Attitudes and beliefs of African-Americans toward genetics, genetic testing, and sickle cell disease education and awareness

Research among African-Americans indicates this population perceives sickle cell (SCD) to be a serious disease and sickle cell trait (SCT) screening an important intervention. However, studies have consistently demonstrated a lower than desired uptake of SCD education, inadequate knowledge regarding personal and family trait status, and a low perceived susceptibility of giving birth to a child with the disease. We examined general attitudes and beliefs regarding genetics and genetic testing including prenatal testing and newborn screening; we used this information as the foundation to more specifically assess attitudes and beliefs regarding SCD and perceived barriers to SCD education and awareness. Thirty-five African-American adult men and women participated in one of four focus groups. Thematic analysis identified that both prenatal testing and newborn screening are acceptable forms of genetic testing. Based largely on their personal experiences, participants possessed an understanding of the natural progression of SCD but had a limited understanding of the inheritance and probable risk of giving birth to a child with the disease. Barriers to education and greater awareness of SCD were classified as personal, familial, and societal. Community based interventions focused on sharing the stories of individuals with first-hand experiences with SCD should be considered.

A reality-oriented approach to interdisciplinary work

Although there is a long history of support in the literature for interdisciplinary education, practice, and research, the actual implementation of such activities has varied greatly. Numerous variables inhibit interdisciplinary work, including a tendency to focus on the many barriers to, rather than opportunities for, such work, a lack of solid data documenting its benefits, the difficulty inherent in finding solutions to the conflicts that arise among the disciplines involved, and organizational reward and regulation systems geared toward single-discipline work. Nonetheless, the goal of interdisciplinary work persists, and there are several notable examples of success. Strategies are outlined for incremental achievement of interdisciplinary aspirations in less-than-ideal environments. These strategies include scanning the environment for promising opportunities, setting realistic goals, building commitment to those goals, avoiding useless battles, and celebrating successes. Specific examples of such strategies as used in the Health Science Center at the University of Florida are provided.

Vaccination of boars with a GnRH vaccine (Improvac) eliminates boar taint and increases growth performance

Peri- and postpubertal boars accumulate substances (e.g., androstenone and skatole) in their fatty tissue that are responsible for boar taint in pork. The objective of this study was to assess the efficacy of a GnRH vaccine, Improvac, in eliminating boar taint. Three hundred male (200 intact boars, 100 barrows) crossbred (Large White x Landrace) pigs were used in a 2 x 3 factorially arranged experiment. The respective factors were sex group (barrows, boars treated with placebo, or boars treated with Improvac) and slaughter age (23 or 26 wk). Vaccines were administered 8 and 4 wk before slaughter. All Improvac-treated pigs exhibited anti-GnRH titers. Testes and bulbo-urethral gland weights in treated pigs were reduced by approximately 50% (P < 0.001) and serum testosterone levels were below 2 ng/mL in the majority of treated boars (94 and 92% across both age groups at 2 and 4 wk, respectively). Boar taint, as assessed by the concentration of androstenone and skatole in s.c. fat, was suppressed to low or undetectable levels in 100% of Improvac-treated boars. No Improvac-treated pigs had significant concentrations of either androstenone (> 1.0 microg/g) or skatole (> 0.20 microg/g). In contrast, 49.5% of placebo-treated controls had significant androstenone and 10.8% had significant skatole levels, resulting in 10% of the control boars with high concentrations of both compounds. The mean concentrations of taint compounds in the Improvac-treated pigs were not significantly different from those in barrows. Improvac-treated boars grew more rapidly (P = 0.051 and < 0.001 for pigs slaughtered at 23 and 26 wk of age, respectively) than control boars over the 4 wk after the secondary vaccination, possibly because of reduced sexual and aggressive activities. Compared with barrows, Improvac-treated boars were leaner and had superior feed conversion efficiency. The vaccine was well tolerated by the pigs, and no observable site reactions could be detected at the time of slaughter. Vaccination of boars with Improvac allows production of heavy boars with improved meat quality through prevention and control of boar taint.

