Supplementation with n-3 fatty acids may improve long-term outcomes of renal transplant recipients (RTR). Recent evidence suggests that EPA and DHA have different outcomes compared with α-linolenic acid (ALA). We examined the prospective associations of EPA–DHA and ALA intakes with graft failure and all-cause mortality in 637 RTR. During 3·1 years (interquartile range 2·7, 3·8) of follow-up, forty-one developed graft failure and sixty-seven died. In age- and sex-adjusted analyses, EPA–DHA and ALA intakes were not associated with graft failure. EPA–DHA intake was not significantly associated with mortality (hazard ratio (HR) 0·79; 95% CI 0·54, 1·15 per 0·1 energy% difference). ALA intake was significantly associated with mortality (HR 1·17; 95% CI 1·04, 1·31 per 0·1 energy% difference). This association remained following adjustments for BMI, proteinuria and intakes of fat, carbohydrate and protein. RTR in the highest tertile of ALA intake exhibited about 2-fold higher mortality risk (HR 2·21; 95% CI 1·23, 3·97) compared with the lowest tertile. In conclusion, ALA intake may be associated with increased mortality in RTR. Future RCT are needed to confirm these results.

Introduction: Spousal support predicts smoking cessation. China is the world's largest consumer of tobacco, with drastic differences in smoking prevalence among men and women. Thus, understanding marital interactions around husbands’ smoking has implications for cultures with similarly large gender disparities in smoking.

Aims: We examined interactions among family members regarding husbands’ smoking in homes with small children in Shanghai.

Methods: In Spring 2013, we conducted in-person semi-structured interviews among 13 male smokers and 17 female nonsmokers recruited from an urban and a suburban community in Shanghai.

Results/Findings: To encourage husbands’ cessation or reduction, some women reported intervening either directly or indirectly through their children, emphasizing the health consequences for the smoker and the family. Some women reported not conversing about cessation due to concern about conflict, tolerance, or resignation. Women reported that their husbands’ responses to anti-smoking messages from family members included promises to quit in the future or noting the strength of the nicotine addiction and the disadvantages of quitting. Men reported the importance of smoking in work/culture and argued against the research about the harms of smoking.

Conclusions: Interventions targeting motivators for cessation among men and to support women in encouraging their husbands’ cessation should be developed.

Hospitalization of nursing home residents can be futile as well as costly, and now evidence indicates that treating nursing home residents in place produces better outcomes for some conditions. We examined facility organizational characteristics that previous research showed are associated with potentially avoidable hospital transfers and with better care quality. Accordingly, we conducted a cross-sectional survey of nursing home directors of care in Vancouver Coastal Health, a large health region in British Columbia. The survey addressed staffing levels and organization, physician access, end-of-life care, and factors influencing facility-to-hospital transfers. Many of the modifiable organizational characteristics associated in the literature with potentially avoidable hospital transfers and better care quality are present in nursing homes in British Columbia. However, their presence is not universal, and some features, especially the organization of physician care and end-of-life planning and services, are particularly lacking.