Psychosocial stress of dermatology inpatients and their relatives - Comparison of patients with and without cancer.

BACKGROUND: In the clinical treatment pathways of certified oncological centers, psychotherapeutic services are mandatory. Although patients with somatic, non-oncological illnesses show an equally high prevalence of psychosocial stress, these guidelines do not exist for the general hospital sector. Are these patients really less burdened and is psychological support only needed in individual cases? The example of dermatological patients will be used to show whether the need for psychosocial care and the desire for support vary between individuals with and without malignant disease. PATIENTS AND METHODS: Using the Hornheider screening instrument and distress thermometer, 216 dermatological inpatients assessed their psychosocial stress and that of a close relative. In addition, they were asked about their desire for support and preferred support provider. RESULTS: i) Patients without skin cancer were more frequently and more severely distressed than cancer patients. ii) Patients of both groups assessed their relatives to be approximately equally distressed. Compared with their own distress, cancer patients assessed their relatives as more frequently and on average more severely distressed. More than 50 % of all patients regarded their own disease as the cause of their relatives' distress. iii) The desire for support in both groups was about 18 %. iv) Doctors and psychologists were usually named as potential contact persons. CONCLUSIONS: The expansion of psychosocial support services for non-tumor patients and their relatives seems necessary. The establishment of appropriate screening methods should be considered. Further studies in other clinical areas are required.

Intention to change smoking in pregnant and postpartum women according to number of pregnancies.

BACKGROUND: The status of a pregnant woman might add to the motivation to stop smoking. However, little is known about whether women who are pregnant for the first time (primigravidae) show a motivation to quit smoking that is different from women who are pregnant at least the second time (multigravidae). The goal of the current study was to compare smoking status, urge to smoke and intention to change smoking behaviour of primigravidae and multigravidae. We hypothesized that amongst primigravidae there are less current smokers, that the smokers consume less cigarettes per day, have less urge to smoke and that more stop smoking after delivery when compared with multigravidae. METHODS: Among 642 women postpartum who had smoked before pregnancy smoking status, the Fagerström Test for Nicotine Dependence and intention to change smoking behaviour were assessed. The data were analysed with the Chi-square test, Mann-Whitney's U-test and the Sign-test. RESULTS: Primigravidae smoked less cigarettes (P < 0.01) and showed less urge to smoke (P < 0.05) than multigravidae. They did not differ according to the intention to change smoking behaviour (P > 0.05). CONCLUSION: Experience of first pregnancy does not seem to automatically induce more smoking cessation compared to multigravidae. Prevention measures are needed for primigravida women and multigravida women to the same extent.

Smoking during pregnancy and postpartum: smoking rates and intention to quit smoking or resume after pregnancy.

BACKGROUND: A substantial number of women smoke while pregnant. The majority of those who quit return to smoking within 12 months. The aim of this study is to estimate smoking rates and to measure the urge to smoke and the motivation to change smoking behavior among women who recently delivered. METHODS: Data presented stem from two studies. Study 1 is an epidemiological survey investigating the health of neonates. Study 2 presents screening data of an efficacy trial for a smoking cessation and relapse prevention intervention. Participants were recruited on maternity wards within 7 days after delivery. RESULTS: Five hundred fifty-three (29.1%) women were never smokers, 145 (7.6%) were former smokers, 492 (25.9%) abstained during pregnancy, and 712 (37.4%) smoked throughout pregnancy. Of the smokers, 69% did not intend to quit smoking within the next 6 months. Of the women who quit during pregnancy, 80% did not want to resume smoking within the next 6 months or after weaning. CONCLUSIONS: Smoking and relapse rates indicate a need for increased efforts to reduce smoking during pregnancy and postpartum. Reported intention to quit or resume does not reflect the high number of relapses. Indicators for relapse need to be found.

Adherence to the principles of Motivational Interviewing, clients' characteristics and behavior outcome in a smoking cessation and relapse prevention trial in women postpartum.

OBJECTIVES: 1. Quantitative description of the adherence to the principles of Motivational Interviewing (MI) in smoking counseling sessions, 2. Examination of the relation between clients' characteristics and the adherence to the principles of MI, and between adherence to the principles of MI and future smoking status. METHODS: A sample of n=163 sessions conducted during a randomized controlled trial in testing the effectiveness of a population-based smoking intervention in women postpartum was investigated. Demographic and behavior-related variables were included in a logistic regression to predict adherence to MI. Adherence was measured using the Motivational Interviewing Treatment Integrity (MITI) scale. RESULTS: Of the sessions, 49.4% showed good adherence to MI. The OR of receiving a good MI session was 3.1 for non-smokers in comparison to daily smokers. No other demographic or behavioral variable gained statistical significance. The relation between adherence and intervention outcome after 6 months was statistically significant (chi(2)=6.459, p<0.05). CONCLUSIONS: This intervention study shows a satisfactory degree of adherence to and the effectiveness of MI. MI-adherence seems more likely in sessions concerned with smoking relapse prevention compared to smoking cessation sessions.

