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Background and Objectives: Children of parents with emotional disorders have an increased risk for developing anxiety and depressive disorders. Yet the mechanisms that contribute to this increased risk are poorly understood. The present study aimed to examine attention biases in children as a function of maternal lifetime emotional disorders and maternal attention biases., Methods: There were 134 participants, including 38 high-risk children, and their mothers who had lifetime emotional disorders; and 29 low-risk children, and their mothers without lifetime emotional disorders. Mothers and children completed a visual probe task with emotional face pairs presented for 500 ms., Results: Attention bias in children did not significantly differ solely as a function of whether or not their mothers had lifetime emotional disorders. However, attention bias in high-risk children was significantly related to their mothers' attention bias. Specifically, children of mothers with lifetime emotional disorders showed a greater negative attention bias if their mothers had a greater tendency to direct attention away from positive information., Limitations: This study was cross-sectional in nature, and therefore unable to assess long-term predictive effects. Also, just one exposure duration of 500 ms was utilised., Conclusion: Attention bias for negative information is greater in offspring of mothers who have lifetime emotional disorders and a reduced positive bias, which could be a risk marker for the development of emotional disorders in children.

Vitamin D is essential for the health of both mother and fetus during pregnancy. In the nonpregnant state, vitamin D demonstrates anti-inflammatory effects, but little is known about this relationship during pregnancy. African-American women are at a higher risk of vitamin D deficiency and for altered inflammatory responses during pregnancy. Therefore, we investigated the association of early pregnancy vitamin D nutrition, as assessed by serum 25-hydroxyvitamin D (25-OHD), with second-trimester inflammatory biomarkers (high-sensitivity C-reactive protein, IL-6, IL-10, IL-1β and TNF-α) in 178 pregnant African-American women. Mean serum 25-OHD was 13.4±8.4 ng/ml, and most women (n=147, 82.6%) had inadequate or deficient levels of 25-OHD (<20 ng/ml). Both serum 25-OHD and some inflammatory cytokines (IL-1β and TNF-α) demonstrated significant seasonal variation. In univariate models, log transformed 25-OHD was significantly and inversely associated with log transformed IL-1β (p=0.002) and log transformed IL-6 (p=0.032). After adjusting for covariates, including seasonality, only the inverse association with IL-1β remained statistically significant (p=0.027). Early pregnancy vitamin D nutrition is associated with some inflammatory biomarkers in mid-pregnancy. Additional studies are needed to determine if low vitamin D nutrition is associated with birth outcomes via an inflammatory-mediated pathway., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Purpose: Approximately 40% of African Americans have hypertension (HTN). Up to 50% of persons with HTN experience symptoms they attribute to HTN. The beliefs African Americans ascribe to their symptoms have not been substantively described in research. Therefore, the purpose of this study was to describe the "representations" (meaning and emotions associated with symptoms) ascribed to hypertensive symptoms., Data Sources: Twenty-six community-dwelling African Americans with hypertensive symptoms were identified from among 51 participants enrolled in a larger HTN study. Participants completed the Symptom Representation Questionnaire for each reported hypertensive symptom., Conclusions: Twenty-six participants (51%) experienced at least one hypertensive symptom (e.g., headaches, dizziness, vision changes). Participants held neutral scores for the level of distress, and expected duration and consequences of their headaches, dizziness, and vision changes. Participants attributed HTN as a cause of their symptom(s) to a greater degree than HTN treatment. Strong symptom cure/control beliefs were reported among participants with headaches, dizziness, and vision changes., Implications for Practice: The study results highlight areas that nurse practitioners should assess with hypertensive patients. Key assessment areas include (a) hypertensive symptom type and frequency; (b) HTN as a cause for symptoms; and (c) beliefs about cure/control of symptoms and patients' corresponding self-management actions., (©2014 American Association of Nurse Practitioners.)

Objective: We examined the association between 1-hour glucose challenge test (GCT) values and risk of caesarean section., Study Design: A prospective cohort study recruited 203 pregnant Black women to participate. At ~28 weeks of gestation, participants underwent a routine 1-hour 50 g GCT to screen for gestational diabetes mellitus. Logistic regression was used to examine the association between 1-hour GCT value and delivery mode., Results: Of the 158 participants included, 53 (33.5%) delivered via C-section; the majority (n = 29; 54.7%) were nulliparous. Mean 1-hour GCT values were slightly, but not significantly, higher among women delivering via C-section; versus vaginally (107.8 ± 20.7 versus 102.4 ± 21.5 mg/dL, resp.; P = 0.13). After stratifying by parity and adjusting for maternal age, previous C-section, and prepregnancy body mass index, 1-hour GCT value was significantly associated with increased risk of C-section among parous women (OR per 1 mg/dL increase in GCT value = 1.05; 95% CI OR: 1.00, 1.05; P = 0.045)., Conclusion: Even slightly elevated 1-hour 50 g GCT values may be associated with delivery mode among parous Black women.

Persons affected by leprosy or by disabilities face forms of stigma that have an impact on their lives. This study seeks to establish whether their experiences of stigma are similar, with a view to enabling the two groups of people to learn from each other. Accounts of experiences of the impact of stigma were obtained using in-depth interviews and focus group discussion with people affected by leprosy and by disabilities not related to leprosy. The analysis shows that there are a lot of similarities in impact of stigma in terms of emotions, thoughts, behaviour, and relationships between the two groups. The main difference is that those affected by leprosy tended to frame their situation in medical terms, while those living with disabilities described their situation from a more social perspective. In conclusion, the similarities offer opportunities for interventions and the positive attitudes and behaviours can be modelled in the sense that both groups can learn and benefit. Research that tackles different aspects of stigmatization faced by both groups could lead to inclusive initiatives that help individuals to come to terms with the stigma and to advocate against exclusion and discrimination.

Background: Stigma plays in an important role in the lives of persons affected by neglected tropical diseases, and assessment of stigma is important to document this. The aim of this study is to test the cross-cultural validity of the Community Stigma Scale (EMIC-CSS) and the Social Distance Scale (SDS) in the field of leprosy in Cirebon District, Indonesia., Methodology/principle Findings: Cultural equivalence was tested by assessing the conceptual, item, semantic, operational and measurement equivalence of these instruments. A qualitative exploratory study was conducted to increase our understanding of the concept of stigma in Cirebon District. A process of translation, discussions, trainings and a pilot study followed. A sample of 259 community members was selected through convenience sampling and 67 repeated measures were obtained to assess the psychometric measurement properties. The aspects and items in the SDS and EMIC-CSS seem equally relevant and important in the target culture. The response scales were adapted to ensure that meaning is transferred accurately and no changes to the scale format (e.g. lay out, statements or questions) of both scales were made. A positive correlation was found between the EMIC-CSS and the SDS total scores (r=0.41). Cronbach's alphas of 0.83 and 0.87 were found for the EMIC-CSS and SDS. The exploratory factor analysis indicated for both scales an adequate fit as unidimensional scale. A standard error of measurement of 2.38 was found in the EMIC-CSS and of 1.78 in the SDS. The test-retest reliability coefficient was respectively, 0.84 and 0.75. No floor or ceiling effects were found., Conclusions/significance: According to current international standards, our findings indicate that the EMIC-CSS and the SDS have adequate cultural validity to assess social stigma in leprosy in the Bahasa Indonesia-speaking population of Cirebon District. We believe the scales can be further improved, for instance, by adding, changing and rephrasing certain items. Finally, we provide suggestions for use with other neglected tropical diseases.

