Prevention of adolescent smoking: A prospective test of three models of intervention

Objective: The onset of smoking in adolescence leads to significant health problems in later life and so adolescent smoking prevention is a crucial concern of health psychology. Yet the evidence on smoking prevention in adolescence is not encouraging. The objective of this study was to examine the relative long‐term efficacy of three specifically focussed prevention strategies (health‐oriented, fitness‐oriented and social skills/stress management‐oriented) directed at the onset of adolescent smoking.

Design: A longitudinal intervention study.

Method: A large sample of adolescents aged 11–17 years was assessed for smoking behaviour and then assigned through group randomization to one of the three intervention programmes listed above. Following intervention, based on four standard classroom sessions, smoking behaviour was then reassessed immediately after intervention. Final follow‐up of smoking behaviour at 12 months after intake yielded completed data for n = 1,694 (62.3%) of the intake cohort. Data on smoking behaviour were then compared both across intervention strategies and with another large “control” cohort of adolescents who had been identically assessed in a previous study by DGB.

Results: Application of a health‐oriented strategy was significantly better than the other two strategies in controlling smoking behaviour immediately following intervention. The intervention strategy emphasizing social skills and stress management in the face of peer pressure to smoke was, however, superior to either the health‐ or fitness‐oriented strategies, or to the “control” group in controlling smoking behaviour at 12‐month follow‐up.

Conclusions: While the health message cannot be dismissed as a focus for adolescent smoking prevention, a strategy that assists young people to resist the effects of peer pressure through social skills and stress management seems to provide the most enduring means of controlling smoking behaviour in adolescence.     

温度干预护理对全麻术后低体温患者的影响

目的探讨全麻恢复期低体温的护理措施,以避免低体温导致的不良反应。方法选择54例择期腹部手术后发生低体温的患者,随机分为对照组和试验组,每组27例。分别监测术前和人麻醉复苏室（PACU）时的体温,记录患者在PACU的复温时间和停留时间。结果温度干预护理后低体温患者复温时间和在PACU停留时间明显缩短。结论加强对PACU患者的体温护理,可缩短患者在PACU的复温时间、停留时间,减少低体温造成的并发症,减轻患者的经济负担。     

If you are pregnant and smoke,admission to hospital may damage your baby's health

Summary

• ? It is recognized that smoking adversely affects the outcome of pregnancy. However, clinical experience suggested that women admitted to hospital during pregnancy smoked more than when they were at home.
• ? Forty-one women who were over 20 weeks pregnant, who smoked and had been in hospital for 2 days or more were interviewed using a structured schedule.
• ? The women had made a significant reduction in their cigarette consumption during pregnancy but on admission to hospital the number of cigarettes smoked had almost returned to the pre-pregnancy level. Boredom was seen as the main factor contributing to this increase.
• ? Strategies for reducing the effects of admission to hospital on smoking behaviour are suggested.

     

Different effects of smoking on atopic and non‐atopic adult‐onset asthma

BackgroundBoth tobacco smoking and atopy increase the risk of adult‐onset asthma. We studied if there are differences in the effects of smoking on the risks of atopic and non‐atopic adult‐onset asthma, and if gender modifies these effects.MethodsThe Finnish Environment and Asthma Study (FEAS) includes 521 incident cases of adult‐onset asthma and 932 population‐based controls, aged 21 to 63 years, recruited from a geographically defined area of Pirkanmaa, South Finland. Asthma was defined based on symptoms and lung function measurements, atopy by IgE antibodies to common aeroallergens and smoking by the study questionnaire.ResultsAltogether 212 cases were atopic, and 251 cases were non‐atopic. Regular smoking increased the risk of atopic asthma (adjusted OR 1.24, 95% CI 0.83–1.85), this effect was seen in women (aOR 1.77, 1.06–2.95) but not in men (aOR 0.75, 0.39–1.45). Among regular smokers, the amount smoked was lowest among women with atopic asthma. Recent quitting of smoking was related to increased risk of both atopic (aOR 4.91, 2.26–10.65) and non‐atopic (aOR 4.37, 1.87–10.21) asthma. Having quitted smoking over a year ago was related to increased risk of non‐atopic asthma (aOR 1.57, 1.08–2.28), mainly in men (aOR 2.03, 1.06–3.88).ConclusionsIn women, rather small amounts of regular smoking increase the risk of atopic asthma. However, for non‐atopic asthma, the smoking induced risk continues for longer after quitting, especially in men. In conclusion, the effects of smoking on the risks of atopic and non‐atopic asthma differ, and gender modifies these effects.     