Postpartum return to smoking: identifying different groups to tailor interventions.

OBJECTIVE: (a) To describe a population-based sample of women postpartum who smoked before pregnancy on grounds of the perceived advantages and disadvantages of nonsmoking and the self-efficacy not to smoke. (b) To identify grouping characteristics that can differentiate among those women. This could lead to the development of intervention strategies that are of different efficacy depending on the cluster the woman is member of. SAMPLE: A population-based sample of 317 women who had smoked at the beginning of pregnancy and who were smoke-free at the time of giving birth. DATA: Data about the acquisition stages of change to restart smoking, the perceived advantages of nonsmoking and the self-efficacy to remain smoke free on grounds of the Transtheoretical Model of Behavior Change was assessed. Smoking status was assessed 12 months later. STATISTICAL ANALYSIS: A cluster analysis was used to identify different groups; a logistic regression was calculated to assure the external validity of the clusters identified. RESULTS: The acquisition stages of change do not fit the situation of nonsmoking women postpartum in Germany, but four different clusters of ex-smoking women postpartum were identified on grounds of the other TTM-constructs. These are: the protected, the high risk, the premature and the ambivalent group. The clusters are associated with relapse after 12 months, none of the other variables controlled for was statistically significant. CONCLUSIONS: The TTM contributes to a better understanding of nonsmoking women postpartum. Further studies have to replicate the clusters found and have to find whether interventions tailored to these clusters are more effective in preventing relapse than other interventions.

Midwives' attitudes to counselling women about their smoking behaviour during pregnancy and postpartum.

OBJECTIVE: to investigate the attitudes of midwives to counselling women about their smoking behaviour during pregnancy and postpartum. DESIGN: survey using postal questionnaires. SETTING: the entire federal state of Mecklenburg-West-Pomerania in Germany. PARTICIPANTS: 189 midwives constituting 77% of all midwives working in that State. FINDINGS: midwives reported that they assessed smoking behaviour regularly (77%), addressed the consequences of smoking (70%) and advised women to quit. Among the midwives, 81% saw low chances of success and parents' expectations as the biggest barriers to counselling. Midwives reported that about 28% of women quit following their advice. KEY CONCLUSIONS: smoking and exposure to environmental tobacco smoke are seen as prominent health threats that midwives reported they addressed routinely, including giving advice to stop smoking. IMPLICATIONS FOR PRACTICE: midwives should be supported in learning effective intervention strategies to further strengthen their work. They are a target population to deliver brief smoking interventions.

Population-based smoking cessation in women post partum: adherence to motivational interviewing in relation to client characteristics and behavioural outcomes.

AIMS: quantitative description of adherence to motivational interviewing (MI) in smoking cessation sessions; and examination of the relationships between client characteristics and adherence to MI, and between adherence to MI and future smoking status. METHODS: 84 sessions were conducted during a randomised controlled trial to test the effectiveness of a population-based smoking intervention in women during the postpartum period. Demographic and behaviour-related variables were included in a logistic regression to predict adherence to MI. MEASUREMENTS: adherence was measured using the MI Treatment Integrity Scale. FINDINGS: 38.1% of sessions showed good adherence to MI. Receiving a good MI session was not related to any demographic or behavioural variables. The relationship between adherence and intervention outcome after six months was not statistically significant (chi(2)=0.355, p=0.551). CONCLUSIONS: the smoking cessation sessions examined in this study failed to adhere to MI. There was no relationship between adherence to MI and behavioural outcome six months after the intervention, indicating that women who smoke post partum may be a high-risk group for whom specific smoking cessation interventions need to be developed.

Smoking cessation counselling for pregnant and postpartum women among midwives, gynaecologists and paediatricians in Germany.