The authors of this paper present the middle-range theory of weight management that focuses on cultural, environmental, and psychosocial factors that influence behaviors needed for weight control. The theory of weight management was developed deductively from Orem's theory of self-care, a constituent theory within the broader self-care deficit nursing theory and from research literature. Linkages between the conceptual and middle-range theory concepts are illustrated using a substruction model. The development of the theory of weight management serves to build nursing science by integrating extant nursing theory and empirical knowledge. This theory may help predict weight management in populations at risk for obesity-related disorders., (© The Author(s) 2014.)

Introduction: Although African American women are at increased risk for antenatal depression, less is known regarding the course of antenatal depression symptoms among African American women. Because pregnancy is a state of rapid physical and mental changes, we examined if depression symptoms changed between the second and third trimesters in a sample of pregnant African American women., Methods: A nonprobability sample of women was recruited from obstetrics clinics within a large Midwestern health system. African American women in their second trimester (N = 189) completed an initial study visit; a convenience sample of 37 women (19.6%) completed a second identical study visit during their third trimester. The 20-item Center for Epidemiological Studies Depression Scale (CES-D) was used to measure depressive symptoms; a CES-D score of 16 or higher equates with clinical depression and a CES-D score of 23 or higher indicates major depression. Paired t tests and correlation coefficients were used to estimate change in depression symptoms., Results: Mean (SD) second- and third-trimester CES-D scores were not statistically significantly different (15.3 [10.6] and 15.1 [10.3], respectively; P = .87) and were moderately and significantly correlated (r = 0.65; P .001). Prevalence of CES-D scores of 16 or higher was 43.2% (n = 16) in the second trimester and 37.8% (n=14) in the third trimester, which was not significantly different (P =.77). Between the 2 visits, 67.6% (n=25) were classified identically with a CES-D scores of 16 or higher with only fair agreement between the 2 measures (kappa = 0.33). Prevalence of CES-D scores of 23 or higher was 27.0% (n = 10) and 21.6% (n = 8) in the second and third trimesters, respectively, and was not significantly different (P = .69). Between the 2 visits, 83.8% (n = 31) were classified identically with CES-D scores of 23 or higher, with moderate agreement between the 2 measures (kappa = 0.56)., Discussion: Depression symptoms were relatively constant across the latter 2 trimesters of pregnancy. The second trimester may be an appropriate time to screen women for antenatal depression, as it is less likely to be affected by early-pregnancy somatic events yet is early enough that intervention may impart positive health benefits for mother and child.

We present a methodology to statistically discriminate among univariate and multivariate indices to improve accuracy in differentiating schizophrenia patients from healthy controls. Electroencephalogram data from 71 subjects (37 controls/34 patients) were analyzed. Data included P300 event-related response amplitudes and latencies as well as amplitudes and sensory gating indices derived from the P50, N100, and P200 auditory-evoked responses resulting in 20 indices analyzed. Receiver operator characteristic (ROC) curve analyses identified significant univariate indices; these underwent principal component analysis (PCA). Logistic regression of PCA components created a multivariate composite used in the final ROC. Eleven univariate ROCs were significant with area under the curve (AUC) >0.50. PCA of these indices resulted in a three-factor solution accounting for 76.96% of the variance. The first factor was defined primarily by P200 and P300 amplitudes, the second by P50 ratio and difference scores, and the third by P300 latency. ROC analysis using the logistic regression composite resulted in an AUC of 0.793 (0.06), p<0.001 (CI=0.685-0.901). A composite score of 0.456 had a sensitivity of 0.829 (correctly identifying schizophrenia patients) and a specificity of 0.703 (correctly identifying healthy controls). Results demonstrated the usefulness of combined statistical techniques in creating a multivariate composite that improves diagnostic accuracy., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Significant racial disparities exist in pregnancy outcomes, but few researchers have examined the relationship between trust in providers and pregnancy outcomes. The Trust in Physician Scale (TPS), the most widely used tool, has not been tested in pregnancy. We assessed the psychometric properties of the TPS and identified correlates of trust in 189 pregnant African American women. Evidence supports internal consistency reliability (>.85) and internal structure of the TPS (CFI = .97; RMSEA = .05; χ(2) (42) = 65.93, p = .001), but TPS scores did not predict pregnancy outcomes. African American women reported a high level of trust in obstetric providers. Trust did not differ by provider type (physician or midwife) but was related to the women's history of perceived racism and strength of ethnic identity., (© 2014 Wiley Periodicals, Inc.)

Guided by Leventhal's common sense model of illness representations, this study examined the relationship between hypertension beliefs and self-care behaviors necessary for blood pressure (BP) control in a sample of 111 community-dwelling African Americans with hypertension. Participants completed the revised Illness Perception Questionnaire, BP Self-Care Scale, and a demographic data sheet, and had BP measured. Analyses revealed that beliefs about the causes of hypertension differed by gender and educational level. Stress-related causal attributions accounted for 34.7% of the variance in hypertension beliefs. Participants who believed stress or external factors caused hypertension were less likely to engage in healthy self-care behaviors (e.g., keeping doctor visits, eating low-salt, low-fat diets). Results suggest that patients who are nonadherent with hypertension self-care recommendations may hold hypertension beliefs that are not consistent with the medically endorsed views of this disease. To more effectively treat and control BP, providers should assess patients' hypertension beliefs.

