Laboratory, morphologic, and immunophenotypic correlates of surface immunoglobulin heavy chain isotype expression in B-cell chronic lymphocytic leukemia.

We compared surface immunoglobulin heavy chain isotype expression with a number of laboratory, morphologic, and immunophenotypic features in a series of 76 cases of B-cell chronic lymphocytic leukemia (B-CLL). Fifty-five cases were IgM+/IgD+, a phenotype associated with antigenically naïve B cells; 16 cases expressed IgD without IgM, a phenotype seen in a subset of normal B cells with extensive somatic immunoglobulin variable region (IgV) gene mutations; and 5 cases were IgD-, a phenotype associated with memory B cells. WBC count, atypical morphologic features, atypical immunophenotypic characteristics, and CD38 expression were nonrandomly distributed among the 3 categories of heavy chain isotype expression. Moreover, a WBC count more than 30,000/microL (30 x 10(9)/L), atypical morphologic features, and CD38 expression in more than 30% of neoplastic cells (all adverse prognostic factors in B-CLL) were less common among IgD-only cases than among IgM+/IgD+ and IgD- cases. These data demonstrate that surface immunoglobulin heavy chain isotype expression is associated with several laboratory, morphologic, and immunophenotypic features in B-CLL. The subset of B-CLL with the IgD-only phenotype is associated with several favorable prognostic factors, suggesting the possibility that IgD-only B-CLL may be associated with a favorable prognosis.

Measuring infant exposure to environmental tobacco smoke.

Methods to measure infant exposure to environmental tobacco smoke (ETS) are needed to identify infants at highest risk for ETS-related health problems. The purpose of this study was to validate measures sensitive to changes in levels of infant exposure to ETS and to develop a predictive model of infant exposure to ETS. Fifteen infants of smoking mothers were followed from birth to 6 weeks of age. Exposure to ETS was measured by using a smoking habits questionnaire, cigarette "butt" collection, infant urine nicotine and cotinine levels, and ambient nicotine (personal air monitors). The 24-hour cigarette butt collection was the best predictor of acute (adjusted r2 = .83) and chronic exposure (adjusted r2 = .47) measured by infant urinary nicotine and cotinine levels when the infants were 2 weeks of age. Including scores on the smoking habits questionnaire and ambient nicotine levels increased the adjusted r2 to .88 and .61, respectively.

Physiological effects of infant exposure to environmental tobacco smoke: a passive observation study.

This study explored infant physiologic responses of exposure to environmental tobacco smoke (ETS) using a longitudinal passive observation study with a control group. Fifteen smoking and 15 non-smoking mothers were initially contacted in hospital maternity units, with home visits made when their infants were 2, 4, and 6 weeks old. Exposure to ETS was measured using infant urinary nicotine and cotinine levels. The physiologic effects of infant ETS exposure were measured by rectal temperature, pulse rate, respiratory rate, blood pressure, and oxygen saturation. The smoking mothers in this sample were poorer, had less education, and were less likely to be married than the mothers who did not smoke. At birth, the infants of smoking mothers had higher diastolic blood pressure than infants of non-smoking mothers (p < .008). Mothers who smoke cigarettes should be educated that maternal smoking behavior can affect an infant's cardiovascular function. Parents should also be counseled about the risks of smoking in close proximity and/or in an enclosed space with an infant, especially in a motor vehicle.

National Delphi study to determine competencies for nursing leadership in public health.

PURPOSE: To identify competencies needed by nurse leaders in public health programs. DESIGN: Five-round national Delphi. SAMPLE: Convenience sample of members of major public health nursing associations and nurse and non-nurse public health leaders in the USA. METHODS: Mailed survey in 1994-1995 using a modified snowball technique based on a modification of the Pew Foundation health professions' competencies for Round 1. Four additional rounds produced consensus. FINDINGS: Initially, 62 competencies were identified. Factor analysis resulted in four factors: political competencies, business acumen, program leadership, and management capabilities; 57 competencies were clustered in the four groupings and accounted for 91.4% of the variance. CONCLUSIONS: Graduate schools in nursing and public health must prepare students with broad-based competencies from a variety of disciplines. Findings of this national survey provide a database for curriculum development and evaluation of programs to prepare nurse leaders for roles in public health-based delivery systems.

Drinking problems of nursing students.

