Uptake of smoking cessation aids by smokers with a mental illness

Psychiatric inpatient settings represent an opportunity to initiate the provision of tobacco cessation care to smokers with a mental illness. This study describes the use of evidence-based smoking cessation aids proactively and universally offered to a population of psychiatric inpatients upon discharge, and explores factors associated with their uptake. Data derived from the conduct of a randomised controlled trial were analysed in terms of the proportion of participants (N = 378) that utilised cessation aids including project delivered telephone smoking cessation counselling and nicotine replacement therapy (NRT), and Quitline support. Factors associated with uptake of cessation aids were explored using multivariable logistic regression analyses. A large proportion of smokers utilised project delivered cessation counselling calls (89 %) and NRT (79 %), while 11 % used the Quitline. The majority accepted more than seven project delivered telephone cessation counselling calls (52 %), and reported NRT use during more than half of their accepted calls (70 %). Older age, higher nicotine dependence, irregular smoking and seeing oneself as a non-smoker were associated with uptake of behavioural cessation aids. Higher nicotine dependence was similarly associated with use of pharmacological aids, as was NRT use whilst an inpatient. Most smokers with a mental illness took up a proactive offer of aids to support their stopping smoking. Consideration by service providers of factors associated with uptake may increase further the proportion of such smokers who use evidence-based cessation aids and consequently quit smoking successfully

The impact of NHS based primary care complementary therapy services on health outcomes and NHS costs: a review of service audits and evaluations

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to review evaluations and audits of primary care complementary therapy services to determine the impact of these services on improving health outcomes and reducing NHS costs. Our intention is to help service users, service providers, clinicians and NHS commissioners make informed decisions about the potential of NHS based complementary therapy services.</p> <p>Methods</p> <p>We searched for published and unpublished studies of NHS based primary care complementary therapy services located in England and Wales from November 2003 to April 2008. We identified the type of information included in each document and extracted comparable data on health outcomes and NHS costs (e.g. prescriptions and GP consultations).</p> <p>Results</p> <p>Twenty-one documents for 14 services met our inclusion criteria. Overall, the quality of the studies was poor, so few conclusions can be made. One controlled and eleven uncontrolled studies using SF36 or MYMOP indicated that primary care complementary therapy services had moderate to strong impact on health status scores. Data on the impact of primary care complementary therapy services on NHS costs were scarcer and inconclusive. One controlled study of a medical osteopathy service found that service users did not decrease their use of NHS resources.</p> <p>Conclusion</p> <p>To improve the quality of evaluations, we urge those evaluating complementary therapy services to use standardised health outcome tools, calculate confidence intervals and collect NHS cost data from GP medical records. Further discussion is needed on ways to standardise the collection and reporting of NHS cost data in primary care complementary therapy services evaluations.</p

Total smoking bans in psychiatric inpatient services: a survey of perceived benefits, barriers and support among staff

Background: The introduction of total smoking bans represents an important step in addressing the smoking and physical health of people with mental illness. Despite evidence indicating the importance of staff support in the successful implementation of smoking bans, limited research has examined levels of staff support prior to the implementation of a ban in psychiatric settings, or factors that are associated with such support. This study aimed to examine the views of psychiatric inpatient hospital staff regarding the perceived benefits of and barriers to implementation of a successful total smoking ban in mental health services. Secondly, to examine the level of support among clinical and non-clinical staff for a total smoking ban. Thirdly, to examine the association between the benefits and barriers perceived by clinicians and their support for a total smoking ban in their unit. Methods: Cross-sectional survey of both clinical and non-clinical staff in a large inpatient psychiatric hospital immediately prior to the implementation of a total smoking ban. Results: Of the 300 staff, 183 (61%) responded. Seventy-three (41%) of total respondents were clinical staff, and 110 (92%) were non-clinical staff. More than two-thirds of staff agreed that a smoking ban would improve their work environment and conditions, help staff to stop smoking and improve patients' physical health. The most prevalent clinician perceived barriers to a successful total smoking ban related to fear of patient aggression (89%) and patient non-compliance (72%). Two thirds (67%) of all staff indicated support for a total smoking ban in mental health facilities generally, and a majority (54%) of clinical staff expressed support for a ban within their unit. Clinical staff who believed a smoking ban would help patients to stop smoking were more likely to support a smoking ban in their unit. Conclusions: There is a clear need to more effectively communicate to staff the evidence that consistently applied smoking bans do not increase patient aggression. There is also a need to communicate the benefits of smoking bans in aiding the delivery of smoking cessation care, and the benefits of both smoking bans and such care in aiding patients to stop smoking

