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Lead is a nonessential metal which enters the body through various means and is considered as one of the most common health toxins. Several cases of lead poisoning are reported as a result of inhalation or ingestion of lead in employees working as painters, smelters, electric accumulator manufacturers, compositors, auto mechanics, and miners. In addition to occupational lead exposure, several cases of lead poisoning are reported in the general population through various sources and pathways. Innumerable signs and symptoms of lead poisoning observed are subtle and depend on the extent and duration of exposure. The objective of this review article is to discuss occupationally and nonoccupationally exposed lead poisoning cases reported in India and the associated symptoms, mode of therapy, and environmental intervention used in managing these cases. Lead poisoning cases cannot be identified at an early stage as the symptoms are very general and mimic that of other disorders, and patients might receive only symptomatic treatment. Knowledge about the various symptoms and potential sources is of utmost importance. Medical practitioners when confronted with patients experiencing signs and symptoms as discussed in this article can speculate the possibility of lead poisoning, which could lead to early diagnosis and its management.

Background: Patients in intensive care units (ICUs) are among the most vulnerable, and they require support to start their recovery. The design of the patient area in the ICU can play a prominent role in both the quality of care and patients’ recovery. The lighting environment has the opportunity to restore and strengthen the natural human circadian rhythm and health. Aim: To evaluate patients’ self-reported recovery after being cared for in an ICU room rebuilt according to evidence-based design principles that promote recovery. Method: An intervention was set up in a two-bed patient room including a cycled lighting system. Self-reported recovery was reported at 6 and 12 months after discharge. Data were analyzed using a 2(mechanically ventilated, nonmechanically ventilated) × 2(intervention room, ordinary room) analysis of covariance (ANCOVA) and 2(male, women) × 2(intervention room, ordinary room) ANCOVA. Results: Data from the different rooms showed no significant main effects for recovery after 6 months, p = .21; however, after 12 months, it become significant, p. < .05. This indicated that patient recovery was positively influenced for patients cared for in the intervention room ( M = 8.88, SD = 4.07) compared to the ordinary room ( M = 10.90, SD = 4.26). There were no interaction effects for gender or if the patients had been mechanically ventilated either at 6 or 12 months’ postdischarge. Conclusions: A cycled lighting system may improve patient self-reported recovery after ICU care; however, more research on the topic is needed.

IMPORTANCE: Reductions in sugar-sweetened beverage (SSB) intake can improve health, but are difficult for individuals to achieve on their own. OBJECTIVES: To evaluate whether a workplace SSB sales ban was associated with SSB intake and cardiometabolic health among employees and whether a brief motivational intervention provides added benefits to the sales ban. DESIGN, SETTING, AND PARTICIPANTS: This before-after study and additional randomized trial conducted from July 28, 2015, to October 16, 2016, at a Northern California university and hospital assessed SSB intake, anthropometrics, and cardiometabolic biomarkers among 214 full-time English-speaking employees who were frequent SSB consumers (≥360 mL [≥12 fl oz] per day) before and 10 months after implementation of an SSB sales ban in a large workplace, with half the employees randomized to receive a brief motivational intervention targeting SSB reduction. INTERVENTIONS: The employer stopped selling SSBs in all workplace venues, and half the sample was randomized to receive a brief motivational intervention and the other half was a control group that did not receive the intervention. This intervention was modeled on standard brief motivational interventions for alcohol used in the workplace that promote health knowledge and goal setting. MAIN OUTCOMES AND MEASURES: Outcomes included changes in SSB intake, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and measures of abdominal adiposity. The primary associations tested were the correlation between changes in SSB intake and changes in HOMA-IR. RESULTS: Among the 214 study participants, 124 (57.9%) were women, with a mean (SD) age of 41.2 (11.0) years and a baseline mean (SD) body mass index of 29.4 (6.5). They reported a mean daily intake of 1050 mL (35 fl oz) of SSBs at baseline and 540 mL (18 fl oz) at follow-up—a 510-mL (17–fl oz) (48.6%) decrease (P

Nidotherapy is a new form of psychological therapy that aims to improve mental health by a systematic and collaborative manipulation of the environment in all its forms without focusing on alleviation of symptoms. Following treatment with nidotherapy, we describe a dramatic, and continuing, improvement in a woman with comorbid severe depressive illness and borderline personality disorder. She had made repeated serious suicide attempts over the previous 25 years and had received many drug and psychological treatments without success. The nidotherapy solution enabled her to leave home and achieve greater autonomy. Prior to this, she had been demeaned and undermined in her role as a family carer, and no health professionals had appreciated previously the restrictions it had placed on her health and well-being. Nidotherapy effected a smooth and orderly transition with family approval; the reasons for this seem to lie in the emotional neutrality of nidotherapy as a purely environmental intervention. Without this approach, we judge that separation from the family would not have been possible. Copyright © 2017 John Wiley & Sons, Ltd.

Globally, the pandemic of non-communicable chronic diseases (NCDs) has become a critical public health problem. Although NCD prevention has been shifting from individual behavioral interventions to broad environmental interventions, it is still necessary to promote research on the environment and NCDs as a whole. Therefore, this conceptual paper aimed to develop a general and novel framework to advance this line of research. The framework uses socio-ecological approaches that emphasize source prevention rather than the end treatment. Specifically, this framework comprehensively covered integrative research approaches, prioritized areas, urgent efforts, innovative methodologies, and improved funding. The framework used China as a typical context, where its public health policies, similar to other nations, still focus on the end treatment of NCDs, placing emphasis on biomedical approaches and technologies. China’s relevant efforts may furnish new insights and approaches concerning NCD prevention, and these efforts may benefit the improvement of global health and well-being. Such social-ecological research efforts can help to accelerate a shift from existing individual interventions to environmental interventions, thereby ultimately achieving the effective source prevention of NCDs in China and around the globe.