Maternal anxiety and depression are significant risk factors for the development of these disorders in offspring. The pathways through which risk is conferred remain unclear. This study examined fear acquisition and extinction in 26 children at high risk for emotional disorders by virtue of maternal psychopathology (n=14 with a mother with a principal anxiety disorder and n=12 with a mother with a principal unipolar depressive disorder) and 31 low risk controls using a discriminative Pavlovian conditioning procedure. Participants, aged between 7 and 14 years, completed 16 trials of discriminative conditioning of two geometric figures, with (CS+) and without (CS-) an aversive tone (US), followed by 8 extinction trials (4×CS+, 4×CS-). In the context of comparable discriminative conditioning, children of anxious mothers showed larger skin conductance responses during extinction to the CS+ compared to the CS-, and to both CSs from the first to the second block of extinction trials, in comparison with low risk controls. Compared to low risk controls, children of depressed mothers showed smaller skin conductance responses to the CS+ than the CS- during acquisition. These findings suggest distinct psychophysiological premorbid risk markers in offspring of anxious and depressed mothers., (Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Tactile acuity is known to decline with age in adults, possibly as the result of receptor loss, but less is understood about how tactile acuity changes during childhood. Previous research from our laboratory has shown that fingertip size influences tactile spatial acuity in young adults: those with larger fingers tend to have poorer acuity, possibly because mechanoreceptors are more sparsely distributed in larger fingers. We hypothesized that a similar relationship would hold among children. If so, children's tactile spatial acuity might be expected to worsen as their fingertips grow. However, concomitant CNS maturation might result in more efficient perceptual processing, counteracting the effect of fingertip growth on tactile acuity. To investigate, we conducted a cross-sectional study, testing 116 participants ranging in age from 6 to 16 years on a precision-controlled tactile grating orientation task. We measured each participant's grating orientation threshold on the dominant index finger, along with physical properties of the fingertip: surface area, volume, sweat pore spacing, and temperature. We found that, as in adults, children with larger fingertips (at a given age) had significantly poorer acuity, yet paradoxically acuity did not worsen significantly with age. We propose that finger growth during development results in a gradual decline in innervation density as receptive fields reposition to cover an expanding skin surface. At the same time, central maturation presumably enhances perceptual processing.

Aims and Objectives: To explore how patients with left-ventricular assist devices (LVAD) meet the health-deviation requisite of modifying self-concept to accept this form of treatment and restore normalcy., Background: LVAD are becoming a standard option to improve the quality of life for patients with advanced heart failure. Past research focused on technology issues and survival rates, but limited research has addressed the effect of LVADs on patients' perceptions of self. Orem's theory of self-care provides a framework to investigate how patients manage threats to self-concept to safely live with such a device., Design: Hermeneutic phenomenology based on van Manen's method., Method: Data were collected using semi-structured interviews. Data saturation was achieved with nine participants (seven men; two women), 31-70 years of age who lived with a LVAD at home for at least three months. Thematic analysis was ongoing, and final themes were consensually validated., Results: Two themes constructed from the data were consistent with the requisite of modifying self-concept. First, Having a LVAD means living. Participants described they 'feel alive again', and they 'had the rest of [their] lives that they didn't have before'. The second theme: A desire to be 'normal' in public, arose from participants descriptions of how the LVAD brought unwanted attention to them and that their appearance was 'shocking' to others., Conclusion: Participants accepted the LVAD as necessary to live making it easier for them to modify their self-concept and accept the changes to their bodies and daily lives. Attaining a sense of normalcy was more difficult in public and required additional lifestyle modifications., Relevance to Clinical Practice: Findings advance self-care knowledge in LVAD management and can heighten nurses' awareness about self-concept as a vital component for maintenance of health and well-being., (© 2013 Blackwell Publishing Ltd.)

In touch as in vision, perceptual acuity improves with training to an extent that differs greatly across people; even individuals with similar initial acuity may undergo markedly different improvement with training. What accounts for this variability in perceptual learning? We hypothesized that a simple physical characteristic, fingertip surface area, might constrain tactile learning, because previous research suggests that larger fingers have more widely spaced mechanoreceptors. To test our hypothesis, we trained 10 human participants intensively on a tactile spatial acuity task. During 4 d, participants completed 1900 training trials (38 50-trial blocks) in which they discriminated the orientation of square-wave gratings pressed onto the stationary index or ring finger, with auditory feedback provided to signal correct and incorrect responses. We progressively increased task difficulty by shifting to thinner groove widths whenever participants achieved ≥90% correct block performance. We took optical scans to measure surface area from the distal interphalangeal crease to the tip of the finger. Participants' acuity improved markedly on the trained finger and to a lesser extent on the untrained finger. Crucially, we found that participants' tactile spatial acuity improved toward a theoretical optimum set by their finger size; participants with worse initial performance relative to their finger size improved more with training, and posttraining performance was better correlated than pretraining performance with finger size. These results strongly support the hypothesis that tactile perceptual learning is limited by finger size. We suspect that analogous physical constraints on perceptual learning will be found in other sensory modalities.

It is imperative to consider the meaning of leprosy and everyday experiences of people affected by leprosy and key persons in the community if one aims to make leprosy services more effective, which appears necessary in Indonesia given the large numbers of new cases detected annually. However, little is written in the international literature about the experiences of people currently being treated for leprosy, those cured, or other key informants. This paper analyses the narratives of the people by drawing upon in-depth interviews with 53 participants and 20 focus groups discussions. The participants were purposively selected. We provide insights into the experiences of people and the meaning they give to leprosy and highlight aspect of aetiology, spirituality, religion, darkening of the skin, and sorcery. We also examine experiences of seeking care and focused on the impact of the disease in particular on the elderly and children. In conclusion, the continued need for implementation of leprosy services in Indonesia is very evident. The diversities in people's experiences with leprosy indicate a demand for responsive leprosy services to serve the diverse needs, including services for those formally declared to be "cured."

This study compares clinical, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and pathology findings in 16 prospectively, and seven retrospectively recruited dogs presented for suspected thyroid carcinoma. Of these, 17 were confirmed thyroid carcinoma, while six were initially misdiagnosed. These included four carotid body tumors, one para-esophageal abscess, and one undifferentiated squamous cell carcinoma. Thyroid carcinomas occurred in older dogs without evidence of sex predilection, and were more often unilateral. All were large, heterogeneous, moderately to strongly vascularized, and most commonly contained areas of dystrophic mineralization and/or fluid accumulations. On MRI, thyroid carcinomas appeared hyperintense compared to surrounding musculature in all imaging sequences used, while on CT they had a lower attenuation value than normal thyroid gland tissue. Histologically confirmed tumor capsule disruption with invasion of the surrounding structures was most commonly detected with MRI. Palpation was not an accurate predictor of locally invasive vs. well-encapsulated masses. Computed tomography had the highest specificity (100%) and MRI had the highest sensitivity (93%) in diagnosing thyroid carcinoma, while ultrasound had considerably lower results. We conclude that ultrasound is adequate for use as a screening tool for dogs with suspected thyroid carcinoma, but recommend either CT or MRI for preoperative diagnosis and staging., (© 2012 Veterinary Radiology & Ultrasound.)

