Smoking rates and smoking cessation among individuals with multiple sclerosis

Purpose. Adults with physical disabilities tend to smoke at higher rates than smokers in the general population. No study to date, however, has assessed smoking prevalence and cessation among individuals with multiple sclerosis (MS). Such information is critically needed because smoking is more deleterious for individuals with MS than for smokers without MS and increases MS risk.

Method. Questionnaires were sent to 700 National Multiple Sclerosis Society Rhode Island Chapter members.

Results. Based on a 50% response rate, results demonstrated a 15.2% current smoker prevalence rate, which is lower than USA and Rhode Island general adult population averages. Individuals who smoked, however, tended to be heavy smokers, consuming 20 – 30 cigarettes daily, and had been smoking 10 years or longer. Smokers varied in their interest in quitting but seemed confident in their ability to do so. Respondents reported that it was difficult to quit because smoking was pleasurable; smoking was helpful in coping with boredom and with having MS; withdrawal symptoms were unpleasant; and treatment for tobacco dependence was expensive.

Conclusions. Efficacious smoking cessation interventions for smokers with MS should be developed to address a critical health need for a population of highly nicotine-dependent smokers who face numerous obstacles to quitting.     

The adoption of tobacco dependence treatment by rehabilitation clinicians

Purpose: Individuals with disabilities tend to smoke at rates that surpass those of the general population. The Public Health Service Guideline on the treatment of tobacco dependence suggests that all smokers be screened at every health care visit and counselled regarding how best to quit smoking. We review the literature on the adoption of tobacco dependence treatment by rehabilitation clinicians working with disabled individuals. Despite the deleterious health effects of smoking on individuals with disabilities, the limited data suggests that rehabilitation clinicians rarely encourage their clients who smoke to quit.

Method: Studies were collected using various computerized databases from 1980 to the present. Because of the paucity of literature on tobacco dependence treatment utilization among rehabilitation clinicians, we also examine research on the use of tobacco dependence treatment by health care providers in the general population and in substance abuse treatment settings.

Results: Despite the efficacy of tobacco dependence treatment in smokers with disabilities, tobacco dependence treatment appears to be underutilized by rehabilitation clinicians.

Conclusions: Interventions that have successfully increased adoption by the two other clinician groups should be utilized to increase tobacco dependence treatment provision by rehabilitation clinicians. Additional research is warranted to determine how to overcome obstacles to adoption.     

Validity of physical activity measures in ambulatory individuals with multiple sclerosis

Purpose. The literature suggests that individuals with multiple sclerosis (MS) engage in less physical activity than non-diseased individuals. That conclusion, however, depends upon the validity of scores from measures of physical activity among the MS population. This study evaluated the validity of scores from two self-report surveys, a pedometer, and an accelerometer and during seven days of free-living conditions among individuals with MS.

Method. Participants were 30 individuals (28 females, two males) with an established definite diagnosis of MS. The participants wore a pedometer and a single-axis accelerometer during the waking hours of a 7-day period. After the 7-day period, participants returned to the lab and completed a self-administered physical activity questionnaire and then underwent a 7-day physical activity recall.

Results. There were strong correlations (a) between scores from the two self-report measures of physical activity and (b) between scores from the two objective measures of physical activity, and (c) weaker, but moderate-to-strong correlations between scores from the self-report and objective measures of physical activity.

Conclusion. Our results support the quantification of physical activity among those with MS using validated self-report and objective measures.     

What can we learn from the personal insights of individuals living and coping with multiple sclerosis?

Purpose. The aim of this qualitative study was to explore the personal accounts of individuals with Multiple Sclerosis (MS). Hence the study presents individuals experiences of living with MS to date and the effective self-management strategies employed to cope in day-to-day life.

Methods. Thematic analysis was used to explore the personal narratives of thirteen individuals with MS in two focus group discussions.

Results. Participants in both groups identified similar themes related to the experiences of living and coping with MS. These were: Learning something was wrong (before diagnosis); getting a name (diagnosis); lack of professional support; unchanging family relationships, adjustments to employment circumstances and social life; challenges; successful coping via proactivity, perspective and control (self-management techniques); advice for others, and recommendations as to how services could be improved and developed.

