Professional Medical Conduct Reform Act

A new law significantly increases the regulation of New Jersey physicians and heightens the State Board of Medical Examiners scrutiny of potentially impaired and incompetent physicians. The law is a comprehensive expansion of New Jersey's physician peer review.

Vitamin E intakes and sources in the United States

Twenty-four-hour-recall data from 11,658 adults interviewed in the Second National Health and Nutrition Examination Survey (NHANES II) were used to estimate intakes of vitamin E and polyunsaturated fatty acids (PUFAs) in the United States. Although mean intakes of vitamin E were close to the recommended dietary allowance for both men and women (9.6 and 7.0 mg/d, respectively), median intakes were considerably lower (7.3 and 5.4 mg/d). If a ratio of vitamin E to PUFAs of greater than or equal to 0.4 is considered desirable, 23% of men and 15% of women had diets with low ratios. Ratios tended to decrease as PUFAs in the diet increased. The fruits-and-vegetables group and the fats-and-oils group each provided 20% of the vitamin E in the US diet. Increasing food choices from the fruits-and-vegetables group would provide low-fat sources of vitamin E for individuals whose intakes are likely to be inadequate.

An evaluation of food group intakes by Mexican-American children

Food group daily servings were examined for 3,436 children who participated in the Mexican-American portion of the 1982-1983 Hispanic Health and Nutrition Examination Survey (HHANES). Mean daily servings of 40 foods and food groups were calculated for four age groups: 1 to 2 years, 3 to 5 years, 6 to 11 years, and 12 to 17 years. The HHANES food servings data were combined into four major groups and compared with recommended servings for children. Mean daily servings of the milk group exceeded the recommended two to three servings for younger children but were low for teenagers. Meat group servings (including eggs and nuts/legumes) exceeded the recommended two daily servings for all age groups, whereas bread group intakes averaged 70% to 80% of a recommendation of four servings but only half of a recommendation of six servings. Intakes of fruits and vegetables were lowest, averaging only 33% to 47% of a recommended four servings, or 26% to 38% of a recommended five servings. Servings of all four groups were lowest for teenagers. A dietary score, based on the number of servings from each of the four groups, was developed for each child. Mean dietary scores ranged from 55% (teenagers) to 70% (toddlers and preschoolers) of the recommended score. According to these analyses, dietary guidance for Mexican-American children should focus on increasing intakes of fruits and vegetables and on encouraging more nutritious food choices by teenagers.

Retinoic acid receptor expression vector inhibits differentiation of F9 embryonal carcinoma cells

Expression vectors have been constructed for a region of the human retinoic acid receptor-alpha (hRAR-alpha) and transferred into F9 embryonal carcinoma (EC) cells. When the vectors are overexpressed in F9 cells, clones can be selected for resistance to retinoic acid-induced differentiation. This effect is obtained even when the hRAR-alpha region is expressed as a beta-galactosidase fusion protein. Using the beta-galactosidase component of the fusion protein as a marker, overexpression of the fusion protein has been correlated with the retinoic acid-resistance effect. The clones resistant to retinoic acid no longer exhibit the normal retinoic acid induction of endo B cytokeratin, laminin B-1, and tissue plasminogen activator mRNAs observed with normal F9 cells. Retinoic acid induction of type IV alpha-1 collagen and Hox-1.3 RNAs is observed with these clones. When transfected with a thyroid receptor DNA-binding sequence (TRE)/thymidine kinase promoter/luciferase construct, the retinoic acid-resistant clones do not yield the same retinoic acid-induced level of luciferase obtained with F9 cells. It is hypothesized that the RAR vectors are interfering with endogenous RAR(s) in a dominant-negative manner to inhibit retinoic acid-induced differentiation of F9 EC cells.

Stressors and patterns of coping in renal transplant patients

Forty patients less than 4 years postrenal transplant rated the severity of 35 potential stressors on a 5-point scale. Patients then rated the extent to which they used each of 40 coping strategies to deal with stress. The most stressful items were cost factors and fear of kidney rejection; fear of not being accepted by family and friends was least stressful. Prayer and looking at the problem objectively were used most in coping with stress. Drug and alcohol use and blaming others for your problems were used least. Problem-oriented coping scores were significantly higher than affective-oriented scores, t (39) = 10.10, p less than .001. Patients 24 to 48 months posttransplant had significantly higher total stressor scores than patients less than 2 years posttransplant. However, the rankings of stressors by mean severity ratings were significantly correlated. Patients 24 to 48 months posttransplant were not significantly different from patients up to 23 months posttransplant with respect to total coping scores and total problem-oriented scores, but they did differ significantly on total affective-oriented scores. The rank orderings of coping methods according to mean degree of use were significantly correlated between the two subgroups, rs = .87. These findings suggest that renal patients may experience continuing stressors of moderate intensity as long as 4 years posttransplant.

