Older patients need greater support, fewer interruptions and more sensitive care at mealtimes, according to research published in the October issue of the UK-based Journal of Clinical Nursing.

Researchers from the University of Adelaide, Australia, spent two weeks studying 48 hospital patients and 50 nurses during mealtimes on two medical wards.

They discovered that 58 per cent of the patients, who were aged 65 or over, had problems eating. Just under a third (31 per cent) left more than two-thirds of their meal and only 15 per cent had eaten it all.

More than half of the patients they studied (55 per cent) had problems opening food and about a third found it difficult to use cutlery (36 per cent) and add seasoning (32 per cent).

More than a fifth (23 per cent) were too far away from their food and 18 per cent said their eating position was uncomfortable or they had problems pouring drinks.

Although nurses were good at describing the food and encouraging patients to eat it, practical support was only given to a small percentage of patients. For example only six percent were made more comfortable or helped with cutlery.

Interruptions were also frequent. One in five patients (19 per cent) had a doctor’s visit during mealtimes and more than half (51 per cent) had mealtimes interrupted by other staff, mostly nurses (92 per cent).

Three patients were asked about their bowels while they were eating and four male patients had urine bottles place on the table beside meals.

“Recent research suggests that 40 per cent of older people are malnourished when they are admitted to hospital” says lead researcher Chenfan Xia, who was based at the University at the time of the study - with co-author Professor Helen McCutcheon - and now works in an aged care facility.

“The nutritional status of 60 per cent of all older patients will deteriorate further while they are in hospital, with those who were malnourished in the first place suffering worst. And insufficient food is regarded as a major cause of the problem.

“This is an important issue, especially with a growing elderly population, because poor nutrition and malnourishment is linked to poor health, slow recovery and longer hospital stays.

“However most of the research to date has been carried out in care homes, so little is known about the situation on hospital wards.”

The researchers make a number or recommendations:

–Nutrition should be given a higher priority in ward routines and staff training.

–Food intake needs to be monitored in the same way as urine output and drugs. The study found that monitoring was very patchy and often only covered fluid intake.

–Many patients were put off by large portion sizes and the researchers suggest that serving smaller portions at more regular intervals or providing nutritious drinks between meals are two possible solutions.

– Staff often took their meal breaks at the same time as the patients and these should be rescheduled to enable them to provide more help.

Interruptions such as doctors’ visits should be discouraged during mealtimes and staff should be more sensitive about discussing or highlighting issues such as toileting during meal times.

Lack of support for older patients during mealtimes was also highlighted by a recent Age Concern survey carried out in the UK. The charity found that nine out of ten nurses don’t always have time to help patients who need help with eating and has launched a campaign - Hungry to be Heard - to tackle the issue in UK hospitals.

China attracts interest all over the world. Finns are now exporting their health care expertise to China. A Chinese-Finnish collaboration, the Healthy China project is about the prevention of lifestyle diseases such as adult onset diabetes and cardiovascular diseases.

Lifestyle diseases have become more common in China with the westernisation of diet and increased prevalence of sit-down work.

“The idea behind the Healthy China project is to bring Finnish and Chinese expertise and technologies together,” says technology expert Jaani Heinonen, Chief Representative of Tekes Shanghai. The Finnish coordinators of the project are Tekes and Finpro, and the Chinese partners are Shanghai’s Huashan Hospital, Hudan University and key public authorities.

Healthy China has been underway for a year and a half. “So far we have mainly been assessing Chinese care models and searching for key actors for the project,” says Heinonen.

A future objective is to establish a Finnish-Chinese Centre at the Key Lab of Health Technology of Huashan Hospital. The Centre would be supported by a disease management programme providing an up-to-date overview of the patient’s status. Information technologies specialising in diagnosis, monitoring and risk management could then be incorporated into it - with the EBM Guidelines as a prime example. The Centre would offer a variety of services including foot examinations in diabetic patients, physiotherapy and advice related to physical activity and diet.

“Our ultimate aim is to find a comprehensive business model that enables us to expand the pilot project to other sectors,” says Heinonen. Project plans currently reach 2008, the year in which expansion is planned.

Chinese medicine and Finnish technology

“Finnish health care know-how and tools are unique even on a global scale,” says Heinonen. “There’s a lot of research, and organisations such as the National Public Health Institute and the Finnish Heart Association have done groundbreaking work in disease prevention and health promotion.”

Finland also has many businesses that have developed products related to issues such as health monitoring and disease prevention. Finns have also excelled in functional foods. Says Heinonen, “Integrating traditional Chinese medicine with Finnish technologies is a fascinating new area.”

