Traditional methods for managing illness in newborns and infants in an Arab society.

AIM: This study explored self-management practices in relation to traditional methods for managing illness in newborns and infants and the implications of these practices on infant health. BACKGROUND: Self-medication with folk remedies is believed to have short- and long-term impacts on well-being. Little is known about how mothers in Arab societies used their traditional beliefs and practices in self-managing their newborns' and infants' health. METHODS: Data were collected from five focus groups using open-ended questions with 37 mothers. Participants were selected using snowball sampling and were recruited from four different cities in Jordan between June 2016 and August 2016. ETHICAL APPROVAL: All identifying information regarding the study participants has been omitted, and this study was approved by the Academic Research Committee at the University of Jordan. FINDINGS: Mothers were more willing to try herbal remedies, traditional massage and certain foods to self-manage their infants' health. Folk remedies were not restricted to traditions handed down through generations, but included a representation of newly emerged trends towards 'safety' or 'nature'. CONCLUSIONS: While the use of folk remedies have been handed down generations as customs, today, virtual support groups and social media provide modern resources for folk remedies' promotion in care and self-management. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing and health policymakers can use our findings for planning and developing strategies and health policies that increase public awareness about adverse health effects associated with herbal remedies. Such strategies are likely to be facilitated through partnerships between nursing and midwifery education institutions, antenatal clinics and social media in the region.

Family-centred care for children in hospital.

BACKGROUND: Family-centred care (FCC) is a widely used model in paediatrics, and is felt instinctively to be the best way to provide care to children in hospital. However, its effectiveness has not been measured. OBJECTIVES: The primary objective of this review was to assess the effects of family-centred models of care for hospitalised children when compared to standard or professionally-centred models of care, on child, family and health service outcomes. SEARCH STRATEGY: We searched: MEDLINE (1966 to February 2004); the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library, Issue 2, 2004); CINAHL (1982 to February 2004); PsycINFO (1972 to February 2004); ERIC (1982 to February 2004); Sociological Abstracts (1963 to February 2004); Social Work Abstracts (1977 to February 2004); and AMI (Australasian Medical Index) (1966 to February 2004). SELECTION CRITERIA: We searched for randomised controlled trials (RCTs) or quasi-randomised controlled trials including cluster randomised trials and controlled clinical trials (CCTs), and controlled before and after studies (CBAs), in which family-centred care models are compared with professionally-centred models of care for hospitalised children (aged up to 12 years). Studies also had to meet criteria for family-centredness and methodological quality. In order to assess studies for the degree of family-centredness, this review utilised a modified rating scale based on a validated instrument. DATA COLLECTION AND ANALYSIS: Two review authors undertook the searches, and three authors independently assessed trial quality and extracted data. We contacted study authors for additional information. MAIN RESULTS: No studies met inclusion criteria, and hence no analysis could be undertaken. Five studies came close to inclusion. Three of these studies were excluded primarily because of inadequate or unclear blinding of outcome assessment, while for one study the age group was outside the parameters of this review. One study met most criteria, but the children were aged up to 18 years. We contacted the study authors who kindly provided a subset analysis, but on further examination the study also proved to have inadequate blinding procedures and so was not included. It was not possible to undertake any subset analysis of populations. Of the other studies identified through the search, 13 met some of the inclusion criteria but were reports of qualitative research and are reviewed elsewhere. AUTHORS' CONCLUSIONS: This review has highlighted the dearth of high quality quantitative research about family-centred care. A much more stringent examination of the use of family-centred care as a model for care delivery to children and families in health services is needed.

Bilateral primary choroidal melanoma treated with bilateral plaque radiotherapy: a report of three cases.

PURPOSE: To report three cases of bilateral primary choroidal melanoma treated with bilateral plaque radiotherapy. METHODS: Retrospective, single-center case series. RESULTS: Case 1: In 1981, a 50-year-old man was diagnosed with a 5-mm-thick choroidal melanoma in the right eye (OD) and treated with plaque radiotherapy. In 1994, a 6.8-mm-thick choroidal melanoma in the left eye (OS) was treated with plaque radiotherapy. Final visual acuity was light perception OD and 20/20 OS at 24 years follow-up. Case 2: In 1983, a 53-year-old woman was diagnosed with a 3.5-mm-thick choroidal melanoma OS and treated with plaque radiotherapy. In 2001, an enlarging 2.5-mm-thick choroidal melanoma OD was treated with plaque radiotherapy. Final visual acuity was 20/30 OD and 20/20 OS at 22 years follow-up. Case 3: In 2001, a 92-year-old man was diagnosed with a 7.9-mm-thick choroidal melanoma OD treated with plaque radiotherapy. In 2003, an enlarging 2.8-mm-thick juxtapapillary choroidal melanoma was treated with plaque radiotherapy. Final visual acuity was 20/70 OD and 20/60 OS at 2.5 years follow-up. No patient showed ocular melanocytosis. Stable tumor regression was achieved in all six eyes. Metastatic disease did not develop in any case over 16 years of follow-up. CONCLUSIONS: Monitoring of both eyes of patients with uveal melanoma is important for the remote possibility of melanoma in the second eye. In these three patients, plaque radiotherapy allowed for preservation of the globes and some vision.

