Measuring the effectiveness of workplace health management programs: An Australian example.

The workplace can provide opportunities to support workers in adopting and sustaining health enhancing behaviours. Health promotion programs based at the workplace need not only to achieve this goal but also the continuing support of the employers. This can best be achieved by demonstrating a return on their investment. The aim of this study therefore was to develop an integrated workplace health management program which could be associated with measurable outcomes related to benefitting the institution's "bottom line". This program was based in a metropolitan surgical hospital in Melbourne, Australia from 2006 to 2010 with a total workforce of 1400 employees aged 18-74 years (86% female 14% male), The program followed two key principles of 1) building safe and familiar support networks in order to build a workplace culture where all the workers felt valued. 2) Providing time for individual workers to focus on themselves as a means to achieve early intervention and management of injuries. Insurance data generated by the Workers Compensation Authority identified the following 'bottom line' benefits over three years: injury management costs reduced by 56%; number of compensation Injury claims dropped by 46%; time to return to work post injury reduced by 68%, and; a reduction. in premiums of 43% achieved over a six-year period. Insurers world-wide calculate workers' compensation insurance premiums on injury claims history. It is concluded that such data as these can offer a reliable and 'persuasive' measure of health and injury outcomes, in workplace interventions of this nature.

A Systematic Review of the Current Status of Safer Conception Strategies for HIV Affected Heterosexual Couples in Sub-Saharan Africa.

We conducted a systematic review of safer conception strategies (SCS) for HIV-affected couples in sub-Saharan Africa to inform evidence-based safer conception interventions. Following PRISMA guidelines, we searched fifteen electronic databases using the following inclusion criteria: SCS research in HIV-affected couples; published after 2007; in sub-Saharan Africa; primary research; peer-reviewed; and addressed a primary topic of interest (SCS availability, feasibility, and acceptability, and/or education and promotion). Researchers independently reviewed each study for eligibility using a standardized tool. We categorize studies by their topic area. We identified 41 studies (26 qualitative and 15 quantitative) that met inclusion criteria. Reviewed SCSs included: antiretroviral therapy (ART), pre-exposure prophylaxis, timed unprotected intercourse, manual/self-insemination, sperm washing, and voluntary male medical circumcision (VMMC). SCS were largely unavailable outside of research settings, except for general availability (i.e., not specifically for safer conception) of ART and VMMC. SCS acceptability was impacted by low client and provider knowledge about safer conception services, stigma around HIV-affected couples wanting children, and difficulty with HIV disclosure in HIV-affected couples. Couples expressed desire to learn more about SCS; however, provider training, patient education, SCS promotions, and integration of reproductive health and HIV services remain limited. Studies of provider training and couple-based education showed improvements in communication around fertility intentions and SCS knowledge. SCS are not yet widely available to HIV-affected African couples. Successful implementation of SCS requires that providers receive training on effective SCS and provide couple-based safer conception counseling to improve disclosure and communication around fertility intentions and reproductive health.

Work-related stress among health professionals in northern Jordan.

BACKGROUND: Job stress is common in health care professionals in the west. Less is known about its prevalence in Middle Eastern countries. AIMS: To determine job stress, its sources and its effect on health care professionals in northern Jordan. METHODS: A simple random sample of 101 physician specialists, 126 dentists, 52 general practitioners and 123 pharmacists in northern Jordan completed a socio-demographic questionnaire, the General Health Questionnaire, and addressed structured questions about job stress. Descriptive statistics and multivariate analyses were used to describe and compare participants, and a binary logistic regression was used to identify factors associated with stress and reported health problems. RESULTS: Of the 402 health care professionals, 27% reported high levels of stress. Prevalence was highest among general practitioners (33%), then dentists (30%) and pharmacists (25%). The lowest stress was among physician specialists (12%). Factors associated with the highest stress were being a general practitioner, being a woman and having long working hours. Dealing with uncooperative patients and heavy workloads were additional stressors. The most frequent problems associated with high stress were irritability (58%), consuming more arousal drinks (e.g. coffee, cola) (56%), difficulty concentrating (51%), headaches (63%), chronic back pain (48%) and common colds (47%). CONCLUSIONS: Compared to physician specialists, general practitioners, dentists and pharmacists were significantly more stressed. Reported stress was associated with job title, being a woman and long working hours. Also uncooperative patients and heavy workloads were significant problems. Being irritable and having headaches and common colds were the most frequent health issues.