About TEKES, THE FINNISH FUNDING AGENCY FOR TECHNOLOGY AND INNOVATION

Tekes, the National Technology Agency is the main financing organization for applied and industrial research and development (R&D) in Finland. The funds are awarded from state budget via the Ministry of Trade and Industry. The impact of Tekes activities is felt in Finland as increasing exports, a broader industrial base, more jobs and an improvement in the general welfare of society.

A time-compressed breast cancer treatment being used by the Hollings Cancer Center at the Medical University of South Carolina results in excellent cosmetic outcome for most women undergoing the treatment, said Anthony E. Dragun, M.D., who will be presenting his research findings Nov. 4 at the 48th Annual Scientific Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO) in Philadelphia, Pa.

MUSC began using the innovative therapy called MammoSite breast brachytherapy in 2002 and was one of the first hospitals in the nation to use the technique after its approval by the Food and Drug Administration.

As a result, MUSC has accumulated one of the largest databases of MammoSite patients with some of the longest follow-ups.

Dragun, chief resident in MUSC’s Department of Radiation Oncology, said that MammoSite is used to deliver radiation therapy following a lumpectomy for early-stage breast cancer. A major advantage of MammoSite is that it reduces the time frame for post-surgical radiation therapy from six weeks to just five days.

Surgeons place the MammoSite device in a separate procedure after a lumpectomy. Radiation oncologists then use the device to guide radiation only to that breast tissue, which is the highest risk for cancer recurrence, sparing the remaining breast tissue from further radiation.

The cosmetic issues that normally stem from traditional radiation therapy include painful redness and peeling of the breast skin. However, MammoSite virtually eliminates these complications. Dragun’s study shows that the majority of patients treated with MammoSite have an excellent cosmetic outcome. In his study, Dragun also found that complications resulting in fair to poor cosmetic outcomes have dropped significantly since the device was first introduced.

Dragun’s study, titled “Predictors of Cosmetic Outcome Following MammoSite Breast Brachytherapy,” was chosen from a record-breaking 1,640 abstracts submitted for review to be presented at the ASTRO meeting, which is the largest gathering of radiation oncology specialists in the world. ASTRO is the largest radiation oncology society in the world, with more than 8,500 members who specialize in treating patients with radiation therapy.

Biothera, the immune health company, announced today that it has successfully completed its second Phase I clinical trial for Imprime PGG(TM), its lead compound for activating the body’s own immune system to fight multiple types of cancer.

The randomized, double-blind, placebo-controlled clinical study in healthy volunteers indicates that Imprime PGG is safe and well tolerated over a wide dose range. The results of the study support the continued development of the drug candidate in multiple indications.

The dose-escalation study evaluated safety, pharmacokinetic and pharmacodynamic responses at three dose levels (1, 2 and 4 mg/kg) administered intravenously daily for seven continuous days. This study followed a previous Phase I study in which Imprime PGG administered in single doses was also shown to be safe and well tolerated in healthy volunteers. A total of 36 volunteers participated in the two Phase I studies.

“The consistent results of these studies confirm our expectations and demonstrate that Imprime PGG has a strong safety profile,” said Myra Patchen, Ph.D., Biothera executive vice president of pharmaceutical development. “We are looking forward to now quickly implementing our Phase II clinical program in cancer patients.”

Biothera’s Phase II clinical trial program is scheduled to begin in the fourth quarter of 2006.

“We are encouraged by these clinical findings and confident in the ability of Imprime PGG to work synergistically with monoclonal antibodies to treat numerous types of cancer,” said Daniel Conners, Biothera founder and chairman.

Preclinical research demonstrated that the combination of Imprime PGG and various anti-cancer monoclonal antibodies significantly improved on the effectiveness of antibodies alone as evidenced by reductions in tumor size and increases in survival in multiple types of cancer, including breast, lung and liver cancer.

Nigel Edwards, Director of Policy at the NHS Confederation which represents over 90 per cent of NHS organisations, said:

“The reduction in the number of beds in the NHS is not a new trend. Figures show that the number of beds has fallen by 40 per cent since 1959 because of developments in technology and changes in the way we treat patients not because deficits. High bed numbers do not necessarily mean better patient care. We should judge the NHS on how many people we make better and keep well.

“The Conservatives are quite right to point out that if we are going to continue to see this downward trend in the number of NHS beds, this must be done safely and with adequate provision of health services in the community. We agree that it is very important that bed occupancy rates are kept within the parameters of what is safe to reduce the likelihood of infection for those patients that have to stay in hospital.

