A program for teaching behavior modification skills to institutional staff.

The role of children's activities in leading to pesticide exposure was evaluated by comparing pesticide loadings on the hands of children with the activities of the same children observed over a 4-h period. In all, 10 children ranging in age from 24 to 55 months were videotaped on the second day following a routine professional crack and crevice chlorpyrifos application in their homes. Before and following the video session, the children's hands were rinsed in isopropyl alcohol. Thus, only the chlorpyrifos that accumulated on and remained on the child's hands during the videotaping were removed for analysis after the videotaping session. The rinsate was analyzed for chlorpyrifos. The children's behaviors were quantified using virtual tracking device and the frequency and duration of behaviors, the hourly rate of behaviors, and the locations in which behaviors occurred were compared to hand loadings of pesticides. Pesticide hand loadings obtained following the videotaping sessions were associated with pesticide levels on surfaces and toys, but not with air levels. Pesticide loadings obtained following the videotaping sessions were also associated with frequencies, durations, and hourly rates of contact with bottles, and object-to-mouth behaviors, as well as contact duration with upholstered/textured surfaces. The hand loadings were also associated with the number of locations where the children exhibited object-to-mouth behavior and with children's use of house space during the videotaping sessions.

Activities of Daily Living↗

PubMed2005

Inmate exposure to secondhand smoke in correctional facilities and the impact of smoking restrictions.

This study was undertaken to measure the passive smoking exposure of prisoners at three correctional facilities in the US and to evaluate the effectiveness of a ban on smoking in reducing these exposures at two of these facilities. The average weekly concentration of nicotine was measured in fixed locations within the correctional facilities using passive samplers. Samples were collected before and after a smoking ban was instituted, and after the policy was modified to allow smoking outdoors. Samples were collected in the living areas, near where inmates slept and watched TV, and in selected central facilities, including dining halls, visiting rooms, booking areas, and learning centers. Average weekly concentrations of nicotine were measured in 84 locations while smoking was allowed; changes in these concentrations were measured with 112 weekly samples 4 and 9 months after the policy restricting smoking was implemented The average concentrations of nicotine were high while smoking was allowed: most living and sleeping areas averaged 3-11 microg/m(3), but the gym that was used as a bunkroom averaged 25 microg/m(3); these values compare to an average of 2 microg/m(3) in the homes of smokers. The smoking ban significantly reduced nicotine concentrations in the living areas (P<0.01 at facility A and P<0.05 at facility B) to averages of 1.5-2.2 microg/m(3); all postban samples were less than 5 microg/m(3). In conclusion, secondhand smoke concentrations in correctional facilities can be quite high; however, policies banning smoking are effective in reducing, but not eliminating, these exposures.

Activities of Daily Living↗

PubMed2004

Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial.

BACKGROUND: Cholinesterase inhibitors produce small improvements in cognitive and global assessments in Alzheimer's disease. We aimed to determine whether donepezil produces worthwhile improvements in disability, dependency, behavioural and psychological symptoms, carers' psychological wellbeing, or delay in institutionalisation. If so, which patients benefit, from what dose, and for how long? METHODS: 565 community-resident patients with mild to moderate Alzheimer's disease entered a 12-week run-in period in which they were randomly allocated donepezil (5 mg/day) or placebo. 486 who completed this period were rerandomised to either donepezil (5 or 10 mg/day) or placebo, with double-blind treatment continuing as long as judged appropriate. Primary endpoints were entry to institutional care and progression of disability, defined by loss of either two of four basic, or six of 11 instrumental, activities on the Bristol activities of daily living scale (BADLS). Outcome assessments were sought for all patients and analysed by logrank and multilevel models. FINDINGS: Cognition averaged 0.8 MMSE (mini-mental state examination) points better (95% CI 0.5-1.2; p<0.0001) and functionality 1.0 BADLS points better (0.5-1.6; p<0.0001) with donepezil over the first 2 years. No significant benefits were seen with donepezil compared with placebo in institutionalisation (42% vs 44% at 3 years; p=0.4) or progression of disability (58% vs 59% at 3 years; p=0.4). The relative risk of entering institutional care in the donepezil group compared with placebo was 0.97 (95% CI 0.72-1.30; p=0.8); the relative risk of progression of disability or entering institutional care was 0.96 (95% CI 0.74-1.24; p=0.7). Similarly, no significant differences were seen between donepezil and placebo in behavioural and psychological symptoms, carer psychopathology, formal care costs, unpaid caregiver time, adverse events or deaths, or between 5 mg and 10 mg donepezil. INTERPRETATION: Donepezil is not cost effective, with benefits below minimally relevant thresholds. More effective treatments than cholinesterase inhibitors are needed for Alzheimer's disease.

Activities of Daily Living↗