The specificity of antibody in chickens immunised to reduce intestinal colonisation with Campylobacter jejuni

Poultry consumption has been identified as a major risk factor for human infection with Campylobacter jejuni in developed countries. C. jejuni is present in the gastrointestinal tract of broiler chickens at the time of slaughter, and faecal contamination of carcases during processing results in significant campylobacter loads on carcases. One approach to reducing the level of carcase contamination with C. jejuni is to control campylobacter infection in broiler chickens. To this end, the study described here investigated the specificity of antibody in serum and intestinal secretions of chickens that had been immunised with campylobacter antigens and then challenged with viable bacteria. The immunodominant antigens in the serum of birds that showed a 2-log reduction in caecal colonisation with C. jejuni included flagellin protein (61-63 Kd) and three additional antigens of 67, 73.5 and 77.5 Kd. Only flagellin and the 67 Kd antigen were recognised by IgG antibody in gastrointestinal secretions of the same birds. Antibody from chickens immunised with purified native flagellin protein recognised flagellin protein and the 67 Kd antigen in Western blots probed with serum, but only the flagellin proteins (61-63 Kd) in Westerns probed with gastrointestinal secretions. Analysis of the specificity of the response to flagellin protein using recombinant clones that expressed regions of the flagellin gene suggests that epitopes in each region of the flagellin protein were immunogenic. Of the immunodominant antigens, only flagellin appeared to be surface-exposed on viable C. jejuni, although conformational epitopes of flagellin appeared to be sensitive to the method of antigen purification. The results of this study suggest that flagellin and possibly the 67 Kd antigen may be valuable for immunological control of intestinal infection with C. jejuni in chickens, but that further work is required to purify these as vaccine candidates by using methods that preserve conformational epitopes.

Health care for the school-age child

The research related to health care for school-age children is reviewed. Two major categories are considered, namely, health-risk behavior and psychosocial health. Research related to the emerging issues of homelessness and AIDS is also reviewed. The research completed to date on school-age children's health care is critiqued with an emphasis on the state of the science in nursing. Recommendations for further research are provided.

Development of a PCR test based on a gene region associated with the pathogenicity of Pasteurella multocida serotype B:2, the causal agent of haemorrhagic septicaemia in Asia

We have developed a PCR assay to detect Pasteurella multocida serotype B:2, the causal agent of Haemorrhagic Septicaemia (HS) in Asia. Nucleotide sequence determination of a 16S rRNA-23S rRNA PCR product unique to B:2 strains was shown to share amino acid sequence homology with a bacteriophage Mu protein. Primers designed from this sequence when tested against a panel of isolates recovered from a wide geographical area and representing a large range of bacterial genera and species, were found to specifically amplify DNA from P. multocida, serotype B:2. Southern hybridisation confirmed the presence of this sequence in only the B:2 serotype of P. multocida, suggesting an association between bacterial virulence and the presence of bacteriophage genes in the bacterial genome. The results of this study demonstrate the potential application of PCR to the diagnosis of HS in cattle and buffalo in Asia. Application of PCR to support diagnosis of HS will greatly improve accuracy, laboratory response time, and will facilitate rational deployment of resources for controlling this disease.

The relationship between maximal expiratory flow and increases of maximal exercise capacity with exercise training

