Focus groups describe rural nursing in New York state.

Focus groups were conducted at three sites in rural regions of New York state to describe the nature of rural nursing in terms of scope of practice, barriers, needs, and resources. Five nurses from a variety of rural practice settings participated in each group (n = 15), which was led by a nurse facilitator who was a member of the New York State Nurses Association Committee on Rural Nursing. The focus group methodology included a semi-structured format in which three defined questions were circulated before the meeting and addressed in sequence at the meeting according to the established and prearranged agenda. Key characteristics defining the scope of rural nursing included autonomy, flexibility, and creativity. The main needs identified were for accessible education and professional collegial relationships. Resources included the ease of communication without complex structures, interdisciplinary interaction and respect, and the sense of being part of the community in which the practice agency existed. Despite the barriers, these rural nurses received a great deal of satisfaction from their nursing activities and felt that they made a significant contribution to health care in their community. They also had feasible suggestions to address their needs.

Domestic pollution and respiratory illness in a Himalayan village.

Summer and winter surveys of a village in Ladakh have been used to study respiratory illness and domestic pollution from fires in an arid high altitude region of northern India. The prevalence of chronic cough with chronic phlegm rose steeply with age, and was greater among women than men. The percentage of villagers with a forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio of less than 65% also rose with age, to include 24% of men and 32% of women over 50 years in the summer survey. Lung function was significantly worse in those reporting chronic cough, independently of age and sex (p less than 0.001). Carbon monoxide (CO) measurements were used to assess domestic pollution from fires. Amongst the small minority of smokers (all men) CO in exhaled air was higher than in non-smoking men. In non-smoking men and the women, levels of exhaled CO were very significantly higher in winter than in summer, as were the levels of CO measured in the houses. There was a fall in FEV1 (but not FVC) between summer and winter (p less than 0.0001), and an association was found between individual change from summer to winter in exhaled air CO and the individual change in FEV1 (p less than 0.01). A significant negative association was found between the winter value of CO in exhaled air and FEV1/FVC ratio in women (p less than 0.05), although a similar association in men was non-significant. No significant associations were found between winter pollution levels and the presence of chronic symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Within- and between-person variation in dietary surveys: number of days needed to classify individuals.

The variation from day to day, between individuals and within individuals, in the consumption of energy and a variety of nutrients is presented for two groups of executive grade civil servants aged 40-49, numbering 83 and 68 and working in London in 1970-1971, and for 98 drivers and 83 conductors aged 30-67 of London's double decker buses in 1958-1967, a total of 332 men. Each man weighed and recorded his food for at least a week. The reliability with which these men could be classified into extreme thirds of the distribution of individual consumption of the various 'nutrients' or foods on the basis of a single day's or of several days' measurement was calculated. The number of days of measurement required to achieve a given reliability of classification into extreme thirds of the distribution was also estimated. The key is the ratio of the 'between-person' to the 'within-person' variance for the particular nutrient. A diagram is presented of how this ratio is related to the number of days of survey required for a given reliability. Nutrients fall into three main groups--those consumed in relatively large amounts each day (eg protein, fat), those found in moderate amounts in many or most foods but in very large quantities in a few foods (eg dietary cholesterol, calcium), and those which may not be consumed at all by some people but are taken in large quantities by others (eg alcohol). The number of days of survey required for 80 per cent reliable classification of individuals varies from 2 or 3 days for some nutrients like sugar or total carbohydrates to 2 or 3 weeks for others like dietary cholesterol or the ratio of polyunsaturated fatty acids to saturated fatty acids. One day's survey classified no nutrients with 80 per cent reliability in our data, whereas one week's survey classified most nutrients with this reliability or better, although for a few the figure is lower. The precision of a week's survey is also shown in absolute quantities such as grams as distinct from thirds of the distribution. The relevance of these observations to the use of the results of 24-hour surveys in population surveys and correlation and regression analysis is discussed.

The prevalence of dysuria in women in London.

