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114. Raymond EG, Cnattingius S, Kiely JL. Effects of maternal age, parity, and smoking on the risk of stillbirth. Br Obstet Gynaecol 1994; 101: 301-6. Schramm WF. Smoking during pregnancy: Missouri longitudinal study. Paediatr. Perinat. Epidemiol 1997; 11 Suppl 1: 73-83. 116. Cnattingius S, Forman MR, Berendes HW, Isotalo L . Delayed childbearing and risk of adverse perinatal outcome. A population-based study. JAMA 1992; 268: 886-90. Walsh RA. Effects of maternal smoking on adverse pregnancy outcomes: examination of the criteria of causation. Hum Biol. 1994; 66: 1059-92. Haglund B, .Cnattingius S. Cigarette smoking as a risk factor for sudden infant death syndrome. J Public Health 1990; 80: 29-32. Kleinman JC, Pierre MB, Jr., Madans JH, Land GH, Schramm WF. The effects of maternal smoking on fetal and infant mortality. J Epidemiol 1988; 127: 274-82. Butler NR, .Goldstein H. Smoking in pregnancy and subsequent child development. Br. Med J 1973; 4: 573-5. Sexton M, Hebel JR, Blackman J. Long-term consequences on cognition and physical growth associated with smoking and pregnancy. J SmokingRelated Dis. 1994; 5: 119-26. Tong S, McMichael AJ. Maternal smoking and neuropsychological development in childhood: a review of the evidence. Dev Med Child Neurol. 1992; 34: 191-7 and elocon.
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Ask your patients or their caregivers to tell you what they know about their medications and how the medication regime will differ from their pre-hospitalization regime after discharge. In response to the OBRA mandated pharmacy counseling of 1990, the Indian Health Service developed a counseling program that includes the use of three questions to assess the patient's understanding. These questions are helpful for all patients: What is this medication for? How did your doctor tell you to use this medication? What did your doctor tell you to expect? Your patient's answers to these questions can provide a good starting point for patient education. When you help your patients and or their caregivers adjust to any change in routine, it is very helpful to give information about the new medications. It is also helpful to emphasize the differences between the new regime and the previous one. To assure that the patient or caregiver s ; understand, ask them to explain these changes to you. Many elders obtain information about medications from the Internet and from advertising. They may have received misinformation or misinterpreted information. Often elders obtain their medicines through the mail and therefore have no contact with a pharmacist. Use the opportunity of this hospitalization to clarify the patient's understanding.

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