We previously reported that patients with mild to moderate airflow limitation have a lower exercise capacity than age-matched controls with normal lung function, but the mechanism of this reduction remains unclear (1). Although the reduced exercise capacity appeared consistent with deconditioning, the patients had altered breathing mechanics during exercise, which raised the possibility that the reduced exercise capacity and the altered breathing mechanics may have been causally related. Reversal of reduced exercise capacity by an adequate exercise training program is generally accepted as evidence of deconditioning as the cause of the reduced exercise capacity. We studied 11 asymptomatic volunteer subjects (58 +/- 8 yr of age [mean +/- SD]) selected to have a range of lung function (FEV1 from 61 to 114% predicted, with a mean of 90 +/- 18% predicted). Only one subject had an FEV1 of less than 70% predicted. Gas exchange and lung mechanics were measured during both steady-state and maximal exercise before and after training for 30 min/d on 3 d/wk for 10 wk, beginning at the steady-state workload previously determined to be the maximum steady-state exercise level that subjects could sustain for 30 min without exceeding 90% of their observed maximal heart rate (HR). The training workload was increased if the subject's HR decreased during the training period. After 10 wk, subjects performed another steady-state exercise test at the initial pretraining level, and another maximal exercise test. HR decreased significantly between the first and second steady-state exercise tests (p < 0.05), and maximal oxygen uptake (VO2max) and ventilation increased significantly (p < 0.05) during the incremental test, indicating a training effect. However, the training effect did not occur in all subjects. Relationships between exercise parameters and lung function were examined by regression against FEV1 expressed as percent predicted. There was a significant positive correlation between VO2max percent predicted and FEV1 percent predicted (p < 0.02), and a negative correlation between FEV1 and end-expiratory lung volume (EELV) at maximal exercise (p < 0.03). There was no significant correlation between FEV1 and maximal HR achieved during exercise; moreover, all subjects achieved a maximal HR in excess of 80% predicted, suggesting a cardiovascular limitation to exercise. These data do not support the hypothesis that the lower initial VO2max in the subjects with a reduced FEV1 was due to deconditioning. Although increased EELV at maximal exercise, reduced VO2max and a reduced VO2max response with training are all statistically associated with a reduced FEV1, there is no direct evidence of causality.

Genotypic Diversity among Campylobacter jejuni Isolates in a Commercial Broiler Flock

Analysis of nucleic acid polymorphism in the flagellin genes of Campylobacter jejuni was used to investigate genetic diversity among Campylobacter spp. in a commercial broiler flock. Three hundred single colonies of C. jejuni were isolated from fecal samples collected weekly for 3 weeks immediately before slaughter. Both the flaA and flaB genes were amplified by PCR, and the PCR product was digested with the restriction enzyme AluI. The fragments generated were then analyzed by agarose gel electrophoresis. Among the 300 recovered isolates, five different restriction fragment length polymorphism profiles were observed. Three of these profiles were dominant during the course of the study, and the other two profiles were detected at low frequency. Analysis of genetic variation in C. jejuni over the course of an experimental infection lasting 7 weeks indicated that there was no obvious drift in the flagellin gene type. These findings demonstrate that a range of bacterial genotypes can constitute the bacterial population within a commercial poultry flock, with the most likely sources of these types being multiple environmental exposure and/or genetic drift within the population. This degree of diversity must be considered in epidemiological analyses which utilize genetic typing methods that investigate Campylobacter contamination of any food source, including poultry, to ensure that the total gene pool for C. jejuni is evaluated.

Advanced Education for the Role of Rural Nurse Generalist

The Montana State University College of Nursing has developed a master's degree program which prepares nurses as generalists with advanced knowledge for understanding and addressing rural health care needs. The programs is clear about its goals and objectives and does not attempt to be "all things for all people." The emphasis is on rural nursing, and this emphasis is present in recruiting, teaching, research and publication at the College. Classroom and clinical experiences challenge students to develop a broad range of skills, and most importantly to enhance critical thinking and problem-solving abilities. Since delivering high quality health care in rural areas requires the ability to understand health care from the consumer's perspective, both data collection and clinical experience in rural communities are required. The enthusiasm for rural nursing--practice, teaching and research--displayed by faculty members, alumnae and students is both a major factor in, and an indication of, the program's success.

