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By Tarun Sai Lomte May 12 2023 Reviewed by Lily Ramsey, LLM

In a recent study published in the eClinicalMedicine Journal, researchers assessed the levels of public support for smoke-free policies in indoor (semi)-private and outdoor areas.

Study:  Public support for smoke-free policies in outdoor areas and (semi-)private places: a systematic review and meta-analysis. Image Credit: LuckyBusiness/Shutterstock.com Background

Second-hand smoke exposure is a significant burden to global public health. Evidence suggests that legislation to protect people from smoke in workplaces and indoor public spaces can decrease the harmful effects of tobacco smoke. Several jurisdictions have extended smoke-free policies to include outdoor and private places.

Public support is critical for policymakers to implement such policies and maximize compliance. Prior studies have observed differences in support within populations and between smoke-free places.

Therefore, it is crucial to gain insights into the determinants and levels of public support for such policies to inform policymaking regarding their expansion covering outdoor and semi-private spaces. About the study

In the present study, researchers systematically reviewed the evidence on public support levels for smoke-free policies encompassing semi-private and outdoor places.

They searched Embase, Medline, Cochrane, PsycINFO, Web of Science, and the cumulative index to nursing and allied health literature (CINAHL) databases for studies published from January 2004 to January 2022, with no restrictions on language.

Studies were eligible if they assessed support for policies in indoor private or semi-private spaces, outdoor hospitality or non-hospitality places, and outdoor semi-private places, with policies already implemented, planned, or hypothetical.

Studies were excluded if the sample size was <400, only non-combustible tobacco products were covered, or support was reported for workplaces or indoor public places. Related StoriesResearchers map the immune system in the gut of kids with inflammatory bowel diseaseGun assault rates doubled for children in 4 major cities during the pandemic, new data showsExperts urge increased attention to the threat of climate change and pollution on children's health

Titles/abstracts and full texts were screened to identify eligible reports, and relevant data were extracted from included studies.

The risk of bias in included studies was assessed using the mixed methods appraisal tool. Logit transformations were applied if support was reported as proportions ranging from zero to one.

If reported as the average score on the Likert scale, it was transformed to the proportion support. A three-level meta-analysis accounted for between-study, within-study, and country-level clustering. Sub-group analyses were also performed by gender, age group, parental status, and smoking status. Findings

The authors identified more than 14,500 records from the databases. Duplicates and pre-2004 studies were removed, resulting in over 6,000 records for screening. Overall, 107 studies from 33 countries were included for analysis.

Sixty-seven studies investigated support for hypothetical scenarios, 36 investigated public support for implemented policies, and four assessed public support for policies likely to be introduced or extended.

Forty-two studies were considered to have a low risk of bias, and 65 were deemed as having a moderate or high risk of bias. Eight studies were excluded from the meta-analysis. The meta-analysis included data from almost 900,000 participants.

The highest public support levels for smoke-free places were for private indoor spaces (73%) and semi-private indoor places (70%). Public support for policies in outdoor non-hospitality and hospitality places was 69% and 50%, respectively.

For semi-private outdoor places, support was 67%. The lowest support was for outdoor private places (41%). Public support was the highest for making cars with children onboard smoke-free at 86%, followed by playgrounds and school grounds at 80% and 76%, respectively.

Parks, beaches, and outdoor hospitality or private places had the lowest public support. There was substantial heterogeneity within or between studies and between countries.

Support was significantly higher among ex- or non-smokers than among current smokers. Females were significantly more often in favor of policies than males.

People in low- and middle-income countries (LMICs) had similar levels of support for policies as those from high-income countries, except for higher support for outdoor non-hospitality policies in LMICs.

Twelve studies assessed public support for policies pre- and post-implementation. Six reported that support was significantly higher after implementation, whereas others did not find significant changes. Sensitivity analyses found no significant differences in support between studies with a low and high risk of bias, indicating that the evidence was robust. Conclusions

The authors observed that public support for smoke-free policies covering outdoor and semi-private spaces was particularly high for places where children are commonly present, such as playgrounds, school grounds, and cars with children.

Support was more than 50% or higher for all areas except private outdoor spaces. Ex- and non-smokers were more in support of policies than smokers.

The findings suggest high support for smoke-free spaces covering outdoor and semi-private areas from the surveyed populations. Policymakers should proceed with further steps in protecting the public, especially children, from the adverse effects of smoke exposure by expanding smoke-free policies. Journal reference:

Boderie, N.W., Sheikh, A., Lo, E., Sheikh, A., Burdorf, A., Van Lenthe, F.J., Mölenberg, F.J.M. & Been, J.V. (2023) Public support for smoke-free policies in outdoor areas and (semi-)private places: a systematic review and meta-analysis. eClinicalMedicine, p.101982. doi: 10.1016/j.eclinm.2023.101982. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00159-1/fulltext

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Robbie Williams forced to cancel world tour gig in ‘interests of public safety’

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Robbie Williams forced to cancel world tour gig in 'interests of public safety'

Robbie Williams has said he is “deeply sorry” his concert in the Turkish city of Istanbul has had to be cancelled “in the interests of public safety”.