”The NHS is doing more than ever before whilst the number of beds is reducing. What we need now is a well-informed debate which is based on evidence of what is best for patients.”

The NHS Confederation represents more than 90% of the organisations that make up the NHS. Its members include the majority of NHS acute trusts, ambulance trusts, foundation trusts, mental health trusts, primary care trusts, special health authorities and strategic health authorities in England; trusts and local health boards in Wales; and health and social service trusts and boards in Northern Ireland.

All types of intravascular devices (IVDs) pose a risk of bloodstream infection to exposed hospitalized adult patients, finds a study published in the September issue of Mayo Clinic Proceedings. What’s more, IVDs have become the leading cause of bloodstream infections in health care settings in the United States and worldwide. An IVD is described as any device that allows access to the bloodstream, but typically a catheter.

As many as 500,000 IVD-related bloodstream infections occur in the United States each year and lead to increased morbidity and prolonged hospital stays, from 10 to 20 days, costing $4,000 to $56,000 per episode. Catheter- or device-related bloodstream infections are widely considered the most preventable class of infections occurring in hospitals.

Authors of the IVD article in Mayo’s medical journal extracted data from 200 prospective studies to examine the risk of IVD-related bloodstream infections associated with each type of IVD. Lead author Dennis Maki, M.D., a researcher and infectious disease and critical care specialist at the University of Wisconsin Hospital and Clinics in Madison, says the findings offer “hard data” that IVDs pose a risk to all recipients.

“We thought this analysis might provide a unique opportunity to wave the flag and convince both health care workers and patients that all types of IVDs pose a risk,” Dr. Maki says. “Clinicians and quality assurance experts need to understand that these risks are significant and are often greater than they might think.”

The use of specialized IVDs for long-term or indefinite vascular access has dramatically increased in recent years in hospital and especially outpatient settings, but attention to reducing incidence of bloodstream infections has focused almost exclusively on patients with short-term central venous catheters in intensive care units, Dr. Maki says. In the last decade, virtually all progress in control of IVD-related bloodstream infections has been restricted to this relatively small fraction of hospitalized patients.

The same strategies need to be implemented on a far wider scale, argue the researchers, to make IVDs safer for all hospitalized patients, as well as outpatients who have IVDs.

Guidelines — such as those published by the Centers for Disease Control’s (CDC) Hospital Infection Control Practices Advisory Committee in 2002 — exist for prevention of IVD-related bloodstream infections and need to be adapted more widely by health care providers to ensure safer IVD use. Reduced bloodstream infections will follow, predicts Dr. Maki.

The article’s authors also urge wider use of novel IVD technologies designed to reduce IVD-related bloodstream infections. In an accompanying editorial, David Snydman, M.D., of Tufts-New England Medical Center, also cites advancing technology as a promising means for reducing IVD-related bloodstream infections.

“Technology holds far more promise for reducing risk than behavioral modification,” Dr. Maki says. “We believe that it holds the greatest promise. In our paper, we point up a number of IVD technologies that have been proven to be effective, but, as yet, inexplicably, aren’t widely used.”

Although consumers may be surprised to learn that all IVDs carry a risk of bloodstream infection, Dr. Maki advises them to become better informed, not alarmed. Vascular access is absolutely essential to today’s health care and in many cases is lifesaving, he says. But if an IVD insertion is scheduled, patients should feel comfortable asking their health care providers what measures will be taken to minimize their risk of bloodstream infection, Dr. Maki says.

The economic cost of HIV/AIDS is far greater than previously estimated, and the cost is even higher for minorities, according to a new study that estimated the direct and indirect costs of the disease. The total lifetime cost of illness for Americans newly diagnosed with HIV in 2002 is approximately $36.4 billion, of which more than 80 percent is related to productivity losses, a cost that most previous studies have omitted. The study also reveals that while the direct costs of antiretroviral therapy may be high, these costs are eventually offset by extended productivity. The research shows that differences in medical care result in dissimilar costs — both direct and indirect — among different racial and ethnic groups.

The study is published on-line in the Journal of Acquired Immune Deficiency Syndromes (JAIDS), ahead of print publication. It is the result of collaboration among researchers at the Centers for Disease Control and Prevention (CDC), the Emory University Center for AIDS Research, and the Andrew Young School of Policy Studies at Georgia State University.