Objective:To investigate patient, staff, and carer responses to an environmental intervention in an oncology clinic waiting room and evaluate the acceptability of artificial plant materials.Design Postintervention:Cross-sectional survey study.Setting:Oncology outpatient clinic waiting room located in a metropolitan comprehensive cancer center in Australia.Main Outcome Measure:Observer ratings of perceived qualities and effects of lifelike (fake) plants while spending time in the waiting room.Participants:Convenience sample ( N = 143) consisted of 73 cancer patients, 13 staff, 52 carers, and 5 “others” aged between 24 and 89 years ( M = 56, SD = 14.5).Intervention:Artificial plant arrangements, hanging installations, two movable green walls, and one rock garden on wheels placed throughout the outpatients’ clinic waiting room.Results:Eighty-one percent (115/142) of respondents noticed the green features when first entering the waiting room and 67% (90/134) noticed they were artificial. Eighty-one percent (115/142) indicated “like/like a lot” when reporting their first reaction to the green features. Forty-eight percent (68/143) were positively affected and 23% (33/143) were very positively affected. Eighty-one percent (110/135) agreed/strongly agreed that “The greenery brightens the waiting room,” 62% (80/130) agreed/strongly agreed that they “prefer living plants,” and 76% (101/133) agreed/strongly agreed that “‘lifelike’ plants are better than no plants.” Comments included mostly positive appraisals and occasional adverse reactions to artificial plants. No significant differences were found between patients’, staff, and carers’ reactions.Conclusions:The environmental intervention positively impacted patients’, staff, and carers’ perceptions of the oncology waiting room environment. Patients, staff, and carers mostly accepted artificial plants as an alternative design solution to real plants.

Sit-stand workstations offer a potential strategy to reduce prolonged occupational sitting. This controlled intervention study examined the effects of an environmental intervention on occupational sedentary time, musculoskeletal comfort and work ability, and the usability of sit-stand workstations in office work via a self-reported questionnaire. The intervention group (n = 24) used sit-stand workstations during the 6-month intervention period, and the control group (n = 21) used traditional sitting workstations. The results showed that working at sit-stand workstations can reduce sitting time significantly compared to control workstations (-6.7% vs. 5.0%, p = .019), which is reallocated mostly to standing (r = -0.719, p .001). Sit-stand workstations improved perceived musculoskeletal comfort in the neck and shoulders (p = .028), as well as work ability (p = .022). The majority of intervention subjects rated sit-stand workstation adjustability as good (83.3%), and 75.0% were satisfied with the workstation. About 41.7% of the intervention participants, who were exclusively female, used the sit-stand function on a daily basis. While the environmental change alone was effective, it is likely that promoting the daily use of sit-stand workstations with counselling would lead to even more substantial positive effects.

Blood pressure is a primary cardiovascular disease risk factor. Population-wide governmental strategies aim to reduce lifestyle and dietary risk factors for hypertension, one of which is an unbalanced diet with high sodium and low potassium intakes. Nutrition interventions in the workplace are considered a promising approach in encouraging health-promoting behaviors. We developed and conducted the health promoting sodium reduction trial “Healthful & Tasty: Sure!” in worksites in the German-speaking part of Switzerland from May 2015 to Nov 2016, for which we present the study protocol and baseline characteristics. Healthful & Tasty, a cluster nonrandomized single-arm trial with calibration arm, aimed to demonstrate the effectiveness of a combined educational and environmental intervention in the workplace in reducing employees’ average daily sodium/salt intake by 15%. To this end, health and food literacy of employees and guideline compliance among the catering facility team needed to be improved. The primary outcome measure was sodium/salt intake estimated from sodium excretion in a 24-h urine sample. Secondary outcome measures included changes in the overall qualitative diet composition, blood pressure, anthropometric indices, and health and food literacy. Of eight organizations with catering facilities, seven organizations took part in the nutrition education and catering salt reduction interventions, and one organization participated as a control. Overall, 145 consenting employees were included in the staggered, one-year four-phase trial, of which 132 participated in the intervention group. In addition to catering surveys and food sampling, the trial included five follow-up health assessments including questionnaires, blood pressure measurements, anthropometrics, and sodium, potassium, and iodine intake measurements obtained from 24-h and spot urine samples, and a food record checklist. Exploratory and hypothesis generating baseline statistical analysis included 141 participants with adequate 24-h urine samples. Despite practice-driven limitations to the study design and small cluster and participant numbers, this trial has methodological strength and will provide important insights into the effectiveness of a combined educational and environmental intervention to reduce salt intake among female and male Swiss employees. German Clinical Trials Register, DRKS00006790 . Registered 23 September 2014.

Environmental exposures have been recognized as critical in the initiation and exacerbation of asthma, one of the most common chronic childhood diseases. The National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Environmental Health Sciences (NIEHS), National Heart, Lung, and Blood Institute (NHLBI), and Merck Childhood Asthma Network (MCAN) sponsored a joint workshop to discuss the current state of the science with respect to the indoor environment and its effects on the development and morbidity of childhood asthma. The workshop included U.S. and international experts with backgrounds in allergy/allergens, immunology, asthma, environmental health, environmental exposures and pollutants, epidemiology, public health, and bioinformatics. Workshop participants provided new insights into the biologic properties of indoor exposures, indoor exposure assessment and exposure reduction techniques. This informed a primary focus of the workshop-- to critically review trials and research relevant to the prevention or control of asthma through environmental intervention. The participants identified important limitations and gaps in the scientific methodologies and knowledge, and proposed and prioritized areas for future research. The group reviewed socioeconomic and structural challenges to changing environmental exposure and offered recommendations for creative study design to overcome these challenges in trials to improve asthma management. The recommendations of this workshop can serve as guidance for future research in the study of the indoor environment and on environmental interventions as they pertain to the prevention and management of asthma and airway allergies.

