Management of alcohol misuse in Scotland: the role of A&E nurses.

Despite national targets to reduce excessive drinking in Scotland, rates have increased dramatically since the mid-eighties. The role of Accident and Emergency (A&E) departments in the management of alcohol misuse is much debated. This postal survey was conducted with senior medical and nursing staff in A&E departments and minor injury units throughout Scotland to examine the prevalence of alcohol-related attendances and staff's attitudes towards identifying and responding to alcohol-related attendances. A 57% response rate was achieved, representing 87% of all A&E institutions in Scotland (n = 84). The results reveal an estimated 1 in 7 attendances in A&E in Scotland are alcohol-related, and 1 in 5 of these result in admission. However, over two-fifths of departments do not routinely screen for, or keep records of, patients who attend with alcohol problems. Intervention is normally limited to a brief dialogue and referral to the patient's GP. Despite considerable barriers, A&E nursing staff express a willingness to assume a preventive role, but acknowledge lack of appropriate training and sources of support. It is concluded that there is scope for developing identification and brief intervention services within A&E. However, such developments are dependent upon alcohol issues assuming a higher priority among senior A&E staff.

General anaesthesia: who decides, and why?

This study sought to determine the relative influence dentists and parents have on the decision to give a general anaesthetic to a child, and to identify the factors that influence that decision. The research involved group discussions and in-depth interviewing as a method of investigating attitudes and behaviour in greater detail. The results indicated that parents are not able to make informed choices about general anaesthesia being used on their child; the dentist has the greatest influence on the decision to use general anaesthesia; and that this decision is often influenced by non-clinical factors. These non-clinical factors were identified as: the norms of the dentist, overall attitudes to general anaesthesia and how general anaesthesia provision was structured locally. The findings suggest that any attempt to reduce the current levels of general anaesthesia further must address these factors, whilst taking into account the needs of patients and dentists.

An exploratory study of barriers to promoting oral hygiene through carers of elderly people.

This paper outlines the main findings of an exploratory study into carers' attitudes towards looking after the oral hygiene needs of their elderly patients and relatives. The data were collected using eight group discussions covering a cross-section of carers and carer settings throughout central Scotland. A range of barriers to improving levels of care was identified. The paper concluded that to make positive progress, a comprehensive oral hygiene programme is required to break down these barriers. It is believed that a strong educational policy based upon carers' needs should form the main impetus of such a programme.

Predisposing effects of cigarette advertising on children's intentions to smoke when older.

Six hundred and forty Glasgow children, initially aged between 11 and 14 years, were interviewed twice, with approximately one year between interviews. Children whose intentions to smoke when older became more positive between the two interviews tended to be more aware of cigarette advertising at the time of the first interview (compared with children whose intentions to smoke were negative at both interviews). Children whose intentions to smoke became more negative between the interviews tended to be less appreciative of cigarette advertisements at the time of the first interview (compared with children whose intentions to smoke were positive at both interviews). Since both groups differed from their respective contrast groups before their declared intentions changed, these findings support the view that cigarette advertising has predisposing as well as reinforcing effects on children's attitudes and behaviour with respect to smoking.

Reinforcing effects of cigarette advertising on under-age smoking.

Interviews were conducted with 848 Glasgow children aged between 11 and 14 years. There were consistent differences between smokers and non-smokers. Smokers tended to be more adept at recalling, recognizing and identifying cigarette advertisements. This suggests they tend to pay more attention to cigarette advertising. Smokers also tended to be generally more appreciative of cigarette advertising. Moreover, this greater awareness and appreciation of cigarette advertising was independent of other important predictors of under-age smoking, such as smoking by peers, siblings and parents. These findings, taken in conjunction with previous research, indicate that cigarette advertising is reinforcing under-age smoking. The smokers showed an enhanced or heightened preference for Kensitas Club, the brand favoured by adults. This is consistent with previous research indicating that promotional devices which help determine and reinforce adult cigarette brand preferences have an even greater effect on under-age smokers.