Granulocyte isolation by counterflow centrifugation-elutriation of canine blood obtained by continuous-flow centrifugation leukapheresis.

Granulocytes have been isolated by counterflow centrifugation-elutriation (CCE) from canine leukocyte-rich blood obtained by continuous-flow centrifugation leukapheresis (CFCL). We have attempted to define both the maximal granulocyte recovery and the efficiency of granulocyte purification for the Beckman JE6 elutriation rotor when large volumes of leukocyte rich blood are utilized. The efficiency of granulocyte purification by CCE is 81% (1.31 +/- 0.1 x 10(9) PMNL) if the number of granulocytes entered into the Beckman JE-6 rotor as leukocyte rich blood is limited to 1.60 +/- 0.13 x 10(9) PMNL. Approximately 96 +/- 2% of the leukocytes in the purified fraction were of the granulocytic series with mononuclear leukocytes comprising the residual 4% of the cell population. In vitro analysis of the isolated granulocytes indicated that the cells did not lose their morphological integrity or physiological function as a result of the dual CFCL/CCE procedure relative to granulocytes isolated by CCE from freshly drawn peripheral blood.

Dynamin-related protein 1 is required for normal mitochondrial bioenergetic and synaptic function in CA1 hippocampal neurons.

Disrupting particular mitochondrial fission and fusion proteins leads to the death of specific neuronal populations; however, the normal functions of mitochondrial fission in neurons are poorly understood, especially in vivo, which limits the understanding of mitochondrial changes in disease. Altered activity of the central mitochondrial fission protein dynamin-related protein 1 (Drp1) may contribute to the pathophysiology of several neurologic diseases. To study Drp1 in a neuronal population affected by Alzheimer's disease (AD), stroke, and seizure disorders, we postnatally deleted Drp1 from CA1 and other forebrain neurons in mice (CamKII-Cre, Drp1lox/lox (Drp1cKO)). Although most CA1 neurons survived for more than 1 year, their synaptic transmission was impaired, and Drp1cKO mice had impaired memory. In Drp1cKO cell bodies, we observed marked mitochondrial swelling but no change in the number of mitochondria in individual synaptic terminals. Using ATP FRET sensors, we found that cultured neurons lacking Drp1 (Drp1KO) could not maintain normal levels of mitochondrial-derived ATP when energy consumption was increased by neural activity. These deficits occurred specifically at the nerve terminal, but not the cell body, and were sufficient to impair synaptic vesicle cycling. Although Drp1KO increased the distance between axonal mitochondria, mitochondrial-derived ATP still decreased similarly in Drp1KO boutons with and without mitochondria. This indicates that mitochondrial-derived ATP is rapidly dispersed in Drp1KO axons, and that the deficits in axonal bioenergetics and function are not caused by regional energy gradients. Instead, loss of Drp1 compromises the intrinsic bioenergetic function of axonal mitochondria, thus revealing a mechanism by which disrupting mitochondrial dynamics can cause dysfunction of axons.

Gene transfer into fetal baboon hematopoietic progenitor cells.

