A. James Fix

Smoking cessation among patients with chronic obstructive pulmonary disease (COPD)

Abstract Nine variables were assessed to determine which were most associated with the ability to quit smoking among 107 pulmonary rehabilitation patients with chronic obstructive pulmonary disease (COPD). Most (67%) patients were ex-smokers at the time of admission. Discriminant analysis revealed that psychosocial factors were significantly related to the ability to stop smoking prior to hospitalization, and pack-years smoking history significantly differentiated smokers from ex-smokers at follow-up 5–54.5 months after hospitalization. None of the other variables were significantly associated with smoking cessation, and even the two significant variables (psychosocial assets and pack-years) were not able to separate smokers from ex-smokers beyond base-rate expectations. While most smokers with COPD did quit smoking, those who failed to do so prior to their hospitalization were likely to continue their habit indefinitely.

RELATIONSHIP BETWEEN A PULMONARY FUNCTION TEST (FEV1) AND THE ADAPT QUALITY-OF-LIFE SCALE

In a previous study the Additive Daily Activities Profile Test (ADAPT©) correlated .83 with maximum oxygen consumption among pulmonary rehabilitation patients. The present study expanded the pulmonary population base and compared the ADAPT scores of 41 patients at two independent centers with a more readily available parameter, the forced expiratory volume in the first second of forced exhalation (FEV1). The relationships between the two major ADAPT subscales and FEV1 were significant but lower in magnitude than that found with maximum oxygen consumption. The ADAPT continues to be sensitive to physical impairment and in translating the effect of impairment upon daily physical activity.

Urinary Alkalinization and Smoking Cessation.

Previous studies have shown that large doses of a urinary alkalinizing agent reduced cigarette consumption spontaneously among smokers. After establishing a safe daily dose of an alkalinizing agent, sodium bicarbonate, its effect upon smoking cessation rates among 72 enrollees in a smoking cessation program was studied. In the first study, we determined that sodium bicarbonate (3900 mg per day) significantly increased urinary pH (from 6.0 to 6.7) and lowered titratable acidity. Ascorbic acid (1500 mg per day) had no effect of pH or acidity. In a second study, a group given sodium bicarbonate surpassed a placebo control group (who were given 1500 mg per day ascorbic acid) in total daily cigarette reduction after 5 weeks and in week-to-week smoking reduction. The groups did not, however, differ in the number who achieved total abstinence.

Physiological-intellectual components of rehabilitation success in patients with chronic obstructive pulmonary disease (COPD)☆

Abstract Intelligence test scores (IQ) and physiological measures were evaluated to determine their relationship in predicting vocational rehabilitation (VR) in patients with chronic obstructive pulmonary diseases (COPD). From a population of COPD patients unrestricted as to age or degree of impairment in a previous study, 52 patients most appropriate for VR in terms of age and severity of disease were selected for retrospective analysis. Intelligence scores were able to predict VR outcome with 83% accuracy. A regression analysis with first-second forced expiratory volume (FEV1.0) and IQ as the predictors increased the accuracy of prediction of VR outcome to 90%. While the FEV1.0 relation to VR outcome has been previously shown, the strong IQ influence as a predictor of VR success in a COPD population was not expected. It was hypothesized that differences in job energy requirements among various IQ levels may be the underlying reason for this finding.

EMOTIONAL, INTELLECTUAL AND PHYSIOLOGICAL PREDICTORS OF VOCATIONAL OUTCOME OF PULMONARY REHABILITATION PATIENTS

Previous researchers have independently shown that pulmonary function measures, intelligence test scores, and a recently developed MMPI-derived scale can predict post-hospital employment among rehabilitation patients with chronic obstructive pulmonary disease. This study compared the effectiveness of the three variables in predicting employment among a group of vocational rehabilitation candidates with chronic obstructive pulmonary disease. Only the MMPI-derived scale (COPD-VR) identified the non-working patients significantly above base rate. While this finding does not necessarily mean that personality, or attitudinal, factors are more important than physiological or intellectual variables in vocational rehabilitation success among such patients, it gives further support to the validity of the COPD-VR scale.

Immediate carbon monoxide estimates and self-reported smoking.

Because carbon monoxide (CO) is an easily understood danger of cigarette smoking, new breath CO analyzers may be useful in cessation programs. Self-reported cigarette consumption and breath CO correlated .70 using a 90-sec. CO-determination method. Smokers averaging 17 daily cigarettes had average breath CO of 24 parts per million (ppm), falling to 7.71 ppm for smokers claiming at least 24-hr. abstinence. Corresponding carboxyhemoglobin (COHb) estimates were 4.34% (slightly above World Health Organization 4% safety limit) and 1.39%. Smoking clinics can use CO-monitoring devices for feedback or surveillance, although feedback would provide the most benefits for participants.

Relationship between psychotherapy skills and level of training in a psychiatric residency program

Abstract Five 1st-year, six 2nd-year, and six 3rd-year residents in psychiatry wrote responses to the Carkhuff (1969) communication scale. These were scored according to level of facilitative communication, shown in previous research to relate to patient progress in psychotherapy. The study failed to find expected superior skills in the advanced residents as compared to the novices. Consideration of providing specific training in facilitative communication is urged.

CIGARETTE SMOKING, URINARY ACIDITY, AND NICOTINE EXCRETION UNDER NATURAL CONDITIONS

For 40 males who smoked 20 cigarettes a day titratable acidity of the urine was significantly correlated with nicotine/cotinine excretion at several sample intervals, as was urinary pH, but not urinary acidity and daily cigarette consumption or serum COHB.

The Educational Implications of Five Behavioral Clusters

A behavior checklist, useful for identifying children who require medical or psychiatric evaluation, is presented. The checklist provides a “behavioral cluster” system, as opposed to single-behavior rating methods. The clusters can identify children with the hyperkinetic syndrome, learning disabilities, depression, psychosis, brain disorders, and unsocialized aggressive personality disorders. For each child fitting a cluster profile, the most beneficial teaching approach is described, and in certain clusters, specific medical and psychiatric intervention strategies are discussed. Parent and teacher cooperation is emphasized in assessing the severity and frequency of the listed behaviors.