Recognition of depression in patients who smoke

BACKGROUND. Depression is a common illness in family practice and is frequently missed by busy practitioners. Recent studies have suggested a relationship between smoking and depression in the general population. The purpose of this study is to determine whether a patient's smoking is related to the physician's recognition of a patient's depression. If so, smoking may serve as a cue used by physicians to recognize depression in their clinical decision-making process. METHODS. Adult patients presenting to the University of Oklahoma Family Practice Residency Clinic were screened for depression using the short form of the Beck Depression Inventory (BDI). After each patient visit, upper level residents or fellows completed response cards on which they recorded their assessment of the likelihood of a depression, their familiarity with the patient, and whether they had any knowledge of a depression history. RESULTS. The prevalence of depression as measured by the BDI among smokers (n = 232) and nonsmokers (n = 472) was 24.1% and 15.3%, respectively, a significant difference (P less than .001). Physicians identified depression at a significantly higher rate (75.0%) among depressed smokers than among depressed nonsmokers (48.6%) (P less than .0001). Smokers were 2.06 times as likely to be labeled depressed when controlling for the presence of a current depression, physician knowledge of a depression history, and physician familiarity with the patient (P less than .0001, 95% CI = 1.44,2.94). CONCLUSIONS. Smoking may serve as a cue for the clinician in the recognition of depression. Further research is needed to determine how smoking or a related factor may be used by physicians to correctly identify depression.     

Pediatric counseling and subsequent use of smoke detectors.

Effects of a brief educational and purchase program concerning home fires and smoke detectors by two pediatricians were compared to "routine" counseling without such a program using two groups each of 120 patients of well children. Inspection performed four to six weeks after the office visits showed that of 55 experimental group parents without detectors prior to the program, 26 purchased and 19 installed them correctly. No control group parents did so.     

Hospital nurse productivity

Nurse staffing patterns have come under increased scrutiny as hospital managers attempt to control costs without harming service quality or staff morale. This study presents production function results from a study of nurse output during the period 1997-2000. The results suggest that productivity varies widely among hospitals as a function of staffing patterns, methods of organization, and the degree of reliance on nurse extender (NE) technicians. NEs can enhance the marginal value product of the most educated nurses as the registered nurses (RNs) concentrate their workday around patient care activities. The results suggest that nurse extenders free RNs from the burden of nonnursing tasks.     

Hospital patients who wear tinted spectacles--physical sign of psychoneurosis: a controlled study.

The wearing of tinted spectacles by patients is often said to be a marker of psychopathology but without supportive evidence. To investigate the validity of this observation the personalities of 20 medical hospital patients who wore tinted spectacles were compared, by means of a self-report inventory, with those of 20 controls who were age, sex, and diagnosis matched. There was a significant increase in the level of psychopathology in the tinted spectacle group, both in terms of an index of global psychological distress; the General Severity Index, and nine primary symptom dimensions measured by the inventory.     

Hospital nurse practice environments and outcomes for surgical oncology patients

Objective. To examine the effect of nursing practice environments on outcomes of hospitalized cancer patients undergoing surgery.
Data Sources. Secondary analysis of cancer registry, inpatient claims, administrative and nurse survey data collected in Pennsylvania for 1998–1999.
Study Design. Nurse staffing (patient to nurse ratio), educational preparation (proportion of nurses holding at least a bachelor's degree), and the practice environment (Practice Environment Scale of the Nursing Work Index) were calculated from a survey of nurses and aggregated to the hospital level. Logistic regression models predicted the odds of 30-day mortality, complications, and failure to rescue (death following a complication).
Principal Findings. Unadjusted death, complication, and failure to rescue rates were 3.4, 35.7, and 9.3 percent, respectively. Nurse staffing and educational preparation of registered nurses were significantly associated with patient outcomes. After adjusting for patient and hospital characteristics, patients in hospitals with poor nurse practice environments had significantly increased odds of death (odds ratio, 1.37; 95 percent confidence interval, 1.07–1.76) and of failure to rescue (odds ratio, 1.48; 95 percent confidence interval, 1.07–2.03). Receipt of care in National Cancer Institute-designated cancer centers significantly decreased the odds of death, which can be explained partly by better nurse practice environments.
Conclusions. This study is one of the first to examine the predictive validity of the National Quality Forum's endorsed measure of the nurse practice environment. Improvements in the quality of nurse practice environments could reduce adverse outcomes for hospitalized surgical oncology patients.     

Effects of a restricted work-site smoking policy on employees who smoke.

