Enactment of smoke-free legislation in Europe and North America,
decreased preterm birth rates and childhood asthma exacerbations by 10%.

To assess the effects of such policies on pregnancy outcomes and risk
for childhood asthma, researchers conducted a meta-analysis of five
North American and six European studies involving >2.5 million
pregnancies and 247,168 asthma exacerbations.

Following the introduction of smoke-free policies, reductions of 10%
were promptly seen in rates of preterm birth and very-small-for-
gestational-age birth. In addition, rates of pediatric asthma
exacerbations fell by 10%.

Been JV et al. Effect of smoke-free legislation on perinatal and child
health: A systematic review and meta-analysis. Lancet 2014 May 3;
383:1549. (http://dx.doi.org/10.1016/S0140-6736(14)60082-9)PubMed
abstract
Kalkhoran S and Glantz SA.Smoke-free policies: Cleaning the air with
money to spare. Lancet 2014 May 3; 383:1526. (http://dx.doi.org/10.1016/S0140-6736(14)60224-5
)PubMed abstract

The CDC now recommends daily treatment with Truvada (300 mg tenofovir
disoproxil fumarate and 200 mg emtricitabine) to lower the risk for
HIV acquisition among high-risk adults.

Pre-exposure prophylaxis with Truvada is recommended in the following
groups-

Men who have Sex with Men-
not in a monogamous relationship who engage in unprotected anal
intercourse

Heterosexually active adults who rarely use condoms during sex with
high-risk partners of unknown HIV status

All adults in an ongoing relationship with an HIV-infected partner

Injection drug users who share needles

Individuals must test negative for HIV before beginning Truvada, and
they should be assessed every 3 months thereafter. Those who acquire
HIV should discontinue the drug.

CDC pre-exposure prophylaxis guidelines

The artificial sweetener advantame has been approved for use as an all-
purpose sweetener, making it the sixth sugar substitute to get the nod
from the FDA.

Advantame, which was deemed safe from possible toxic effects in some
35 animal and human studies, does not raise blood sugar levels and
adds few calories to food. Like aspartame, it should be avoided by
people who can’t metabolize phenylalanine, one of the sweetener’s
ingredients.

The product has no brand name yet.

Researchers have identified several risk factors for shingles that appear to pose a higher risk for younger adults, particularly those under age 50.

Using a U.K. primary care database, researchers identified nearly
150,000 incident cases of zoster over 11 years, matched with roughly
550,000 controls who didn’t have zoster at their index visit.

The following conditions were associated with increased shingles risk:
systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel
disease, chronic obstructive pulmonary disease, asthma, chronic kidney
disease, type 1 diabetes, and depression. These conditions had greater
effects among younger patients. The authors ask “whether targeted
zoster vaccination of specific high risk groups at younger ages is
warranted.”

Patients with contraindications to the vaccine (e.g., lymphoma and
HIV) were at highest risk for zoster, “highlighting the need to
identify strategies to reduce the risk of zoster among these groups,”
they write.

The case-control study appears in BMJ.

Four medications have clinical value in treating patients with alcohol-
use disorders, according to a review in JAMA.

Researchers examined over 120 studies of medications used for alcohol-
use disorders. Some 23,000 patients were enrolled, most after
detoxification or a period of sobriety.

Acamprosate (a glutamine antagonist and γ-aminobutyric acid agonist)
and oral naltrexone (an opioid antagonist) were about equally
effective in preventing resumption of any drinking.

Naltrexone was also effective in reducing heavy drinking, but
acamprosate was not.
Disulfiram (an acetaldehyde dehydrogenase inhibitor) did not reduce
alcohol consumption..

Two off-label medications — nalmefene (an opioid antagonist) and
topiramate (an anticonvulsant) — were associated with improvements in
heavy drinking. There was insufficient evidence for other off-label
drugs, including SSRIs, tricyclic antidepressants, atypical
antipsychotics, and gabapentin.

JAMA article

Syphilis rates have nearly doubled in the past decade, with the 
steepest rise among men who have sex with men (MSM), according to an 
analysis of national data in MMWR.

From 2005 to 2013, annual rates of primary and secondary syphilis 
increased from 2.9 to 5.3 cases per 100,000 population. Increases were 
greatest among men, who accounted for 91% of cases in 2013, and were 
seen in men of all ages, races/ethnicities, and geographic regions. 
The rise was especially pronounced among MSM, who accounted for about 
80% of cases in men. Among women, rates increased from 2005 to 2008 
and dropped thereafter.

Notably, syphilis was at record low levels in 2000.

Calling the syphilis increase in MSM “a major public health concern,” 
the researchers recommend promoting prevention measures, including 
safer sex practices, syphilis screening, and partner notification.

MMWR article