Differential expression of the homeobox gene Hox-1.3 in F9 embryonal carcinoma cells

The Hox-1.3 gene is located on mouse chromosome 6 and has been previously shown to be expressed in mouse embryos and adults. In this study, we have examined the steady-state levels of the Hox-1.3 transcripts in undifferentiated and differentiated F9 embryonal carcinoma cells. We find that there is a rapid increase of Hox-1.3 transcripts after differentiation induction of F9 cells. The level of the major 1.85-kilobase (kb) transcript peaks at 16-24 hr after differentiation induction of F9 cells. By using primer extension techniques the 5' ends of the major 1.85-kb transcript have been mapped to two sites in induced F9 cells. Cellular fractionation of RNA and transfer blot gel analysis has localized one minor transcript to the nucleus, whereas the major transcript and two additional minor transcripts appear in the nucleus and the cytoplasm of induced F9 cells. The results of nuclear run-off experiments with uninduced and induced F9 cell nuclei indicate that there is a substantial increase in the rate of Hox-1.3 transcription upon induction of F9 cells with retinoic acid.

Living arrangements and eating behaviors of older adults in the United States

Associations between living arrangements and several eating behaviors were examined for 4,402 adults aged 55 and older using three-day food intake data from the 1977-78 Nationwide Food Consumption Survey (NFCS). Compared to those living with a spouse, persons living alone ate more meals alone and consumed a higher proportion of total calories away from home; a higher proportion of those living alone skipped meals, including breakfast. There was a sex differential in the effect of living alone for some, but not all, of the eating behaviors. Both the probability of eating away from home and of skipping breakfast declined with age, as did the percentage of calories consumed from snacks. These results indicate a need to focus further research not only on the effects these eating behaviors have on the nutritional status of elderly persons, but also on middle-aged cohorts as they age and on food programs targeted at elderly persons living alone.

Nutrient intakes of women in NHANES II, emphasizing trace minerals, fiber, and phytate

Nutrient intakes of 1,066 young women 18 to 24 years of age were estimated using a shortened nutrient data base (the University of California, Berkeley Minilist) containing 235 food items. The dietary data consisted of 24-hour recalls collected during the Second National Health and Nutrition Examination Survey (NHANES II). A cross-reference index, recipe file, and concentration factors were developed to substitute foods on the data base for the 1,267 foods reported by the young women. Estimates of energy, protein, fat, carbohydrate, and iron intakes using the NHANES II nutrient data base and the UCB Minilist were within 3% of one another, and had correlation coefficients above 0.97. Mean +/- S.E. daily intakes of copper, zinc, dietary fiber, and phytate, which are not included in the NHANES II data base, were estimated to be 1.16 +/- 0.02 mg, 8.11 +/- 0.14 mg, 13.2 +/- 0.3 gm, 395 +/- 14 mg, respectively. The values agree closely with other published values for young women's intakes. A shortened nutrient data base can be a valid tool for estimating intakes of populations.

Psychometric evaluation of the Hemodialysis Stressor Scale

This report updates the psychometric information available on the Hemodialysis Stressor Scale. The tool is a 29-item scale that rates the incidence and severity of stressors associated with hemodialysis treatment of end-stage renal disease. Six items are classified as physiologic stressors and 23 as psychosocial stressors. Alpha homogeneity coefficients achieved acceptable standards for reliability. Content validity is demonstrated by the varied sources used to ascertain pertinent items for the scale. Construct validity of the scale was investigated by factor analysis (N = 174). A two-factor solution to evaluate the validity of the physiological-psychosocial dichotomy showed insufficient support for this simplistic dichotomous classification of hemodialysis stressors. A subsequent unrestricted factor solution to explore the multidimensionality of the scale yielded eight factors, but only three were significant, so a three-factor solution was subjected to rotation. The content of the 6 physiological and 9 psychosocial items loading significantly on Factor I characterized this factor as psychobiological; Factor II consisted of 12 psychological and social stressors; Factor III pertained to 8 dependency and restriction stressors. The three-factor solution was seen as the best-fitting solution with this particular data set because it was conceptually clear, informative, and parsimonious.