An estimated 40,000 people in the United States become infected with HIV each year. While researchers have previously estimated the economic costs of HIV/AIDS, they have focused primarily on the direct medical expenses of treating the disease. The results up to now have given an incomplete picture of the disease’s economic consequences, according to Angela Blair Hutchinson, PhD, MPH, a health economist at the CDC and lead author of the paper.

“We wanted to assess the economic burden of an HIV infection in the U.S.,” says Dr. Hutchinson, “by examining the impact of stage of disease at diagnosis and access to treatment on the cost of HIV infection and how this might differ by race/ethnicity.”

The research shows that differences in medical care result in dissimilar costs–both direct and indirect Ð for various racial/ethnic groups. “We found that direct costs were lower and productivity losses were higher for minorities,” says Dr. Hutchinson.

Specifically, minorities incur fewer direct medical costs than whites ($160,400 for blacks on average, compared with $180,900 for whites), but suffer greater financial damage from lost productivity ($838,000 for Hispanics and $766,800 for blacks on average, compared with $661,100 for whites).

The differences, according to Hutchinson, reflect disparities in treatment. Minorities are, on average, diagnosed at later stages of the disease than whites. In addition, whites with HIV/AIDS are more likely to receive antiretroviral therapy (ART).

As Dr. Hutchinson notes, “ART is not used universally because it is expensive. Many patients with HIV/AIDS do not have health insurance and/or do not have access to ART.”

Though ART is costly, it has proven very effective at extending lives, and productivity. The researchers found that ART patients have direct medical costs averaging $230,044, with a projected life expectancy of 24.4 years. Patients not receiving ART have direct medical costs of approximately $114,938, with a projected life expectancy of 12.4 years.

The additional years of productivity after being treated with ART mean that the more expensive treatment is actually more cost effective in the long run. “Universal access to treatment would be cost saving,” says Dr. Paul Farnham, a co-author and economist from the Andrew Young School of Policy Studies at Georgia State University, “because it decreases the years of life lost from the illness, and thus lowers productivity losses more than it increases the direct medical costs.”

Besides recommending such universal access, the paper also emphasizes the importance of diagnosing the disease early. As Dr. Hutchinson explains, in order to narrow the treatment divide and expense gap among racial/ethnic groups with HIV/AIDS, “There needs to be a focus on earlier diagnosis, particularly for minorities.”

Cardiologists know that treating depression likely will benefit patients complaining of cardiovascular problems, but lack the guidance to properly diagnose or recommend treatment for depression, according to a report out today from a National Heart, Lung and Blood Institute (NHLBI) Working Group, according to a report from a National Heart, Lung and Blood Institute (NHLBI) Working Group. The paper was published simultaneously in “Annals of Behavioral Medicine” and “Psychosomatic Medicine.”

According to the report, up to 20 percent of patients with heart disease meet the American Psychiatric Association’s criteria for major depression, and identifying better treatments for depression in this population could lead to improved medical, financial and psychosocial outcomes.

“One major aspect of the problem is that cardiologists don’t have a standard assessment to diagnose depression,” said Karina Davidson, Ph.D., chair of the NHLBI Working Group and co-director of the Behavioral Cardiovascular Health and Hypertension Center at Columbia University Medical Center. “It’s important that research in this area move forward so cardiologists can confidently address the issue of depression, knowing that their patients are getting the most appropriate and effective therapy.”

Dr. Davidson pointed out that antidepressant prescription use in heart attack patients is steadily rising, but in the absence of a large clinical trial that would clearly indicate the best way to treat depression in these cases.

There are a number of ways treating depression may impact cardiovascular health. Antidepressants may normalize platelet reactivity, which is implicated in leading to heart attacks. Also, depressed patients tend not to follow medical recommendations, so treating depression may influence them to take prescribed medications or follow other guidance from doctors.

Although depressed patients might be more likely to have cardiovascular risk factors such as increased weight and a sedentary lifestyle, many studies reviewed by the NHLBI Working Group controlled for those factors and still found a relationship between depression and cardiovascular health, meaning the link is independent of those risk factors.

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The NHLBI Working Group included an interdisciplinary team of cardiologists, psychiatrists, epidemiologists and clinical researchers from Columbia University Medical Center, Mount Sinai School of Medicine, University of Pittsburgh School of Medicine, Duke University Medical Center, University of Pennsylvania School of Medicine, University of California San Francisco, Harvard University, and many other major institutions.

Columbia University Medical Center provides international leadership in pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, nurses, dentists, and public health professionals at the College of Physicians & Surgeons, the College of Dental Medicine, the School of Nursing, the Mailman School of Public Health, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions.