The Earthlike Shoreline Morphology of Titan's Ontario Lacus

Ontario Lacus' shoreline features include Earth-like rivers, deltas and flooded topography. Ontario is a dynamic lake, similar in many ways to terrestrial lakes, with active shoreline processes

The Social Relations Approach, empowerment and women factory workers in Malaysia

This article discusses the empowerment of women factory workers in Malaysia through the lens of Kabeer’s Social Relations Approach. The approach offers an institutional analysis of how gender inequality is produced and calls for the overall terms of exchange and cooperation to be shifted in women’s favour. Its application shows that Malaysian women factory workers face significant challenges, due to the character of institutions, and women’s difficulties in adopting and internalising the notion of ‘empowerment’

Correlations between VIMS and RADAR data over the surface of Titan: Implications for Titan's surface properties

We apply a multivariate statistical method to Titan data acquired by different instruments onboard the Cassini spacecraft. We have searched through Cassini/VIMS hyperspectral cubes, selecting those data with convenient viewing geometry and that overlap with Cassini/RADAR scatterometry footprints with a comparable spatial resolution. We look for correlations between the infrared and microwave ranges the two instruments cover. Where found, the normalized backscatter cross-section obtained from the scatterometer measurement, corrected for incidence angle, and the calibrated antenna temperature measured along with the scatterometry echoes, are combined with the infrared reflectances, with estimated errors, to produce an aggregate data set, that we process using a multivariate classification method to identify homogeneous taxonomic units in the multivariate space of the samples.In medium resolution data (from 20 to 100. km/pixel), sampling relatively large portions of the satellite's surface, we find regional geophysical units matching both the major dark and bright features seen in the optical mosaic. Given the VIMS cubes and RADAR scatterometer passes considered in this work, the largest homogeneous type is associated with the dark equatorial basins, showing similar characteristics as each other on the basis of all the considered parameters.On the other hand, the major bright features seen in these data generally do not show the same characteristics as each other. Xanadu, the largest continental feature, is as bright as the other equatorial bright features, while showing the highest backscattering coefficient of the entire satellite. Tsegihi is very bright at 5 μm but it shows a low backscattering coefficient, so it could have a low roughness on a regional scale and/or a different composition. Another well-defined region, located southwest of Xanadu beyond the Tui Regio, seems to be detached from the surrounding terrains, being bright at 2.69, 2.78 and 5 μm but having a low radar brightness. In this way, other units can be found that show correlations or anti-correlations between the scatterometric response and the spectrophotometric behavior, not evident from the optical remote sensing data. © 2010 Elsevier Inc

Implementing the model of human occupation across a mental health occupational therapy service: communities of practice and a participatory change process

The implementation of evidence-based change in practice settings is complex and far reaching, but only limited research has been undertaken in this area. This participatory action research study investigated the implementation of the Model of Human Occupation (MOHO) across a mental health occupational therapy service. Method: The study involved preparatory workshops and 12 months of team-based, monthly group reflective supervision sessions, facilitated by a colleague from academia, with follow-up contact for a further 12 months. Findings: The main findings emphasise the importance of developing a critical learning space, or 'community of practice', and identify that barriers to theory implementation can be overcome by collective effort with a shared dialectic. The successful development of a community of practice required the careful consideration of a number of interconnected influences, including those of self, peer and facilitator, and contextual and theoretical relationships. Conclusion: The study concluded that the community of practice was central in supporting the effective implementation of MOHO and its associated assessment tools. A key output of the study is a Participatory Change Process, which illustrates the key steps undertaken and interrelated factors affecting theory uptake. The process requires further testing, but has potential to guide theory implementation in other settings. © The College of Occupational Therapists Ltd

Prevalence and Control of Diabetes and Impaired Fasting Glucose in New York City

OBJECTIVE—To determine the prevalence of diabetes and impaired fasting glucose (IFG) and to assess clinical management indicators among adults with diabetes in a representative sample of New York City adults