Comparison of personal characteristics, tobacco use, and health states in Chaldean, Arab American, and non-Middle Eastern White adults.

This study compared and contrasted personal characteristics, tobacco use (cigarette and water pipe smoking), and health states in Chaldean, Arab American and non-Middle Eastern White adults attending an urban community service center. The average age was 39.4 (SD = 14.2). The three groups differed significantly (P < .006) on ethnicity, age, gender distribution, marital status, language spoken, education, employment, and annual income. Current cigarette smoking was highest for non-Middle Eastern White adults (35.4%) and current water pipe smoking was highest for Arab Americans (3.6%). Arab Americans were more likely to smoke both cigarettes and the narghile (4.3%). Health problems were highest among former smokers in all three ethnic groups. Being male, older, unmarried, and non-Middle Eastern White predicted current cigarette smoking; being Arab or Chaldean and having less formal education predicted current water pipe use.

Nursing interventions for smoking cessation.

BACKGROUND: Healthcare professionals, including nurses, frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: To determine the effectiveness of nursing-delivered smoking cessation interventions. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group specialized register and CINAHL in July 2007. SELECTION CRITERIA: Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow up of at least six months. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel-Haenszel fixed effect model and reported the outcome as a risk ratio (RR) with 95% confidence interval (CI). MAIN RESULTS: Forty-two studies met the inclusion criteria. Thirty-one studies comparing a nursing intervention to a control or to usual care found the intervention to significantly increase the likelihood of quitting (RR 1.28, 95% CI 1.18 to 1.38). There was heterogeneity among the study results, but pooling using a random effects model did not alter the estimate of a statistically significant effect. In a subgroup analysis there was weaker evidence that lower intensity interventions were effective (RR 1.27, 95% CI 0.99 to 1.62). There was limited indirect evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non-hospitalized patients also showed evidence of benefit. Nine studies comparing different nurse-delivered interventions failed to detect significant benefit from using additional components. Five studies of nurse counselling on smoking cessation during a screening health check, or as part of multifactorial secondary prevention in general practice (not included in the main meta-analysis) found nursing intervention to have less effect under these conditions. AUTHORS' CONCLUSIONS: The results indicate the potential benefits of smoking cessation advice and/or counselling given by nurses to patients, with reasonable evidence that intervention is effective. The evidence of an effect is weaker when interventions are brief and are provided by nurses whose main role is not health promotion or smoking cessation. The challenge will be to incorporate smoking behaviour monitoring and smoking cessation interventions as part of standard practice, so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and/or counselling to quit along with reinforcement and follow up.

Intervenciones de enfermería para el abandono del hábito de fumar

Antecedentes: Los profesionales de la salud, incluidos los enfermeros, suelen aconsejar a las personas que mejoren su salud dejando de fumar. Dicho consejo puede ser breve o formar parte de intervenciones de mayor intensidad. Objetivos: Determinar la efectividad de las intervenciones para dejar de fumar realizadas por enfermeras en adultos. Establecer si las intervenciones para dejar de fumar realizadas por enfermeras son más efectivas que ninguna intervención; son más efectivas si la intervención es más intensiva; difieren en efectividad con el estado de salud y el entorno de los participantes; son más efectivas si incluyen seguimientos; son más efectivas si incluyen ayudas que demuestran el efecto fisiopatológico del tabaquismo. (AU)

Nursing interventions for smoking cessation.

BACKGROUND: Health care professionals, including nurses, frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: To determine the effectiveness of nursing-delivered smoking cessation interventions. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group specialized register and CINAHL in June 2003. SELECTION CRITERIA: Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow-up of at least six months. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently. MAIN RESULTS: Twenty-nine studies met the inclusion criteria. Twenty studies comparing a nursing intervention to a control or to usual care found the intervention to significantly increase the odds of quitting (Peto Odds Ratio 1.47, 95% CI 1.29 to 1.68). There was heterogeneity among the study results, but pooling using a random effects model did not alter the estimate of a statistically significant effect. There was limited evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non-hospitalized patients also showed evidence of benefit. Five studies comparing different nurse-delivered interventions failed to detect significant benefit from using additional components. Five studies of nurse counselling on smoking cessation during a screening health check, or as part of multifactorial secondary prevention in general practice (not included in the main meta-analysis) found the nursing intervention to have less effect under these conditions. REVIEWER'S CONCLUSIONS: The results indicate the potential benefits of smoking cessation advice and/or counselling given by nurses to patients, with reasonable evidence that interventions can be effective. The challenge will be to incorporate smoking behaviour monitoring and smoking cessation interventions as part of standard practice, so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and/or counselling to quit along with reinforcement and follow-up.