Conclusion. The most salient finding is that there is a need for a formal approach to the management of psychosocial problems and challenges associated with MS. This will require both users and health professionals working together to further the development of clinical guidelines and services for this population.     

Measuring fatigue in people with multiple sclerosis

Objective: To compare methods of assessing fatigue.

Design: Cross sectional.

Setting: Community.

Subjects: Forty Multile Sclerosis (MS) patients and 20 healthy controls.

Main outcome measures: Fatigue questionnaires, SDSA dot cancellation test, finger tapping test, TEA Lottery.

Results: The MS patients had significantly higher levels of fatigue than the controls on the Task Induced Fatigue Scale, Fatigue Severity Scale and Fatigue Impact Scale. The Task Induced Fatigue Scale completed whilst imagining oneself driving and the Fatigue Assessment Instrument did not differentiate between MS patients and controls. Finger tapping differentiated between MS patients and controls but there was no significant difference between MS patients and controls on visual and auditory concentration tests. A factor analysis indicated that questionnaire measures of fatigue were inter-related but independent of objective test performance.

Conclusions: Questionnaire measures can be used to assess fatigue in people with MS. The FSS differentiated MS patients from controls and is relatively short. It was therefore recommended for clinical use.     

Integrated care for MS patients

Purpose. The problem of complex healthcare to MS patients, together with the rising prevalence of MS and escalating costs, has caused healthcare policy makers to consider innovative approaches to controlling costs and improving the quality of care. An integrated care approach may provide a means for better coordination and delivery of care. The aim is to review recent integrated care initiatives and their significance for MS patients.

Method. A literature search was conducted to trace relevant literature on integrated care for MS patients published between 1995 and 2003.

Results. Although integrated care appears to offer potential for eliminating fragmentation and discontinuity in healthcare for MS patients, there are few published studies which have evaluated its implementation with MS patients.

Conclusions. Even though the potential advantages of integrated care are well known, the applicability of this approach for MS patients has still to be demonstrated.     

Performance of activities of daily living in multiple sclerosis

Purpose: To assess the performance of activities of daily living (ADL) in individuals with moderate to severe multiple sclerosis (MS).

Method: A total of 12 men and 32 women with MS (Expanded Disability Status Scale, EDSS, 6.0 - 8.5) were studied. The performance of personal ADL (P-ADL) and instrumental ADL (I-ADL) was assessed with the Functional Independence Measure (FIM) and the Assessment of Motor and Process Skills (AMPS).

Results: Twenty-four of the 44 individuals were rated dependent in P-ADL by the FIM motor score, mainly due to limitations in some areas of self-care and in transfers and locomotion. Only three individuals were rated dependent by the FIM cognitive score, indicating no or little cognitive disability. Two thirds of the individuals who were rated independent/modified independent in P-ADL by the FIM were rated dependent in I-ADL by the AMPS. Only the FIM motor score was significantly related to the EDSS score, indicating that ADL performance and disease severity is weakly related.

Conclusions: Moderate to severe MS reduces the ability to perform both P-ADL and I-ADL. An individual with MS can be independent in P-ADL but still unable to perform I-ADL satisfactorily. Assessments of both P-ADL and I-ADL are advocated to evaluate ADL performance in order to implement appropriate management strategies for individuals with MS.     

Prevalence of low back pain after transfemoral amputation related to physical activity and other prosthesis-related parameters

Background: Although clinical experience indicates that prolonged use of a prosthesis after transfemoral amputation (TFA) is related to a higher incidence of low back pain (LBP), few data are available to substantiate this impression. Therefore, in a TFA population, we investigated the prevalence of LBP and its relationship with years since amputation, as well as the level of daily physical activity and other prosthesis-related parameters.

Method: Questionnaires were sent to 490 subjects with TFA. Of these, 240 questionnaires could be used for analysis.

Results: Trauma and tumours were the most frequent reasons for amputation. The majority of the study group was aged under 30 years at the time of surgery, had been using a prosthesis more than 10 years, and had a moderately active life. Serious LBP (i.e. frequent or permanent LBP) was reported in 26.3% of the participants. No relationship was found between LBP and years since amputation or physical activity.