Background: Vitamin D deficiency is associated with depression; however, no studies have examined the relationship of vitamin D and antenatal depression. Antenatal depression increases the risk of adverse birth outcomes and poorer postpartum maternal and infant health. African American women are at increased risk for vitamin D deficiency and antenatal depression. Thus, we examined if early pregnancy vitamin D nutrition (VDN) was associated with antenatal depressive symptoms among African American women in the second trimester of pregnancy., Methods: Women (n=178) were recruited from obstetrics clinics of a large health system. VDN was assessed by serum 25-hydroxyvitamin D (25-OHD). Depression symptoms were measured with the Center for Epidemiological Studies Depression (CES-D) scale; CES-D≥16 equates with criteria for clinical depression. Logistic regression was used to examine the association of log-transformed 25-OHD and elevated depression symptoms (CES-D≥16)., Results: Mean 25-OHD was 13.4±8.4 ng/mL; most women (82.6%, n=147) were vitamin D inadequate or deficient (25-OHD<20 ng/mL). Mean CES-D was 15.2±10.7, and 74 (41.6%) women had a CES-D≥16, suggestive of clinical depression. A significant inverse relationship was found between log (25-OHD) and CES-D≥16 (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.29-0.99, p=0.046). For every 1-unit increase in log (25-OHD) (corresponding to ~2.72 ng/mL increase in 25-OHD), the odds of CES-D≥16 decreased by 46%., Conclusions: African American women with lower VDN exhibit increased depressive symptoms. Research on vitamin D supplementation for reducing antenatal depressive symptoms is needed.

The human genomic instability syndrome ataxia telangiectasia (A-T), caused by mutations in the gene encoding the DNA damage checkpoint kinase ATM, is characterized by multisystem defects including neurodegeneration, immunodeficiency and increased cancer predisposition. ATM is central to a pathway that responds to double-strand DNA breaks, whereas the related kinase ATR leads a parallel signaling cascade that is activated by replication stress. To dissect the physiological relationship between the ATM and ATR pathways, we generated mice defective for both. Because complete ATR pathway inactivation causes embryonic lethality, we weakened the ATR mechanism to different degrees by impairing HUS1, a member of the 911 complex that is required for efficient ATR signaling. Notably, simultaneous ATM and HUS1 defects caused synthetic lethality. Atm/Hus1 double-mutant embryos showed widespread apoptosis and died mid-gestationally. Despite the underlying DNA damage checkpoint defects, increased DNA damage signaling was observed, as evidenced by H2AX phosphorylation and p53 accumulation. A less severe Hus1 defect together with Atm loss resulted in partial embryonic lethality, with the surviving double-mutant mice showing synergistic increases in genomic instability and specific developmental defects, including dwarfism, craniofacial abnormalities and brachymesophalangy, phenotypes that are observed in several human genomic instability disorders. In addition to identifying tissue-specific consequences of checkpoint dysfunction, these data highlight a robust, cooperative configuration for the mammalian DNA damage response network and further suggest HUS1 and related genes in the ATR pathway as candidate modifiers of disease severity in A-T patients.

Depression and inflammation are associated with poorer birth outcomes. African-American women have higher levels of inflammatory biomarkers, more depressive symptoms, and a disparate burden of poorer birth outcomes, but the association between depressive symptoms and inflammation within this higher-risk group is unknown. We examined this association among African-American women in the second trimester of pregnancy and additionally tested whether body mass index (BMI) mediates or moderates this relationship. We recruited 187 women from the obstetrics clinics of a large urban health system. Depression symptoms were measured with the Center for Epidemiological Studies Depression (CES-D) scale and inflammatory biomarkers (high-sensitivity C-reactive protein [hs-CRP], interleukin [IL]-6, IL-10, IL-1β, and tumor necrosis factor-α [TNF-α]) with enzyme immunoassays. Multivariate regression models were fitted to determine the association between CES-D score and each inflammatory biomarker. CES-D was not associated with hs-CRP or TNF-α. CES-D was directly associated with IL-1β (P=0.03). BMI moderated the relationship between CES-D and IL-6 (P<0.01) and IL-10 (P=0.04); in leaner women, depressive symptoms were associated with higher IL-6 and IL-10 levels, whereas in heavier women, depressive symptoms were associated with lower IL-10 levels. BMI did not mediate the relationship between CES-D and inflammation. We conclude that depressive symptoms are associated with increased inflammation among pregnant African-American women. Future studies are needed to examine if depression, mediated through inflammation, increases the risk of adverse pregnancy outcomes in African-American women., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Purpose: This qualitative study used focus group methodology to explore attitudes and beliefs of Hispanics regarding hypertension prevention behaviors., Method: The sample was composed of 17 participants from varied Hispanic backgrounds. The theory of planned behavior guided interview questions., Findings: Analysis indicated that participants were knowledgeable about and had a positive attitude toward preventing hypertension. However, they identified numerous barriers to preventive behaviors. Two key themes, limited resources (e.g., no time to prepare healthy meals or exercise) and cultural expectations and values (e.g., traditional food as a marker of ethnicity, hospitality, and affection; valuing social interaction over solitary exercise) summarized significant barriers to engaging in recommended preventive behaviors., Discussion: Findings suggest that literature about lack of knowledge about hypertension prevention in Hispanics may be outdated or not applicable to many Hispanics. Select resource and cultural barriers to engaging in hypertension prevention behaviors are important areas to target., Implications: Exercise, stress reduction, and diet modification strategies for hypertension prevention among Hispanics should be consistent with the cultural norms regarding the importance of social interactions and leisure.

Hypertension disproportionately affects all African-Americans and lack of adequate blood pressure control could contribute to cognitive decline among older adult African-Americans. Cognitive difficulties might impair the self-management ability of these individuals, further limiting their blood pressure control. The purpose of this study, therefore, was to determine the personal characteristics that were associated with cognitive difficulties in order to identify older adults who needed environmental supports to enhance their self-management capabilities. A sample of 102 African-Americans from 60 to 89 years of age with diagnosed hypertension was recruited. Forty-nine percent (n = 50) of the sample had cognitive impairments that could hinder hypertension self-management. Depressive symptoms were also associated with a decrease in cognitive function (i.e., orientation and complex cognitive skills), as well as being negatively associated with social support. These findings support the need for nurses to assess personal characteristics in order to plan self-management strategies that help clients compensate for cognitive deficits.

Background and Research Objective: Left-ventricular assist devices (LVADs) sustain and improve the quality of life of people living with an advanced stage of heart failure. Past research focused on the development and advancement of LVAD technology, complications, and survival rates. Limited research addressed the psychosocial aspects of living with an LVAD, yet research related to sexual functioning and intimacy is lacking. The purpose of this study was to explore and describe sex and intimacy among adults living with an LVAD., Participants and Methods: We used an interpretive phenomenological study to explore the experiences of adults living with a long-term implantable LVAD, including the effect of the LVAD on their intimate and sexual functioning. Semistructured interviews were conducted with 7 men and 2 women, 31 to 70 years of age, who had lived with the LVAD at home for at least 3 months. Interviews were audiorecorded and transcribed. The wholistic and selective approach by van Manen (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy. Albany, NY: SUNY Press; 1990) guided the analysis and interpretation of the transcribed interviews. Data were organized and coded into words and phrases using qualitative software., Results and Conclusion: Three themes emerged from the data: (a) improved sexual relations with LVAD, (b) sexual adjustment, and (c) nonsexual intimacy. The themes identified were consistent with the concept of normalcy from the theory of self-care. Participants reported that as the LVAD improved their overall health, their sexual functioning also improved. Participants also reported an increased sense of connectedness and intimacy with their partners even in the absence of sexual intercourse. Participants discussed ways in which they continued to develop intimate relationships even in the presence of limitations in structural and functional integrity. The knowledge derived from this study can be used as a guide for healthcare providers in counseling LVAD recipients on psychosocial and sexual health essential for achieving an optimum quality of life.