We studied hematopoietic progenitors from fetal baboon blood, marrow, and liver at four time points (125, 140, 160, and 175 days) during the third trimester (gestation approximately 180 days) to determine if fetal baboons might be an appropriate model for in utero gene therapy of hematopoietic stem cells (HSCs). Cells were studied for expression of CD34, CD33, CD38, and HLA-DR, for progenitor content in colony-forming cell assays, and for susceptibility of CD34+ progenitors to retrovirus-mediated gene transfer. Throughout the third trimester, the frequency of CD34+ progenitors in blood and marrow appears to remain unchanged at approximately 0.6 and 5.0%, respectively. In liver, progenitors progressively decrease to undetectable levels by day 175. The proportion of fetal baboon bone marrow and liver CD34+ cells expressing CD38 and HLA-DR appears to increase with increasing fetal age, similar to changes reported for human cord blood CD34+ cells. In fetal baboon blood the proportion of CD34+ cells expressing CD33 appears to decrease with increasing gestational age, also similar to changes reported for human cord blood cells. Progenitors from human cord blood and baboon fetal tissues were similarly susceptible to transduction by the gibbon ape leukemia pseudotyped retroviral vector LAPSN(PG13) containing the genes for human placental alkaline phosphatase (AP) and the bacterial neomycin phosphotransferase (neo). Fetal baboon and human hematopoietic progenitor cells undergo similar phenotypic changes during the third trimester of fetal development and are similarly susceptible to retrovirus-mediated gene transfer. The fetal baboon may be a model in which approaches to mobilization and gene transfer into fetal HSCs can be studied.

Ultrasonography for cervical length measurement: agreement between transvaginal and translabial techniques.

OBJECTIVE: To assess agreement between transvaginal and translabial ultrasonography for measuring cervical length in the second and third trimesters. METHODS: Eighty-four obstetric patients at 14-40 weeks' gestation were enrolled. Three images of the cervix were obtained by translabial (3.5-MHz curvilinear transducer) and transvaginal (6.5-MHz endovaginal probe) ultrasonography. The mean cervical length obtained by using each method was used for data analysis. The McNemar chi(2) test was used to assess the difference between techniques in their ability to obtain a measurement. The paired t-test was used to evaluate the differences between the measurements. The mean difference and SD for the differences were used to calculate the limits of agreement. An acceptable difference was defined as less than 0.5 cm. RESULTS: Cervical length measurements were obtained in 84 patients (100%) by using the transvaginal technique and in 80 patients (95%) by using the translabial technique (P =.1). Eighty patients had both transvaginal and translabial measurements for comparison. The mean difference in cervical length was 0.37 cm (P <.001; 95% confidence interval [CI] 0. 21, 0.52). The upper and lower limits of agreement were 1.75 cm (95% CI 1.48, 2.02) and -1.01 cm (95% CI -0.74, -1.28), respectively. The differences between the two measurements were within these limits 95% of the time. These limits of agreement were greater than the acceptable difference of 0.5 cm. CONCLUSION: Transvaginal and translabial techniques should not be used interchangeably for clinical assessment of cervical length because agreement between the methods is not within an acceptable range.

The prognostic value of hemoglobin A1c in predicting fetal heart disease in diabetic pregnancies.

OBJECTIVE: To evaluate detailed fetal echocardiography for predicting congenital heart disease in overt diabetic pregnancies. METHODS: Overt diabetic gravidas with initial hemoglobin A1c (HbA1c) at or above 8.5%, a family history of congenital heart disease, or fetal cardiac anomaly suspected on screening sonography were referred to a pediatric cardiologist for detailed fetal echocardiography. After 7 years, the results of the protocol were reviewed retrospectively. The sensitivity and specificity of the initial HbA1c in predicting congenital heart disease were assessed. RESULTS: During the study period, 193 patients received care in the diabetes and pregnancy service. Sixty-four received fetal echocardiography, 47 because of initial HbA1c levels at or above 8.5% and 17 for other indications. Twenty fetuses had major anomalies, eight of which were cardiac (40%). Six of the cardiac anomalies had been studied by fetal echocardiography, and four were diagnosed correctly. The initial HbA1c was not different among pregnancies with major anomalies, cardiac anomalies, or no anomalies. No malformations were noted in patients with normal initial HbA1c values. The overall sensitivity of the protocol for identifying congenital heart disease was 50% (four of eight) and specificity was 54% (90 of 167). Detailed fetal echocardiography had a sensitivity of 66% (four of six) and a specificity of 100% (58 of 58) for correctly identifying fetal congenital heart disease. CONCLUSIONS: No cases of congenital heart disease were observed in patients with a normal initial HbA1c value. Among patients with abnormal HbA1c values, no critical level of glycohemoglobin was identified that provided optimal predictive power for congenital heart disease screening. We recommend detailed fetal echocardiographic imaging in all patients with initial HbA1c levels above the upper limit of normal of 6.1%.

Alterations in humoral immune responses associated with recurrent pregnancy loss.

