Participant perspectives of a home-based palliative approach for people with severe multiple sclerosis: A qualitative study.

BACKGROUND: We performed a qualitative study to investigate the experiences of participants in a multicentre randomized controlled trial on a home-based palliative approach (HPA) for adults with severe multiple sclerosis (MS) and their caregivers. Our aim was to explore the strengths and challenges of the intervention, and circumstances that may have influenced its efficacy. METHODS: Participants to the qualitative study were the patients, their caregivers, patient referring physicians, and the teams who delivered the HPA intervention. We performed semi-structured one-on-one interviews with 12 patients and 15 informal caregivers chosen using a maximum variation strategy, two focus group meetings with patient referring physicians (4 participants each), and one with the HPA teams (9 participants). RESULTS: From data analysis (framework method) 38 sub-categories emerged, which were grouped into 10 categories and 3 themes: 'expectations,' 'met and unmet needs', and 'barriers'. Intervention benefits were improved control of symptoms and reduced sense of isolation of the patient-caregiver dyads. Limitations were: factors related to experimental design (difficulty of dyads in identifying examiner and team roles, additional burden for caregivers); team issues (insufficient team building /supervision, competing priorities); limitations of the intervention itself (insufficient length, lack of rehabilitation input); and external factors (resource limitations, under-responsive services/professionals). The referring physician focus groups provided little experiential data. CONCLUSIONS: The HPA reduced patient symptoms and sense of isolation in patients and caregivers. The indirect role of the HPA teams, and insufficient length of the intervention were key limitations. The experimental design imposed additional burdens on the dyads. Key barriers were the paucity of available services, the demanding administrative procedures, and lack of networking facilities. These findings suggest that two major requirements are necessary for home palliative care to be effective in this patient population: HPA teams well-connected with MS rehabilitation services, and care delivered over the long-term, with variable intensity. TRIAL REGISTRATION: Current Controlled Trials ISRCTN73082124 (Registered 19/06/2014).

Efficacy of pins and diplomas as a reward for long-term smoking cessation.

AIMS AND BACKGROUND: Since 2004, the Antismoking Center of the National Cancer Institute of Milan has rewarded those who have been ex-smokers for longer than a year with a "former smoker" pin and a diploma. We investigated firstly whether these rewards contributed to maintain smoking withdrawal, secondly, which one of these was more appreciated and why, and thirdly, how they may have influenced the ex-smokers' perception of smoking and how this was reflected on those surrounding them (i.e., ex-smokers' personal and/or interpersonal areas). METHODS: A multiple-choice questionnaire was developed to investigate how much the rewards were appreciated and their effectiveness in maintaining smoking cessation. Moreover, smokers and non-smokers were asked about the impact of the pin. The questionnaire was completed on the phone by the last 100 ex-smokers who entered the pin and diploma program. RESULTS: All subjects appreciated the rewards, but only a few of them considered them as an aid to maintain long-term smoking cessation. Those who preferred the diploma stated that it represented a contribution to their self-esteem, an official recognition of being an ex-smoker, besides being something to show with pride to others. Those who preferred the pin principally stated it allowed them to be an example to other smokers. Most of the subjects reported that they wore the pin in several circumstances, raising interest and admiration. CONCLUSIONS: Rewarding ex-smokers one year after smoking cessation with a small prize may be a useful practice to improve the doctor-patient relationship, which is vital to maintain smoking cessation, and to boost the awareness of the availability of aids to reach this objective.

[A comparison between indoor air quality before and after the implementation of the smoking ban in public places in Italy]. / Un confronto tra la qualità dell'aria nei luoghi pubblici prima e dopo l'introduzione della legge sull fumo passivo in Italia.

OBJECTIVE: To monitor indoor air quality index in a few Italian hospitality industry venues before and after the implementation of the smoking ban in January 2005. DESIGN: Indoor PM2.5 measurements were carried out in four Milan restaurants during evening hours in the period January-February 2004, and again in January-February 2005, with concurrent outdoor PM2.5 monitoring. The measures were recorded with a portable laser-operated aerosol analyzer with a sampling time of 2 minutes, calibrated by comparison with gravimetric method RESULTS: PM2.5 ranged between 187+/-52 and 709+/-180 mg/m3, and between 24+/-10 e 141+/-28 mg/m3 (p <0.0001) in the years 2004 and 2005, respectively. After the 2005 smoking ban, overall indoor fine particle pollution decreased by values in the range from 81 to 96%. CONCLUSIONS: Within the limits of a small sample, the study showed a good compliance with the smoking ban in the hospitality industry which resulted in a remarkable improvement in air quality index. Smoking ban thus appears to achieve the aims of protecting people from exposure to an unwanted dangerous pollutant such as environmental tobacco smoke.

[Real-time measurement of indoor particulate matter originating from environmental tobacco smoke: a pilot study]. / La misurazione in tempo reale del particolato fine prodotto da fumo di sigaretta negli ambienti indoor: risultati di uno studio pilota.

Short-term measurement of suspended particulate matter has been recently made possible since the release of laser-operating portable instruments. Data of a pilot study of field evaluation of environmental tobacco smoke (ETS) with a portable instrument are reported. We analysed the concentrations of total suspended particle (TSP) and of the fine particles PM10, PM7, PM2.5 and PM1 released indoor from a single cigarette, and their levels inside smoking- and non-smoking-areas of a restaurant. The results indicate that ETS creates high level indoor particulate pollution, with concentrations of PM10 exceeding air quality standards. This kind of field evaluation could allow a more careful assessing of short-term exposure to ETS and its relevance to public health.