Objective: To explore and describe the lifestyle adjustments made by adult recipients of a long-term implantable left ventricular assist device (LVAD)., Methods: A phenomenologic inquiry was used to uncover the lifestyle adjustments of 7 men and 2 women, ages 31 to 70 years, who had an LVAD for more than 3 months after hospital discharge., Results: An overarching theme, "adjustment takes time," represents the lifestyle adjustments of the study participants. Early adjustment was highlighted by participants' concerns with physical, psychologic, and environmental aspects, whereas late adjustment was highlighted by behaviors associated with acceptance of the LVAD as an integral component of their bodies and lives., Conclusion: This study provides insight into the patient's perspective regarding the challenges faced in living with an LVAD. The findings inform health care providers in the acute and critical care settings in assisting patients to positively adjust with the lifestyle imposed by an LVAD., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Abstract A 5-year-old male telescope goldfish (Carassius auratus) developed buphthalmia of the left eye. An enucleation was performed and a diagnosis of a neuroectodermal tumor was made on histological examination. Although the fish initially recovered, it was killed 49 days postsurgery due to a severe decline in its condition. On histological evaluation of postmortem tissue samples, it was determined that the fish also had a neuroectodermal tumor of the right eye with local invasion of the brain. On immunohistochemistry, the neoplastic cells were positive for S-100. To the authors' knowledge, this is the first published case of naturally occurring bilateral intraocular neuroectodermal tumors in a fish.

Runx1/AML1 is a transcription factor implicated in tissue stem cell regulation and belongs to the small Runx family of cancer genes. In the hair follicle (HF), Runx1 epithelial deletion in morphogenesis impairs normal adult hair homeostasis (cycle) and blocks adult hair follicle stem cells (HFSCs) in quiescence. Here, we show that these effects are overcome later in adulthood. By deleting Runx1 after the end of morphogenesis, we demonstrate its direct role in promoting anagen onset and HFSC proliferation. Runx1 deletion resulted in cyclin-dependent kinase inhibitor Cdkn1a (p21) upregulation. Interfering with Runx1 function in cultured HFSCs impaired their proliferation and normal G(0)/G1 and G(1)/S cell cycle progression. The proliferation defect could be rescued by Runx1 readdition or by p21 deletion. Chemically induced skin tumorigenesis in mice turned on broad Runx1 expression in regions of the skin epithelium, papillomas, and squamous cell carcinomas. In addition, it revealed reduced rates of tumor formation in the absence of Runx1 that were accompanied by decreased epithelial levels of phospho-Stat3. Runx1 protein expression was similar in normal human and mouse hair cycles. We propose that Runx1 may act as a skin oncogene by directly promoting proliferation of the epithelial cells.

Lung cancer is the leading killer among all cancers for both men and women in the US, and is associated with one of the lowest 5-year survival rates. Current diagnostic techniques, such as histopathological assessment of tissue obtained by computed tomography guided biopsies, have limited accuracy, especially for small lesions. Early diagnosis of lung cancer can be improved by introducing a real-time, optical guidance method based on the in vivo application of multiphoton microscopy (MPM). In particular, we hypothesize that MPM imaging of living lung tissue based on two-photon excited intrinsic fluorescence and second harmonic generation can provide sufficient morphologic and spectroscopic information to distinguish between normal and diseased lung tissue. Here, we used an experimental approach based on MPM with multichannel fluorescence detection for initial discovery that MPM spectral imaging could differentiate between normal and neoplastic lung in ex vivo samples from a murine model of lung cancer. Current results indicate that MPM imaging can directly distinguish normal and neoplastic lung tissues based on their distinct morphologies and fluorescence emission properties in non-processed lung tissue. Moreover, we found initial indication that MPM imaging differentiates between normal alveolar tissue, inflammatory foci, and lung neoplasms. Our long-term goal is to apply results from ex vivo lung specimens to aid in the development of multiphoton endoscopy for in vivo imaging of lung abnormalities in various animal models, and ultimately for the diagnosis of human lung cancer.

The theory of planned behavior (TPB) was integrated within the theory of self-care (SCT) to explore the predictive value of extending TPB to measure attitudes and beliefs regarding a behavioral goal, and determine the ability of goal beliefs to predict engagement in the combined, multiple behaviors necessary to control BP. The hypothesized model was evaluated in a sample of 306 community-dwelling African Americans between 21 and 65 years of age. Scales developed for the study achieved acceptable reliability (alpha = .68-.95). Structural equation modeling analysis resulted in a second-order factor structure with attitude, subjective norm, perceived behavioral control, and intention modeled as indicators of a construct representing goal beliefs related to keeping BP within normal limits. This latent construct was conceptualized within the theory of self-care as "self-care motivation," and predicted 18% of the variance in self-care behaviors necessary for BP control. The model achieved acceptable fit (CMIN/df = 2.32; CFI = .95; RMSEA = .066). Final assessment of fit was done using multi-group SEM and bootstrapping techniques. In this extension of the TPB attitudes and beliefs regarding the goal of keeping BP within normal limits were found to determine one's motivation to engage in the multiple behaviors necessary for BP control.

We have observed that passive tactile spatial acuity, the ability to resolve the spatial structure of surfaces pressed upon the skin, differs subtly but consistently between the sexes, with women able to perceive finer surface detail than men. Eschewing complex central explanations, we hypothesized that this sex difference in somatosensory perception might result from simple physical differences between the fingers of women and men. To investigate, we tested 50 women and 50 men on a tactile grating orientation task and measured the surface area of the participants' index fingertips. In subsets of participants, we additionally measured finger skin compliance and optically imaged the fingerprint microstructure to count sweat pores. We show here that tactile perception improves with decreasing finger size, and that this correlation fully explains the better perception of women, who on average have smaller fingers than men. Indeed, when sex and finger size are both considered in statistical analyses, only finger size predicts tactile acuity. Thus, a man and a woman with fingers of equal size will, on average, enjoy equal tactile acuity. We further show that sweat pores, and presumably the Merkel receptors beneath them, are packed more densely in smaller fingers.