The incorporation of guidelines for the treatment of tobacco smoking into routine care requires positive attitudes, counselling skills and knowledge about additional help available for smokers. The study assesses performance of smoking cessation intervention, attitudes, training status and knowledge about additional help for smokers in the care for pregnant and parenting women by midwives, gynaecologists and paediatricians. A survey of all midwives, gynaecologists and paediatricians registered for primary medical care in the federal state Saarland, Germany, was conducted. Participation in the postal questionnaires was 85 %. Depending on profession, 90 % to 100 % see smoking cessation counselling as their assignment, 17 % to 80 % screen for, 48 % to 90 % document smoking status, and 55 % to 76 % offer brief or extensive counselling. 61 % to 87 % consider training to enhance their knowledge and/or counselling skills necessary. The compliance of providers with the necessity to give support in smoking cessation is very high. However, the current status of cessation counselling does not sufficiently correspond to the evidence based requirements. Reports in medical press and advanced training courses should support health care providers and establish smoking as an inherent topic of the anamnesis and treatment of current and former pregnant or parenting smokers.

Smoking cessation and relapse prevention for postpartum women: results from a randomized controlled trial at 6, 12, 18 and 24 months.

AIM: To test the efficacy of an aid to cessation/relapse prevention intervention for women postpartum. METHOD: Two-armed randomized controlled trial. Follow-ups at 6, 12, 18, and 24 months, screenings on maternity wards. Intervention group received face-to-face counseling 40 days postpartum plus telephone counseling calls 4 and 12 weeks later. Control group received usual care plus self-help material for each parent. RESULTS: With regard to smoking cessation, 4 week point prevalence abstinent rates were higher in the treatment group at 6, 12, and 18 months (7% vs. 1%, 7% vs. 2%, and 9% vs. 1%, respectively). Sustained abstinence was higher in the treatment group at 6 months follow-up (3% vs. 0%). No difference was observed with regard to relapse prevention. DISCUSSION: Regarding aid to cessation we observed small effects, regarding relapse prevention no effect. In order to capitalize on the opportunity childbirth poses with regard to smoking, theories on relapse prevention in smoking cessation that guide in designing interventions are needed.

[Cooperation of general practitioners with priority practices for addiction in Mecklenburg-Western Pommerania]. / Die Kooperation niedergelassener Arzte mit den Schwerpunktpraxen "Sucht" in Mecklenburg-Vorpommern.

OBJECTIVE: The nine "priority practices for addiction" in Mecklenburg-Western Pommerania participating in a model project are supposed to take a central and coordinating position within the addiction management. The aims of this study were to investigate a) the extent to which general practitioners are aware of these priority practices, b) the collaboration among general practices and priority practices and c) the predictors which promote cooperation. METHODS: One third of all general practitioners in Mecklenburg-Western Pommerania (n = 330) were randomly sampled. Of these, 250 (75,8 %) practitioners (M = 51 years, SD = 10; 55,6 % female) participated in a 10 minutes telephone interview. RESULTS: About a fourth of the practitioners reported cooperation with "priority practices for addiction". Of all practitioners 53,8 % were not collaborating with these practices or did not know about them. Logistic regressions revealed distance to a priority practices as the only significant predictor which indicated if practitioners referred patients to these priority practices. CONCLUSIONS The concept of this unique project is largely unknown and insufficiently used by practitioners. It should be more strongly communicated within the medical community in order to improve the numbers of referrals. Above that, these specialised practices should be established throughout the country.

An intervention to support postpartum women to quit smoking or remain smoke-free.

Effectiveness studies among pregnant and postpartum women indicate that pregnancy and the postpartum period provide a window of opportunity to promote smoking cessation and smoke-free families. Yet, there is a lack of information about interventions that are portable to routine care. The goal of this article is to describe the structure, basic strategies, and the application of a smoking cessation and relapse prevention intervention for postpartum women in the general population. By using the stages of change concept and motivational interviewing, a classification of current and former smokers is given, and basic strategies and techniques are described to counsel women postpartum with regard to smoking.

Post-partum intention to resume smoking.

Little is known about the motivational background of smoking after a period of nicotine abstinence during pregnancy. The study examines the intention to resume smoking (IRS) in the post-partum period and its predictive value for smoking within 12 months post-partum. In a sample of 301 women recruited from obstetric wards who reported having stopped smoking during pregnancy, data on IRS, sociodemographic variables, recent smoking behaviour and smoking in the social network were collected. Smoking status was assessed 6 and 12 months after pregnancy. Among all formerly smoking women, 39 (13%) intended to resume smoking and 262 (87%) intended to maintain abstinence. Women with IRS returned to smoking more often than women without IRS [77 versus 45%, odds ratio (OR) = 4.1, 95% confidence interval (CI): 1.89-9.05]. In a logistic regression model, IRS (OR = 3.7, 95% CI: 1.51-9.01) and number of months currently abstinent (OR = 0.9, 95% CI: 0.76-0.96) attained statistical significance. IRS proved to be the main predictor for relapse; yet, women with no IRS are at risk to restart smoking again, too. IRS offers a cue for tailoring interventions.