1,721,137 research outputs found
Electronic cigarettes for smoking cessation
Get PDFSupplementary data tables of results drawn from included studies
Electronic cigarettes for smoking cessation: April 2021
Get PDFWe included 56 completed studies, representing 12,804 participants, of which 29 were RCTs. Six of the 56 included studies were new to this review update. Of the included studies, we rated five (all contributing to our main comparisons) at low risk of bias overall, 42 at high risk overall (including the 25 non-randomized studies), and the remainder at unclear risk.
There was moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (risk ratio (RR) 1.69, 95% confidence interval (CI) 1.25 to 2.27; I2 = 0%; 3 studies, 1498 participants). In absolute terms, this might translate to an additional four successful quitters per 100 (95% CI 2 to 8). There was low-certainty evidence (limited by very serious imprecision) that the rate of occurrence of AEs was similar) (RR 0.98, 95% CI 0.80 to 1.19; I2 = 0%; 2 studies, 485 participants). SAEs occurred rarely, with no evidence that their frequency differed between nicotine EC and NRT, but very serious imprecision led to low certainty in this finding (RR 1.37, 95% CI 0.77 to 2.41: I2 = n/a; 2 studies, 727 participants).
There was moderate-certainty evidence, again limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non-nicotine EC (RR 1.70, 95% CI 1.03 to 2.81; I2 = 0%; 4 studies, 1057 participants). In absolute terms, this might again lead to an additional four successful quitters per 100 (95% CI 0 to 11). These trials mainly used older EC with relatively low nicotine delivery. There was moderate-certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 3 studies, 601 participants). There was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 0.60, 95% CI 0.15 to 2.44; I2 = n/a; 4 studies, 494 participants).
Compared to behavioral support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.70, 95% CI 1.39 to 5.26; I2 = 0%; 5 studies, 2561 participants). In absolute terms this represents an increase of seven per 100 (95% CI 2 to 17). However, this finding was of very low certainty, due to issues with imprecision and risk of bias. There was no evidence that the rate of SAEs differed, but some evidence that non-serious AEs were more common in people randomized to nicotine EC (AEs: RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%; 4 studies, 765 participants; SAEs: RR 1.17, 95% CI 0.33 to 4.09; I2 = 5%; 6 studies, 1011 participants).
Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued use. Very few studies reported data on other outcomes or comparisons and hence evidence for these is limited, with confidence intervals often encompassing clinically significant harm and benefit
Cochrane review of electronic cigarettes for smoking cessation (10.1002/14651858.CD010216.pub9)
No full textSupplementary tables 1-10 for the update to the Cochrane review of electronic cigarettes for smoking cessation. Once accepted the DOI for the publication will be: 10.1002/14651858.CD010216.pub
Electronic cigarettes for smoking cessation: September 2021
Get PDFWe included 61 completed studies, representing 16,759 participants, of which 34 were
RCTs. Five of the 61 included studies were new to this review update. Of the included
studies, we rated seven (all contributing to our main comparisons) at low risk of
bias overall, 42 at high risk overall (including all non-randomized studies), and
the remainder at unclear risk.
There was moderate-certainty evidence, limited by imprecision, that quit rates were
higher in people randomized to nicotine EC than in those randomized to nicotine replacement
therapy(NRT) (risk ratio (RR) 1.53, 95% confidence interval (CI) 1.21 to 1.93; I
= 0%; 4 studies, 1924participants). In absolute terms, this might translate to an
additional three quitters per 100 (95%CI 1 to 6). There was low-certainty evidence
(limited by very serious imprecision) that the rate of occurrence of AEs was similar
(RR 0.98, 95% CI 0.80 to 1.19; I
= 0%; 2 studies, 485participants). SAEs were rare, but there was insufficient evidence
to determine whether rates differed between groups due to very serious imprecision
(RR 1.30, 95% CI 0.89 to 1.90: I
= 0;4 studies, 1424 participants).