Psychological factors that influence traumatic injury occurrence and physical performance.

This 9 month prospective study, conducted at the US Army Sergeants Major Academy (USASGMA), examined the association of selected psychological variables (e.g., measures of tension/anxiety, sleep disturbance, Type A behavior pattern) with injury occurrence and physical performance in 126 soldiers. ANOVA and logistic regression analyses revealed significant relationships between: 1) Traumatic injury occurrence and mean tension/anxiety scores, 2) Mean self-reported sleep disturbance scores and traumatic injury occurrence, 3) The Type A behavior pattern (abbreviated Jenkins Activity Survey) and number of sit-ups repetitions completed in 2 minutes, one component of the Army Physical Fitness Test (APFT), 4) The Type A behavior pattern and total score APFT. No significant associations were found for mean tension/anxiety scores and overuse injuries, or Type A behavior pattern and two mile run time or number of push-up repetitions completed in 2 minutes. These data suggest traumatic injury occurrence is influenced by tension/anxiety and disturbances in sleep habits. Additionally, individuals with higher Jenkins Activity scores (characteristic of the Type A behavior pattern) perform better physically.

Nursing interventions for smoking cessation.

BACKGROUND: Health care professionals, including nurses, frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: To determine the effectiveness of nursing delivered smoking cessation interventions. SEARCH STRATEGY: The Cochrane Tobacco Addiction Group register was searched for studies of interventions using nurses or health visitors and an additional search made on CINAHL. SELECTION CRITERIA: Randomised trials with follow-up of at least 6 months. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently. MAIN RESULTS: Sixteen studies comparing nursing intervention to a control or usual care found intervention to significantly increase the odds of quitting (Peto Odds Ratio 1.50, 95% CI 1.29-1.73). There was heterogeneity between the study results, but pooling using a random effects model did not alter the estimate of effect. There was no evidence from indirect comparison that interventions classified as intensive had a larger effect than less intensive ones. There was limited evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non hospitalised patients also showed evidence of benefit. Five studies of nurse counseling on smoking cessation during a screening health check, not included in the main meta-analysis, found that under these conditions nursing intervention had less effect. REVIEWER'S CONCLUSIONS: The results indicate the potential benefits of smoking cessation advice and counseling given by nurses to their patients, with reasonable evidence that interventions can be effective. The challenge will be to incorporate smoking cessation intervention as part of standard practice so that all patients are given an opportunity to be queried about their tobacco use and to be given advice to quit along with reinforcement and follow-up.

Surgical outcomes after breast cancer surgery: measuring acute lymphedema.

BACKGROUND: Studies of lymphedema have used inconsistent measures and criteria. The purpose of this pilot study was to measure the onset and incidence of acute lymphedema in breast cancer survivors using strict criteria for limb evaluation. MATERIALS AND METHODS: Eligible women were those undergoing breast cancer surgery that included axillary staging and/or radiation therapy of the breast. Arm volume, strength, and flexibility were measured preoperatively and quarterly. Lymphedema was defined as a greater than 10% increase in limb volume. Additional strength and flexibility assessments were done at these times. RESULTS: In 30 evaluable patients, half underwent modified radical mastectomy and half lumpectomy, with half of the lumpectomy patients undergoing axillary node staging. Of the 30 patients 27% were Stage 0; the rest were Stage I (27%), IIA (13%), IIB (23%), and IIIA (7%). One subject was IIIB postoperatively. There were 2 women with a 10% or greater change in limb volume; the change was detected in one woman at 3 months (5% incidence) and in the second woman at 6 months (11% incidence). Both had undergone mastectomy and axillary dissection and one of these two women had symptoms of tingling and numbness in the affected arm that began at 3 months. Overall, 35% of the sample experienced symptoms by 3 months, which included numbness, aching, and tingling of the entire upper extremity, but without volume changes. The relationship between undergoing modified radical mastectomy and experiencing symptoms in the affected limb at 3 months was significant (P = 0.05). CONCLUSIONS: In this interim report strict methods of measurement and limb volume comparisons detected acute lymphedema at 3 months in 5% of the sample, and at 6 months in 11% of the sample. Furthermore, symptoms were detected in 35% without volume changes at 3 months postoperatively, which may warn of lymphedema occurrence within the next 3 months. This may assist clinical evaluation of symptoms in the postoperative period and support early referral to lymphedema experts.