OBJECTIVE: To investigate the reactivity of maternal antibodies with endometrium-derived antigens and to correlate their association with recurrent pregnancy loss (RPL). DESIGN: Prevalence study. SETTING: Academic research center. PATIENT(S): Nulliparous women (n = 10), women with RPL (n = 15), pregnant women (n = 8), and multiparous women with a normal obstetric history (n = 20). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Reactive antibodies were analyzed by Western immunoblot techniques and quantitated by densitometry. RESULT(S): Antibodies from women with RPL and multiparous women recognized antigens ranging from 10-120 kd on normal endometrium and endometrial tumors. Antibodies from most women with RPL (10/15) and from multiparous women (15/20) recognized 65-kd and 80-kd proteins in normal endometrium. Antibodies from women with RPL recognized 21-kd and 28-kd antigens (12/15 and 13/15, respectively) in endometrial tumors at a significantly greater rate (than did antibodies from multiparous women (5/20 and 8/20, respectively). Women with RPL had significantly lower levels of asymmetric IgG compared with controls. CONCLUSION(S): Recurrent pregnancy loss may be linked with the failure to elicit asymmetric IgG and a unique immunologic recognition of endometrial antigens.

Fetal electrolyte and acid-base responses to amnioinfusion: lactated Ringer's versus normal saline in the ovine fetus.

OBJECTIVE: We hypothesized that amnioinfusion with normal saline would increase fetal plasma sodium and chloride concentrations, resulting in a hyperchloremic acidosis, and that these alterations would not occur after amnioinfusion with lactated Ringer's solution. METHODS: Chronically catheterized fetal sheep (137 +/- 1 days' gestation; mean +/- SE) were divided into three groups: control (n = 8), infused with normal saline (n = 10), and infused with lactated Ringer's solution (n = 10). The protocol consisted of a 30-minute pre-infusion period, a 1-hour amnioinfusion, and a 1-hour recovery period. During amnioinfusion, warmed solution was infused at a rate of 100 mL/minute for 1 hour. Fetal plasma and amniotic fluid electrolyte concentrations and osmolalities were measured every 20 minutes. Statistical analysis was by analysis of variance and linear regression. RESULTS: Amniotic fluid electrolyte concentrations changed significantly (P < .001) in both amnioinfusion groups, resulting in amniotic fluid compositions that were essentially the same as the infused fluid 20 minutes after starting the amnioinfusion. Significant increases in fetal plasma Na+ and CI- concentrations (2-3 mEq/L) occurred in the normal-saline infusion group relative to both the control and lactated Ringer's groups (P < .001). The lactated Ringer's group demonstrated only a modest increase in plasma Na+ (P = .04) and no change in plasma Cl- concentration. Fetal arterial pH decreased (-0.015 U) in the normal-saline group, and the change in fetal pH was linearly related to the change in plasma Cl- concentration (r = -0.532, P = .004). CONCLUSIONS: Normal-saline amnioinfusion can significantly alter fetal plasma electrolyte concentrations and blood pH, whereas amnioinfusion with lactated Ringer's solution results in minimal changes in fetal electrolytes and acid-base balance. The fetal plasma changes that occur during saline infusion are in the physiologic but not the pathologic range.

Induction of immune responses to ovarian tumor antigens by multiparity.

OBJECTIVE: Because epidemiologic data indicate a reduction in ovarian cancer risk with increased parity, the occurrence of maternal immunization against ovarian tumor-associated antigens during pregnancy was investigated. METHODS: Sera were obtained from nulligravid and multiparous women and from men. Cellular proteins were isolated from four ovarian tumor cell lines as well as from normal ovaries. These proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and the presence of cellular proteins reactive with each individual's serum was assessed by Western immunoblot. Tumor-reactive antibodies from two multiparous women were used to prepare immunoaffinity columns for the isolation of reactive proteins from ovarian tumor cells. These immunoaffinity-purified antigens were transferred electrophoretically to nitrocellulose membranes, stained with Ponceau S, and identified by amino acid sequencing. RESULTS: Western immunoblot analysis of the cellular proteins from four established ovarian tumor cell lines using sera from multiparous women as the primary antibody indicated that these samples recognized multiple bands on ovarian tumors, ranging from 30 to 150 kD. Two commonly recognized proteins were isolated and subjected to microsequencing, which identified the 56-kD band protein as elongation factor-1 alpha and the 38-kD protein as nucleophosmin/B23 protein. Both of these proteins play integral roles in cell growth. CONCLUSION: These findings suggest that certain antigens expressed by the fetus immunize women during pregnancy. This immune response may protect these women from the subsequent development of cancer.