Conclusion: The data show that the prevalence of LBP in our study group is higher than in the general population, and higher in the female than in the male participants. The initial assumption that there is a higher and increasing length of time since amputation and physical activity level is not confirmed in this study.     

H型高血压患者吸烟与血清同型半胱氨酸的相关性研究

目的 分析H型高血压患者吸烟、戒烟对血清同型半胱氨酸(Hcy)水平的影响,分析吸烟指数、戒烟时间与Hcy水平的相关性.方法 对2018年10月至2019年10月在北京老年医院就诊的高血压患者进行Hcy检测,高血压合并Hcy≥10μmol/L者为H型高血压患者,筛选出H型高血压人群587例.对该人群全部进行调查问卷.分析...     

The social experience of aging with a chronic illness: perspectives of older adults with multiple sclerosis

Purpose. The purpose of this study was to explore the social experiences of older adults with multiple sclerosis (MS) in order to recognize the changes in social experience and social needs that may occur with aging with a chronic illness.

Method. Analysis of qualitative data from an exploratory study utilizing a phenomenological approach with 27 older adults with MS, aged 55 - 81.

Results. In-depth interviews revealed that the social experience was influenced by groups of factors including the person's social needs, experience of MS, values and expectations, characteristics of the social support system, the response of the support providers, and the accessibility of the social environment. The participants discussed concerns about the future adequacy of support. A process of negotiation was also described and was seen as an opportunity to change the social experience and social support received.

Conclusion. This study provides an insider's view of the social changes that older adults living with MS experience. This study also identifies barriers to the acquisition of support and addresses the importance of appropriately responding to the changing needs of this population.     

Characteristics of disability pensioners returning to work: an interview study among individuals with musculoskeletal disorders

Purpose. To explore adaptation patterns among disability pensioners with musculoskeletal disorders returning to work by means of the Swedish law on 'resting disability pension'.

Method. Qualitative analyses of interviews with 17 individuals going back to work.

Results. Three adaptation patterns were identified: The Go-getter, the Realist and the Indifferent. These differed regarding influence factors, own expectations, motive, morals and mentality.

Conclusion. Several actors may support a return to work for individuals who received a disability pension due to musculoskeletal disorders. In order to succeed, however, it is essential that the disability pensioner is motivated for a reconstruction of his/her life.     

Perceptions of persons with multiple sclerosis on cognitive changes and their impact on daily life

Purpose. Cognitive changes occur in over 50% of persons diagnosed with multiple sclerosis (MS). Although previous research has provided information of the nature and severity of cognitive changes among persons with MS, it has offered relatively limited insight on the impact of these changes on levels of functioning and disability. The purpose of this study was to explore the impact of cognitive changes on the lives of four individuals with MS with different life roles (worker, parent, retired older adult).

Method. Qualitative methodologies were used in the study and included multiple open-ended interviews with the study participants and the completion of Cognitive Experience Forms in between interviews. In addition, the Perceived Deficits Questionnaire and a demographics form were administered. Thematic analysis was used to analyse the study data.

Results. Participants described the types of cognitive changes they are experiencing and how these changes affect their ability to participate and engage in desired activities and maintain their primary roles. Participants also talked about how cognitive changes affect their quality of life.

Conclusions. This study points to the complexity of cognitive changes and highlight the importance of addressing these changes in rehabilitation.     

Psychological adjustment to lower limb amputation amongst prosthesis users

Purpose. Clinical reports indicate that many lower limb amputees experience problems with psychological adjustment. Although depressive responses to amputation have been well investigated, there has been insufficient attention to other aspects of adjustment. This study aimed to determine the prevalence of psychological morbidity in an amputee population and identify variables associated with increased distress. Particular attention was given to cognitive models of emotion which postulate a key role for self-consciousness and appearance-related beliefs.

