Integration of viral DNA into host cell genome occurs early in HBV infection. HBV DNA integrations arise when HBV double-stranded linear (dsl)DNA acts as a substrate for the repair of cellular DNA breaks. Intriguingly, HBV DNA integration has been detected in most patients with HBV infection, despite this form not being necessary for new virion production. Of clinical importance, HBV DNA integration may drive cancer and viral persistence (e.g. as a source of HBV immunomodulatory surface antigen). It remains unknown if HBV actively drives its integration or if it occurs passively through cellular DNA repair factors. Thus, we explored HBV DNA integration and its dependence on various viral factors.

This study examines discharge-related anxiety in a group of 65 patients resident in five medium secure units located in the South of England. The study is part of a larger investigation of non-compliance within medium secure unit environments. Participants completed standardised questionnaire measures of self-efficacy, self-esteem, anxiety and locus of control, together with a newly constructed questionnaire investigating anxiety relating to discharge. Results of ordinal regression procedures indicated that the main predictors of a general discharge-related anxiety scale were low self-esteem and perceived absence of social support, although on univariate analysis high trait anxiety also exerted a significant independent effect. The clinical implications of the findings are discussed.

OBJECTIVE:To evaluate the efficacy of a brief smoking cessation intervention with pregnant women practicable routinely by midwives.DESIGN:Midwives were randomized to deliver the experimental intervention or usual care. The 10-15-minute intervention was based on brief counselling, written materials, arrangements for continuing self-help support and feedback on expired-air carbon monoxide levels. The intervention was tailored to the women's needs: those who did not want to stop smoking received a brief motivational intervention, those who wanted to stop received an intervention designed to assist them and those that had stopped recently (recent ex-smokers) received a relapse prevention intervention.SETTING:Booking interviews with pregnant women in nine hospital and community trusts.SUBJECTS:A total of 1120 pregnant women in the third month of pregnancy (249 recent ex-smokers and 871 current smokers).MAIN OUTCOME MEASURES:Three indicators of biochemically validated abstinence were collected. Continuous abstinence for at least 3 months prior to delivery, point prevalence abstinence immediately post-delivery, and continuous abstinence from 3 months pre-delivery to 6 months post-delivery.RESULTS:Only a small proportion of the women who would have been eligible to take part in the trial were actually recruited by 178 recruiting midwives, with lack of time being cited as the main barrier. The intervention and usual care groups differed in post-delivery point prevalence abstinence rates for recent ex-smokers (65% vs. 53%, p < 0.05, one-tailed), but not in other outcome measures. Overall, 54% of "recent ex-smokers" at booking and 7% of "current smokers" at booking had been abstinent for at least 3 months at the time of delivery, and 23% and 3%, respectively, were still abstinent by the time the child was 6 months old (i.e. 12 months post-intervention). Smoking status at follow-up was predicted by dependence indexed by time to first cigarette in the morning.CONCLUSIONS:A brief "one-off" smoking cessation intervention by midwives does not seem to be a practicable or effective method of helping pregnant smokers to stop. Other options such as tailored self-help materials and telephone counselling and other specialist treatments should be examined. Current smoking cessation rates in pregnancy are very low.

Midwives (N = 138, response rare = 51%) from two regions (SW England and London/SE England) responded to a questionnaire designed to assess (a) their attitudes to giving anti-smoking advice to pregnant smokers, and whether they perceived this as part of their professional role; and (b) the types of advice they gave to pregnant smokers as part of their routine practice. Midwives' own smoking status was also recorded. Attitudes towards giving anti-smoking advice were generally positive, and almost all reported routinely explaining the health dangers of smoking to pregnant smokers. Midwives who had never smoked (63%) reported attitudes and behaviour which did not differ significantly on average from those of the remainder of the sample. Overall, those who gave more anti-smoking advice also perceived this to be a more important part of their professional role. The form of this relationship depended somewhat on midwives' own smoking status. Among midwives who had never smoked, those who held role attitudes that were more favourable towards anti-smoking intervention reported providing relatively more advice based on warnings of health consequences and an emphasis on abstinence. Among the remainder of the sample, more favourable attitudes predicted greater use of behaviourally-oriented advice to facilitate cessation or smoking reduction, but were unrelated to the use of health warnings and emphasis on abstinence. These findings underline the need for professional training of midwives in the use of strategies for behavioural change.