Immunisation of chickens to reduce intestinal colonisation with Campylobacter jejuni

1. Systemic and intestinal antibody titres were measured in chickens following subcutaneous, intraperitoneal (i.p.), oral (p.o.) and combined i.p./p.o. administration of antigen, in soluble, emulsified or microparticulate form. Antigens tested included keyhole limpet haemocyanin (KLH), killed Campylobacter jejuni whole cells and purified campylobacter flagellin protein. 2. The effect of immunisation with purified flagellin protein or with killed C. jejuni whole cells in reducing intestinal colonisation was assessed. The ability of newlyhatched chicks to respond to immunisation was limited, possibly because of the immaturity of the immune system rather than maternal suppression of an immune response. Only 5 to 13 birds that were first immunised when 1-d-old with KLH showed a systemic response, even after 4 immunisations, whereas 10 of 11 birds that were first immunised at 24 d-old responded systemically. 3. In an immunisation and challenge experiment, birds that were immunised twice intraperitoneally, at 16 and 29 d-old, with killed C. jejuni whole cells, had fewer C. jejuni, in the caecal contents than unimmunised control birds. This reduction in intestinal colonisation, to less than 2% of bacterial numbers in control birds, was associated with an increase in specific IgG in intestinal secretions. There was no significant increase in specific IgA or IgM in intestinal secretions following immunisation and challenge. 4. These results indicate that immunisation can reduce the level of intestinal infection with C. jejuni. The protection may be enhanced by developing improved methods of immunisation that stimulate production of increased titres of specific antibody in intestinal secretions, particularly specific IgA antibody.

Ethical responsibility for the community's mental health: a professional nursing role

TOPIC

A review of data from multiple sources indicates a decline in support services for children and families, and an increase in the prevalence of psychiatric disorders as well as psychosocial problems among children. A discussion of trends reveals reforms that are reducing all healthcare expenditures and limiting the provision of publicly funded services.

PURPOSE

To discuss the essential values of professional nursing and considers them as a basis for needed nursing action.

CONCLUSION

Individual nurses have an ethical responsibility to take social, political, and economic actions to enhance community mental health. Specific strategies and approaches for doing so are presented.

Variations in bone status of contralateral and regional sites in young athletic women

To determine if volleyball (VB), basketball (BB), soccer (SO) and swimming (SW) programs were associated with site-specific differences in contralateral, regional, and total body bone mineral density (BMD), 62 eumenorrheic female athletes [BB (N = 7), VB (N = 11), SO (N = 9), and SW (N = 7)] and controls participated in the study. The controls were categorized as either moderately active control (MOD) (N = 17) or sedentary control (SED) (N = 11) based on fitness and activity assessments. Contralateral, total body, lumbar (L2-L4), and femur BMD were measured (Lunar DPX). The between sport contralateral comparisons indicated that VB and BB had significantly greater leg and arm measurements than all other groups, while the within contralateral comparisons revealed significantly greater right arm measurements for all groups, except SW. No significant differences were found for the within group contralateral leg comparisons, except VB. VB and BB had significantly higher (P < or = 0.05) total body and lumbar BMD values than SW, MOD, and SED. At the femur neck, trochanter, and Ward's triangle, BB showed significantly higher BMD than SW, MOD, and SED. Only BB had significantly higher Ward's triangle BMD than SW, MOD, and SED. Our findings show site-specific differences in BMD associated with selected sports' programs.

Master's degree nursing education and health care reform: preparing for the future

Current and anticipated changes in health care delivery indicate a need for reform within nursing education. Master's degree education can be a valuable component in the preparation of future nurses, but assessment and revision of existing programs are necessary. The American Association of Colleges of Nursing's position paper, Nursing Education's Agenda for the 21st Century, provides recommendations for educational reform in general and for master's degree education specifically. Overall recommendations include greater focus on the development of unique aspects in each school's mission, emphasis on nursing as a practice discipline, and the inclusion of all aspects--content, processes, and outcomes--in curricular revisions. Master's degree education is reaffirmed as preparation for those who will advance practice. In keeping with health care delivery trends, advanced practice nurses will require substantial expertise in health promotion, primary health care, case management, health care economics, and change strategies. Many questions remain unanswered regarding appropriate future directions for master's degree education. There is little consensus on core knowledge or a single appropriate title for advanced practice nurses. The amount and type of research preparation, and the need for role preparation are other controversial issues. The future holds exciting potential, but there will be significant challenges in program revisioning, faculty redevelopment and clarification of goals and methods for master's degree education.