Method. A cross-sectional survey of 67 adult lower limb prosthesis users who had experienced amputation within the last five years. Outcome measures were the Psychosocial Adjustment Scale of the Trinity Amputation and Prosthesis Experience Scales, the Hospital Anxiety and Depression Scale, the Self Consciousness Scale and the Appearance Schemas Inventory.

Results. Using conservative cut-off scores the prevalence of anxiety and depression was 29.9 and 13.4%, respectively. Appearance-related beliefs were associated with both distress and psychosocial adjustment difficulties. Public but not private self-consciousness was associated with distress and psychosocial adjustment difficulties.

Conclusions. Clinicians need to monitor amputees for distress over a longer time period than the initial post-operative phase. It is particularly important to assess for anxiety. Interventions that target appearance-related beliefs may be of benefit to this population.     

Depression in adults with disabilities, in primary care

Purpose: This research was designed to answer the question: Does the prevalence of depression differ between adults with and without disability, in the same family medicine practice?

Method: A retrospective cohort design was used, to study depression among adults, with and without primary disabling conditions, receiving primary care in either a university based urban or rural family practice setting.

Results: When we compared individuals with disability to those without disability, and controlled for individual characteristics, the relative risk for depression was significantly lower for individuals with autism (Relative Risk (RR) 0.20: 95% Confidence Interval (CI) 0.05 - 0.55), cerebral palsy with mental retardation (RR 0.40: 95% CI: 0.24 - 0.65), and MR (RR 0.56: 95% CI: 0.39 - 0.77). The risk for depression was significantly higher for those with cerebral vascular accidents/stroke (RR 2.18: 95% CI: 1.72 - 3.76) and traumatic brain injury (RR 2.55: 95% CI: 1.72 - 2.77). The earliest onset of depression was among individuals with traumatic disabilities and mild mental retardation. Our estimate of depression prevalence for the non-disabled and disabled primary care patients was 22.8% and 24.9% respectively, when patients with disabilities were grouped together (p = 0.008).

Conclusion: It is important for physicians to recognize the higher prevalence of depression among patients with adult onset disabilities (e.g. stroke, traumatic brain injury). In addition, they should be aware of lower prevalence of depression among many individuals with lifelong disabilities, such as mental retardation, cerebral palsy, and autism.     

Use of complementary and alternative medicine practitioners by people with physical disabilities: estimates from a National US Survey

Purpose. To estimate the prevalence of complementary and alternative medicine (CAM) practitioner use, assess the reasons for use, and determine the symptoms for which CAM practitioners were consulted in a national US sample of insured adults with physical disabilities.

Methods. Data for this study come from a longitudinal survey conducted in 2000 and 2001 on a national sample of 830 adults with health insurance who had one of four disabling conditions: multiple sclerosis, cerebral palsy, spinal cord injury, and arthritis. Estimates of annual prevalence and reasons and symptoms for which CAM practitioners were consulted are derived from cross-sectional analysis of the 2001 survey data. Prior use of CAM was assessed using the 2000 survey.

Results. CAM practitioners were consulted by 19% of the sample, a rate similar to, or higher than the general population. CAM use was more prevalent among women than men (24 vs. 10%), in the Western US (30%) compared to the Midwest (20%) Northeast (14%), and South (10%) and among prior users (62%) compared to non-users (8%). There were no significant differences in CAM use by condition, although individuals with spinal cord injury reported the lowest use (14%). Common symptoms treated were pain (80%), decreased functioning (43%), and lack of energy (24%). Common reasons for using CAM practitioners included lifestyle choice (67%) and because they are perceived to be more effective than conventional medicine (44%).

Conclusions. Evidence from the current survey suggests that a significant proportion of people with physical disabilities consult CAM practitioners. Many of those who use CAM do so because it fits their lifestyle and because they perceive it to be more effective than conventional medicine for treating common symptoms including pain and decreased functioning.     