Relation of rifle stock length and weight to military rifle marksmanship performance by men and women.

15 male and 13 female soldiers participated in a study to examine the effects of sex, rifle stock length 117.8 cm, 22.3 cm, and 26.2 cm), and rifle weight (3.2 kg vs 3.8 kg) on military marksmanship performance. The Noptel simulator was used to assess marksmanship accuracy (proximity of shots to the target center) and precision (proximity of shots to one another regardless of proximity to the target center). There were no significant differences in either measure of marksmanship performance as a function of sex. Marksmanship accuracy was significantly better with the shortest rifle stock, and marksmanship precision was significantly better with the lighter rifle. Regardless of the sex of the shooter, stock length and weapon weight should be considered in any new combat rifle design as these results indicate they significantly affect marksmanship.

Herbimycin, a tyrosine kinase inhibitor with Src selectivity, reduces progesterone and estradiol secretion by human granulosa cells.

The purpose of the present study was to investigate whether the tyrosine kinase inhibitor herbimycin with some selectivity to block Src would alter the stimulatory effects of follicle-stimulating hormone (FSH) and cyclic adenosine monophosphate (cAMP) on estradiol secretion by human granulosa cells. Granulosa cells were taken from ovaries of premenopausal women undergoing oophorectomy for reasons unrelated to ovarian pathology. Granulosa cells from follicles ranging from 5-20 mm in diameter were subjected to culture. Granulosa cells were cultured with human FSH (2 ng/mL) or cAMP (0-1 mM) and testosterone (1 microM) in the presence and absence of herbimycin (0-2 pM). Media were collected at 24, 48, and 72 h. Accumulation of cAMP, progesterone, and estradiol in the media was determined by radioimmunoassay. Herbimycin dose dependently inhibited the ability of FSH to induce increases in progesterone and estradiol secretion. Although herbimycin increased (p < 0.0001) the accumulation of cAMP in response to FSH, this was evident only at the high concentrations of herbimycin (2 microM). To determine whether herbimycin would inhibit the ability of exogenous cAMP to induce estradiol and progesterone secretion, granulosa cells were incubated with 0-1 mM cAMP in the presence and absence of various doses of herbimycin. Herbimycin inhibited cAMP-induced estradiol and progesterone secretion in granulosa cells. The results from seven experiments indicate that herbimycin inhibits FSH stimulation of estradiol and progesterone secretion and that this inhibition may be, in part, at post-cAMP site(s).

The critical care consortium. Maximizing continuing education dollars.

Facing the current challenges in health care delivery and tremendous changes predicted for the new millennium, educators must consider nontraditional approaches to meet the learning needs of critical care nurses. The education consortium, as described in this article, should be considered as one possible approach. Consortiums have the potential to enhance program quality, reduce costs, promote positive participant interaction, and strengthen community spirit. The consortium approach is not a panacea, but it has proven to be a successful model for critical care education.

Nursing interventions for smoking cessation.

BACKGROUND: Health care professionals frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: To determine the effectiveness of nursing delivered smoking cessation interventions. SEARCH STRATEGY: The Cochrane Tobacco Addiction Group register was searched for studies of interventions using nurses or health visitors and an additional search made on CINAHL. SELECTION CRITERIA: Randomised trials with follow-up of at least 6 months. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently. MAIN RESULTS: Fifteen studies comparing nursing intervention to a control or usual care found intervention to significantly increase the odds of quitting (Peto Odds Ratio 1.43, 95% CI 1.24-1.66). There was heterogeneity between the study results, but pooling using a random effects model did not alter the estimate of effect. There was no evidence from indirect comparison that interventions classified as intensive had a larger effect than less intensive ones. There was limited evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non hospitalised patients also showed evidence of efficacy. Three studies of nurse counseling on smoking cessation during a screening health check, not included in the main meta-analysis, suggested that under these conditions nursing intervention was likely to have less effect. REVIEWER'S CONCLUSIONS: The results indicate the potential benefits of smoking cessation advice and counseling given by nurses to their patients, with reasonable evidence that interventions can be effective. The challenge will be to incorporate smoking cessation intervention as part of standard practice so that all patients are given an opportunity to be queried about their tobacco use and to be given advice to quit along with reinforcement and follow-up.

Nursing intervention and smoking cessation: A meta-analysis.