The former Take That singer said it was his “dream” to perform at Atakoy Marina on Tuesday but the decision by city authorities to cancel the show “was beyond our control”.

Williams’ Britpop world tour began in May and has taken him to cities including London, Amsterdam, Berlin, Helsinki and Athens.

The 51-year-old Angels singer said in a post on Instagram to his 3.7m followers: “The last thing I would ever want to do is to jeopardise the safety of my fans – their safety and security come first.

“We were very excited to be playing Istanbul for the first time, and purposely chose the city as the final show of the Britpop tour.

“To end this epic run of dates in front of my Turkish fans was my dream, given the close connections my family have with this wonderful country.

“To everyone in Istanbul who wanted to join the 1.2 million people who have shared this phenomenal tour this year with us, I am deeply sorry. We were so looking forward to this show, but the decision to cancel it was beyond our control.”

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Williams is still expected to perform a small ticketed gig on Thursday at Camden’s Dingwalls venue in London.

He will run through his upcoming album Britpop, which is yet to be released, in full, with his first solo LP, Life Thru A Lens.

After leaving Take That in 1995, Williams released his chart-topping debut album in 1997, and has achieved seven UK number one singles and 15 UK number one albums.

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Healthcare AI firm Heidi valued at £345m after Point72 backing

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Healthcare AI firm Heidi valued at £345m after Point72 backing

A healthcare AI company which claims to be used by more than 60% of NHS GPs will this week announce a funding injection led by one of Wall Street’s most prominent investors.

Sky News has learnt that Heidi, which promises to reduce doctors’ workloads by removing layers of bureaucracy from their daily tasks, will unveil a $65m (£48m) Series B fundraising which will value the company at $465m (£346m).

The round has been led by Point72 Private Investments, part of the investment empire of Steven Cohen, the billionaire asset management tycoon.

Existing investors including Blackbird, Headline and Latitude – which is part of the London-based venture capital group LocalGlobe – are also participating in the funding boost.

The raise brings the total sum of funding injected into Heidi since it was founded by a trio of Australian healthcare professionals to nearly $100m.

Heidi says its technology is now used to support more than 340,000 patient consultations each week in the UK.

It adds that organisations utilising it include One Care and Modality Partnership, the NHS’s largest GP “super-partnership”.

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Heidi Health CEO, Dr Thomas Kelly. Pic: Heidi Health
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Heidi Health CEO, Dr Thomas Kelly. Pic: Heidi Health

Heidi is also running pilot programmes with NHS Trusts across the North West London Acute Provider Collaborative – a group of hospitals serving a local population of approximately 2.2 million people – as well as One LSC, a collective of five NHS Trusts in Lancashire and South Cumbria which serves nearly 1.8 million people.

The company says its administrative aids have already saved British doctors 3 million hours annually by cutting paperwork and other bureaucracy.

It automates tasks such as clinical documentation, evidence search, and follow-up communications with patients.

More widely, Heidi claims to have supported more than 70 million patient consultations globally over the last 18 months, returning more than 18 million hours to frontline clinicians by streamlining administrative functions.

“It is untenable that healthcare demand continues to rise while clinical time continues to shrink,” Dr Thomas Kelly, the CEO and co-founder of Heidi, said.

“Building a sustainable healthcare system requires expanding clinical capacity without compromising clinician wellbeing or patient safety.”

The new funding will be used to accelerate Heidi’s expansion in the US, UK and Canada, including doubling its workforce in Britain to meet growing NHS demand.

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“What we’re witnessing with Heidi in the UK’s NHS isn’t just fast growth, it’s a clinician-led movement,” said Ferdi Sigona, a partner at Latitude.

“When doctors themselves are championing a tool so passionately – from individual practices to major NHS Trusts serving millions of patients – we know we’re backing a company with universal appeal across healthcare.”

Alongside the funding round, Heidi is also expected to announce the appointment of Paul Williamson, a former executive at the fintech Plaid, as chief revenue officer, and former Microsoft chief medical officer Dr Simon Kos to the same role.

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‘We don’t have anything for winter’: Families fear months ahead after earthquake wiped out entire villages in Afghanistan

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'We don't have anything for winter': Families fear months ahead after earthquake wiped out entire villages in Afghanistan

It is a breathtaking and, at points, pretty perilous journey through the remote mountainous region of eastern Afghanistan.