‘Only ever as a last resort’: Mental health nurses' experiences of restrictive practices

Nurses play a crucial role in the implementation of restrictive practices such as seclusion and restraint. Restrictive practices have been widely recognized as harmful practices and efforts to reduce their use have been in place for several years. While some reductions have been achieved, more information and insight into the perspectives and experiences of front‐line mental health nursing staff is required if further changes are to be realized. Sixty‐five respondents participated in an online survey to investigate Australian mental health nurses' personal experiences and opinions regarding restrictive practices. Analysis revealed restrictive practices as a complex, contested and challenging area of practice. Analysis of data revealed five main ways that restrictive practices were framed by respondents. These were as follows: as a response to fear; to maintain safety for all; a legacy of time and place; the last resort; and, a powerful source of occupational distress. In addition, findings revealed the need to support staff involved in restrictive practices. This need could be satisfied through the implementation of procedures to address post‐restrictive distress at all levels of the organization. Ensuring an optimal work environment that includes appropriate staffing, availability of supportive education and structured routine debriefing of all episodes of restrictive practice is critical in achieving further reductions in seclusion and restraint.     

Smoking Cessation and Chronic Pain: Patient and Pain Medicine Physician Attitudes

Although previous studies suggest that the clinical setting of an interdisciplinary pain treatment program may provide an optimal environment to promote smoking cessation, currently available smoking cessation interventions may be less effective for adults with chronic pain due, in part, to unrecognized clinical factors related to chronic pain. The specific aim of this qualitative study was to solicit information from adult smokers with chronic pain participating in an interdisciplinary pain treatment program regarding their perceptions of how smoking affects pain symptoms, and how these beliefs, cognitions, and emotions may either impede or facilitate smoking cessation. Similar information was solicited from a group of pain specialty physicians. The study involved 18 smokers with chronic pain, and seven physicians. Patients reported that smoking was an important coping strategy for pain and distress, primarily by offering an opportunity for distraction and avoidance, respectively. The majority of patients using opioids reported that opioid consumption stimulated smoking. Important barriers were identified toward making a quit attempt during pain treatment including quitting smoking while making changes in opioid use, and perceived difficulty managing multiple treatment‐related stressors. Several pain‐related benefits of smoking cessation were identified by physicians, but important barriers to providing smoking cessation services were recognized including lack of time and knowledge about how to help patients quit smoking. The findings of this study identified several novel and important clinical factors that should be incorporated into a targeted smoking cessation intervention for adults with chronic pain.     

体外受精-胚胎移植早孕保胎孕妇心理状态调查及护理对策

目的：分析体外受精-胚胎移植（IVF-ET）早孕保胎孕妇的心理状态,提出护理对策。方法采用心理状态90项症状自评量表（SCL -90）调查IVF-ET早孕保胎孕妇的心身症状水平,并对心身症状的频数进行分析。结果 IVF-ET早孕保胎孕妇的焦虑、抑郁、躯体化、敌对、强迫和人际关系敏感得分明显高于国内常模（P＜0．05）。结论 IVF-ET早孕保胎孕妇存在明显的心理问题,需要采取相应的护理措施。     

Psychosocial factors and heavy smoking during pregnancy among parous Scandinavian women

Objective - To analyse how psychosocial and social factors are associated with heavy smoking in the third trimester of pregnancy.

Design - Data were collected from a prospective study primarily initiated to study fetal growth retardation. (NICHD Study of successive small for gestational age births).

Setting - Uppsala in Sweden, Bergen and Trondheim in Norway.

Subjects - Study subjects were 775 para I and II, referred from GPs or maternity wards to the University Hospitals in Uppsala, Bergen and Trondheim. AH women smoked at the time of conception. “Heavy smokers” were defined as women who smoked 15 or more cigarettes per day during the third trimester.

Main outcome measure - Psychosocial factors and potentially associated heavy smoking in the third trimester.

Results - Young women and women without a partner smoked heavily more often than older women and married/cohabitant women. Growing up with just one parent and the experience of a difficult childhood were also significantly associated with heavy smoking before delivery. If the woman's family (except partner) did not approve of the pregnancy, the woman was more often a heavy smoker. the women who smoked heavily in the third trimester had started smoking at an earlier age than the rest of the smokers.

Conclusion - the pregnant woman's previous and present psychosocial conditions are related to her heavy smoking in the third trimester of pregnancy.     