OBJECTIVE: To determine with meta-analysis the effects of nursing-delivered smoking cessation interventions. RESULTS: Fifteen studies comparing nursing intervention with a control or usual care found intervention to significantly increase the odds of smoking cessation. There was heterogeneity among the study results, but pooling by using a random effects model did not alter the estimate of effect. There was no evidence from indirect comparison that interventions classified as intensive had a larger effect than less intensive ones. There was evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in nonhospitalized patients also showed evidence of efficacy. Nurse counseling on smoking cessation during a screening health check was likely to have less effect. The results indicate the potential benefits of smoking cessation advice and counseling given by nurses to their patients, with reasonable evidence that intervention can be effective.

Tumor necrosis factor alpha inhibition of follicle-stimulating hormone-induced granulosa cell estradiol secretion in the human does not involve reduction of cAMP secretion but inhibition at post-cAMP site(s).

Tumor necrosis factor alpha (TNF) inhibits follicle-stimulating hormone- (FSH)induced estradiol secretion by granulosa cells in several species, including humans. One major inhibitory effect of TNF in rat granulosa cells is at the level of stimulatable adenylyl cyclase, resulting in reduced cAMP concentrations. The purpose of the present study was to investigate whether a reduction in cAMP secretion could account for the inhibitory effects of TNF on FSH-induced estradiol in human granulosa cells. Granulosa cells were taken from ovaries of premenopausal women undergoing oophorectomy for reasons unrelated to ovarian pathology. Women in this study were in various stages of the menstrual cycle or exhibited irregular cycles. Granulosa cells from follicles ranging from 5 to 10 mm diameter were subjected to culture for 48 and 96 h. Granulosa cells were cultured with human FSH (2 ng/mL) and testosterone (1 microM) in the presence and absence of human TNF (20 ng/mL). Media were collected at 48 h, fresh media and hormones added, and cultures continued for an additional 48 h. Accumulation of cAMP, progesterone, and estradiol in media were determined by radioimmunoassay (RIA). FSH induced significant increases in cAMP, progesterone, and estradiol by 96 h of culture. TNF inhibited the secretion of estradiol at 96 h without reducing the accumulation of cAMP and progesterone in media. Similar results were observed in the presence of 0.1 mM isobutylmethylxanthine (D3MX), a phosphodiesterase inhibitor that would prevent metabolism of cAMP to AMP. To determine whether TNF would inhibit the ability of cAMP to induce estradiol and progesterone secretion, granulosa cells were incubated with 0.1 mM cAMP in the presence and absence of TNF. TNF consistently inhibited the ability of cAMP to increase estradiol secretion. These results indicate that a pathway for TNF inhibition of FSH- or cAMP-induced estradiol secretion in human granulosa cells is at post-cAMP sites rather than inhibition of FSH-stimulatable adenylyl cyclase.

Changes in circulating and ovarian concentrations of bioactive tumour necrosis factor alpha during the first ovulation at puberty in rats and in gonadotrophin-treated immature rats.

Tumour necrosis factor alpha (TNF-alpha) concentrations were measured during periods of controlled and natural follicular development and ovulation in rat ovaries. Concentrations of bioactive TNF-alpha were determined in the ovaries and sera of rats during puberty (the period of vaginal opening and the first ovulation) and in immature rats after gonadotrophin treatment. Ovaries and sera were collected from 33-, 35-, 37-, 39-, 41- and 43-day-old rats (n = 6 or 7 per group); vaginal opening occurs on day 35. The presence of ovarian follicles and corpora lutea or ova in the oviducts was assessed. For gonadotrophin treatment, a single subcutaneous injection of 5 iu equine chorionic gonadotrophin (eCG) was administered at 08:00 h to 28-day-old rats to stimulate follicular development. A single subcutaneous injection of 10 iu human chorionic gonadotrophin (hCG) was administered 48 h later to induce ovulation. Ovaries and sera from three to six animals per group were collected 0, 3, 24, 48, 51, 54, 57, 60 and 72 h after injection of eCG. At puberty, ovarian concentrations of TNF-alpha were highest (approximately 1.1 fg micrograms-1 ovarian protein) before vaginal opening and the first ovulation. After vaginal opening and ovulation at day 37, ovarian concentrations of TNF-alpha were markedly reduced (0.091 fg microgram-1 ovarian protein) and remained low up to day 43. Serum concentrations of TNF-alpha remained low throughout the period of vaginal opening and the first ovulation (8-32 pg ml-1). In 43-day-old rats serum concentrations of TNF-alpha increased (105 pg ml-1). In the immature ovaries of 28-day-old rats TNF-alpha concentrations were highest before injection of eCG (approximately 1.2 fg micrograms-1 ovarian protein) and decreased to approximately 0.4 fg microgram-1 protein 3 h after injection. TNF-alpha concentrations decreased further 24 h after eCG injection (< 0.1 fg microgram-1 protein) and remained low until 48 h after eCG injection. Serum concentrations of TNF-alpha did not change during the 48 h period after injection of eCG. hCG was administered 48 h after eCG, and ovarian and serum TNF-alpha concentrations increased transiently. Serum TNF-alpha concentrations increased 3 h after hCG and remained elevated until 9 h after injection, after which concentrations decreased. Ovarian concentrations of TNF-alpha increased 6 h after hCG, peaked (approximately 0.5 fg microgram-1 protein), and then declined. These results indicate that during puberty and the first ovulation, circulating and ovarian TNF-alpha concentrations change. In addition, exogenous gonadotrophins alter circulating and ovarian TNF-alpha concentrations. These data suggest that TNF-alpha has a role in follicular development and ovulation during puberty and in immature rats treated with gonadotrophins to induce ovulation.

