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Background: Nearly 70% of nursing home residents are eligible for palliative care, yet few receive formal palliative care outside of hospice. Little is known about nursing home staff attitudes, knowledge, skills, and behaviors related to palliative care., Methods: We administered a modified survey measuring attitudes toward death to 146 nursing home staff members, including both clinical and nonclinical staff, from 14 nursing homes., Results: Nursing home staff generally reported feeling comfortable caring for the dying, but half believed the end of life is a time of great suffering. Pain control (63%), loneliness (52%), and depression (48%) were the most important issues identified with regard to these patients, and there was ambivalence about the use of strong pain medications and the utility of feeding tubes at the end of life. Top priorities identified for improving palliative care included greater family involvement (43%), education and training in pain control (50%) and in management of other symptoms (37%), and use of a palliative care team (35%) at their facility., Conclusions: Findings show there is a need for more palliative care training and education, which should be built on current staff knowledge, skills, and attitudes toward palliative care.

The present study investigated the current contamination status and evaluated several kinetic-related features of organochlorine pesticides (OCPs) and PCBs in human breast milk collected from northern Vietnam. The variation in the levels of these contaminants was found to be strongly associated with total lactation time and dietary habits. OCPs exhibited the characteristics of steadily declining compounds: the overall levels of DDTs and HCHs in the population decreased with a half-time of only 5years and it can be suggested that OCPs depurated relatively fast with breastfeeding (5% per month). PCBs were slower in both regards, with a temporal decrease half-time of 12years and a suggested depuration rate via breastfeeding of 2.5% per month, indicating that the exposure level was still high relative to the human body burden. It was found that the PCB exposure levels of infant from breastfeeding exceeded the reference dose, and this situation may continue for the next two or three decades. Knowledge of these kinetic-related characteristics not only is useful for risk assessment and prediction of future trends of legacy contaminants but also may provide insight regarding similar kinetic processes of emerging persistent pollutants., (Copyright © 2010 Elsevier Ltd. All rights reserved.)