Objective: to determine whether the age and medical condition of a patient influences hospital-based doctors' decision making when advising patients to stop smoking cigarettes. Methods: we presented 142 doctors from four grades (consultant, registrar, senior house officer and house officer) and four specialities (medicine, surgery, psychiatry and anaesthetics), based in a Dublin teaching hospital, with 20 clinical vignettes. Each vignette described a patient from one of five age groups with one of four levels of health. The vignettes were randomly mixed. We asked doctors to say whether they would advise the patient in each case to quit smoking. Results: hospital-based doctors are significantly less likely to advise patients aged over 65 years than younger patients of the hazards of cigarette smoking, irrespective of the person's physical or mental health (P < 0.001). Conclusion: the advice given to patients about their cigarette smoking habits by hospital doctors is strongly influenced not only by the patient's health, but also by the patient's chronological age.

Psychiatric symptoms are common among individuals who live in nursing homes, with prevalence rates ranging from 51 percent to 94 percent. Accordingly, psychotropic medications are widely prescribed in this setting and are the subject of considerable debate and regulation. Current regulations arose from public and governmental concerns that psychiatric medications were being prescribed inappropriately to frail patients. Concern has also been raised about the absence of evidence on which to base prescribing decisions. Nursing homes are slowly being recognized as complex health care settings that warrant considerable research attention. This article explores the origins of the regulation of the use of psychotropic drugs in nursing homes, reviews controlled trials of these drugs in nursing homes, examines the role of these agents in adverse drug events experienced by nursing home residents, and proposes policy and research areas that merit consideration.

H epatitis C (H C V ) is ve ry prevalent am ong injecting drug users (ID U ). Control of this infection poses a m ajor challenge to harm red uction services. Education of all ID U regarding H C V constitutes part of the harm reduction program m e. W e soug h t to assess understanding of H CV am ong ID U attend ing an addiction treatm ent clinic and to identify w hethe r or no t those w ith increased contact w ith he alth professionals dem onstrated better un derstand ing. A total of 105 ID U were interviewed to assess their kno w ledge regarding m ode s of transm ission and ch ronicity of H CV infection. The y had ® rst injected an ave rage of 10.0 ye ars previously. Interviewees were m ore successful at identifying activities w hich carried a risk of H C V transm ission than they were at identifying activities w hich posed no risk of infection. O ve r one -third falsely believe d that one could contract H CV infection eve n w he n injecting`safely'. U nde rstand ing of the long -term nature of H CV infection w as also im paired. A g roup on m ethadonem aintena nce for a m edian period of 1.4 ye ars failed to de m onstrate signi® cantly better know ledge than those attend ing for a 21-day de toxi® cation. Those in frequent contact w ith a G P pe rform ed less well than those w ithout such contact. U nderstanding of H CV am ong ID U is inadequa te and m ust im prove if prim ary preve ntion efforts are to succeed. W e que stion the value of didactic approaches to educating ID U and call for a m ore expe riential teaching style w hich m ay be m ore successful at countering prevalent m isconceptions.

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