A sample of 315 nursing students in yearly cohorts (1988-1992) completed the Michigan Alcoholism Screening Test (MAST). A simple and quick instrument with established reliability and validity, the MAST had a reliability coefficient of .78 with this sample. The MAST scores of the nursing students indicated that 21.5% had probable alcoholism or were alcoholic. Drinking problems among these nursing students were similar to those of other nursing students and college students in general. Implications for nurse educators include recognition that nursing students need continuing self-assessment and monitoring to avoid drinking problems as a student and future practitioner. Alcoholism self-screening is an excellent introduction to client assessment for drinking problems. Implications for future research include identifying correlates and determinants of problem drinking behaviors and ultimately developing and testing educational interventions to eliminate the problem.

Testicular versus breast and colorectal cancer screening: early detection practices of primary care physicians.

Testicular cancer is the most common solid tumor among men 20 to 34 years old, and it accounts for one of every seven deaths in late adolescent and young adult men. However, studies during the past 20 years continue to show that a majority of men in the most vulnerable ages are unaware of their risk for testicular cancer, deny having had testicular examinations as a part of their routine physical assessments, and lack knowledge of testicular self-examination techniques. This descriptive study used a mailed questionnaire and evaluated self-reported testicular cancer detection behaviors among primary care physicians (N = 116). Breast exams and colorectal screening were included for masking and comparative purposes. Forty-nine percent of the physicians reported routinely performing age-appropriate testicular exams on patients, in contrast to performing breast (83%) and colorectal exams (68%). Instructing male patients to perform testicular self-examination was reported as a routine procedure by 29%, and breast exams were taught routinely by 86% of the physicians. Providing an opportunity for patients to give a return demonstration of the technique was reported 16% of the time for breast self-examination and 4% of the time for testicular self-examination. Teaching patients to do appropriate self-examinations can enhance the provider-client partnership in the provision of healthcare. When providers do not teach the patient to perform self-examinations, a valuable opportunity is missed.

Influence of family functioning on maternal-fetal attachment.

Although the development of a positive relationship between the mother and infant most likely begins during pregnancy, the correlates of maternal-fetal attachment are poorly understood. This study examined the influence of family functioning on maternal-fetal attachment in a sample of varied ethnic and socioeconomic backgrounds. The authors surveyed 339 pregnant women in their last trimesters with the Family Adaptability and Cohesion Scales-III (FACES-III), Maternal-Fetal Attachment Scale (MFA), and a demographic interview. On the basis of correlational and regression analyses, the demographic variables of parity, ethnicity, age, education, and occupation of primary wage earner correlated significantly with maternal-fetal attachment. When entered in a multiple regression analysis, parity, ethnicity, and occupation explained 12% of the variance in the MFA scores. The FACES-III total score and the subscale scores of adaptability and cohesion also correlated significantly with scores on the MFA and explained an additional 3% of the variance in the MFA beyond that explained by the demographics. Support of positive family dynamics during pregnancy by health care workers may potentially increase the quality of maternal-fetal attachment.

Job satisfaction of nurse practitioners: an analysis using Herzberg's theory.

The current sociopolitical and economic forces affecting health care may lead to job dissatisfaction among nurse practitioners, according to results of a South Carolina study. A mailed survey that consisted of the Index of Job Satisfaction and the Minnesota Satisfaction Questionnaire--Short Form was used to test Herzberg's dual-factor theory of job satisfaction. A response rate of 90 percent was attained, with a final sample of 132 nurse practitioners and midwives. Consistent with the predictions of Herzberg's model, intrinsic factors served as sources of job satisfaction, while extrinsic factors were the primary sources of job dissatisfaction. Nurse practitioners in the sample reported a moderate amount of satisfaction with their "overall jobs." Suggestions are provided for ways both nurse practitioners and health administrators can enhance job satisfaction.

An explanatory model of nurse practitioner job satisfaction.

Job satisfaction influences employee retention, worker productivity, and performance quality. To retain qualified nurse practitioners (NPs), health administrators must identify sources of job satisfaction and dissatisfaction. Herzberg's dual-factor theory of job satisfaction addresses extrinsic and intrinsic work-related factors. Expansion of the model to include global job satisfaction and individual differences provided a broad framework for the assessment of nurse practitioner job satisfaction. The expanded model was used to analyze the job satisfaction of 132 NPs registered with the South Carolina State Board of Nursing in 1988 (final response rate = 90%). Participants completed the Index of Job Satisfaction (IJS), the Minnesota Satisfaction Questionnaire-Short Form (MSQ-SF), and the Personal and Work Background Questionnaire (PWBQ). Although the NPs were moderately satisfied with their overall jobs, extrinsic factors were found to be major sources of dissatisfaction. The optimal combination of variables predicted by regression analysis to influence global job satisfaction were age, number of children, urban locations, achievement, company policies and practices, creativity, independence, and compensation. Implications for health administrators to improve the work environments of NPs are discussed.