There was moderate-certainty evidence, again limited by imprecision, that quit rates
were higher in people randomized to nicotine EC than to non-nicotine EC (RR 1.94,
95% CI 1.21 to3.13; I
= 0%; 5 studies, 1447 participants). In absolute terms, this might lead to an additional seven quitters per 100 (95% CI 2 to 16). There was moderate-certainty evidence of
no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11;
I
= 0%; 3studies, 601 participants). There was insufficient evidence to determine
whether rates of SAEs differed between groups, due to very serious imprecision (RR
1.06, 95% CI 0.47 to 2.38; I
= 0;5 studies, 792 participants).
Compared to behavioural support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.61, 95% CI 1.44 to 4.74; I
= 0%; 6 studies, 2886participants). In absolute terms this represents an additional
six quitters per 100 (95% CI 2 to15). However, this finding was of very low certainty,
due to issues with imprecision and risk ofbias. There was some evidence that non-serious
AEs were more common in peoplerandomized to nicotine EC (RR 1.22, 95% CI 1.12 to
1.32; I = 41%, low certainty; 4 studies,765 participants), and again, insufficient evidence
to determine whether rates of SAEs differed between groups (RR 1.51, 95% CI 0.70 to
3.24; I = 0%; 7 studies, 1303 participants).
Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended
to dissipate with continued use. Very few studies reported data on other outcomes
or comparisons, hence evidence for these is limited, with CIs often encompassing clinically significant harm and benefit
Oxford Food and Activity Behaviours Study
Get PDFData from a prospective, web-based cohort study of overweight UK adults (BMIâ¥25kg/m2) trying to lose weight through behaviour change. Strategy use was assessed using the OxFAB questionnaire
Behavioural interventions for smoking cessation: an overview and network meta-analysis
Get PDFSupplementary tables in Microsoft Word and Excel that provide additional information to accompany the Cochrane Overview: Behavioural interventions for smoking cessation: an overview and network meta-analysi
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The impacts of private equity hospital ownership on patient health outcomes and quality of care: a systematic scoping review
No full textBackground
Private equity (PE) acquisitions of acute care hospitals in the United States have fueled concerns about the effects of profit-driven management practices on care delivery. This review aimed to investigate the impacts of PE hospital ownership on patient health outcomes and quality of care.
Methods
PubMed was searched on 2 March 2025 for observational and quasi-experimental studies comparing patient outcomes in PE hospitals to those in non-PE hospitals or to outcomes before PE acquisition. Eligible studies reported at least one outcome related to mortality, readmissions, hospital-acquired conditions, or care access/quality. Results were narratively synthesized, grouped by outcome and by comparator.
Results
Six studies were included, encompassing 1,036 PE-owned and 6,718 non-PE hospitals. Study sizes ranged from 9,462 to 21,091,222 patients, with periods of analysis spanning from 2001 through 2020. All studies that reported it were conducted in majority white populations, with mean age ranging from 72.9 to 79.45. Two studies comparing pre- and post-acquisition outcomes found either modest declines or no differences in mortality at PE hospitals. Two other studies reported higher 30-day mortality rates among surgical patients at PE hospitals compared to non-PE hospitals. Readmission rates were largely similar across hospital types. One study found increased rates of hospital-acquired conditions, including falls and infections, at PE hospitals following acquisition. Two additional studies reported higher surgical complication rates at PE hospitals, with one also identifying elevated incidence of failure-to-rescue. Regarding care access/quality, one study found decreases in patient-reported experience ratings at PE hospitals post-acquisition, while another reported improved process quality scores for select conditions. Findings on length of stay and discharge status varied, with some studies noting longer admissions or increased transfers from PE hospitals after acquisition.