去除主要诱因,预防压疮形成

近年来对压疮的管理有着较大的进展,但是在临床护理中,压疮仍然是一种较常见的并发症。据报道压疮发生率住院患者为3％～6％,昏迷、截瘫患者为24％-48％,住院老年患者10％～25％。其主要原因在于临床护士中还有很多人不能准确识别,正确防护。谢小燕等对护士压疮防治相关知识现状的调查显示,目前护士对压疮防治相关知识相当缺乏,护士的压疮知识水平和实践亟待改善。     

脉冲式冲管预防化疗药物所致静脉炎的效果观察

目的观察生理盐水脉冲式冲管预防经外周浅静脉留置针输注化疗药物所致静脉炎的效果,以帮助患者顺利度过治疗期。方法选取2012年1月～6月经外周浅静脉留置针输注化疗药物治疗的患者60例,随机分为观察组和对照组,各30例。观察组采用生理盐水脉冲式冲管再常规重力滴注生理盐水冲管。对照组采用直接重力滴注生理盐水冲管。比较两组静脉炎的发生率。结果两组静脉炎的发生率比较有显著性差异(P<0.05),观察组静脉炎的发生率较对照组明显降低。结论生理盐水脉冲式冲管可降低化疗药物所致静脉炎的发生率。     

Do pregnant women who report a reduction in cigarette consumption consume less tobacco?

Objective - To investigate the relationship between changes in self-reported cigarette consumption and changes in serum thiocyanate among pregnant and non-pregnant women who participated in a smoking cessation trial.

Design - Intervention study.

Setting - General practitioners in western Norway.

Subjects - 146 pregnant and 102 non-pregnant women who were daily smokers at inclusion. Self-reported cigarette consumption and serum thiocyanate were recorded at inclusion and after 12 months.

Results - Women who smoked in the first trimester of pregnancy reported 21% less cigarette consumption than non-pregnant women. This was in accordance with the serum thiocyanate values. Twelve months later the mean values of serum thiocyanate had increased irrespective of whether the postpartum women reported that they had reduced, increased, or not changed their cigarette consumption. However, among those who reported that they had stopped smoking, analyses of serum thiocyanate confirmed their statements, with very few exceptions. Among nonpregnant women, the serum thiocyanate changed in accordance with the reported changes in cigarette consumption in all groups.

Conclusion - Women smoking daily in the first trimester of pregnancy had a lower exposure to tobacco than daily smoking non-pregnant women. Twelve months later (six months after delivery) analyses of serum thiocyanate indicated that postpartum women underestimated their tobacco consumption.     

Prevalence of Smokers and Nicotine-addicted Patients in a Suburban Emergency Department

OBJECTIVE: To define the prevalence of smokers and nicotine-addicted patients in a suburban, community ED. METHODS: This was a prospective survey of consecutive ED patients seen in a suburban ED with an annual patient census of 48,000. Medically stable patients aged 18 years or older were eligible for inclusion. Patients were excluded if they had predominantly psychiatric complaints or were critically ill. Patients were queried about their smoking habits by a closed-question survey, which included the previously validated Fagerstrom Test for Nicotine Dependence. The study was conducted during a six-week period, only at times when there were dedicated research associates available to ensure consecutive patient entry. Continuous variables were analyzed by Student's t-tests. Clinical variables were analyzed by chi-square tests. All tests were two-tailed with alpha at 0.05. RESULTS: 1,515 patients comprised the study group. The mean age (+/-SD) was 45.6 (+/-18.9) years; 52% were female, 25% were nonwhite, and 47% were college graduates. There were 317 (21%) smokers. Patients having private physicians were less likely to smoke (18% vs 29%, p = 0.001). Of all smokers, 46% were moderately to severely nicotine-dependent, 69% wanted to quit, and 30% expressed an interest in joining a smoking cessation program. CONCLUSION: A substantial percentage of ED patients smoke, many of them are nicotine-addicted, and the majority would like to quit. Randomized, controlled trials are needed to determine whether interventions by physicians in the ED can have an impact on the smoking habits of these patients.     

边远地区糖尿病患者眼病自我防护知识的调查与对策

目的分析边远地区糖尿病患者对眼病的自我防护情况。方法采用自行设计的问卷、评价表对160例糖尿病患者进行眼病自我防护知识调查。结果56．88％的糖尿病患者合并眼病，38．75％的糖尿病患者为低视力，77．72％糖尿病患者缺乏眼病防治相关知识。结论糖尿病眼病发病率高，对视力影响大，患者缺乏眼病防治知识，急需制定相应的对策，积极防治，加大宣传教育力度，增强患者的自我防护意识。     

应用现代结核病控制策略干预羁押人员肺结核患者效果分析

目的 总结与评价应用现代结核病控制策略在周口市某监狱羁押人员肺结核患者干预效果.方法 在我市某监狱羁押人员中实施现代结核病控制策略干预,对干预后的治疗转归结果进行评价探讨.结果 通过实施现代结核病控制策略干预,周口市某监狱羁押人群中肺结核患病率稳定在(745～889)/10万之间;涂阳肺结核患病率稳定在(366～443)/10万之间;初治涂阳肺结核患者治愈率88％;复治涂阳肺结核患者治愈率81％.结论 通过实施现代结核病控制策略的干预措施,可以有效地控制结核病在羁押人群内的传播.     