Background:The purpose of this study was to determine the effectiveness of Ready for Recess, an elementary school recess intervention targeting staff training (ST) or providing recreational equipment (EQ) separately, and the combination (EQ+ST) on physical activity (PA).Methods:Participants were children attending 1 of 12 elementary schools (grades 3rd–6th) included in the study. Separate analytical models were used to evaluate the effects of the intervention conditions on children’s accelerometry and direct observation derived PA measures.Results:Boys and girls were measured using accelerometry (n = 667). Boys in EQ+ST increased their MVPA by 14.1% while ST decreased their MVPA by –13.5%. Girls in ST decreased their MVPA by –11.4%. Neither boys nor girls in EQ increased their time spent in MVPA. A total of 523 (boys) and 559 (girls) observations were collected. For boys’ and girls’ sedentary and vigorous activity there were no significant main effects for treatment condition, time, or treatment condition-by-time effects.Conclusions:Environmental modifications are only as strong as the staff that implements them. Supervision, if not interactive, may be detrimental to PA participation, especially in girls. Research related to staff training for encouragement and promotion of PA coupled with appropriate use of equipment during recess is warranted.

Purpose. Examine the effects of an interactive environmental intervention on stair usage. Design. A nonrandomized, quasi-experimental intervention. Setting. Two three-story office buildings. Subjects. Approximately 200 employees at the intervention site and 140 at the comparison site. Intervention. The stairwell was decorated with interactive paintings such as maps, storyboards, and wish lists to encourage employees to take the stairs rather than the elevator. Measures. Daily stair and elevator usage were measured using electronic sensors or door-access card counters for 2 weeks prior to the intervention and 6 weeks after. Analysis. The daily counts of stair use were modeled using a Poisson regression to estimate the effect of the intervention on staircase use. Results. At baseline, the mean proportion of stair use relative to stair plus elevator use at the intervention site was 31.5% (95% confidence interval [CI], 30.3%–32.7%). During the 6-week intervention period, this proportion increased significantly to 66.2% (95% CI, 64.4%–67.9%). There was no significant change in stair use at the comparison site. In a Poisson regression of the daily number of stair users, the incidence rate ratio associated with the intervention was 2.57 (95% CI, 2.35–2.82). Conclusion. This interactive environmental intervention increased stair usage in an office setting relative to the comparison site, and this increase was sustained over a 6-week period. Adding interactive components to motivational or environmental change interventions shows promise in increasing stair usage.

BACKGROUND: The widespread use of in-store marketing strategies to induce unhealthy impulsive purchases has implications for shopping experience, food choice and possibly adverse health outcomes. The aim of this study was to examine consumer attitudes and evaluate sales effects of a healthy checkout supermarket intervention. The study was part of Project Sundhed & Lokalsamfund (Project SoL); a Danish participatory community-based health promotion intervention.METHODS: Consumer attitudes towards unhealthy snack exposure in supermarkets were examined in a qualitative pre-intervention study (29 short in-store interviews, 11 semi-structured interviews and three focus group interviews). Findings were presented to food retailers and informed the decision to test a healthy checkout intervention. Sugar confectionery at one checkout counter was substituted with fruit and healthy snacking items in four stores for 4 weeks. The intervention was evaluated by 48 short exit interviews on consumer perceptions of the intervention and by linear mixed model analyses of supermarket sales data from the intervention area and a matched control area.RESULTS: The qualitative pre-intervention study identified consumer concern and annoyance with placement and promotion of unhealthy snacks in local stores. Store managers were willing to respond to local consumer concern and a healthy checkout intervention was therefore implemented. Exit interviews found positive attitudes towards the intervention, while intervention awareness was modest. Most participants believed that the intervention could help other consumers make healthier choices, while fewer expected to be influenced by the intervention themselves. Statistical analyses suggested an intervention effect on sales of carrot snack packs when compared with sales before the intervention in Bornholm control stores (P CONCLUSIONS: The present study finds that the healthy checkout intervention was positively evaluated by consumers and provided a 'responsible' branding opportunity for supermarkets, thus representing a win-win strategy for store managers and consumers in the short term. However, the intervention was too modest to draw conclusions on long-term sales and health implications of this initiative. More research is needed to assess whether retailer-researcher collaborations on health promotion can be a winning strategy for public health.

The International Classification of Functioning, Disability and Health provides a useful model to guide the complex aspects of assessment for Assistive Technology. Evaluations based on the ICF help professionals to comprehend the patient’s needs and prioritize goals for intervention. The aim of this study was to demonstrate how to incorporate the ICF framework in the treatment of a patient with severe Cerebral Palsy, with particular focus on Environment Factors, mainly Assistive Technologies to achieve optimal functioning. The study design was single-case interventional type. The study variables were the Environmental Factors included in the ICF Core Sets for children with CP. These factors were evaluated with the ICF-based tools and other standardized measures. After the assessment, the rehabilitation team designed a Comprehensive Environmental Intervention, which consisted in Assistive Technologies implementation and environmental modifications. At the end of intervention, the patient’s achievements were considerable, with improvements on six ICF Categories related to environmental factors.

