BackgroundHome visiting programs represent an important primary prevention strategy for adverse prenatal health behaviors; the various ways in which home visiting programs impact prenatal smoking cessation and reduction behaviors remain understudied.MethodsMixed methods approach using a retrospective cohort of propensity score matched home visiting clients and local-area comparison women with first births between 2008–2014 in a large Northeast state. Multivariable logistic and linear regression estimated third trimester prenatal tobacco smoking cessation and reduction. Additionally, qualitative interviews were conducted with 76 home visiting clients.ResultsA program effect was seen for smoking cessation such that clients who smoked less than ten cigarettes per day and those who smoked 20 or more cigarettes per day during the first trimester were more likely to achieve third trimester cessation than comparison women (p <0.01 and p = 0.01, respectively). Only for heavy smokers (20 or more cigarettes during the first trimester) was there a significant reduction in number of cigarettes smoked by the third trimester versus comparison women (p = 0.01). Clients expressed the difficulty of cessation, but addressed several harm-reduction strategies including reducing smoking in the house and wearing a smoking jacket. Clients also described smoking education that empowered them to ask others to not smoke or adopt other harm reducing behaviors when around their children.ConclusionsWhile a significant impact on smoking cessation was seen, this study finds a less-clear impact on smoking reduction among women in home visiting programs. As home visiting programs continue to expand, it will be important to best identify effective ways to support tobacco-related harm reduction within vulnerable families.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3464-4) contains supplementary material, which is available to authorized users.

This is a case report of an HIV-positive patient with miliary tuberculosis (MTB). He presents to the emergency department (ED) two-weeks following the initiation of antiretroviral therapy (ART) with worsening cough, fevers, and malaise. The patient was diagnosed with Tuberculosis-Immune Reconstitution Inflammatory Syndrome (TB-IRIS) and subsequently treated with corticosteroids, resulting in clinical improvement over a two-week in-patient hospitalization. This case report details a rare case of TB-IRIS, a clinical diagnosis without universally agreed upon criteria. It also demonstrates a classic miliary pattern of disseminated tuberculosis on chest radiography.

Despite rapid economic growth during the last half of the twentieth century, gender inequality has remained high in Korea. Using data from the 2001 Korean National Health and Nutrition Examination Survey (KNHANES), previous research found that gender differences in sociostructural and psychosocial factors contributed to a substantial female excess in poor self-rated health. To the extent that women's overall social status relative to men has improved over time in Korea, it is possible that the gender gap in perceived health has decreased. This study used repeated cross-sectional KNHANES data from 2001-2012 to examine temporal trends in gender differences in self-rated health. In age-adjusted models, we found no significant trend in the female excess of poor self-rated health among respondents aged 25-44 (p=0.685). In contrast, we found a statistically significant downward trend among those aged 45-64 (p<0.001). In fully adjusted models controlling for age and behavioral, sociostructural, and psychosocial covariates, we found a marginally significant upward trend (p=0.08) among younger respondents, while the downward trend among older respondents remained significant (p<0.001). More work is needed to determine why gendered health disparities decreased among older adults in Korea but not among those aged 25-44.

This is a case report of an HIV-positive patient with miliary tuberculosis (MTB). He presents to the emergency department (ED) two-weeks following the initiation of antiretroviral therapy (ART) with worsening cough, fevers, and malaise. The patient was diagnosed with Tuberculosis-Immune Reconstitution Inflammatory Syndrome (TB-IRIS) and subsequently treated with corticosteroids, resulting in clinical improvement over a two-week in-patient hospitalization. This case report details a rare case of TB-IRIS, a clinical diagnosis without universally agreed upon criteria. It also demonstrates a classic miliary pattern of disseminated tuberculosis on chest radiography. Topics Infectious disease, respiratory, tuberculosis, milary tuberculosis.