神经外科手术体位压疮的预防和对策

神经外科手术精准,手术时间长,患者普遍存在多种发生压疮的危险因素,给手术体位安置带来很大风险。我科致力于解决手术体位压疮的发生,通过系列的预防和对策,减少了神经外科手术患者体位压疮的发生,取得满意效果。     

神经外科手术体位压疮的预防和对策

目的探讨PDCA循环管理在手术患者预防压疮中的应用效果。方法将200例手术在3h及以上的患者随机分为对照组和试验组,各100例。对照组采用常规护理模式实施护理。试验组采用PDCA循环管理方法实施护理。观察两组压疮发生情况。结果试验组压疮发生率低于对照组（P〈0.05）。结论 PDCA循环管理能有效预防手术患者压疮的发生,提高护理质量。     

Angiogenic profile and smoking in the Finnish Genetics of Pre-Eclampsia Consortium (FINNPEC) cohort

Objectives: The biological mechanism by which smoking reduces the risk of pre-eclampsia (PE) is unresolved. We studied serum levels of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF) and their ratio, in addition to soluble endoglin (sEng) in early and late pregnancy to ascertain whether these factors are altered in women who smoke.

Subjects and methods: First trimester serum samples were available from 217 women who later developed PE and 238 women who did not develop PE. Second/third trimester serum samples were available from 174 PE and 54 non-PE women.

Results: PE women who smoked during pregnancy had elevated first trimester concentrations of serum PlGF [geometric mean (95% CI): 39.8 (32.6–48.5) pg/ml, p?=?.001] and reduced sEng concentration [5.0 (4.6–5.6) ng/ml, p?=?.047] compared to PE non-smokers [30.0 (28.1–32.1) pg/ml and 6.1 (5.9–6.4) ng/ml, respectively]. Non-smoking women in the PE group had the highest sFlt-1/PlGF ratio in early and late pregnancy.

Conclusions: The protective effect of smoking in reducing the risk of PE may be due to the early pregnancy change towards pro-angiogenic marker profile. Also, in late pregnancy, smoking exerted effect in sFlt-1/PlGF ratio in PE pregnancies, and may complicate its use as a prognostic and diagnostic marker.

• Key messages

• Smoking appears to have angiogenic effects in early pregnancy with reduced sEng concentrations and elevated PlGF concentrations in both normal and PE pregnancies.

• Throughout pregnancy, smoking exerted effect in PlGF concentration and sFlt-1/PlGF ratio in PE pregnancies, and thus may complicate its use as a prognostic and diagnostic marker.

     

Smoking Habits of Emergency Department Patients: An Opportunity for Disease Prevention

Objective: To determine smoking habits, levels of addiction, readiness to quit, and access to primary care among ED patients.
Methods: A questionnaire was administered prospectively to all non-critical adult patients who presented to one university hospital ED during 23 randomly selected four-hour time blocks; 336 (89%) of 376 eligible patients responded. Self-reported smoking was validated by carbon monoxide breath testing in a pilot sample of 49 patients.
Results: The study patients were mostly young (mean age = 35 ± 15 years), female (59%), white (62%), and high school-educated (73%). Of the 336 ED patients, 41% were current smokers (95% CI = 0.36–0.46); 42% of these were "moderately" to "very highly" dependent on nicotine (Fagerstrom Test for Nicotine Dependence > 4). Of those who smoked, 68% stated they wanted to quit, and 49% wanted to quit within the month. Fifty-six percent of all those who smoked stated that they had never been told to quit smoking by any physician. Thirty-five percent of the ED sample (118 patients) relied upon EDs for most or all of their routine, primary health care; 55% (95% CI = 0.46–0.64) of these patients were current smokers.
Conclusions: The prevalence rates of smoking and nicotine addiction among ED patients are high. Almost half of ED smokers are ready to quit, but most state they have never been told by a physician to do so. Finally, a large proportion of ED smokers receive their primary care in EDs. Therefore, the ED may be an underused setting for smoking cessation intervention.