We used meta-analysis to measure the effect of high-altitude climate therapy (HACT) on lung function outcomes in asthma, and systematically searched PubMed, Embase and www.elibrary.ru for publications appearing from 1970 to mid-2015. We included studies carried out with children or adults with an exposure of up to 12 weeks at an altitude of ≥1500 m above sea level. Changes in forced expiratory volume in 1 s (FEV1), FEV1/vital capacity ratio or peak expiratory flow rate as the HACT intervention outcomes were analysed. We included data for 907 participants (age range 4–58 years) from 21 studies, altogether including 28 substrata based on asthma type or severity. Only three of 21 included studies had high quality, whereas 93% of substudies reported lung function improvement with an overall pooled standardised mean difference (SMD) of 0.53 (95% CI 0.43–0.62). The measured effect of HACT was greater in adults (SMD 0.75, 95% CI 0.63–0.88, n=14) than in children (SMD 0.24, 95% CI 0.09–0.38, n=14). Studies at altitude >2000 m above sea level yielded the same effect as those at lower altitude. Based on a cut-point of a 0.50 change in SMD to define a meaningful clinical difference, HACT appears to have efficacy as an intervention. This extent of benefit appears to be limited to adults with asthma., High-altitude alpine therapy may be an effective intervention to improve lung function in patients with asthma http://ow.ly/u3i23008vU5

BACKGROUND: To recover from work stress, a worksite health program aimed at improving physical activity and relaxation may be valuable. However, not every program is effective for all participants, as would be expected within a "one size fits all" approach. The effectiveness of how the program is delivered may differ across individuals. The aim of this study was to identify subgroups for whom one intervention may be better suited than another by using a new method called QUalitative INteraction Trees (QUINT). METHODS: Data were used from the "Be Active & Relax" study, in which 329 office workers participated. Two delivery modes of a worksite health program were given, a social environmental intervention (group motivational interviewing delivered by team leaders) and a physical environmental intervention (environmental modifications). The main outcome was change in Need for Recovery (NFR) from baseline to 12 month follow-up. The QUINT method was used to identify subgroups that benefitted more from either type of delivery mode, by incorporating moderator variables concerning sociodemographic, health, home, and work-related characteristics of the participants. RESULTS: The mean improvement in NFR of younger office workers in the social environmental intervention group was significantly higher than younger office workers who did not receive the social environmental intervention (10.52; 95 % CI: 4.12, 16.92). Furthermore, the mean improvement in NFR of older office workers in the social environmental intervention group was significantly lower than older office workers who did not receive the social environmental intervention ( -10.65; 95 % CI: -19.35, -1.96). The results for the physical environmental intervention indicated that the mean improvement in NFR of office workers (regardless of age) who worked fewer hours overtime was significantly higher when they had received the physical environmental intervention than when they had not received this type of intervention (7.40; 95 % CI: 0.99, 13.81). Finally, for office workers who worked more hours overtime there was no effect of the physical environmental intervention. CONCLUSIONS: The results suggest that a social environmental intervention might be more beneficial for younger workers, and a physical environmental intervention might be more beneficial for employees with a few hours overtime to reduce the NFR. TRIAL REGISTRATION: NTR2553. ispartof: BMC Public Health vol:16 issue:1 pages:1-15 ispartof: location:England status: published

…This communication refers to growth retardation in the human at certain stages of development and illustrates the influences of infection on the nutritional status and growth of children. The study was conducted in a typical representative highland rural community of low socioeconomic development where environmental intervention was minimized during the study period.

A school-based environmental program to reduce adolescent smoking was conducted in 20 schools (10 intervention, 10 control) in south central Louisiana. The 9th grade cohort (n = 4,763, mean age = 15.4 yrs, 51% female, 61% Caucasian, 30-day smoking prevalence at baseline = 25%) was followed over four years for 30-day smoking prevalence with the school as the unit of analysis. Although prevalence decreased in intervention schools and increased in control schools in Year 2 the significant difference between the two groups at baseline was not overcome by the intervention and increases in prevalence were observed in both groups in Years 3 and 4. The higher the percentage of white students in a school the higher the prevalence rates regardless of intervention/control status. Boys’ and girls’ smoking rates were similar. These outcome data, student feedback and process evaluation provide a basis for continuing to create more innovative adolescent tobacco control programs.

OBJECTIVE: The study analyzed the effect of a combined environmental and educational intervention solely promoting water consumption on the incidence of overweight among school children. METHODS: 2,950 second and third graders of 32 elementary schools in socially deprived neighborhoods of two German cities participated in a randomized controlled intervention trial (August 2006-June 2007). In intervention schools (N = 17), water fountains were installed, each child received a water bottle, and teachers performed classroom lessons to promote water consumption. Control schools (N = 15) did not receive any intervention. Body heights and weights were measured at baseline and follow-up to assess the incidence and remission of overweight and obesity during follow-up. The water flow of the fountains was measured regularly during follow-up. Children's beverage consumption was self-reported in 24-hour recall questionnaires before and after intervention. METHODS: After the intervention, the incidence of overweight was significantly lower in the intervention group (3.8%) than in the control group (6.0%, p = 0.018). Remission of overweight and obesity did not differ between the groups. Measured water flow of the fountains indicated a sustained use. CONCLUSION: A simple dietary intervention with the sole focus on the promotion of drinking water effectively reduced the incidence of overweight among school children.

