Three novel colorimetric methods of detecting urinary nicotine metabolites called the barbituric acid, diethylthiobarbituric acid (DETB), and DETB extraction methods were evaluated for use as a simple, cheap, objective test of smoking. Urine samples were collected from 103 male smokers and 78 male non-smokers working at two London factories. The smokers recorded the number of cigarettes smoked over the previous 36 hours. All three methods correctly classified the smokers. The DETB extraction method had a lower false positive rate (averaging 3% on morning and afternoon urine samples) than either the DETB or the barbituric acid method (12% and 6% respectively) and was the best procedure for classifying subjects as "smokers" or "non-smokers." When a quantitative variant of the barbituric acid method was used there was a significant correlation (r = 0.85, p < 0.001) between the ratios of urinary nicotine metabolites to creatinine and the number of cigarettes smoked. The ratios for smokers of 6-15, 16-25, and 26 or more cigarettes, however, overlapped considerably. The methods can be performed very rapidly and the reagent cost is equivalent to less than lp per test.
Chronic bronchitis is a common reason for admitting an old person to hospital. Government statistics measure the impact of admission only in terms of mortality. A follow-up study of disability among the elderly admitted to hospital with an exacerbation of chronic bronchitis is described. One month after discharge about 30% of patients were unable to walk as far on the flat or climb as many steps as they did before admission and 900% were unable to do all previous household chores or social activities. After a further two months, although the proportion of patients unable to do all previous household chores or social activities had decreased significantly the proportion with restricted ambulation or ability to climb stairs had not decreased. The proportion of patients admitting to anxiety or depression and being dissatisfied with their progress also remained high. We conclude that there is a need for graduated rehabilitation programmes, which have been shown to increase the walking distance of elderly bronchitics, to be extended to cover all aspects of disability and for home rehabilitation to become an integral part of the care of all elderly bronchitics discharged from hospital.The natural history of chronic bronchitis is one of increasing episodes of cough, sputum, wheeze, and dyspnoea commonly following chest infections from which the patient takes progressively longer to recover and is left with residual symptoms which become progressively more troublesome.' "Chronic bronchitis and emphysema" is one of the most common conditions with which elderly patients are admitted to hospital. Seventy-five per cent of the patients are admitted as emergencies during an acute exacerbation and 50 % usually have no other serious medical condition.2 The success of such hospital admissions is only measured in government statistics in terms of mortality. Fifty per cent of elderly patients admitted during the acute episode survive to be discharged. However, no statistics are routinely available about the impact which admission to hospital with an acute exacerbation of chronic bronchitis has on the everyday life of elderly patients even though the average length of hospital stay in uncomplicated cases is 24 days.2 We describe a followup study of disability and psychological impairment
Four hundred and twenty nine current smokers and ex-smokers who had provided details 12 years previously completed a self administered questionnaire about their present and past smoking habits, and two weeks later current smokers supplied an empty cigarette packet. The tar group and brand name of the current cigarette given on the questionnaire were compared with details on the packet, and the brand alleged to have been smoked 12 years ago was compared with that actually recorded at that time. Only 55% of "low middle" tar cigarettes as indicated by returned packets had been correctly identified in the questionnaire. The ing brands on health may have to collect information on brands on the basis of recall over a long period because of the time taken for some effects to become apparent. For example, Fletcher et al'8 showed that at least eight years of follow up is needed to distinguish even between smokers and ex-smokers on the basis of lung function tests. Moreover, the validity of information about current cigarettes smoked (type, tar group, or brand name) has never been established, for example, against the details on the packet.In this paper we assess the validity of smokers' information about present and past cigarette brands and discuss the implications of the results for past and future studies of the effects of the falling tar yields of cigarettes on health. MethodThe Heart Disease Prevention Project was a randomised controlled trial of the benefits to middle aged men of mounting a preventive campaign in industry. 19 At the start of the study in 1971-3 a self administered questionnaire was used to obtain data on the type and brand of cigarette smoked from all men employed in the 12 intervention factories and 10% of those in the 12 control factories. The men were asked 203 on 11 April 2019 by guest. Protected by copyright.
SUMMARY In 1971-3 data on smoking habits, cigarette brand smoked, morning phlegm production, and lung function were recorded for factory workers as part of the Heart Disease Prevention Project. These men were reassessed in 1984 and those who had always smoked cigarettes from the same tar group were compared with those who had dropped one tar group (mean decreases of 6-6 mg tar, 0-1 mg nicotine) and two tar groups (mean decreases of 11-9 mg tar, 0 5 mg nicotine). Over the 13 years, men who had dropped one tar group were significantly more likely (p <0O05) to stop producing phlegm, but the effect was less marked for those who had dropped two tar groups. The mean fall in FEV, was similar in all three groups, but 95% confidence limits showed that although dropping one tar group could be associated with at most a saving of 84 ml over the follow up
SUMMARY The method of linear analogue self-assessment (LASA) was used to quantify the views concerning day care which were held by patients attending a geriatric day hospital. The results suggest that day hospitals are an acceptable form of care for the elderly.Although during the past 18 years there has been a steady increase in the number of geriatric day hospitals in the UK, the attitude of the patients to day hospital care has been largely ignored. The few measurements of the success of day hospitals have been objective-such as, ultimate outcome for the patients (Woodford-Williams et al., 1962;Blake, 1968;Brocklehurst, 1970; Millard and Martin, unpublished). To try to find out the patients' views on day hospital care the technique of LASA was introduced at the St David's Day Hospital, Cardiff. Patients and methodsFor this study 15 questions were used covering most aspects of day hospital care (Table 1). For each question a 5 cm or 10 cm line was drawn and the ends of the line were labelled with words descriptive of the extremes of the response. The patient was asked to mark the line at the point most appropriate to her feelings at that moment. The distance in cm along the line to this mark (questions 4, 6-8, 10, 12, 14, 15) or from the centre of the line to mark (questions 1-3, 5, 9, 11, 13) gave a score out of 5. The questions were read to the patients by two lay persons who were not involved in the day hospital but who had extensive experience of interviewing patients. Patients attending the day hospital for the first time were interviewed at the end of the first month after their admission.To assess the reliability of the technique a sample of patients completed the questionnaire with each of the interviewers separately in the same week, and a further sample completed the questionnaire alone and again with an interviewer in the same week. ResultsFifty-one patients were used in the study of whom 19 By answering the following questions you will tell us how beneficial your time at the day hospital has been. To answer each question simply mark the line with an X at the point most near to your present feelings.
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