In response to DNA damage, checkpoint proteins halt cell cycle progression and promote repair or apoptosis, thereby preventing mutation accumulation and suppressing tumor development. The DNA damage checkpoint protein Hus1 associates with Rad9 and Rad1 to form the 9-1-1 complex, which localizes to DNA lesions and promotes DNA damage signaling and repair. Because complete inactivation of mouse Hus1 results in embryonic lethality, we developed a system for regulated Hus1 inactivation in the mammary gland to examine roles for Hus1 in tissue homeostasis and tumor suppression. Hus1 inactivation in the mammary epithelium resulted in genome damage that induced apoptosis and led to depletion of Hus1-null cells from the mammary gland. Conditional Hus1 knockout females retained grossly normal mammary gland morphology, suggesting compensation by cells that failed to undergo Cre-mediated Hus1 deletion. p53-deficiency delayed the clearance of Hus1-null cells from conditional Hus1 knockout mice and caused the accumulation of damaged, dying cells in the mammary gland. Notably, compensatory responses were impaired following combined Hus1 and p53 loss, resulting in aberrant mammary gland morphology and lactation defects. Overall, these results establish a requirement for Hus1 in the survival and proliferation of mammary epithelium and identify a role for p53 in mammary gland tissue regeneration and homeostasis.

Degenerative myelopathy (DM) is a common, slowly progressive, debilitating disease reported in several dog breeds, including the German Shepherd Dog and Pembroke Welsh Corgi. Boxer dogs present occasionally for a thoracolumbar myelopathy for which no cause is identified on MRI or cerebrospinal fluid analysis. Despite a lack of a histologic description of DM in the Boxer in the veterinary literature, such dogs are presumed to have DM. Here we report 2 histologically confirmed cases of DM in the Boxer breed in which histologic studies disclosed marked degenerative changes in the spinal cord that were most prominent in the thoracic and cranial lumbar segments. Lesions consisted of myelin vacuolation and degeneration, myelophagocytosis, reactive astrocytosis, and ellipsoid formation most prominent in the lateral and ventral funiculi. We present a detailed histologic description of DM in the Boxer dog and compare it to DM in other purebred dogs.

Although tactile spatial acuity tests are used in both neuroscience research and clinical assessment, few automated devices exist for delivering controlled spatially structured stimuli to the skin. Consequently, investigators often apply tactile stimuli manually. Manual stimulus application is time consuming, requires great care and concentration on the part of the investigator, and leaves many stimulus parameters uncontrolled. We describe here a computer-controlled tactile stimulus system, the Tactile Automated Passive-finger Stimulator (TAPS), that applies spatially structured stimuli to the skin, controlling for onset velocity, contact force, and contact duration. TAPS is a versatile, programmable system, capable of efficiently conducting a variety of psychophysical procedures. We describe the components of TAPS, and show how TAPS is used to administer a two-interval forced-choice tactile grating orientation test.

Heart failure (HF) is a growing public health problem affecting approximately 23 million people worldwide. Treatment options for advanced HF patients have moved beyond pharmacologic therapy to include left-ventricular assist devices (LVADs). Patients with an LVAD must manage a complex regimen of care. This article proposes the use of self-care deficit nursing theory (SCDNT) as a framework to identify and organize the care needs of patients with an LVAD from a nursing perspective. Within SCDNT, self-care refers to actions designed to meet self-care requisites to achieve regulatory goals. When formalized, self-care requisites have two components: the general action to be taken and a "factor" to be controlled. The reformulation of health-deviation self-care requisites common to LVAD patients are presented and may serve as an exemplar for other technology-assisted living situations. The strengths and limitations of using the SCDNT for patients with such complex needs, as well as implications for clinical practice, research, and advancement of nursing science, are examined.

Previous studies showed that a considerable proportion of Listeria monocytogenes isolates obtained from foods carry a premature stop codon (PMSC) mutation in inlA that leads to production of a truncated and secreted InlA. To further elucidate the role these mutations play in virulence of L. monocytogenes, we created isogenic mutants, including (i) natural isolates where an inlA PMSC was reverted to a wild-type inlA allele (without a PMSC) and (ii) natural isolates where a PMSC mutation was introduced into a wild-type inlA allele; isogenic mutant sets were constructed to represent two distinct inlA PMSC mutations. Phenotypical and transcriptional analysis data showed that inlA PMSC mutations do not have a polar effect on the downstream inlB. Isogenic and natural strains carrying an inlA PMSC showed significantly reduced invasion efficiencies in Caco-2 and HepG2 cell lines as well as reduced virulence in oral guinea pig infections. Guinea pigs were also orally infected with a natural strain carrying the most common inlA PMSC mutation (vaccinated group), followed by challenge with a fully virulent L. monocytogenes strain 15 days postvaccination to probe potentially immunizing effects of exposure to L. monocytogenes with inlA PMSC mutations. Vaccinated guinea pigs showed reduced bacterial loads in internal organs and improved weight gain postchallenge, indicating reduced severity of infections in guinea pigs exposed to natural strains with inlA PMSC mutations. Our data support that (i) inlA PMSC mutations are causally associated with attenuated virulence in mammalian hosts and (ii) naturally occurring virulence-attenuated L. monocytogenes strains commonly found in food confer protective immunity.

African Americans bear a disproportionate burden of hypertension. A causal-modeling design, using Donabedian's Quality Framework, tested hypothesized relationships among structure, process, and outcome variables to assess quality of care provided to this population. Structural assessment revealed that administrative and staff organization affected patients' trust in their provider and satisfaction with their care. Interpersonal process factors of racism, cultural mistrust, and trust in providers had a significant effect on satisfaction, and perceived racism had a negative effect on blood pressure (BP). Poorer quality in technical processes of care was associated with higher BP. Findings support the utility of Donabedian's framework for assessing quality of care in a disease-specific population.

Cell cycle checkpoints are evolutionarily conserved signaling pathways that uphold genomic integrity. Complete inactivation of the mouse checkpoint gene Hus1 results in chromosomal instability, genotoxin hypersensitivity, and embryonic lethality. To determine the functional consequences of partial Hus1 impairment, we generated an allelic series in which Hus1 expression was incrementally reduced by combining a hypomorphic Hus1 allele, Hus1(neo), with either wild-type or null (Hus1(Delta1)) alleles. Primary Hus1(neo/Delta1) embryonic fibroblasts exhibited spontaneous chromosomal abnormalities and underwent premature senescence, while higher Hus1 expression in Hus1(neo/neo) cells allowed for normal proliferation. Antioxidant treatment almost fully suppressed premature senescence in Hus1(neo/Delta1) cultures, suggesting a critical role for Hus1 in oxidative stress responses. Treatment of Hus1(neo/neo) and Hus1(neo/Delta1) cells with the DNA adducting agent benzo(a)pyrene dihydrodriol epoxide resulted in a loss of cell viability that was associated with S-phase DNA damage checkpoint failure. Likewise, the DNA polymerase inhibitor aphidicolin triggered increased cell death, chromosomal aberrations, and H2AX phosphorylation, a marker for double-stranded DNA breaks, in Hus1(neo/neo) and Hus1(neo/Delta1) cultures compared to controls. Despite these pronounced genome maintenance defects in cultured Hus1(neo/Delta1) and Hus1(neo/neo) cells, mice of the same genotypes were born at expected frequencies and appeared grossly normal. A significant increase in micronucleus formation was observed in peripheral blood cells from Hus1(neo/Delta1) mice, but reduced Hus1 expression did not cause an elevated predisposition to spontaneous tumor development or accelerate tumorigenesis in p53-deficient mice. These results identify differential effects of altered Hus1 gene dosage on genome maintenance during in vitro culture, genotoxic stress responses, embryonic development, and adult homeostasis.