Lower quit rates among African American and Latino menthol cigarette smokers at a tobacco treatment clinic

Background: Lower rates of smoking cessation and higher rates of lung cancer in African American (AA) smokers may be linked to their preference for mentholated cigarettes. Aim: This study assessed the relationship between menthol smoking, race/ethnicity and smoking cessation among a diverse cohort of 1688 patients attending a specialist smoking cessation service. Results: 46% of the patients smoked mentholated cigarettes, but significantly more AA (81%) and Latino (66%) patients than Whites (32%) smoked menthols. AA and Latino menthol smokers smoked significantly fewer cigarettes per day (CPD) than non‐menthol smokers (15.7 vs. 20.3, for AA, and 17.0 vs. 22.1, for Latinos), with no differences among White menthol and non‐menthol smokers. At 4‐week follow up, AA, Latino and White non‐menthol smokers had similar quit rates (54%, 50% and 50% respectively). In contrast, among menthol smokers, AAs and Latinos had lower quit rates (30% and 23% respectively) compared with Whites (43%, p < 0.001). AA and Latino menthol smokers had significantly lower odds of quitting [odds ratio (OR) = 0.34; 95% CI = 0.17, 0.69 for AA, and OR = 0.32; 95% CI = 0.16, 0.62 for Latinos] than their non‐menthol counterparts. At 6‐month follow up, a similar trend was observed for the race/ethnicity subgroups, with AA menthol smokers having half the odds of being abstinent compared with AA non‐menthol smokers (OR = 0.48; 95% CI = 0.25, 0.9). Conclusions: Despite smoking fewer CPD, AA and Latino menthol smokers experience reduced success in quitting as compared with non‐menthol smokers within the same ethnic/racial groups.     

Caregiver strain and factors associated with caregiver self-efficacy and quality of life in a community cohort with multiple sclerosis

Purpose. To describe the level of caregiver strain and factors associated with caregiver self-efficacy and quality of life (QoL) in a community cohort with multiple sclerosis (MS).

Method. A cross-sectional survey of 62 informal caregivers and 101 participants with confirmed MS and quantified physical and cognitive disability recruited from a tertiary hospital MS database. Structured interviews conducted at home using standardized assessments to measure: (i) Caregiver strain and subjective burden of care; (ii) participant with MS and caregiver QoL and self-efficacy; and (iii) participant with MS level of depression, anxiety and stress.

Results. The mean caregiver age was 54 years (range 37 - 62). The mean caregiver strain score was 5.63 (SD 3.63). Twenty-six of 62 (42%) caregivers reported strain for items such as emotional adjustments, demands on time, change in personal plan and disrupted sleep. Caregiver burden was higher in those caring for the more severely affected persons with MS, especially those with higher depression, anxiety and stress levels. The caregiver strain correlated with a lower QoL in both the person with MS and their caregiver, but not with their self-efficacy scores.

Conclusion. Caregivers of persons with MS reporting high levels of caregiver strain experienced a lower QoL and were caring for persons with MS with a lower QoL and higher levels of depression and anxiety. Interventions to reduce caregiver strain and burden in those at risk are necessary to reduce poor outcomes among both caregivers and care recipients with MS.     

The media exchange

OVER THEIR DEAD BODIES, by Thomas Mann and Janet Creme, Brattleboro, Vermont: The Stephen Crecne Press, 1962, hardbound, $5.95. ISBN 0-8289-001 7-5. Reviewed by Sandra L Bertman, University of Massachusetts Medical School.

THE JEWISH WAY IN DEATH AND MOURNING, by Maurice Lamm, New York: Jonathan David Publishers, 1969 (rev. ed., 1972), + 285 pages, hardbound, $6.95; paperbound, $3.95, ISBN 0-8246-0041-X hardbound; 0-8246-01 26-2 softbound. Reviewed by Paul K. Chafetz, Department of Clinical Psychology, University of Florida.

DYING AND DEATH: A Clinical Guide for Caregivers, edited by David Barton, M.D. Baltimore: Williams & Wilkins, 1977, 256 pages, soft cover, $14.95, ISBN 0-683-00440-9. Reviewed by Ruth Reko. Continuing Care Unit, Lutheran Medical Center, St. Louis.