Discussion
Evidence on the effects of PE hospital ownership on patient outcomes is limited and mixed. Some findings suggest potential harms, including increased mortality among surgical patients, higher rates of hospital-acquired conditions, and declines in patient- reported experiences. Future research should include more diverse populations, clearly defined acquisition timelines, and stronger adjustments for confounders. Greater transparency and regulatory oversight are recommended to ensure that operational strategies of PE-owned hospitals prioritize patient safety and equitable care delivery.Master of Public Health (MPH
Planetary health-informed health systems change: a circumpolar-based multi-methods approach
Get PDFHealth systems are underprepared for the effects of an increasingly stressed planet. In this dissertation, I used a multi-methods, pragmatist approach to identify influences on planetary health-informed health systems change in a Circumpolar and diverse healthcare setting, and to explore transferable knowledge for other contexts. Through a mixed-methods systemic review, I identified factors that influence adaptation of patient-planetary health (P-PH) co-benefit prescribing using content analysis. Barriers included a lack of knowledge and time; facilitators included policy statements and guidelines from respected associations. Informed by this review, I then conducted interviews exploring physician perspectives around P-PH co-benefit prescribing in a Circumpolar region. Using reflexive thematic analysis, I found the current healthcare system does not support planetary health, with many physicians discussing difficulties. I then held a sharing circle with Indigenous Elders from the same area, and inductively coded the data to generate key themes and a systems map. Findings included four interconnected themes: the past and how we got here; where we are now; where we need to go in the future; and reflections. Overall, health systems were viewed as devoid of any environmental context or consideration. I then carried out reflexive thematic analysis regarding nature prescriptions in the context of Indigenous Peoples. Findings included the need for things to be done “in the right way”, and the sentiment that the Land is not just an experience but a way of life. Lastly, I carried out a scoping review to identify current planetary health frameworks for health systems. Using content analysis to identify the different domains, I described six overarching categories including, as examples: key structural components for environmentally sustainable health systems; climate resilient and sustainable technologies and infrastructure; and evaluation and accountability mechanisms. By triangulating data across these studies, I identified common elements, including an implicit focus and understanding that some level of the status quo (i.e., Nature disconnection) is still being perpetuated within research and discourse around planetary health-related health systems change
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The impacts of natural disasters on breastfeeding practices: A systematic scoping review
No full textBackground:
Understanding barriers and facilitators to breastfeeding practices in areas impacted by natural disasters can help humanitarian aid organizations make changes to the way they provide resources during crises. This review aims to assess the impacts of natural disasters on women’s breastfeeding practices.
Methods:
PubMed was searched on February 19, 2025 for primary studies looking at the impact of a natural disaster directly on women’s breastfeeding practices globally. The results were narratively synthesized and grouped by natural disaster type and outcome.
Results:
10 studies were included in this review with 11 papers, with one reporting on the same event. Included studies all focused on barriers and facilitators of breastfeeding. Overall, the included studies represented 1,400 participants. Study size ranged from 6 to 897 participants. All studies were conducted outside of the United States, with two being in Turkey, and the rest from Iran,
Italy, India, Haiti, Nepal, Canada, and Pakistan. Natural disaster types in this review included earthquakes, floods, a tsunami, and a wildfire.
In the aftermath of a natural disaster, common barriers to breastfeeding practices were lack of privacy for breastfeeding, stress/anxiety, nutrition and low food consumption, cultural beliefs, and shelter. Nutrition and low food consumption as well as mental health stressors both, in some cases, reduced breast milk production. Humanitarian aid acted as a barrier to some and a
facilitator to others, depending on the circumstances. Facilitators of breastfeeding were more sparse in the literature, but themes were religion and cultural breastfeeding norms, aid, privacy, and sense of community among other women. Only one study had breastfeeding practices assessed at more than one time after the natural disaster.
Discussion:
Further research should be done assessing breastfeeding practices at multiple points in time. These papers presented information about displaced populations and it would be interesting to see future research on non-displaced populations. Humanitarian interventions were sometimes
inconsistent with the needs of the displaced mothers pointing to the need for further refinements to encourage breastfeeding practices during natural disasters.Master of Public Health (MPH
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