Thyroidectomy (removal of the thyroid) has traditionally required multi-day hospitalization. At a minimum, many surgeons advocate overnight observation following this special surgical procedure. While the thyroid is a relatively superficial organ and mortality related are extremely low, its close proximity to other structures has inspired caution out of concern for possible complications, such as laryngeal nerve damage, hemorrhage, and trauma to the upper airway. Although the thyroidectomy can now be performed with minimally invasive approaches, short operative time, and without the need for surgical drains, physicians have continued to guard against complications with inpatient hospital stays.

Some surgeons have actively advocated moving the thyroidectomy from a primarily inpatient surgery toward an outpatient procedure. Despite their efforts, a consensus regarding optimal postoperative management of thyroidectomy patients has not been reached. A new study may shed some light on optimizing practices.

A new study examines a novel approach of careful patient selection coupled with prophylactic calcium supplementation to minimize hospital stays and enable same-day discharge. The authors of “Outpatient Thyroid Surgery is Safe and Desirable” are David J. Terris MD, Brent Moister, Melanie W. Seybt MD, and Christine G. Gourin MD, from the Department of Otolaryngology- Head and Neck Surgery, and Edward Chin MD, from the Department of Medicine (Section of Endocrinology), all at the Medical College of Georgia, Augusta, GA. Their findings are being presented at the 110th Annual Meeting & OTO EXPO of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, being held September 17-20, 2006, at the Metro Toronto Convention Centre, Toronto, Canada.

Methodology

This prospective, non-randomized study of consecutive patients undergoing thyroidectomy between December 2004 and October 2005 was performed at the Medical College of Georgia Health System and Augusta Veterans Administration Hospital. Patients were segregated into two groups on the basis of admission status (outpatient or inpatient). Patients undergoing 23-hour observation with an overnight stay were considered inpatients, while outpatients were discharged directly from the ambulatory recovery unit. Demographic and clinical data were collected; outcome data were compiled including estimated blood loss (EBL), duration of surgery (time from skin incision to closure), time to discharge (time from skin closure to hospital discharge), need for admission, and hospital charges. Hospital charges were queried to include total billed charges over the dates of service related to thyroidectomy.

A number of surgical techniques were used, including a Kocher incision, minimally invasive thyroid surgery with access to the thyroid compartment, and endoscopic thyroidectomy. Laryngeal nerve monitoring was employed as required. Vocal cord mobility was assessed and documented preoperatively and again in the post-anesthesia care unit or on the ward using flexible fiberoptic laryngoscopy. Following surgery, outpatients were assessed and discharged once ambulatory, tolerating a diet, and managing their pain with oral medications. Patients were seen for follow-up within one to two weeks after surgery and subsequently as clinically indicated.

All patients who underwent total or completion thyroidectomy were placed on a prophylactic calcium supplementation regimen consisting of a three-week taper of oral calcium carbonate (600mg TID for the first week, 600mg BID for the second week, and 600mg Qday for the third week). Postoperative ionized calcium levels were measured following convalescence to determine the presence of permanent hypocalcemia. Inpatient stays were for medically infirm patients with significant co-existing conditions, patients who underwent concomitant procedures requiring admission, and patients who expressed a preference for admission. Patients with large lesions incurring a potential for significant postoperative dead space were not considered suitable for outpatient management. All other patients were considered for management on an outpatient basis.

Results

Ninety-one patients underwent thyroid surgery. Fifteen patients were male, seventy-six patients were female; the mean age was 46.3 ± 14.7 years. Fifty-two (57 percent) were managed on an outpatient basis. Thirty-nine were considered inpatients (twenty-six of these remained in the hospital overnight for a 23-hour observation period; 13 were admitted for a mean of 3.4 ± 2.8 days). The mean age of the outpatients (44.8 ± 13.3 years) was not statistically different from the mean age of the inpatients (48.5 ± 16.3 years). The gender ratio was also similar (85 percent female among outpatient, 82 percent female among inpatients).

Outpatient Thyroid Surgery is Safe and Desirable

Fifty-two patients had a thryroid procedure performed on an outpatient basis, 26 patients were observed under a 23-hour status, and 13 were admitted. There were two complications in the outpatient group and one in the inpatient group. Costs were significantly lower for outpatients ($7,814) than for inpatients ($10,288. The procedures consisted of 42 hemithyroidectomies (surgical removal of one lobe of the thyroid gland), 38 total thyroidectomies, and 11 completion thyroidectomies. Operative time was lower in the outpatient group (102 ± 32 vs. 144 ± 51 minutes).

