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Objective. To evaluate the impact of implementing a smoke-free policy in an Australian high-security forensic psychiatry in-patient hospital. Methods. Focus groups (n = 21) and surveys with both patients (n = 45) and staff (n = 111, 53.2% nurses) elicited participants' experience of and attitudes towards an introduced smoke-free policy. A follow-up survey elicited the impact of the policy on 15 patients' smoking practice after discharge. Results. Eighty-five per cent of patients stated it was easier to quit smoking when no one else smoked. Over half the discharged patients surveyed (58%) continued to not smoke after discharge, despite almost half the staff (41%) perceiving that patients were unlikely to quit long-term. Smoking staff were significantly more pessimistic than non-smoking staff. Many patients (69%) perceived that their health had improved as a result of not smoking. Most staff (80%) viewed nicotine dependence treatment as important, but fewer (66%) felt confident to support patients to stop smoking. Increased patient violence and management difficulties expected by staff were not realised. Conclusions. A smoke-free policy can be successfully implemented in forensic psychiatry in-patient units. Nursing staff are a large and important group who need particular support to implement a smoke-free policy into practice effectively, particularly those who are smokers. Continuity of care as part of a coordinated policy and service response is needed. [ABSTRACT FROM AUTHOR]

Background: Hypertensive disorders of pregnancy have longer-term implications, increasing women's lifetime cardiovascular disease risk. The Blood Pressure Postpartum study is a multi-centre randomised three-arm trial of interventions, ranging in intensity and including education and lifestyle coaching, to support women to maintain or adopt healthy eating and physical activity during the first postpartum year. This qualitative sub-study nested within the main trial aimed to investigate whether and how women adopted healthy behaviours after a pregnancy complicated by a hypertensive disorder.Methods: Semi-structured telephone interviews were recorded, transcribed and analysed thematically, following Braun and Clarke principles. They explored behaviour change among new mothers following their hypertensive pregnancy, and the intervention's effect on their capacity and motivation to pursue healthy lifestyles.Results: Thirty-four women from all three trial arms participated at 10-12 months postpartum. The three main themes were 1) Awareness of cardiovascular risk: some did not acknowledge the health risks, whereas others embraced this information. 2) Sources of motivation: while the majority were motivated to make a concerted effort to adapt their health behaviour, motivation often centred on their baby and family rather than their own needs. 3) Sustaining behaviour change with a new baby: women in the more intensive intervention arm demonstrated increased recognition of the importance of reducing cardiovascular health risks, with greater motivation and guidance to change their health behaviour. There was minimal evidence of crossover amongst groups, with women largely accepting their randomised level of intervention and not seeking additional help when randomised to minimal intervention.Conclusions: Among women participating in an early post-hypertensive disorders of pregnancy randomised controlled trial aimed at improving their cardiovascular disease risk profile, the majority recognised the future health risks and appeared motivated to improve their lifestyle, particularly women in the highest-intensity intervention group. This highlights the importance of structured support to assist women embrace healthy lifestyles especially during the challenges of new parenthood.Trial Registration: The Blood Pressure Postpartum study was prospectively registered as a clinical trial with the Australian New Zealand Clinical Trials Registry (anzctr.org.au) on 13 December 2018 (registration number: ACTRN12618002004246). [ABSTRACT FROM AUTHOR]

Summary: Objective: To investigate the health care utilization cost of patients presenting with psychogenic nonepileptic seizures (PNES) to a tertiary hospital in Australia. Methods: This is a retrospective analysis of adult patients with PNES based on video‐electroencephalographic confirmation over a 5‐year period. We used an itemized list to collect detailed health care utilization data. The items included emergency room visits, hospital ward admissions, intensive care unit (ICU) admissions, outpatient neurology clinic visits, medical interventions, Code Blue and Medical Emergency Team calls for seizures, medications, and investigations. We calculated the cost of each individual item separately for each individual presentation. To investigate the proportional contribution of each covariate toward the total health care utilization cost, an analysis of the relative importance in the linear regression was performed. Results: There were 39 patients, of whom seven (18%) were admitted to the ICU with suspected status epilepticus. The median total health care utilization cost per person until the diagnosis of PNES was established as 26 468 Australian dollars (AUD; 19 207 US dollars [USD]). In the item breakdown, the highest median cost was incurred by investigations (13 119 AUD = 9520 USD), followed by hospital ward management (8890 AUD = 6451 USD), ICU stay (3764 AUD = 2731 USD), outpatient neurology clinics (2200 AUD = 1596 USD), and emergency room visits (570 AUD = 413 USD). Nonepileptic psychogenic status (23%) and the duration of PNES disorder (10%) were the most significant variables contributing to the variance (R2) of the model. Significance: A considerable burden of health care utilization cost is caused by PNES. The presence of nonepileptic psychogenic status and a longer duration of the condition predict a higher cost. [ABSTRACT FROM AUTHOR]