OBJECTIVES. This study evaluated the biological and subjective consequences observed in individual smokers after implementation of a workplace smoking-restriction policy. METHODS. Employees were evaluated for 4 weeks before and 4 weeks after their workplace became smoke-free (n = 34). A comparison group of smokers whose work-site smoking was unrestricted served as controls (n = 33). Daily exposure to tobacco constituents and withdrawal effects were measured. RESULTS. Smokers at the restricted site had verified smoking reduction (mean = four cigarettes per day) and significantly reduced nicotine and carbon monoxide during the work shift. There were increases in ratings of some common withdrawal symptoms (cravings/urges, concentration difficulties, increased eating, depression). No evidence of compensatory smoking during nonwork hours was found. Overall tobacco exposure, as measured in saliva cotinine, showed a nonsignificant 15% decline. CONCLUSIONS. Workplace smoking restriction markedly altered smoking patterns (i.e., reduced daytime smoking) and reduced cotinine levels to an amount consistent with cigarette reduction. Thus, work-site smoking restriction may promote meaningful, albeit limited, reductions in tobacco exposure and consequent health risks.     

Mothers who smoke: confessions and justifications

Interviews with mothers who smoke were analyzed to examine the influence of social discourses. Women presented themselves as knowledgeable about the health risks of tobacco, confessed guilt and shame, attempted to deflect accusations of neglect for smoking or exposing their children to tobacco, provided rationalization that they smoked for the sake of their children, and, although they were all smokers, demonstrated an antismoking stance. The findings indicate that mothers are in a "bind" when it comes to smoking and fulfilling societal expectations of a good mother. Health professionals must be cognizant of how discourses constrain women's choices in relation to tobacco.     

Two courts rule against inmates who sought counseling

Individuals who are diagnosed with HIV infection often seek counseling to deal with the disease and its complications. Prisoners who receive counseling after a diagnosis of HIV have little recourse if they believe the counseling is insufficient. Two recent court cases resulted in rulings against HIV-infected inmates claiming inadequate counseling. In Harris v. Shuman, the 7th U.S. Circuit Court of Appeals found that adequacy of psychological counseling for an inmate could not be challenged under the Americans with Disabilities Act. In Hetzel v. Swartz, a Federal judge in Pennsylvania found that the constitutional rights of an inmate were not violated when he was denied treatment for depression following his diagnosis of AIDS.     

A cross-sectional study comparing the motivation for smoking cessation in apparently healthy patients who smoke to those who smoke and have ischaemic heart disease, hypertension or diabetes

BACKGROUND: Smoking remains the largest preventable cause of morbidity and mortality in the UK. OBJECTIVES: We aim to compare the motivation to stop smoking of patients with either ischaemic heart disease, hypertension or diabetes (diseased smokers) with apparently healthy smokers (controls), and comment on smoking cessation rates at 18 months following nurse-led active intervention in those who are motivated to stop smoking. METHODS: Questionnaires were sent out to 220 patients in each group. Those patients who had expressed a desire to stop smoking were invited to attend one to one or within a group. RESULTS: In total, 328 questionnaires were returned. Significantly more patients in the diseased group were ex-smokers, 29% versus 18% (P = 0.04), expressed a desire to stop smoking, 45% versus 30% (P = 0.02), and stated that they would like to receive individual support, 38% versus 23% (P = 0.05). Thirty-four patients attended for professional help to stop smoking. At 18 months follow-up, four patients remained not smoking. CONCLUSIONS: The findings in this study suggest that individuals who smoke and have either ischaemic heart disease, hypertension or diabetes may be more motivated to give up smoking and were more receptive to individual support. However smoking cessation rates at 18 months were disappointing.     

In-flight radiation: counseling patients about risk.

BACKGROUND: At the high altitudes, which are the domain of commercial airliners, cosmic-ray exposure rates are hundreds of times greater than at ground level. If this radiation originated at a regulated industrial or medical facility, many frequent flyers would receive annual exposures in excess of the present legal limit applicable to members of the public. For pregnant travelers, the fetus is also at risk, with a sensitivity that varies during the course of pregnancy. METHODS: Health risks from in-flight radiation exposure are analyzed specifically to calculate the likelihood of cancer, birth defects, and genetic damage. A literature review was conducted from 1985 to 1998, using the key words "cosmic radiation," "aviation medicine," "radiation risk," and "in-flight radiation." RESULTS AND CONCLUSIONS: The analysis shows that for the passenger who travels only occasionally, the risks are extremely small. For business frequent flyers the risks are still small, but not negligible.