YOU CANNOT DIE, by Ian Currie, Toronto: Methuen, 1978,288 pages, $9.95. hardbound, ISBN 0458-95750-0. Reviewed by Richard Lonetto. University of Guelph

Audiovisual Reviews: COMING TO TERMS WITH LOSS A SERIES OF INTERVIEWS

DEATH NOTIFICATION, Film, 23 min, color (rental $65/dc $395). Harper & Row Publishing Company. 2350 Via Avenue, Hagerstown, MD 21740. Reviewed by J. Eugene Knotr, Ph.D., Department of Human Development, Counseling, and Family Studies, University of Rhode Island

AFTER OUR BABY DIED, Film, 20 min, color (rental-free loan by Modem Talking Pictures Service, Inc., 2323 New Hyde Park Road, New Hyde Park, N.Y. 11042/sale $116 from National Audio Visual Center, Order Department, Washington, D.C. 20409). Reviewed by Andrea Parkus Patenuude, Ph.D., Staff Psychologist, Children's Hospital Medical Center, Boston, MA 021 15.

THE SYNDROME OF ORDINARY GRIEF, VC. 32 min, color (rental $50/sale $150). Videotape Library of Clinical Psychiatric Syndromes. University of Texas Medical Branch, Galveston, TX 77550. Reviewed by Joanne T. Jozefowski, R.N., Ph.D., Director, Thanatology Resource Center of Massachusetts, Worcester.

THE LIFE THAT'S LEFT, Film and VC, 29 min, color (rental $25/sale: film $S75, VC $225). Great Plains National Insauctional Television Library, Box 80669, Lincoln, NE 68501. Reviewed by Michael A. Simpson, M.D., B.S., M.R.C., Psychiatry, D.P.M. Associate Professor of Psychiatry, Temple University, Philadelphia; Convener, International Task Force on Death and Dying.     

Experiencing the loss of mobility: perspectives of older adults with MS

Purpose : The purpose of this study was to develop an understanding the experience and meaning of mobility loss among older adults with multiple sclerosis (MS). This work is part of a larger study on the health concerns and service needs of older adults with MS.

Methods : Twenty-seven people with MS (mean age = 62 years, range = 55 - 82) were interviewed using a phenomenological approach.

Results : Thematic analysis found that three factors contributed to participants' experience of mobility as a person with MS: reality of having MS, mobility needs, and contextual factors. Participants discussed how the reality of MS meant variability in their ability to get around and the importance of trying to remain in control over their mobility experiences. The experience of mobility lead participants to mourn losses, take action, and contemplate their futures. They expressed concerns about the continual declines in their mobility, losing independence, becoming a burden on caregivers, and the potential for having to move into a nursing home.

Conclusions : Findings provide insight into the experience of mobility loss among older adults with MS, and point to potential strategies that can be used to help people cope with and adapt to these losses.     

Rationale and design of a clinical trial investigating resistance training as an aid to smoking cessation in persons with multiple sclerosis

Cigarette smoking is the leading preventable cause of death and disease among adults, and there is evidence that smokers with multiple sclerosis (MS) are at an increased risk for accelerated disease conversion and progression toward disability. Recent research has shown resistance training (i.e., weight training) to be beneficial for smoking cessation in the general population; however, no study has examined the use of resistance training as an aid to cessation in those with MS. Methods: After receiving brief smoking cessation counseling and the nicotine patch, smokers with relapsing-remitting MS will be randomized into a Resistance Training (RT) or Contact Control (CC) group. Participants in the RT group will attend a 60-minute resistance training session twice weekly for eight weeks, while participants in the CC will attend a 30-minute health education control session twice weekly for eight weeks. Measurements will be taken at baseline, weekly during the intervention, at the end of the eight-week study period, and at a one-month follow-up. The primary outcome will be smoking cessation, indicated by a 7-day abstinence, and verified by biochemical assay (i.e., carbon monoxide breath test). Secondary outcomes will include other smoking-related variables (e.g., nicotine withdrawal symptoms), multiple sclerosis-related factors (e.g., fatigue), and physical assessments (e.g., muscular strength). Discussion: The results from this study will lay the foundation for subsequent tests of the intervention in smokers with MS, with the long-term goal of providing specific recommendations and guidelines for smoking cessation that can be integrated into the clinical care of persons with MS.