Molar function depends on molecular structure of behavior

Pigeons chose between green side keys, then waited a shorter or longer time before pecking a center key, and finally chose between red side keys. Two successive left choices (to green and then red) with a shorter wait intervening, or 2 successive right choices with a longer wait intervening, were intermittently reinforced with food. The 2 required waiting times and the relative frequency of reinforcement for the shorter reinforced pattern were varied. Molar preference, defined in terms of coherent responses that satisfied the molecular reinforcement contingency, conformed to the highly adaptive matching level, but molar preference, defined in terms of incoherent responses, did not. The molar matching result therefore generalizes to responses with complex molecular structures provided that analyses distinguish between coherent and incoherent responses. The results are compatible with the idea that awareness can facilitate adaptation.

Comparison of metabolic and perceptual responses during maximal exercise on two ergometers: NOVA 5000 vs treadmill

The purpose of this study was to investigate the physiological and perceptual responses to exercising on the NOVA 5000 (NO). The NO is a new computer controlled multi-limb exercise device which allows the exerciser to work arms and legs individually or in any combination from a seated position. Eleven subjects (7 males, 4 females) participated in two sessions of graded exercise testing (GXT) within the same week. One session involved a GXT treadmill test (TR) to exhaustion utilizing the Bruce protocol. A second GXT was performed on the NO that utilized a protocol consisting of successive 3 minute stages starting at 50 watts and increasing 25 watts until exhaustion. A Quinton Q-5000 and a Sensor Medics metabolic cart monitored cardiorespiratory function during both tests. MANOVA analysis revealed no significant (p < 0.05) differences between the NO and TR maximal values for VO2 (1.min-1 and ml.kg-1.min-1), HR, RER, VE, and workload (WR). There were significant (p < 0.05) differences between the to modes of testing for RPE and TT (time on task) with the NO having significantly higher values on both variables. The correlation coefficient for the VO2max values on the TR vs NO was r = 0.97. When the HR and VO2 means from each stage of the NO GXT were correlated over the duration of the test, a positive correlation (r = 0.99) was obtained. The results of this study indicate that the NOVA 5000 may be a suitable alternative device for testing healthy adults.

Predicting alcohol use in rural children: a longitudinal study

The purposes of this study were to describe the prevalence and correlates of alcohol use and to examine the ability to predict alcohol use among rural sixth- and seventh-grade children. The sample consisted of 625 children from six schools in small Montana towns. Self-administered questionnaires contained measures of sociodemographic characteristics, self-concept, school attitudes, beliefs about the effects of alcohol, and alcohol use. Fifty-eight percent of the children reported using alcohol. Children's beliefs about alcohol were significantly correlated with alcohol use. Logistic regression analysis failed to identify a model having adequate sensitivity and specificity for classifying sixth- and seventh-grade students as "users" and "nonusers" based on variables assessed in Grades 3 and 4. Nevertheless, holding other variables constant, children who displayed both negative self-concept and negative school attitudes in Grades 3 and 4 were most likely to use alcohol in Grades 6 and 7.

The concept of health. Rural perspectives

An understanding of the client's concept of health is necessary to conduct relevant and effective health assessment, planning, intervention, and evaluation. Client health concepts are affected by place of residence and further colored by specific community and individual level variations including occupation, education, subculture, age, gender, and health status. Rural nursing practice can be improved through knowledge of the health perceptions and definitions held by the rural clients to be served. Nursing, as a discipline, has traditionally emphasized the need to understand the client's perspective and to develop mutually agreed on health goals in collaboration with the client. Rural nursing practice offers unique opportunities to consider meanings of health within the environmental context. Further, it challenges nurses to work hand-in-hand with clients to develop strategies that fit the context, and thus effectively address rural health care needs.