© 2014, Springer Science+Business Media New York. Urban food swamps are typically situated in low-income, minority communities and contribute to overweight and obesity. Changing the food landscape in low income and underserved communities is one strategy to combat the negative health consequences associated with the lack of access to healthy food resources and an abundance of unhealthy food venues. In this paper, we describe Proyecto MercadoFRESCO (Fresh Market Project), a corner store intervention project in East Los Angeles and Boyle Heights in California that used a multi-level approach with a broad range of community, business, and academic partners. These are two neighboring, predominantly Latino communities that have high rates of overweight and obesity. Located in these two communities are approximately 150 corner stores. The project used a community-engaged approach to select, recruit, and convert four corner stores, so that they could become healthy community assets in order to improve residents’ access to and awareness of fresh and affordable fruits and vegetables in their immediate neighborhoods. We describe the study framework for the multi-level intervention, which includes having multiple stakeholders, expertise in corner store operations, community and youth engagement strategies, and social marketing campaigns. We also describe the evaluation and survey methodology to determine community and patron impact of the intervention. This paper provides a framework useful to a variety of public health stakeholders for implementing a community-engaged corner store conversion, particularly in an urban food swamp.

In the present study 487 adolescents (11-15 years) were randomly assigned to experimental and control groups. The experimental group underwent a 2 school-years intervention including school environment changes (alternative healthy vending machines, educational posters) and reinforcement tools (school curriculum lessons, textbook, text messages, pedometers, reusable water bottles). BMI z-score and waist-to-height ratio (WHtR) were measured. A decrease in BMI z-score was found as an effect of the intervention (between-group difference in change from baseline -0.09±0.04, p=0.03), mainly in overweight/obese subjects (-0.17±0.05, p

Recent studies have suggested that mouse allergen exposure and sensitization are common in urban children with asthma. The effectiveness of environmental intervention in reducing mouse allergen exposure has not been established.To evaluate whether environmental intervention of mouse extermination and cleaning results in a reduction in mouse allergen levels.Eighteen homes of children with positive mouse allergen skin test results and at least mild persistent asthma in urban Boston, MA, with evidence of mouse infestation or exposure were randomized in a 2:1 ratio (12 intervention and 6 control homes). The intervention homes received an integrated pest management intervention, which consisted of filling holes with copper mesh, vacuuming and cleaning, and using low-toxicity pesticides and traps. Dust samples were collected and analyzed for major mouse allergen (Mus m 1) and cockroach allergen (Bla g 1) at baseline and 1, 3, and 5 months after the intervention was started and compared with control homes.Mouse allergen levels were significantly decreased compared with control homes by the end of the intervention period at month 5 in the kitchen and bedroom (kitchen intervention, 78.8% reduction; control, 319% increase; P = .02; bedroom intervention, 77.3% reduction; control, 358% increase; P.01; and living room intervention, 67.6% reduction; control, 32% reduction; P = .07).Mouse allergen levels were significantly reduced during a 5-month period using an integrated pest management intervention.

Earlier research indicated that attentional fatigue with reduced capacity to direct attention in women treated for breast cancer may be ameliorated by a theoretically based intervention involving regular exposure to the natural environment. This study tested the efficacy of a natural environment intervention aimed at restoring attention in 157 women with newly diagnosed breast cancer. Capacity to direct attention was assessed with a brief battery of objective measures at two time points: approximately 17 days before surgery (time 1) and 19 days after surgery (time 2). A randomly assigned intervention protocol was initiated after the first assessment and before any treatment. The intervention comprised a home-based program involving 120 minutes of exposure to the natural environment per week. The intervention group (n = 83) showed greater recovery of capacity to direct attention from the pretreatment (time 1) to the preadjuvant therapy period (time 2), as compared with the nonintervention group (n = 74). A significant effect of the natural environment intervention was observed even after control was used for the effects of age, education, attention scores at time 1, other health problems, symptom distress, and extent of surgery. The findings suggest therapeutic benefits for capacity to direct attention from early intervention aimed at restoring attention in women with newly diagnosed breast cancer.

Objectives The purpose of this study was to assess one-year changes in corner store purchases (nutritional characteristics, amount spent) of children, adolescents, and adults in a low-income urban environment before and after implementing an environmental intervention to increase the availability of healthier products. Methods Corner store owners were provided tools (trainings, signage, refrigeration) to increase the promotion and availability of several healthy foods. Based on the degree of support provided, stores were classified as “basic” or “high-intensity” intervention stores. Data on purchases and their nutrient content were gathered (n = 8671 at baseline, n = 5949 at follow-up) through customer purchase assessment interviews and direct observation outside of 192 corner stores in Philadelphia from March 2011 to August 2012. Results At baseline, shoppers spent $2.81 ± 3.52 for 643 ± 1065 kcal. Energy, select nutrients, and the total amount spent did not significantly change in the overall sample from baseline to follow-up. Similarly, there was no effect on energy and nutrient content when comparing changes over time between basic and high-intensity stores. Conclusions There were no significant changes in the energy or nutrient content of corner store purchases one year after implementation of environmental changes to increase the availability of healthier products.

Previous studies have demonstrated that early environmental interventions influence the consumption of palatable food and the abdominal fat deposition in female rats chronically exposed to a highly caloric diet in adulthood. In this study, we verified the metabolic effects of chronic exposure to a highly palatable diet, and determine the response to its withdrawal in adult neonatally handled and non-handled rats. Consumption of foods (standard lab chow and chocolate), body weight gain, abdominal fat deposition, plasma triglycerides, and leptin, as well as serum butyrylcholinesterase (BuChE), and cerebral acetylcholinesterase (AChE) activities were measured during chronic chocolate exposure and after deprivation of this palatable food in female rats exposed or not to neonatal handling (10 minutes/day, 10 first days of life). Handled rats increased rebound chocolate consumption in comparison to non-handled animals after 1 week of chocolate withdrawal; these animals also decreased body weight in the first 24 hours but this effect disappeared after 7 days of withdrawal. Chocolate increased abdominal fat in non-handled females, and this effect remained after 30 days of withdrawal; no differences in plasma leptin were seen after 7 days of withdrawal. Chocolate also increased serum BuChE activity in non-handled females, this effect was still evident after 7 days of withdrawal, but it disappeared after 30 days of withdrawal. Chocolate deprivation decreased cerebral AChE activity in both handled and non-handled animals. These findings suggest that neonatal handling modulates the preference for palatable food and induces a specific metabolic response that may be more adaptive in comparison to non-handled rats.