Solid-state characterization of chlordiazepoxide polymorphs.

A novel crystal form (form II) of the benzodiazepine chlordiazepoxide is reported. The new polymorphic phase was characterized and distinguished from the standard form (form I) by X-ray diffractometry, differential scanning calorimetry, infrared spectroscopy, microscopy, solution calorimetry, and solid-state nuclear magnetic resonance. The formation of form II was dependent on the crystallizing solvent, being the predominant form isolated from methanol. Recrystallization from other alcoholic solutions (ethanol, propanol, and butanol) and toluene yielded form I. Differential scanning calorimetry and powder X-ray diffraction indicated that the two forms were enantiotropically related with a transition of form II to form I occurring between 200 and 225 degreesC. Visual examination by hot stage microscopy in this temperature range revealed a dramatic solid-state transition. Single-crystal X-ray analysis was performed on form II which was found to crystallize in the triclinic space group P1 with a = 10.736(2) A, b = 16.921(4) A, c = 17.041(4) A, alpha = 100.76(1) degrees, beta = 95.27(1) degrees, gamma = 97.53(1) degrees, Z = 8, and dcal = 1.33 g/cm3. When compared with the published crystal structure of form I, the cell symmetry, volume, and density were similar. Both structures consisted of four crystallographically independent molecules linked in pairs through intermolecular hydrogen bonding. Differences were observed in the packing arrangement of the dimers in the polymorphs. The small heat of transition calculated from solution calorimetry (1.5 kJ mol-1) was sufficient to effect a crystallographic rearrangement of the dimers.

Solid-state properties and crystal structure of gliclazide.

The solid-state characterization of gliclazide, for which no analytical standard was previously available, has been completed by extensive structural and physical analytical examination. The crystal and molecular structure for gliclazide was determined by single-crystal X-ray diffraction. Gliclazide crystallizes in the monoclinic space group P2(1)/n, with the unit cell dimensions a = 10.828(2) A, b = 14.342(19) A, c = 11.005(6) A, and with beta = 106.97(2) degrees, V = 1635(12) A3, and Z = 4. The gliclazide molecule is articulated in an open extended conformation about the sulphonylurea nucleus. Two gliclazide molecules form a complex with one calcium atom to facilitate the transport of calcium ions across the pancreatic beta cells necessary for the stimulation of insulin secretion. The only conformation that allows for the close apposition of the tolyl groups, and therefore the formation of the gliclazide:calcium complex, is the extended conformer.

Group counseling in cardiac rehabilitation: effect on patient compliance.

A multicenter clinical trial was conducted to evaluate the effects on compliance of a group counseling program for cardiac patients and spouses. The sample comprised 58 couples in which one of the partners had documented atherosclerotic heart disease and was enrolled in an outpatient cardiac rehabilitation program. The experimental intervention involved a ten-week series of group sessions based on symbolic interactionist role theory. The research used a quasi-experimental, three-group, time-series design: Experimental group 1 consisted of 17 patients and their spouses who participated in group counseling; experimental group 2 consisted of 22 patients and their spouses, but only the patients participated in the group series; the control group consisted of 19 patients and their spouses who did not participate in the experimental program. Data were collected at baseline, ten weeks, and six months on four cardiac risk factors: weight loss, blood pressure, exercise, and smoking. Repeated measures analysis of variance showed a significant difference (P less than 0.01) in mean body fat among treatment groups, with experimental group 2 having the greatest decrease over time. Patients in both experimental groups demonstrated lowered blood pressure, with a significant decrease (P less than 0.05) in systolic blood pressure. Again, the largest decrease was in experimental group 2. Changes in weekly exercise level were not significantly different among groups, although the highest compliance was reported by experimental group 1 patients. Results support the efficacy of group counseling based on an interactionist role theory framework to increase compliance. The anticipated effect of spouse participation was not confirmed.

Karyotyping for isolated neural tube defects. A report of two cases.

BACKGROUND: Neural tube defects occur in approximately 1 in every 1,000 live births. In the United States, chromosomal abnormalities have been noted in 2-10% of fetuses with neural tube defects; however, there is no consensus on whether to offer karyotype analysis to patients with isolated neural tube defects found on ultrasound. CASE: We reviewed the prenatal diagnosis database for the University of Washington between 1985 and 1997. We report on two fetuses who, on ultrasound, were found to have "isolated" neural tube defects. Karyotype analysis revealed trisomy 18 in both fetuses. The pregnancies were subsequently terminated, and autopsy revealed subtle syndromic findings that were not identified on ultrasound. CONCLUSION: Fetuses with isolated neural tube defects also appear to have a high risk of chromosomal abnormalities, so patients should be offered fetal karyotyping to define recurrence risks for future pregnancies.