Psychometric assessment of the Jalowiec Coping Scale

The Jalowiec Coping Scale consists of 40 coping behaviors culled from a comprehensive literature review, which are rated on a 1- to 5-point scale to indicate degree of use. Twenty judges classified the items to permit analysis of the coping behaviors according to a problem-oriented/affective-oriented dichotomy; 15 problem and 25 affective items resulted. Overall agreement by the judges was 85%, with greater consensus on problem items. Evaluation of stability using a two-week retest interval (N = 28) yielded significant rhos of .79 for total coping scores, .85 for problem, and .86 for affective. With a one-month interval (N = 30) coefficients were .78, .84, and .83, respectively. Alpha reliability coefficients of .86 (N = 141) and .85 (N = 150) supported instrument homogeneity. Content validity is substantiated by the systematic manner of tool development, by the large number of items used, and by the inclusion of diverse coping behaviors. Factor analysis (N = 141) was used to investigate construct validity. A two-factor solution to evaluate the validity of the dichotomous classification showed that 80% of the problem items loaded on Factor I, but only 56% of the affective items loaded on Factor II. To examine this multidimensional aspect, several other factor solutions were explored. Ultimately, the four-factor solution provided the most intelligible conceptual pattern with the least loss of information. Conceptual composition of these factors is discussed, and several tentative labels for each factor are suggested.

Validation of two experimental nursing approaches using content analysis

The purpose of this study was to analyze and compare the recorded content of two experimental nursing interventions used in a hypertensive-education program. One intervention was characterized as deliberative or high indirect, the other as task-centered or low indirect. A total of 4,149 nurse-patient interaction units was derived from 62 typed interview transcripts, equally representative of both approaches. Two trained coders categorized the interactions, based upon recurring themes of the teaching content; 24 distinct topical categories were identified. Intercoder agreement above chance for all 4,149 interaction units was k = .68, with confidence limits of 99% +/- .03, p less than .0001. A space-time unit for quantifying the relative amounts of time spent on the various categories also was developed, and analyses were conducted for space-time units as well as interaction units. The main findings showed no definable differences in the frequency of categories or the amounts of time spent in their discussion in the two approaches. These results were contrasted to results obtained when the validity of the nursing approaches was tested previously, and differences between the two interventions in attaining social and health goals were interpreted in light of the findings of the content analysis.

Stress identification and coping patterns in patients on hemodialysis

The types and severity of stressors and methods of coping with stress were assessed for 35 patients on hemodialysis. Coping was measured with a tested scale and stress was evaluated with a scale developed for the study. Test-retest reliability of the stressor scale was satisfactory (rs = .71). Results indicated that stressors experienced by the hemodialysis patient can be measured with an objective tool; psychosocial stressors have an impact equal to that of physiological stressors. Fluid restriction was ranked as the highest psychosocial stressor and the top physiological stressors were muscle cramps and fatigue. Patients on dialysis for one to three years indicated the greatest amount of stress. Patients used problem-oriented coping methods significantly more than affective-oriented methods (t [34] = 7.06), p greater than .001). Optimism and controlling the situation were the two most common coping methods, and putting the problem out of one's mind and blaming someone else were the least important coping tools.

Learning needs of cancer patients: a comparison of nurse and patient perceptions

The purposes of this study were to discover and compare patients' and nurses' perceptions of the learning needs of cancer patients. Using rating scales, 33 nurses and 27 patients rated the degree of importance of learning 36 informational items, including nutrition, treatment, and diagnostic testing. In addition, nurses and patients ranked six content areas according to: how problematic each area was for the patient; how much knowledge the patient had about each area; and how much the patient wanted information about each area. Results indicated that significant differences existed between nurses' and patients' perceptions of the learning needs of cancer patients. Nurses rated the degree of importance of the 20 general information items significantly higher than did the patients. The rank order of the six content areas for each of three questions by nurses and patients showed nurses ranked dealing with feelings as the most problematic area for patients, while patients ranked this area low.