Tobacco and Cannabis Use During Pregnancy.

OBJECTIVES: Nicotine (NIC) use during pregnancy can influence markers used in biochemical maternal serum screening. This study was designed to determine prevalence of disclosed tobacco smokers in our patient population and to compare disclosed tobacco smoking status with the presence of serum nicotine and a common tetrahydrocannabinol (THC) metabolite. METHODS: A deidentified dataset of disclosed smoking status for quadruple (Quad) screens was obtained. Residual serum submitted for Quad screens was obtained from frozen storage and analyzed for NIC and THC metabolites. RESULTS: Of specimens that had corresponding responses to the smoking history question on the patient history form, 7.2% (n = 1,783 of 24,611) specified that the patient was a tobacco smoker. Of the 271 specimens biochemically analyzed for NIC and THC metabolites, disclosed tobacco smokers had the highest prevalence of detectable NIC and THC metabolites. THC product use was most prevalent in patients categorized as probable tobacco smokers based on cotinine concentrations, as well as in younger patients. CONCLUSIONS: Prevalence and concentration of NIC and THC metabolites vary based on disclosed tobacco smoker status. Biochemical testing may increase sensitivity for the identification of NIC and THC status over self-reporting.

Balancing Caregiving and Work: Role Conflict and Role Strain Dynamics.

Positing role conflict as a bidirectional construct in which work interferes with caregiving (WIC) and caregiving interferes with work (CIW), this study investigated its antecedents (demands and support of caregiving and work) and consequences (role strain). A national sample of 583 women between the ages of 50 and 64 years identified using random-digit-dial procedures completed a telephone survey. Structural equation modeling revealed that caregiving demands were positively associated with CIW and caregiving burden; instrumental caregiving support reduced CIW and caregiving burden. Work demands were positively associated with WIC, CIW, caregiving burden, and work burden. Emotional workplace support reduced WIC, CIW, and work burden. CIW and WIC were positively associated with caregiving burden; only WIC was positively associated with work burden. Findings suggest that demands and supports related to the caregiving role do not influence work-related role strain; work demands and supports influence role strain experienced from both caregiving and work domains.

Privacy rights in mental health counseling: Constitutional confusion and the voicelessness of third parties in criminal cases.

The past 20 years of criminal law and practice have produced much heat but little light on the issue of when, if ever, the accused in a criminal case can legitimately seek disclosure of a victim's privileged files that exist exclusively in the custody of a private third party. In many jurisdictions, forced disclosure is routine, and victims must choose between justice and privacy, resulting in either the dismissal or underprosecution of serious violence or the victim's opting to forego necessary treatment. This dilemma is disproportionately imposed on women and child victims of sexual violence, and it threatens to prevent healing for a significant percentage of victimized persons. This article outlines the legal and policy interests of third parties in this debate and offers a model set of procedures to protect against needless harm to third parties, while respecting the important rights of the criminally accused.

A new way of reflecting in nursing: the Peshkin Approach.

TITLE: A new way of reflecting in nursing: the Peshkin Approach. AIM: This paper is a report of a new approach to reflection in nursing and demonstrates its positive outcomes for student learning in clinical practice. BACKGROUND: Reflection is a popular educational tool in nursing and most traditional reflective models take an incident as the starting point. We have developed a new approach that focuses on subjective thoughts and feelings. We were inspired by the work of Peshkin and his focus on the 'subjective I'. For this reason, we have termed this new way of reflecting 'The Peshkin Approach'. DATA SOURCES: Eight nursing students kept a reflective diary during a 6-week clinical placement in 2008. The focus was on recording their thoughts and feelings. They analysed the diary entries using a systematic approach. The aim was to identify aspects of their subjectivity influencing them in clinical practice. DISCUSSION: Through analysis of journal entries, the students became aware of the subjective I's that were influencing their experiences. They found the advantages of the approach to be twofold: increased self-awareness and enhanced learning. CONCLUSION: Maintaining a reflective journal that focuses on subjectivity can enhance the clinical experiences of nursing students. We advocate this new approach as complementary to more traditional forms of reflection and argue for its incorporation into nurse education programmes. In comparison to traditional reflective models that we have used, the Peshkin Approach to Reflection has significant advantages in terms of promoting student learning in clinical practice. We hope the approach can be critiqued and developed further by those interested in enhancing nurse education.

Drug use and risk of bloodborne infections: a survey of female prisoners in British Columbia.

BACKGROUND: Clinicians working in a women's prison in British Columbia observed hepatitis C sero-conversion among inmates, prompting this study to determine: the characteristics of women who do and do not report illicit drug use in prison; patterns of drug use inside prison; factors associated with illicit drug use that might contribute to bloodborne transmission inside prison. METHODS: A cross-sectional observational data set was created using an anonymous 61-item self-administered survey. RESULTS: Eighty-three percent (104/126) of eligible inmates participated. Seventy-four percent (77/104) reported their current prison sentence was related to illicit drug use and 25% (26/104) reported their ethnicity as Aboriginal. Ninety-three percent (97/104) reported a prior history of illicit drug use, of whom 70% (68/97) reported a history of injection drug use. Thirty-six percent (37/104) reported illicit drug use in prison, and 21% (22/104) reported injection drug use in prison. Fifty-two percent (54/104) reported hepatitis C sero-positivity, and 8% (8/104) reported HIV sero-positivity. Of the 22 women who reported prison injection drug use, 91% (20/22) reported hepatitis C infection and 86% (19/22) reported injecting with shared needles inside prison, with or without bleach cleaning. Women were more likely to report illicit drug use in prison if they had had illegal sources of income prior to incarceration (p=0.0081, OR 3.19), had previously injected drugs (p=0.036, OR 2.97), and had first injected drugs at a friend's house (p=0.066, OR 2.70). INTERPRETATION: The majority of women reporting prison injection drug use also reported hepatitis C sero-positivity and shared needle use. Canadian prisons are risk situations for transmission of bloodborne pathogens, and provide opportunities for harm reduction strategies.