Descriptions and perceptions of health among rural and urban adults with multiple sclerosis

The purpose of this study was to compare the health descriptions and perceptions of adults with multiple sclerosis living in rural and urban areas. Data were obtained from 361 adults, who responded to a mail survey including standardized self-report measures of physical and mental health, disability and social support, and an open-ended question on the meaning of health. In contrast to findings with general, nonclinical populations, the health perceptions and descriptions of this chronically ill population were not significantly affected by their place of residence. Further research is needed to examine the applicability of health-related findings from general populations to persons who are chronically ill.

The Masculinity-Femininity Scale of MMPI-2: is it useful with normal men?

Using ratings provided by significant others, we examined characteristics of 819 normal men whose scores on the Masculinity-Femininity scale (Scale 5) of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) ranged from low to high. Also examined were the possible effects of educational level as a moderator variable. Only one external characteristic was correlated with Scale 5 scores at a level of significance that could not be attributed to chance, and that correlation was negative, whereas previous literature indicated a positive relationship. The findings were essentially the same whether or not the effects of education were controlled. Regardless of Scale 5 scores and the higher the men's educational levels, the more positive were ratings by their partners. In general, the results do not support the usefulness of Scale 5 in describing the personalities and behaviors of normal men.

Sex-role stereotyping: implications for the mental health of school-age children

Theories related to sex-role stereotyping are reviewed, and the implications of these stereotypes for children's mental health are discussed. Attention is given to the impact of particular social trends, including political conservatism and religious fundamentalism. Case examples of children affected by sex-role stereotypes are presented and therapy approaches discussed. Overall intervention strategies are summarized.

Use of the Piers-Harris Self-Concept Scale with Indian children: cultural considerations

Data from a survey of 241 Montana school children, Indian and white, were used as a basis for examining the psychometric properties of the Piers-Harris Self-Concept Scale. Strong estimates of internal consistency and support for construct validity were found. Studies using the Piers-Harris scale over the past 15 years have indicated that ethnic minority status per se is not related to lower self-concept score and that the scale is a reliable measure for use with minority group children. However, validity of the scale with Indian children warrants further examination, particularly in relation to the differential effects of ethnic culture and social environment on the measurement of self-concept.

Pitfalls to avoid and positive approaches in the nurse-adolescent relationship

The establishment of a therapeutic nurse-adolescent relationship can be facilitated by the nurse's awareness of specific personality characteristics prominent during the adolescent period. These characteristics not only color the adolescent's behavior, but they can elict marked responses from the nurse. Nurses must, therefore, be self-aware if they are to deal with adolescents objectively and therapeutically. Positive approaches to the nurse-adolescent relationship include the establishment of a therapeutic alliance, the use of reality-based limits, and an emphasis on insight-producing communication techniques. Problem areas to be alert for are over-identification with adolescent problems, responses based on surface behaviors, and manipulation by the adolescent. Nurses must also work at decreasing non-therapeutic attitudes such as viewing the adolescent as an "enemy" to be controlled, or as a potential person to be molded according to the nurse's personal goals and aspirations.

Detection and treatment of emotionally disturbed children in public schools: problems and theoretical perspectives

Examined the effect of selected socio-demographic, mental health resource, and school system variables on the identification and treatment of children as emotionally disturbed. An explanatory model is provided, and the Labeling and Social Movements perspectives are examined in terms of their explanatory power. The major finding is that emotionally disturbed children are significantly underdetected and underserved nationally in public school systems, and, specifically, in Maryland and Washington, D.C. Further, results indicate that the attitudes of school system officials and the community in general, as well as the availability of mental health professionals, determine whether school systems detect emotionally disturbed children. When such children are detected, more specialized and expensive services are provided in school districts with higher per capita income, school budget, and proportion of mental health professionals.

The experience of repeated and traumatic loss among Crow Indian children: response patterns and intervention strategies

Crow Indian children residing on the Montana Reservation appear to experience traumatic losses of family members and friends with much greater frequency than children in the population at large. Responses to these losses include interpersonal distancing, and sadness without apparent anger. Assessment and clinical intervention are considered within the sociocultural context of Indian child client and white, middle-class clinician.