we also collated data on adherence. MAIN RESULTS: Six trials of NRT enrolling 1745 pregnant smokers were included; we found no trials of varenicline or bupropion. No statistically significant difference was seen for smoking cessation in later pregnancy after using NRT as compared to control (risk ratio (RR) 1.33, 95% confidence interval (CI) 0.93 to 1.91, six studies, 1745 women). Subgroup analysis comparing placebo-RCTs with those which did not use placebos found that efficacy estimates for cessation varied with trial design (placebo RCTs, RR 1.20, 95% CI 0.93 to 1.56, four studies, 1524 women; non-placebo RCTs, RR 7.81, 95% CI 1.51 to 40.35, two studies, 221 women; P value for random-effects subgroup interaction test = 0.03). There were no statistically significant differences in rates of miscarriage, stillbirth, premature birth, birthweight, low birthweight, admissions to neonatal intensive care or neonatal death between NRT or control groups. AUTHORS' CONCLUSIONS: Nicotine replacement therapy is the only pharmacotherapy for smoking cessation that has been tested in RCTs conducted in pregnancy. There is insufficient evidence to determine whether or not NRT is effective or safe when used to promote smoking cessation in pregnancy or to determine whether or not using NRT has positive or negative impacts on birth outcomes. Further research evidence of efficacy and safety is needed, ideally from placebo-controlled RCTs that investigate higher doses of NRT than were tested in the included studies. Descriptors Links Book Title Database Publisher Data Source Authors Coleman,T., Chamberlain,C., Davey,M.A., Cooper,S.E., Leonardi-Bee,J. Original/Translated Title URL Date of Electronic 20120912 PMCID Editors

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