Adams and Murphy Table 1 Medical and surgical conditions associated with obesity Category Cardiovascular disease Respiratory disease Endocrine disease Gastrointestinal disease Genitourinary Malignancy Musculoskeletal Examples Sudden (cardiac) death; obesity cardiomyopathy; hypertension; ischaemic heart disease; hyperlipidaemia; cor pulmonale; cerebrovascular disease; peripheral vascular disease; varicose veins; deep-vein thrombosis and pulmonary embolism Restrictive lung disease; obstructive sleep apnoea; obesity hypoventilation syndrome Diabetes mellitus; Cushing's disease; hypothyroidism; infertility Hiatus hernia; gallstones; inguinal hernia Menstrual abnormalities; female urinary incontinence; renal calculi Breast, prostate, colorectal, cervical and endometrial cancer Osteoarthritis of weight-bearing joints, back pain Obese, anaesthetized

The findings from this study suggest that if clinical supervision is effective then community mental heath nurses report lower levels of burnout. Further research is required to determine the long-term benefits of implementing clinical supervision and to determine which other factors have an influence on levels of burnout for this group of nurses. Health service organizations have a responsibility for ensuring that all individual practitioners have access to effective clinical supervision and the Nursing and Midwifery Council could extend the registered nurses personal accountability to include - to seek clinical supervision as and when necessary.

Factors influencing the effectiveness of clinical supervisionClinical supervision is widely accepted as an essential prerequisite for high quality nursing care. This paper reports findings from a study that aims to identify the factors that may influence the effectiveness of clinical supervision for community mental health nurses (CMHNs) in Wales, UK. Two hundred and sixty (32%) CMHNs from an estimated total population of 817 completed the Manchester Clinical Supervision Scale (MCCS) and a demographic questionnaire. The MCCS is a 36-item questionnaire measuring the quality and effectiveness of the supervision received. Three-quarters of CMHNs reported having participated in six or more sessions of supervision in their current posts. Clinical supervision was more positively evaluated where sessions lasted for over one hour, and took place on at least a once-monthly basis. Perceived quality of supervision was also higher for those nurses who had chosen their supervisors, and where sessions took place away from the workplace. These findings have important implications for the organization and delivery of mental health nursing services.

Dupuytren's disease (Dupuytren's contracture) results in progressive and irreversible flexion of the fingers

The mainstream and sidestream smoke of four types of popular US cigarettes were analyzed for toxic and carcinogenic agents. The cigarettes included one without a filter tip, and one filter cigarette each with medium, low and ultra-low smoke yields. The analyses clearly demonstrated that 12 toxic agents determined in this study were significantly reduced in the mainstream smoke of filter cigarettes, as compared with smoke yields from the nonfilter cigarette. In the case of the ultra-low yield cigarette, mainstream smoke emissions were reduced by about 90%. In contrast to this finding, the emissions of the same toxic and carcinogenic components into sidestream smoke of the filter cigarettes were not greatly reduced. Sidestream smoke is the major contributor to environmental tobacco smoke, to which both smokers and non-smokers are exposed. Although the exposure of the smoker to mainstream smoke components is decreased due to proportionally greater consumption of low and ultra-low yield cigarettes, and lower rates of consumption of cigarettes with high smoke yields, the carcinogenic potential of indoor pollutants originating from tobacco products is not diminished.