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This follow-up study investigated whether attitudes toward the metric system have changed over the last 15 years. 132 subjects ranging in age from 18 to 45 years participated by filling out a 7-item survey designed to measure attitudes toward the metric system. Each survey item was scored using a 5-point rating, e.g., "the change to the metric system will create more problems than it solves," 1: strongly agree and 5: strongly disagree. Scores were compared to those obtained for a similar sample in 1983. Comparisons using t tests indicated no significant differences between attitude scores from 1983 to 1998 for either men (t64 = .95) or women (t133 = .06).

This paper presents the concept of the town hall meeting and discusses how it can be used as a forum for those who have been touched by cancer. It can be a platform for people to express their views about cancer, not only in the community but also nationally. Empowerment is the hallmark of a town hall meeting. Those who are in leadership positions in health care and elected officials and community leaders are given the opportunity to hear the opinions of people who represent a broad-based constituency of individuals affected by cancer. The idea of holding a town hall meeting was first introduced in the cancer community by the National Coalition for Cancer Survivorship NCCS) as a means of identifying issues, exchanging information and considering creative solutions to problems. The first town hall meeting was held in 1994 in conjunction with the NCCS annual assembly. Since then, utilizing the guidelines set forth by the NCCS, 30 or more town hall meetings have been held across the United States. Cancer survivors have, by and large, been responsible for garnering the necessary support for conducting a town hall in their local area. Organizations such as the American Cancer Society, the Leukemia Society of America, hospitals, clinics, pharmaceutical and healthcare companies and also noncancer groups, such as the YMCA, churches, and radio/T.V. stations, join with the cancer survivors in organizing the meeting, planning related displays, and advertising the event. In 1998, seven town hall meetings were sponsored jointly by OnCare and NCCS in advance and support of the upcoming THE MARCH- Coming Together To Conquer Cancer, a national rally held in Washington, D.C. in September 1998. Attendees at the meetings included not only cancer survivors and their families, but also healthcare professionals, local and state legislators, community leaders and the media. Results of the 1998 town hall meetings are discussed and compared with the topics identified during the meetings held in 1994-1996. Town hall participants were outspoken about what is needed in America if cancer is truly to become the nation's healthcare priority. They are asking for equal access to quality care, increases in financial backing for research, and more support for cancer advocacy efforts. Benefits of holding town hall meetings are identified.

Current guidelines and recommendations for genotoxicity testing of pharmaceuticals are disparate, both in terms of the most appropriate tests to use and the protocols to follow. Recent attempts have been made to standardise genotoxicity testing procedures, coinciding with the current review of the OECD guidelines and the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). However, as with other aspects of non-clinical safety assessment of pharmaceuticals, guidelines have been prepared by evaluation of general chemical data due to the lack of specific information on pharmaceuticals. To address this, a project was undertaken to collect and collate information specifically pertaining to the genotoxicity testing of pharmaceuticals in order to obtain a clear understanding of international strategy and procedures in the pharmaceutical industry. It is clear that the practices and regional variations are strongly influenced by national guidelines and do not necessarily follow companies' preferences. However, there is a surprising amount of variation in approach between companies on some issues. This is evident in how companies define a genotoxin. This ranges from a positive result in an in vivo assay as indicative of a genotoxin (43%) to any positive result in vitro or in vivo (30%). Indeed many companies (particularly in Japan) will terminate development on the strength of a clear positive result in an Ames test. There is much debate within the ICH process concerning tests to detect gene mutations in mammalian cells as part of a primary test battery. This survey shows that in general, the pharmaceuticals industry has severe doubts about these assays. Thirty-seven (78%) of the 47 participating pharmaceutical companies include an in vitro test to detect gene mutation in mammalian cells as part of their routine test battery. The HPRT test using Chinese hamster cells has the most widespread use, although there is only limited use of such tests in Japan. Compound development has been affected by the results of such tests, but usually only in terms of clarification of equivocal results in other genotoxicity tests in the test battery. The majority (63%) of companies do not support its use as a primary regulatory requirement, and 83% do not consider the mouse lymphoma assay (L5178Y) an acceptable replacement for in vitro mammalian cytogenetics. In conclusion, this survey has provided valuable information on the current modus operandi of the international pharmaceutical industry for consideration in current harmonisation initiatives.