When nursing home residents with dementia are unable to locate their own rooms, it often creates problems for staff and other residents. The impact of placing two external memory aids outside participants' bedrooms was evaluated by using a multiple-baseline design experiment. Three female special care unit (SCU) residents with severe Alzheimer's disease (MMSE = 5.7) participated in the study. Results showed that a combination of a portrait-type photograph of the participant as a young adult and a sign stating the resident's name increased room finding by over 50 percent with all three participants. Room finding stabilized at 100 percent accuracy for all participants within a few days of implementing the environmental intervention.

Statement: This article describes the specific environmental strategies that were accepted and used by 100 family caregivers who participated in a home-based occupational therapy intervention. The intervention was designed to enhance the skills of caregivers in using the physical and social environment to address troublesome behaviors and dependency associated with the progression of dementia. The intervention involved five 90-minute home visits by occupational therapists who worked with families to identify caregiving issues and generate environmental-based solutions. Solutions ranged from no cost recommendations (e.g., removing clutter, simplifying the environment), to resource dependent recommendations (e.g., installing grab bars or handrails).Method of Study: Study participants were interviewed at home prior to intervention to gather basic demographic information and level of functioning of the person with dementia. During intervention, the occupational therapist recorded the number and types of careg...

Purpose of Study: The authors determined short-term effects of a home environmental intervention on self-efficacy and upset in caregivers and daily function of dementia patients. They also determined if treatment effect varied by caregiver gender, race, and relationship to patient. Design and Methods: Families ( N � 171) of dementia patients were randomized to intervention or usual care control group. The intervention involved 5 90-min home visits by occupational therapists who provided education and physical and social environmental modifications. Results: Compared with controls, intervention caregivers reported fewer declines in patients’ instrumental activities of daily living ( p � .030) and less decline in self-care and fewer behavior problems in patients at 3 months post-test. Also, intervention spouses reported reduced upset ( p � .049), women reported enhanced self-efficacy in managing behaviors ( p � .038), and women ( p � .049) and minorities ( p � .037) reported enhanced self-efficacy in managing functional dependency. Implications: The environmental program appears to have a modest effect on dementia patients’ IADL dependence. Also, among certain subgroups of caregivers the program improves self-efficacy and reduces upset in specific areas of caregiving.

Environmental modifications have been shown to increase short-term stair use, longer-term success is unclear. This study assessed the 2-year effectiveness of an environmental intervention promoting worksite stair use. We assessed stair use at work by means of self-reports and infrared beam counters (which send a safe and invisible beam of infrared light from one side of a stairwell to a reflector on the other side; when an individual uses the stairs, the infrared beam is disrupted and an instance of stair use is recorded) at six worksites (three intervention, three control) in a group randomized, controlled worksite weight-gain prevention trial in Minneapolis/St. Paul, MN. Intervention modifications were signs encouraging stair use, music, and art posters in stairwells. We collected data before environmental modifications (2006–2007) and at the end of the 2-year intervention (2008–2009). The intervention had a significant positive effect on stair use measured both objectively and via self-report, with greatest increases reported among those participants who used the stairs least at baseline. Following 2-years of continuously-maintained stairwell modifications, increases in both objectively-measured and self-reported stair use were significantly larger at intervention than control worksites. Study findings suggest that the positive impact of environmental modifications on stair use persist over a longer time period than has been previously demonstrated. Results also indicate that infrequent stair users may be most amenable to the behavior changes encouraged by these environmental enhancements.

This case study provides an in-depth examination of process and feasibility factors associated with the development of a multi-component environmental intervention designed to increase access to fresh fruits and vegetables in four low-income, minority, urban communities with few healthy food retail outlets. The intervention, the Veggie Project, included three components: (a) onsite farmers’ markets, (b) a Super Shopper voucher program, and (c) a Youth Leader Board. We analyzed receipts from sales transactions at the farmers’ markets, close-ended surveys with participants, in-depth interviews with project stakeholders, and journal entries completed by youth participants. Thirty-four farmers’ markets occurred, resulting in 1,101 sales transactions. Financial vouchers were used to purchased 63% of the produce. All of the youth Super Shoppers came to the market at least once and made significantly more purchase transactions than adults. The farmers’ markets were never accessed by 38% of the adult Super Shoppers. The Veggie Project increased access to healthy foods, particularly among youth. More research is warranted to examine the relationship between market use and dietary behaviors as well as other factors (i.e., besides physical and economic) influencing food access among adults.

Background: Childhood asthma morbidity and mortality in New Orleans, Louisiana, is among the highest in the nation. In August 2005, Hurricane Katrina created an environmental disaster that led to high levels of mold and other allergens and disrupted health care for children with asthma. Objectives: We implemented a unique hybrid asthma counselor and environmental intervention based on successful National Institutes of Health asthma interventions from the National Cooperative Inner City Asthma (NCICAS) and Inner-City Asthma (ICAS) Studies with the goal of reducing asthma symptoms in New Orleans children after Hurricane Katrina. Methods: Children (4–12 years old) with moderate-to-severe asthma (n = 182) received asthma counseling and environmental intervention for approximately 1 year. HEAL was evaluated employing several analytical approaches including a pre–post evaluation of symptom changes over the entire year, an analysis of symptoms according to the timing of asthma counselor contact, and a comparison to previous evidence-based interventions. Results: Asthma symptoms during the previous 2 weeks decreased from 6.5 days at enrollment to 3.6 days at the 12-month symptom assessment (a 45% reduction, p < 0.001), consistent with changes observed after NCICAS and ICAS interventions (35% and 62% reductions in symptom days, respectively). Children whose families had contact with a HEAL asthma counselor by 6 months showed a 4.09-day decrease [95% confidence interval (CI): 3.25 to 4.94-day decrease] in symptom days, compared with a 1.79-day decrease (95% CI: 0.90, 2.67) among those who had not yet seen an asthma counselor (p < 0.001). Conclusions: The novel combination of evidence-based asthma interventions was associated with improved asthma symptoms among children in post-Katrina New Orleans. Post-intervention changes in symptoms were consistent with previous randomized trials of NCICAS and ICAS interventions.