A postal questionnaire was used in a survey of dysuria in women aged 20-54 years in four London general practices. Twenty per cent of all women reported dysuria in the previous year (recent dysuria) and half of these women suffered at least one further episode in the same year. The prevalence of recent dysuria showed a decline with increasing age, a small increase with increasing number of pregnancies, no social class effect and no difference with marital status. Frequent recent episodes were more likely in women whose first reported episode of dysuria occurred before the age of 20 years. The risk of dysuria occurring in any pregnancy was about 12 per cent, and a small group - about 6 per cent of those who had had more than one pregnancy - reported dysuria in every pregnancy. Comparison of the practice records of non-responders and responders suggested that the true prevalence of recent dysuria was over-estimated by about one third. The routine use of a few specific questions in clinical and epidemiological practice may help to identify those women at increased risk from urinary tract infection, particularly in pregnancy.

Quantitative estimates of beta-lactam residues in raw milk around a reference standard: collaborative study.

A collaborative study was conducted to determine the reliability of a Bacillus stearothermophilus disc assay method for differentiating various concentrations of penicillin in raw milk. Participating laboratories tested 10 different samples (including one negative) in blind duplicate. Triplicate standards were alternated with triplicate unknowns around the periphery of each of 5 different plates. Zone diameters were measured and the difference in zone size of pairs of adjacent standard and unknown samples were analyzed by a paired t-test. Penicillin concentrations 0.003 IU/mL different from the reference concentrations were consistently distinguishable at a 95% confidence level. Such discriminatory power was determined to be possible with as few as 3 plates (9 replicates) per unknown. The method has been adopted official first action.

A cooperative trial in the primary prevention of ischaemic heart disease using clofibrate: some statistical aspects.

Some results of the primary prevention trial using clofibrate not published in the original report are presented. After showing that the entry characteristics of the "dropouts" in the treated group and in the main control group were similar, the emphasis is on deaths from causes other than ischaemic heart diseases in the trial and within 1 year of leaving it. Such deaths occurred no earlier, in terms of time since entry to the trial, in the clofibrate-treated group than in the main control group; they were no less frequent in those men in the treated group who were shown in the earlier report to have the greatest reduction in nonfatal myocardial infarction than in the remainder; and they showed no clear relationship with cholesterol reduction during the trial. Death rates calculated by the indirect method of age-standardization are presented and are preferred to the published rates calculated by the direct method. All men in the trial were followed to the end of 1978 to ascertain survival or cause of death. This will provide much larger numbers on many of the issues discussed here.

Alteration of glycine N-methyltransferase activity in fetal, adult, and tumor tissues.

Glycine N-methyltransferase activity has been examined in a number of fetal and adult organs, as well as in several rodent hepatomas, using both enzymatic and immunological techniques. In fetal rabbit liver, the activity first appears at a low level at about 20 days postfertilization and rises to high levels after birth, reaching maximum in the adult liver. In fast-growing hepatomas, the activity could not be detected by either enzymatic or immunological assay. It could be detected in the slower-growing hepatomas, but in considerably diminished levels compared with that of normal adult rat liver. Immunoassays gave no evidence for inactive forms of the enzyme in the tissues that had no enzymatic activity. Transfer RNA methyltransferase assays carried out simultaneously showed an inverse relationship to the glycine N-methyltransferase activity. The levels of transfer RNA methyltransferase activity were high in fetal and tumor tissues and lower in normal adult tissues.

A cooperative trial on the primary prevention of ischaemic heart disease using clofibrate: design, methods, and progress.

The paper describes the design of, and the procedures used in a double blind randomized trial to determine whether the incidence of ischaemic heart disease can be lowered by the reduction of high and moderately high lipid levels in healthy men aged 30-59 years. The trial started in Edinburgh in 1965 and was extended to Prague and Budapest in 1966 and 1967. It is coordinated and controlled by a committee of investigators convened by the World Health Organization. The subjects were selected on the basis of a preliminary determination of serum cholesterol level. Half of the men in the upper third of the distribution of cholesterol values have been assigned at random to a treated group and take 1.6 g of clofibrate daily; the other half make up a control group and take identical capsules containing 300-350 mg of olive oil. A second control group, chosen at random from the lowest third of the cholesterol distribution, also receives the olive oil capsules. The study is designed to have a 90% chance of detecting, in the treated group, a reduction of one-third in the incidence of ischaemic heart disease if this should occur. The subjects are examined at the beginning of the trial, then at 6-month intervals for 2 years, and thereafter annually for at least 3 further years. The criteria of ischaemic heart disease are defined and the different control procedures are described. The required 15 000 subjects have now been admitted to the trial and their characteristics are described, but it is too early to report any results.