Purpose/objective: To review and discuss the economic and care delivery implications of the healthcare reform currently being debated., Data Sources: Projections are based on synthesis of multiple scholarly, professional, and governmental sources of information., Data Synthesis: Future projections regarding the hallmarks of healthcare reform (e.g., universal access, fewer payors, rationing of care), changes in practice settings, and novel communications technologies are discussed., Conclusions: Opportunities for nurses resulting from these changes include roles as resource allocators, cost-benefit analysis, cancer system liaisons, satellite-program builders, and quality-assessment experts., Implications for Nursing Practice: Changes will challenge nurses to assume multiple responsibilities as clinicians, administrators, educators, and researchers who will need to integrate input from numerous sources to make decisions that take into account competing and contradictory factors.

The role of the adult oncologists in the area of pediatric cancer treatment previously has been unmeasured. A questionnaire bearing regarding the practice of 447 adult oncologists was administered in June 1991. The membership list of the Association of Community Cancer Centers was used to identify contact oncologists. One hundred thirty-one questionnaires (29.3%) were returned for analysis. The data reveal that 204 patients younger than 21 years of age were treated during the last year in 63 adult oncology practices. Most of these patients were more than 15 years of age. Only a minority (53) were treated in rural practices. In addition, only a minority (27%) of these patients are reported to be enrolled in clinical trials. In addition, adult oncologists appear to regard physiologically mature adolescents (age 16-21 years) as adults. They do not seem to make a distinction between patients 16-21 years old and those older than 21 years.

New estimates of the direct costs of traumatic spinal cord injuries (SCI) are obtained from a comprehensive survey of the US SCI population. These direct costs, defined as the value (in 1988 dollars) of resources used specifically to treat or to adapt to the SCI condition, represent the average experience of the US SCI population. Responses to a detailed questionnaire administered to a sample of traumatic SCI persons in the United States provide the primary source of data for this study. Analysis of this survey data indicates that more recently injured SCI persons (ie those injured since 1970) spent an average of 171 days in a hospital over the first 2 years post injury. Initial hospital expenses will average $95,203. Home modification costs in excess of $8,000 can also be expected. After recovery and rehabilitation, a SCI person will pay, on average, $2,958 per year in hospital expenses and $4,908 per year for other medical services, supplies and adaptive equipment. Personal assistance costs and costs of institutional care will average $6,269 per year. These cost estimates represent the incremental costs of SCI, ie they exclude any costs that would have been incurred in the absence of SCI.

In the 1982-84 Hispanic Health and Nutrition Examination Survey, the prevalence of cigarette smoking was examined among Mexican Americans, Puerto Ricans, and Cuban Americans in the United States. Among 20-74 years olds, the age-adjusted smoking rates for Mexican American, Puerto Rican, and Cuban American men were high--42.5, 39.8, and 41.6 percent, respectively. Quite striking among Cuban American men was the high smoking rate among 20-34 year olds (50.1 percent), the highest smoking rate in the three Hispanic groups compared. The age-adjusted smoking rates for Mexican American, Puerto Rican, and Cuban American women were much lower than those for men-23.8, 30.3, and 24.4 percent, respectively. Both Puerto Rican and Cuban American men were more likely to be heavy smokers (52.3 and 64.1 percent, respectively, smoking a pack or more a day) as compared to the Mexican Americans (33.8 percent smoking a pack or more a day). The pattern was the same for women, with Mexican American women being lighter smokers (18.8 percent smoking a pack or more a day) as compared to heavy smoking among Puerto Rican and Cuban American women (35.1 and 48.6 percent, respectively, smoking a pack or more a day). Given the health hazards of smoking, future research and intervention are required for those groups with high exposure to cigarette smoking.

New estimates of traumatic spinal cord injury (SCI) prevalence are developed from a survey specifically designed to identify the SCI population in both institutional and non-institutional settings. The survey utilised a mixed-mode sampling design based on probability sampling methods. Detailed interviews were conducted with SCI persons identified in this survey. We estimate that the traumatic SCI prevalence rate in the United States is 721 cases per million, and that there are about 177,000 SCI persons residing in the United States.