Sense of coherence and life satisfaction: patient and spousal adaptation to home dialysis.

OBJECTIVE: This research examined the adaptation of 24 male patients and their spouses to end-stage renal disease and home/self-care dialysis. The research was conceptualized within the T-Double ABCX Model. Selected predictors included sense of coherence (SOC) (the degree to which one feels confident that life's challenges will be comprehensible, manageable, and worthy of a commitment of self), age, and socioeconomic status (SES). SETTING: Eleven of the 22 dialysis centers in the province of Ontario, Canada were invited to participate. Of these 11, seven agreed to participate. SAMPLE: Twenty-eight couples who were using home PD. DESIGN: A descriptive, correlational research design was used with data collected by mailed survey. METHOD: Adaptation, the health outcome of interest, was measured using perceived satisfaction with life (SWL). RESULTS: There was a large, positive relationship between patients' and spouses' SOC and adaptation. However, further analyses challenged the construct validity of the SOC instrument. A small, positive relationship was found between age and adaptation. CONCLUSION: Further research regarding the SOC is required prior to use in nursing practice.

Differential responses of granulosa cells from small and large follicles to follicle stimulating hormone (FSH) during the menstrual cycle and acyclicity: effects of tumour necrosis factor-alpha.

This study determined effects of follicle stimulating hormone (FSH) alone and in combination with tumour necrosis factor (TNF), on granulosa cells from small (5-10 mm diameter) and large (>10-25 mm) follicles during follicular and luteal phases of the cycle and during periods of acyclicity. Granulosa cells were collected from ovaries of premenopausal women undergoing oophorectomy. The cells were cultured with human FSH (2 ng/ml) and testosterone (1 microM) in the presence or absence of human TNF-alpha (20 ng/ml). Media were removed at 48 and 96 h after culture and progesterone, oestradiol and cAMP in media were measured by radioimmunoassays. FSH stimulated the accumulation of oestradiol from granulosa cells of small follicles during the follicular and luteal phases but not during acyclicity; and TNF reduced oestradiol accumulation in the presence of FSH. Interestingly, in granulosa cells from small follicles, progesterone and cAMP secretion increased in response to FSH and neither was affected by TNF. Thus, TNF specifically inhibited the conversion of testosterone to oestradiol in granulosa cells from small follicles. FSH stimulated oestradiol production by granulosa cells of large follicles obtained only during the follicular phase of the cycle and TNF inhibited the FSH-induced oestradiol secretion. Granulosa cells obtained from large follicles during the luteal phase and during acyclicity did not accumulate oestradiol in response to FSH. However, FSH increased progesterone and cAMP secretion by granulosa cells obtained from large follicles during the follicular and luteal phases. During the luteal phase alone, TNF in combination with FSH increased progesterone accumulation above that of FSH alone. FSH did not increase progesterone, oestradiol or cAMP secretion by granulosa cells obtained from large follicles during acyclicity. Thus, FSH increases progesterone, oestradiol and cAMP secretion by granulosa cells of small follicles during the follicular and luteal phases and TNF appears to inhibit FSH-induced oestradiol secretion specifically in those cells. In large follicles, FSH-stimulated granulosa cell secretion of oestradiol is limited to the follicular phase and this effect can be inhibited by TNF. In addition, when granulosa cells of large follicles do not increase oestradiol secretion in response to FSH, TNF stimulates progesterone secretion.