Purpose. The current study compared two interventions for promotion of stair climbing in the workplace, an information-based intervention at a health information day and an environmental intervention (point-of-choice prompts), for their effectiveness in changing stair climbing and cost per employee. Design. Interrupted time-series design. Setting. Four buildings on a university campus. Subjects. Employees at a university in the United Kingdom. Interventions. Two stair-climbing interventions were compared: (1) a stand providing information on stair climbing at a health information day and (2) point-of-choice prompts (posters). Measures. Observers recorded employees' gender and method of ascent (n = 4279). The cost of the two interventions was calculated. Analysis. Logistic regression. Results. There was no significant difference between baseline (47.9% stair climbing) and the Workplace Wellbeing Day (48.8% stair climbing), whereas the prompts increased stair climbing (52.6% stair climbing). The health information day and point-of-choice prompts cost $773.96 and $31.38, respectively. Conclusion. The stand at the health information day was more expensive than the point-of-choice prompts and was inferior in promoting stair climbing. It is likely that the stand was unable to encourage stair climbing because only 3.2% of targeted employees visited the stand. In contrast, the point-of-choice prompts were potentially visible to all employees using the buildings and hence better for disseminating the stair climbing message to the target audience. (Am J Health Promot 2011;25[4]:231–236.)

Energy restriction (ER), without malnutrition, is the only environmental intervention that consistently increases maximum life span in laboratory rodents. One theory proposes that a reduction in energy expenditure and reactive oxygen species production is the mechanism responsible for this action of ER. To further test this theory, proton leak, H2O2production, lipid peroxidation, and protein carbonyls were measured in mitochondria from FBNF1rats fed either a control or 40% ER diet (onset at 6 mo of age). Liver mitochondria were isolated at 7 and 12 mo of age. Liver weight decreased 25 and 36% at 1 and 6 mo of ER, respectively ( P < 0.05). ER resulted in an increase ( P < 0.05) in percent total polyunsaturates, n-6 polyunsaturates, and total unsaturates (6 mo only) in mitochondrial lipids. These changes, however, were not associated with significant alterations in mitochondrial function. State 4 respiration and membrane potential were not different ( P > 0.05) between groups at either assessment period. Similarly, proton leak kinetics were not different between control and ER animals. Top-down metabolic control analysis and its extension, elasticity analysis, were used at the 6-mo assessment and revealed no difference in control of the oxidative phosphorylation system between control and ER rats. H2O2production with either succinate or pyruvate/malate substrates was also not different ( P > 0.05) between groups at either time point. In conclusion, ER did not alter proton leak or H2O2production at this age or stage of restriction in liver.

Health Economics evaluations are typically applied to medications or surgery costs, but this unique study has investigated the economic benefits of discrete deployment of antimicrobial copper alloy touch surfaces in ICUs. Copper/copper alloy surfaces have been shown to act as an adjunct to standard infection control practices in diverse clinical settings, continuously reducing contamination by over 90%. Moreover, work reported by Dr Michael Schmidt at the first ICPIC revealed the link between reduced bioburden and significant reductions in the risk of acquiring an HCAI. This study investigates the cost-effectiveness of this intervention, comparing expenditure with the improvements in patient outcomes and other tangible benefits.

The release by the Centers for Disease Control (CDC) 1 of new guidelines on lead poisoning prompts us to express concern about the present direction of governmental control of lead exposure in children. Pediatricians, psychologists, and epidemiologists 2-4 are uneasy about the ramifications of lowering the blood lead level at which we should become involved, through increased medical monitoring or environmental intervention. Parents are becoming concerned about the intellectual future of their children at the same time that they are faced with both an apparent inability to eliminate low levels of lead in children, and the dangers of removing lead from houses. To make things worse, it is now suggested that these effects persist for years, resulting in a poor performance in school and higher dropout rate for older children. Parents now see future prospects for their children permanently jeopardized.

Background: This study evaluated an environmental intervention intended to increase consumption of the fruit serving among elementary school children participating in the National School Lunch Program (NSLP).

Morgan WJ, Crain EF, Gruchalla RS, et al. N Engl J Med . 2004;351:1068‐1080 To determine if environmental modification reduces asthma morbidity in inner-city, atopic children. Asthmatic children (age range: 5–11 years) from inner cities who were skin-test positive to at least 1 of 11 indoor allergens. To be eligible for the study, the children had to have had 1 hospitalization or 2 unscheduled medical visits for asthma in the previous 6 …