Postmortem diagnosis of leukodystrophies.

Leukodystrophies are progressive disorders involving the development and maintenance of myelin in the central and peripheral nervous systems. Although relatively uncommon, leukodystrophic disorders may be undiagnosed or misdiagnosed during life, and may appear as "sudden death." In such instances, these victims may be referred to a forensic pathologist. In general, leukodystrophies are inherited in an autosomal recessive manner so that proper postmortem diagnosis by the forensic pathologist is extremely important to the decendant's family for future family planning.

Hypernatremia and subdural hematoma in the pediatric age group: is there a causal relationship?

Several researchers in the 1950's proposed that hypernatremia causes water to leave brain cells, shrinking the brain, thus tearing the bridging veins and resulting in subdural hematomas. Although the old literature suggests mechanisms linking the two in a cause and effect relationship, there is controversy as to whether hypernatremia leads to subdural bleeding or whether the reverse is true. This issue is important for forensic pathologists who must distinguish natural disease from trauma. An etiologic link between hypernatremia and subdural hematomas was suggested recently, and was proposed originally before Kempe's 1962 paper "The Battered Child Syndrome" which widely disseminated the concepts of child physical abuse, and of subdural bleeding resulting from non-accidental injury. Our study is a multifaceted investigation of infants which includes: a literature review, retrospective chart reviews of both living and deceased hypernatremic infants, a retrospective review of infants hospitalized with subdural hematoma, and a prospective collection of head injured, hypernatremic children. We conclude that hypernatremia, if present in association with subdural hemorrhage, is most likely secondary to intracranial pathology, and that hypernatremia often develops in critically ill infants suffering from a variety of medical conditions.

Navajo birth outcomes in the Shiprock uranium mining area.

The role of environmental radiation in the etiology of birth defects, stillbirths, and other adverse outcomes of pregnancy was evaluated for 13,329 Navajos born at the Public Health Service/Indian Health Service Hospital in the Shiprock, NM, uranium mining area (1964-1981). More than 320 kinds of defective congenital conditions were abstracted from hospital records. Using a nested case-control design, families of 266 pairs of index and control births were interviewed. The only statistically significant association between uranium operations and unfavorable birth outcome was identified with the mother living near tailings or mine dumps. Among the fathers who worked in the mines, those of the index cases had histories of more years of work exposure but not necessarily greater gonadal dosage of radiation. Also, birth defects increased significantly when either parent worked in the Shiprock electronics assembly plant. Overall, the associations between adverse pregnancy outcome and exposure to radiation were weak and must be interpreted with caution with respect to implying a biogenetic basis.

Preventive behaviours in the Hutterite community following a nurse-managed cholesterol screening program.

In this study we examined the effect of a nurse-managed cholesterol screening program on the preventive health behaviours (e.g., diet changes, weight loss, medical surveillance) of 534 Hutterites. Hutterites are the largest single rural ethnic group in Canada and they have been found to be at high risk for heart disease. Eighty-one percent of the participants engaged in at least one preventive behaviour. Ongoing cholesterol surveillance was reported by 34.5% of the participants. Weight loss and dietary fat reduction were reported by 31% and 62% of the respondents, respectively. Seven percent of the respondents began lipid-lowering pharmacologic therapy. Screening cholesterol levels and age were significantly related to all of the outcomes except weight loss. This study provides evidence that community-based screening accompanied by counselling and referral by nurses can positively affect preventive behaviours.

Gender influencers on work values of black adolescents.

Work values and key influencers of a sample of black male and female adolescents were examined. Results indicated that boys and girls valued both the intrinsic and extrinsic rewards of work; however, girls reported slighter stronger extrinsic values than did boys. In addition, the sexes reported differences in the importance of specific work values such as "making lots of money," and "doing important things." When naming a key influencer, respondents tended to cite a same-sex and race individual. Sex of one's key influencer was related to certain work values, with subjects reporting a male key influencer valuing "trying out one's own ideas" and "having a secure future" more than those reporting a female key influencer. The interaction of sex of subject and sex of key influencer was significant on one of the work value outcomes. Implications of these findings are considered.