Background: Alexithymia, a deficit in emotional awareness and expression, may contribute to cardiovascular disease (CVD) and other diseases. African Americans have a high prevalence of CVD, but almost nothing is known about alexithymia in this ethnic group. This study examined the relationship of alexithymia to a range of risk factors for CVD among African Americans., Methods: On a community sample of 162 African American adults, we assessed alexithymia (Toronto Alexithymia Scale-20) and several risk factor domains: physiological (body mass index, blood pressure), behavioral (smoking, exercise), emotional (trait anxiety, depression, and anger; forms of anger expression), racial discriminatory, and socioeconomic (income, education)., Results: Alexithymia was positively correlated with all emotional risk factors (P < .01) and inversely correlated with socioeconomic status (P < .01). Alexithymia has a small, inverse relationship with responses to racism (P < .01) but was not significantly related to the experience of racism. Alexithymia was weakly related to smoking but was unrelated to physiological risk factors. These relationships were largely unchanged when only people without hypertension (n = 116) were studied., Conclusions: This pattern of relationships is consistent with findings on ethnic majority samples and suggests that alexithymia as measured with the Toronto Alexithymia Scale-20 is a valid construct among African Americans. It correlates with socioeconomic and emotional variables in this population, but only minimally or not at all with behavioral or physiological factors. If alexithymia influences CVD and other diseases, it appears to do so through social and emotional pathways.

A qualitative study was done to explore attitudes and beliefs of African Americans regarding hypertension-preventive self-care behaviors. Five focus groups, with 34 participants, were held using interview questions loosely based on the Theory of Planned Behavior (TPB). Analysis revealed themes broadly consistent with the TPB and also identified an overarching theme labeled "circle of culture." The circle is a metaphor for ties that bind individuals within the larger African American community and provides boundaries for culturally acceptable behaviors. Three subthemes were identified: One describes how health behaviors are "passed from generation to generation," another reflects a sense of being "accountable" to others within the culture, and the third reflects negative views toward people who are "acting different," moving outside the circle of culture. Findings provide an expanded perspective of the TPB by demonstrating the influence of culture and collective identity on attitude formation and health-related behaviors among African Americans.

Discriminatory treatment of African Americans in healthcare is well recognized, yet the literature is unclear on the specific role that perceived racism and mistrust play in the patient-provider relationship. The purpose of this study was to test a mid-range theoretical model entitled Perceptions of Racism and Mistrust in Health Care (PRMHC). This model hypothesized that perceived racism influences cultural mistrust, which affects trust in providers--and these combined psychosocial aspects of healthcare affect satisfaction with the care received. One-hundred-forty-five African-American subjects participated in structured interviews to collect demographic and psychosocial data. Provider data was obtained through chart audits. In a group of low-income African Americans in two primary care clinics, perceptions of racism and mistrust of whites had a significant negative effect on trust and satisfaction. Perceived racism had both a significant, inverse direct effect on satisfaction as well as a significant indirect effect on satisfaction mediated by cultural mistrust and trust in provider. Structural equation modeling analysis supported the hypothesized theoretical relationships and explained 27% of the variance in satisfaction with care. The findings add to the existing literature by enhancing our understanding of the complex perspectives on trust and overall satisfaction with care among African-American patients. Results suggest that improving health outcomes for African Americans requires a broader understanding of cultural competence, one that addresses societal racism and its impact on provider-patient relationships.

Purpose: To test a middle-range theory of chronic stress emotions to examine the effects of perceived racism and emotion-focused coping on psychological and physiological health outcomes in African Americans., Design: A descriptive-correlational, causal modeling study was conducted with a convenience sample of 162 community-dwelling adults., Methods: Participants completed the Racism and Life Experience Scale; Krieger Racial Discrimination Questionnaire; Toronto Alexithymia Scale; Emotional Approach Coping Scale; State-Trait Personality Inventory; and a demographic data sheet. Automated blood pressure (BP) readings were obtained., Analysis: Structural equation modeling techniques were used to examine the hypothesized causal and correlational links between the theoretical constructs, as well as to examine the relationship between the observed variables and the latent constructs measured. FINDING AND CONCLUSIONS: The proposed model fits the sample data. Racism was a commonly experienced stressor associated with chronic stress emotions, but not with BP. Emotion-focused coping was strongly associated with socioeconomic status and chronic stress emotions but not with BP.

African American clients have reported racism and prejudice in health care; yet there is limited documentation of the strategies used to cope with these experiences. This study describes African American women's perceptions of prejudice in health care and the strategies used to cope with the experiences. This qualitative study used the constructivist perspective of interpretive interactionism for paradigmatic and methodological guidance. Participants were 20 women ranging from age 26 to 74 years with 50% having a high school education. Individual interviews consisting of five areas were conducted with three instruments measuring ethnic identity, socioeconomic status, and general demographics. The analyses provide two themes: experience with the "White health care system" and strategies for coping with the prejudice, which included getting angry, learning to unlearn, being assertive, and walking away. Consistent with the discussions of race in the United States, racism in health care has become a subtle entity that infuses health care relationships.

An adult, female binturong (Arctictis binturong) was examined due to lethargy, inappetence, and an abdominal mass. Diagnostic investigations, including radiographs, abdominal ultrasound, clinical laboratory findings, and a fine-needle aspirate of the mass, were suggestive of a sarcoma with metastasis. Necropsy and histopathologic findings confirmed a widely disseminated sarcomatoid variant of a renal cell carcinoma, likely originating in the left kidney, with metastasis to the right kidney, spleen, pancreas, liver, mesenteric lymph nodes, and lungs. This is the first report of this neoplasm in a binturong and only the second report in the veterinary literature. Sarcomatoid renal cell carcinoma is a rare histologic variant of renal cell carcinoma that is aggressive, commonly metastatic, and associated with a very poor prognosis in humans. Accurate antemortem diagnosis of this tumor may be complicated by its biphasic morphology, which may resemble carcinoma or sarcoma (or both), often necessitating the use of immunohistochemical techniques.

Uremic gastritis is a term commonly used to describe the gastrointestinal signs and histopathologic changes associated with renal failure in the dog. This retrospective study reviews the clinical, serum biochemical, and postmortem histopathologic data from 28 dogs with renal failure to determine the prevalence of gastric histopathology, characterize the gastric histopathology, and identify associations between gastric histopathology and serum concentrations of blood urea nitrogen (BUN), creatinine (Cr), calcium-phosphorus product (Ca x Phos), and hematocrit. Affected and control dogs with available renal and gastric tissue, serum biochemistry data, and urinalysis data were identified over a 10-year period (1992-2002) in the pathology department postmortem examination database at the Cornell University College of Veterinary Medicine. The serum biochemistry data and histopathologic findings were scored as normal, mild, moderate, and severe. All affected dogs had derangements of BUN, Cr, or Ca x Phos with gastric histopathology in 22 of 28 dogs (79%). Dogs with renal failure had a higher prevalence of gastric histopathologic changes compared with the control group. Associated histopathologic changes in the stomach were edema (P = .008), mineralization (P = .03), and vasculopathy (P = .03). Only 1 dog had evidence of gastric ulceration. Gastric necrosis was an uncommon finding (4/28, 14%). Gastric histopathology appears to be common in dogs with renal failure and is associated with increasing severity in the serum biochemistry data. Unlike humans with renal failure, in whom gastric ulceration predominates, gastric necrosis and ulceration appear to be uncommon in dogs with renal failure.