Morgan WJ, Crain EF, Gruchalla RS, et al. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med 2004;351:1068–80. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Q In inner city children with atopic asthma, is a multifaceted, home based, environmental intervention (HBEI) effective for improving asthma related outcomes? Clinical impact ratings Paediatrics ★★★★★★☆ Respirology ★★★★★★☆ Immunology ★★★★★☆☆ Allergy and Immunology ★★★★★☆☆ ### ![Graphic][5] Design: randomised controlled trial. ### ![Graphic][6] Allocation: {concealed*}†. ### ![Graphic][7] Blinding: blinded (clinical outcome assessors).* ### ![Graphic][8] Follow up period: 1 year of intervention followed by a 1 year observational period. ### ![Graphic][9] Setting: 7 major cities in the US. ### ![Graphic][10] Patients: 937 children 5–11 years of age (mean age 7.7 y, 63% boys) with atopic asthma who were residents of census tracts in which ⩾20% of the households had incomes below the federal poverty level. Children were also required to have had ⩾1 asthma related hospital admission or 2 unscheduled, asthma related visits to the clinic or emergency department during the previous 6 months and a positive skin test in response to ⩾1 of 11 indoor allergens. ### ![Graphic][11] Intervention: a 1 year … [1]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.aulast%253DMorgan%26rft.auinit1%253DW.%2BJ.%26rft.volume%253D351%26rft.issue%253D11%26rft.spage%253D1068%26rft.epage%253D1080%26rft.atitle%253DResults%2Bof%2Ba%2BHome-Based%2BEnvironmental%2BIntervention%2Bamong%2BUrban%2BChildren%2Bwith%2BAsthma%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa032097%26rft_id%253Dinfo%253Apmid%252F15356304%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJMoa032097&link_type=DOI [3]: /lookup/external-ref?access_num=15356304&link_type=MED&atom=%2Febmed%2F10%2F2%2F51.atom [4]: /lookup/external-ref?access_num=000223733900006&link_type=ISI [5]: /embed/inline-graphic-1.gif [6]: /embed/inline-graphic-2.gif [7]: /embed/inline-graphic-3.gif [8]: /embed/inline-graphic-4.gif [9]: /embed/inline-graphic-5.gif [10]: /embed/inline-graphic-6.gif [11]: /embed/inline-graphic-7.gif

▴ Morgan WJ, Crain EF, Gruchalla RS, et al . Results of a home-based environmental intervention among urban children with asthma. N Engl J Med2004;351:1068–80 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Children with asthma who live in the inner city are exposed to multiple indoor allergens and environmental tobacco smoke in their homes. It is difficult to reduce these triggers and previous studies have not shown any significant decrease in morbidity. In this randomised controlled trial of an environmental intervention over 1 year, 937 children (age 5–11 … [1]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.aulast%253DMorgan%26rft.auinit1%253DW.%2BJ.%26rft.volume%253D351%26rft.issue%253D11%26rft.spage%253D1068%26rft.epage%253D1080%26rft.atitle%253DResults%2Bof%2Ba%2BHome-Based%2BEnvironmental%2BIntervention%2Bamong%2BUrban%2BChildren%2Bwith%2BAsthma%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa032097%26rft_id%253Dinfo%253Apmid%252F15356304%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJMoa032097&link_type=DOI [3]: /lookup/external-ref?access_num=15356304&link_type=MED&atom=%2Fthoraxjnl%2F59%2F12%2F1040.atom [4]: /lookup/external-ref?access_num=000223733900006&link_type=ISI

Rationale To reduce asthma symptoms in 5-12 year old children through a multifaceted environmental/educational intervention. Methods Changes in indoor allergen levels and asthma severity scores (summary score of symptoms, activity limitations, medication use, hospitalization and emergency department [ED] use) were compared over 14 months between an intervention and delayed intervention ("control") groups in a prospective, randomized field trial. Intervention group households had dust mite covers put on the child's sleeping surfaces, received a professional house cleaning, had roach bait and trays placed appropriately along with instructions in their monitoring, and received customized information about common allergens avoidance. Results Of 981 eligible subjects presenting to the ED, 410 (42%) were enrolled; 161 (40%) completed baseline activities and were randomized: 84 to intervention and 77 to control. At study's end, control children compared to baseline had a 163% increase in dust mite levels, while the intervention group levels were stable. There was no change in the overall asthma severity scores, however, relative to baseline, the median functional severity score (FSS) component declined more in the intervention (33% versus 20%) than the control group. The median FSS for the intervention group showed a 25% improvement compared to the control group (p Conclusions Dust mite allergen levels did not increase for the intervention group and the FSS indicated improvement without changing the overall asthma severity score. The interventions probably contributed to improvements in the allergenic environment and the function of the children.

Rationale Recent studies have suggested that mouse allergen exposure and sensitization are common in urban children with asthma. The effectiveness of environmental intervention in reducing mouse allergen exposure has not been established. Our goal was to evaluate whether environmental intervention of mouse extermination and cleaning results in a reduction in mouse allergen levels and whether this intervention has any effect on lung function and asthma morbidity. Methods Eighteen homes of children with positive mouse allergen skin tests and at least mild persistent asthma in urban Boston with evidence of mouse infestation/exposure were randomized in a 2:1 ratio (12 intervention to 6 control homes). The intervention homes received an integrated pest management strategy, which consisted of filling holes with copper mesh, vacuuming and cleaning, and low toxicity pesticides and traps. Dust samples were collected and analyzed for major mouse allergen (Mus m 1) and cockroach allergen (Bla g 1) at baseline and 1, 3, and 5 months after the intervention was started and compared to control homes. Results Mouse allergen levels were significantly decreased compared to control by the end of the intervention period at month 5 in the kitchen and bedroom (kitchen intervention 78.8% reduction: control 319% increase, P =0.025; bedroom intervention 77.3% reduction: control 358% increase, P =0.006; and living room intervention 67.6% reduction: control 32% reduction, P =0.07). There was no significant change in lung function or asthma morbidity from baseline. Conclusions Mouse allergen levels were significantly reduced over a 5 month period using an integrated pest management intervention.