Potential toxicity of chlorpheniramine plus chloroquine for the treatment of childhood malaria

OBJECTIVES

To compare the adverse effects of two regimens of chlorpheniramine plus chloroquine (CP+CQ) in children who live in a country where chloroquine resistant malaria is endemic.

METHODS

99 children with acute uncomplicated malaria were randomised into two treatment groups. Group I received high dose chlorpheniramine (6 mg +12 mg/day for 7 days in children = 5 years; 8 mg + 18 mg/day for 7 days in those >5 years) plus chloroquine 10 mg/kg daily for 3 days. Group II received a 50% higher dose of chlorpheniramine plus chloroquine 10 mg/kg daily for 3 days. Outcome measures were vital signs, clinical response and parasite clearance on days 0-7 and day 14.

RESULTS

Parasite clearance, fever clearance and cure rate were comparable for the two groups. Drowsiness occurred in 66.7% of high dose and 86.3% of higher dose CP+CQ subjects (p = 0.05). Compared to children treated with high dose, those treated with higher dose CP+CQ had significantly lower respiratory rates on day 2 (p = 0.001), day 6 (p = 0.015), and on day 14 (p = 0.003).

CONCLUSION

The higher rates of drowsiness and lower respiratory rates in children treated with higher dose CP+CQ calls for caution in the clinical application of the higher dose combination. The higher dose has no additional benefit and may in fact be dangerous.

Enhanced life functioning: Initial efficacy of a theoretical approach to integrate multiple health behavior interventions in young adults

OBJECTIVES

We propose a new theoretical model that integrates health interventions targeting multiple health behaviors around a common framework of enhancing life functioning. We then test an enhanced life functioning message against an enhanced physical health message in increasing participants' perceived importance of engaging in multiple health behaviors.

METHODS

94 undergraduate participants were exposed to either an enhanced life functioning message or an enhanced physical health message and then completed measures of health behavior importance and benefits associated with enhanced life functioning importance in the spring of 2008 at Rutgers University.

RESULTS

Results indicate the efficacy of an enhanced life functioning message in increasing participants' perceived importance of engaging in multiple health behaviors. Moreover, the effect of an enhanced life functioning message on perceived health behavior importance is mediated by perceived importance of the benefits associated with enhanced life functioning.

CONCLUSIONS

Emphasizing enhanced life functioning as an outcome of engaging in multiple health behaviors increases the perceived importance of performing multiple health behaviors, which may influence the performance of multiple health behaviors.

Efficacy of tobacco dependence treatment in the context of a "smoke-free grounds" worksite policy: a case study

BACKGROUND

Smoking restrictions provide opportunities to modify smoking behavior. A large insurance company implemented a smoke-free grounds policy at two of their office complexes in January, 2000.

METHODS

This cohort study evaluated the impact of the smoke-free grounds policy on abstinence among 128 employees who participated in a tobacco dependence treatment program.

RESULTS

The overall quit rate at 6 months was 44.5%. The larger complex showed a trend for higher quit rates compared to the smaller complex (46.5 vs. 28.6%). Post-ban participants had higher quit rates than pre-ban participants (52.4 vs. 43.0%). The probability of abstinence at 6 months follow-up was higher for post-ban compared to pre-ban participants (P = 0.03). Post-ban participants were 80% less likely to relapse than pre-ban participants. Non-quitters decreased their consumption by 6.6 cigarettes/day (39.1% decrease).

CONCLUSIONS

A "smoke-free grounds" policy encourages abstinence and may play a significant role in harm reduction among continuing tobacco users.

A pilot study of telephone-based smoking cessation intervention in asbestos workers

Smoking markedly increases the risk of asbestos-related lung cancer. We conducted a randomized pilot trial of a telephone-based smoking cessation intervention in asbestos workers. Fifty-nine smokers were assigned to either a control or telephone-based smoking cessation treatment group and were followed-up at 6 months. Intent-to-treat analysis revealed a 16.7% quit rate at 6 months for the intervention group compared to 6.9% for the control group (P = 0.25). Treatment-received quit-rates were 33% for the intervention group and 6.9% for the control group (P = 0.05). The intervention group was twice as likely to use smoking cessation medicines and progressed further along the stage of change continuum compared with the control group. Incorporating telephone-based smoking cessation treatment into medical screening activities for asbestos workers is feasible and the intervention is effective in increasing quit rates at 6 months.

Tobacco in the workplace

Tobacco use, the leading cause of preventable death, has numerous adverse impacts in the workplace. It is associated with increased healthcare costs and disability, greater absenteeism, decrements in job performance, and increased risk of injury, and secondhand smoke is a major pollution problem. Tobacco dependence responds to treatment, and employers have several opportunities to offer treatment to employees and their families. Smoke-free environments can help smokers cut back or quit. Combining sound workplace policies and treatment with community involvement in tobacco control provides synergies to reduce tobacco use in the community as well as in the workforce. These activities benefit workers and their families, employers, and society at large.

Study of smoking behavior in asbestos workers

BACKGROUND

Asbestos exposure and concomitant cigarette smoking markedly increase the risk of lung cancer and contribute to the prevalence and severity of pulmonary interstitial fibrosis.

METHODS

A cross-sectional survey of 214 asbestos workers was initiated to determine the prevalence of smoking and their readiness to quit smoking using the stage of change theory.

RESULTS

The study was comprised of 61 never smokers (28.5%), 118 ex-smokers (55.1%), and 35 current smokers (16.4%). Reasons for smoking cessation in ex-smokers included perception of ill-health (51%) and knowledge of smoking-asbestos hazards (3.4%). Stage of change of current smokers revealed: precontemplation (26.5%), contemplation (35%), preparation (29%), and action (8.8%). Current smokers had the highest prevalence of small airway obstruction on spirometry.

CONCLUSIONS

A detailed smoking history during medical surveillance activities will enable the occupational physician to identify asbestos workers who have difficulty quitting and to develop a system in which such individuals can be referred to comprehensive smoking cessation programs.