Although HIV infection is increasing among all women, pregnant women are primarily targeted for testing. The authors explore the experience of nonpregnant women seeking HIV testing, particularly factors that influenced testing, waiting for results, and the testing process. They interviewed 26 first-time testers, analyzed transcripts independently, then compared and consensually validated. Phenomenological reflection guided thematic analysis. A pattern of Worry emerged from relational themes evident in three phases of the experience: (a) Deciding, (b) Testing, and (c) What Next? Participants identified HIV testing as stressful, even when they regarded the process positively. Findings can sensitize providers to women's perceptions, decision making, and barriers to testing. Providers are challenged to provide accessible testing that protects confidentiality in conjunction with supportive discussion of concerns.

The purpose of this study was to examine the relationship of racism and blood pressure (BP). Participants were 162 urban African American adults. Measurements included the Racism and Life Experiences Scale, Krieger Racial Discrimination Questionnaire, State-Trait Personality Inventory (anxiety and depression), State-Trait Anger Expression Inventory, and automated measures of BP. Correlational and multiple regression analyses were done to examine relationships among key variables, t tests and ANOVA tested group differences by age, gender, and racism category. There was a high prevalence of perceived racism, which was not associated with higher BP. The racism/BP relationship was moderated by age with significant age related differences noted. Older participants (40 years or older) experienced more distress from racism, more anger suppression, and higher BP but lower levels of stress emotions. The highest levels of BP were noted in older adults reporting the lowest level of perceived racism, raising the issue of "internalized oppression."

Diabetes affects more than 18 million people in the United States. The prevalence of type 2 diabetes has increased at an alarming rate in the past 20 years. Minorities are disproportionately affected, with the greatest increase in adult prevalence noted in African-American women. The increasing prevalence of type 2 diabetes in both children and adults is strongly associated with the increasing prevalence of obesity. Diabetes and its complications can be controlled with appropriate health care and patient self-management techniques. There is strong empirical evidence supporting the efficacy of dietary and physical activity interventions in the prevention and treatment of type 2 diabetes. The results of empirical studies have not translated well into clinical practice. Four key theoretical concepts are presented in an effort to increase the effectiveness of lifestyle intervention counseling by primary care providers. The four concepts include: perceptual congruence, mutual goal setting, readiness to change, and tailored interventions.

Hypertensive disorders occur in 6% to 8% of all pregnancies, are the second leading cause of maternal death, and contribute to significant neonatal morbidity and mortality. This is a problem not only in inpatient settings, as ambulatory and home-care nurses are increasingly being called upon to monitor women who are at high risk and may have hypertensive disorders. To prevent hypertension-induced problems in pregnant women, nurses must have strong assessment, advocacy, and counseling skills. Nurses also must provide care based on the latest national standards as described in this article.

Background: Early identification of persons at risk for kidney disease provides an opportunity to prevent or delay its progression and decrease morbidity and mortality. Our hypothesis was that implementation of a targeted screening program in communities with high-risk populations would detect previously unidentified persons with or at high risk for chronic kidney disease (CKD) with a prevalence that exceeds that predicted for CKD in the general population., Methods: Persons with hypertension or diabetes or a first-order relative with hypertension, diabetes, or kidney disease were screened for kidney disease risk factors. Blood pressure, blood glucose level, serum creatinine level, hemoglobin level, microalbuminuria, hematuria, pyuria, body mass index, and estimated glomerular filtration rate (EGFR) were evaluated., Results: Six thousand seventy-one eligible persons were screened from August 2000 through December 2001: of these persons, 68% were women, 43% were African American, 36% were white, 10% were Hispanic, and 5% were Native American. Most reported high-school education or more (84%) and health insurance coverage (86%). Twenty-seven percent met the screening definitions for diabetes; 64%, for hypertension; 29%, for microalbuminuria; 8%, for anemia; 18%, for hematuria; 13%, for pyuria; 5%, for elevated serum creatinine level; 16%, for reduced EGFR; and 44%, for obesity. Among participants without a reported history of specified conditions, screening identified 82 participants (2%) with diabetes, 1,014 participants (35%) with hypertension, 277 participants (5%) with elevated serum creatinine levels, 839 participants (14%) with reduced EGFRs, and 1,712 participants (29%) with microalbuminuria. Thirty-five percent of participants with a history of diabetes had elevated serum glucose levels at screening (> or =180 mg/dL [10 mmol/L]), and 64% with a history of hypertension did not have blood pressure controlled to less than 140/90 mm Hg. Only 18% of participants with a history of diabetes and 31% with a reduced EGFR had blood pressure controlled to less than 130/80 mm Hg and less than 135/85 mm Hg, respectively., Conclusion: Targeted screening is effective in identifying persons with previously unidentified or poorly controlled kidney disease risk factors, as well as persons with a moderately decreased EGFR.

In 2000, the National Kidney Foundation implemented the Kidney Early Evaluation Program (KEEP 2.0) to increase awareness of kidney disease among those at highest risk, and improve outcomes through early detection and referral for care. The KEEP 2.0 screening program identified significant numbers of persons with reduced kidney function, with previously undetected kidney disease risk factors, and with inadequate risk factor control. These data support the evolution to KEEP 3.0, which will continue to identify individuals at high risk for kidney disease, and will address the educational needs of health care providers and consumers, given that preventing and managing kidney disease requires their joint effort. Consumers need to embrace lifestyle behaviors that reduce risk, and adhere to medical recommendations in managing their existing conditions. At the same time, providers need to ensure that the latest evidence-based guidelines in diagnosis and treatment are being implemented in their clinical practice. KEEP 3.0 participants will be randomly assigned to one of several educational programs that vary on whether they provide individually tailored or nontailored information, with long-term follow-up for evaluation of clinical outcomes. Tailored programs may be more successful in supporting behavioral change as these consider the individuals' "readiness to change." In addition, participant-identified providers will be randomly assigned to one of several educational protocols designed to provide evidence-based recommendations for clinical and pharmaceutical management of kidney disease and risk factors; these programs vary on whether they require active or passive participation of providers. Analytic evaluations will examine changes from baseline in participant kidney disease and risk factor status during follow-up, and estimate the influence of the various educational protocols on both process of care measures and clinical outcomes.