Despite the trend toward outpatient surgery, surgeons who perform thyroid and parathyroid surgery have been reluctant to adopt this approach primarily out of concern for bleeding and transient hypocalcemia. However, the advent of new ultrasonic technology, used in this study, has improved the ability to achieve and maintain a bloodless field. This technology has led to a conclusion by many that surgical drains, a soft plastic tube that drains fluid out and sources of infection of the area, offer no benefit to the patient, and if anything, result in a higher rate of infection and bleeding.

A second major deterrent to performing thyroid (and parathyroid) surgery on an ambulatory basis is the fear of life-threatening hypocalcemia, or low blood calcium level. Ten years ago, researchers described a regimen of oral calcium administration following parathyroidectomy, supporting outpatient status in nearly all cases performed at a major hospital. Researchers for this current study provided oral calcium supplementation in patients undergoing total or completion thyroidectomy to accomplish outpatient thyroid surgery safely. This method has proven uniformly successful with the study subjects, with none displaying any signs of calcium deficiency in the blood.

Conclusions

Despite cost-savings achieved with outpatient surgery, the real benefits of pursuing ambulatory thyroidectomy were not financial. The peripheral benefits of outpatient surgery include the advantages of convalescence in the home environment (which is appealing to many individuals) and minimizing exposure to the organisms which populate most medical centers. On the other hand, patients for whom inpatient hospitalization should still be considered include medically infirm individuals, those undergoing concomitant procedures that would normally require admission, or those with known blood disease.

This study suggests that for carefully selected patients who prefer convalescence at home, and are not weak due to age and disease, outpatient thyroid surgery is safe and cost-effective, even when a total or completion thyroidectomy has been performed.

Two-thirds of women who quit smoking during pregnancy want to avoid cigarettes after delivery, but concern about weight may interfere, according to a new study.

“A woman’s feeling about her ability to control her weight affected her motivation to smoke,” said lead author Michele Levine, Ph.D., at the University of Pittsburgh Medical Center. This association went “above and beyond” factors including a woman’s level of dependence on nicotine, whether she had a partner who smoked and whether she planned to breastfeed her baby.

Levine and her colleagues conducted the study to understand why so many women resume prior smoking habits after pregnancy. Levine said that although there’s a lot of research on helping women to quit during pregnancy, “something happens after the baby is born that leads women to go back to smoking.”

The authors interviewed 119 pregnant women who smoked at least eight cigarettes a day before pregnancy but quit once they became pregnant. During the third trimester, the women responded to the question, “How motivated do you feel to stay quit after your baby is born?” Based on their responses, researchers divided the women into two groups: those highly motivated and those less motivated to remain smoke-free after birth.

The women were also asked if they felt confident about their ability to avoid cigarettes after giving birth and if they thought they could manage their weight after quitting smoking.

Study questions also addressed symptoms of stress and depression, since mood may affect a woman’s desire to abstain from smoking.

Sixty-five percent of women in the study - published in the October issue of the Annals of Behavioral Medicine - reported feeling highly motivated to steer clear of cigarettes after delivery and 74 percent expressed confidence in their ability to do so, a finding supported by previous research. Not surprisingly, the authors said, women who felt highly motivated to avoid smoking also tended to feel confident that they could do so.

What surprised the authors was the link between weight concerns and desire to remain abstinent. Compared to less-motivated women, “Motivated women were more likely to say they could control their weight without smoking and less likely to say they used smoking to control their weight,” Levine said. Women motivated to remain smoke-free during the postpartum period were also more likely to say they would breastfeed their infants.

Elyse Park, Ph.D., a psychologist in Boston not involved with the study, said the results deal only with what women intend to do after delivery - not their actual behavior. “Most women who are smoking want to quit during pregnancy, but the reality is that very few of them are able to do so. Even in women who are successful, very few are able to maintain quitting,” she said.

Because weight concerns are such a prevalent problem for American women, finding ways to address concerns about eating and weight may help prevent postpartum smoking relapse, the authors suggested.

Park suggests that pregnant women who want to remain smoke-free find a behavioral program - whether that’s quitting cold turkey or taking a stepwise approach to cutting back on cigarettes - that fits them. “There’s a lot of stigma against smoking during pregnancy; a lot of women genuinely want to quit but they’re struggling to do so,” she said.

This research was supported by a grant from the National Institute on Drug Abuse.