We’re trying to reach the Mazar Dara valley, where an earthquake wiped out whole villages. The force of the quake ripped apart roads, cut off communities and buried multiple generations.

It’s slow going – navigating around sheer drops on a road scattered with rocks and boulders. But after three hours, we start to see the first signs of the disaster that, within minutes, plunged this region into darkness.

Last month's earthquake killed some 2,000 people and was one of the worst Afghanistan has seen
Image:
Last month’s earthquake killed some 2,000 people and was one of the worst Afghanistan has seen

We are driving into Wadir, a village in Nurgal District, where everyone we meet has lost someone. The earthquake, which struck around midnight, killed many in their sleep here, especially women and children.

Standing by a makeshift graveyard peppered with white flags and gravestones, we meet little Rahmanullah. He’s eight but looks much younger, and his glassy eyes look heavy with grief.

His fragile, tiny hands point to the grave where his six-year-old brother Abouzar is buried. He was sleeping alongside him.

The earthquake struck around midnight and killed many in their sleep
Image:
The earthquake struck around midnight and killed many in their sleep

The only reason Rahmanullah survived was because his older sibling, Saied Rahman, was able to pull him out.

“I was asleep when I heard a crash,” Rahmanullah tells me. “My brother said ‘it’s an earthquake, get up, or the building will fall on you’.

“He took my hand and pulled me out, put me on some wood, and said, ‘get out quick’.”

Saied Rahman pulled Rahmanullah from his home during the quake
Image:
Saied Rahman pulled Rahmanullah from his home during the quake

Rahmanullah takes us up a steep hill to show us what remains of his home.

On the edge of a vast drop, it is now a mound of rubble – only a broken bed and shoes left behind.

Rahmanullah (pictured) lost his younger brother Abouzar after the earthquake in Wadir
Image:
Rahmanullah (pictured) lost his younger brother Abouzar after the earthquake in Wadir

The earthquake killed some 2,000 people and was one of the worst Afghanistan has seen. And it came at an already desperate time for Afghans – with an economic crisis, rising unemployment, drought and malnutrition.

The quake's epicentre was near the city of Jalalabad
Image:
The quake’s epicentre was near the city of Jalalabad

In Afghanistan, there has been a seemingly endless cycle of hunger and displacement. Compounding those problems since the Taliban took control in 2021, aid has dropped off a cliff.

This year, the US cut almost all of its funding to the country, and it’s had a massive impact.

The demise of the US Agency for International Development this year has forced the closure of 400 health facilities and left hundreds of thousands of Afghans without consistent access to food.

Nearly everyone we spoke to in this region praised the speed and effectiveness of the Taliban response – the government sending in helicopters to evacuate the injured and the dead.

White tents have sprouted up next to each affected village too – a sign international aid was able to get to these far-flung communities against the odds.

But winter is coming, and sickness is starting to spread. In Andarlackhak, we meet Ajeebah. She’s keen to speak to us in private, in the tent she now calls home.

She married at 10 years old and went on to have 10 children. But five of them died in the quake – three-year-old Shabhana, seven-year-old Wali Khan, nine-year-old twins Razimah and Nasreen, and 13-year-old Saleha.

Ajeebah, with her niece Zarmina, 22, daughter Asiya, 8, and son Abdul Raziq, 11
Image:
Ajeebah, with her niece Zarmina, 22, daughter Asiya, 8, and son Abdul Raziq, 11

Their mother is clearly still processing the immense, almost unimaginable loss.

“I don’t want to bury them. What could I do?” she says. “I can’t keep them outside. But I don’t want to put them in a graveyard.”

Outside, dozens of children are playing, many orphaned by the disaster.

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Children, many of whom are orphaned, are living in tents
Image:
Children, many of whom are orphaned, are living in tents

Malnutrition is a major issue in Afghanistan and keeping these children fed will be an overwhelming burden in the months ahead.

With women unable to work under the Taliban and a struggling economy, families were already in dire straits.

Mohammad Salem, who’s 45, has injured his foot. And he’s deeply worried about the months ahead.

“We don’t have anything for winter,” he said. “The snow is coming, and our children are living in tents.

“They’re lying in the dirt. We don’t have any shelter for the future. Everything we had is destroyed.”

Mohammad Salem injured his foot and is deeply worried about the months ahead
Image:
Mohammad Salem injured his foot and is deeply worried about the months ahead

The Taliban forbids physical contact between men and women who are not family members, even in emergencies. That raised fears some women would be left without help.

However, the villagers we spoke to praised the rescue efforts and said female aid workers were able to reach them.

But what hangs over every community in these deep and now scarred valleys is the fear of the hardships to come and the realisation that their communities, their families, have been changed forever.

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