A stratified random sample of recent cancer deaths was drawn from the Pennsylvania death registry, and 433 family members or close friends were interviewed concerning unmet needs during the last month of life. It was estimated that 72% of persons who died of cancer in Pennsylvania experienced at least one unmet service need during this period. The most frequently reported was help with activities of daily living, estimated at 42% of cancer deaths, involving over 11,000 persons each year in the state. There were significantly more unmet needs during the terminal period, compared with just after diagnosis, in activities of daily living, obtaining health care, transportation, and problems with medical staff. Our findings indicate a need to increase a broad range of support programs during the terminal period, especially of home-care services.

SUMMARY Recent research has demonstrated the importance of particular features of mothers' speech in influencing the rate of language acquisition in very young children. In the present study of 22 mother‐child pairs, the occurrence of these features was examined in samples of mothers' speech to children (aged 18 to 29 months), obtained in unstructured observations in the homes. The features facilitating language acquisition were found to be more frequent in the context of joint attention to pictures or books; speech in other contexts showed social‐class differences, with a higher frequency of ‘facilitating’ features in the speech of middle‐class mothers. There was also a tendency for the relative frequency of these features to be positively associated with the children's linguistic ability. RÉSUMÉ Discours des mères à leurs enfants: variation du contexte Des recherches récentes ont souligné l'importance de caractéristiques particulières du discours de mères sur le niveau d'acquisition de langage chez de très jeunes enfants. Dans la présente étude de 22 couples mère‐enfant, la fréquence de ces caractéristiques a été appréciée dans des échantillons de discours de mères à des enfants (ǎgés de 18 à 29 mois) obtenus dans des observations non structurées à domicile. Les caractéristiques facilitant l'acquisition du langage ont été trouvées plus fréquemment dans le contexte d'une attention conjointe à un matériel pictural; le discours dans d'autres contextes variait selon la classe sociale, avec une plus grande fréquence de caractéristiques ‘facilitantes’ dans le discours des mères de classe moyenne. La fréquence relative de ces caractéristiques était également associée positivement avec la capacité linguistique des enfants. ZUSAMMENFASSUNG Sprache zwischen Mutter und Kind: Variation und Zusammenhang Jüngste wissenschaftliche Ergebnisse haben gezeigt, daβ besondere Eigenschaften der mütterlichen Sprache einen wichtigen Einfluβ auf das Erlernen der Sprache bei sehr jungen Kindern haben. In der vorliegenden Studie wurde bei 22 Mutter‐Kind Paaren das Vorkommen dieser Eigenschaften in Stichproben der Sprache der Mütter mit ihren Kindern (Alter zwischen 18 und 29 Monate) in ungestellten Beobachtungen zu Hause untersucht. Die Spracheigenschaften, die das Erlernen der Sprache erleichtern, ergaben sich häufiger im Zusammenhang mit der auf Bildmaterial gerichteten Aufmerksamkeit; Sprache in anderem Zusammenhang zeigte soziale Unterschiede, wobei die Sprache der Mütter aus mittleren sozialen Schichten häufiger ‘erleichternde’ Eigenschaften aufwiesen. Die relative Häufigkeit dieser Eigenschaften war ebenfalls im positiven Sinne mit den Sprachfähigkeiten der Kinder verbunden.

From 1985 to 1988, a state-wide program of cancer education was offered to community-based allied health professionals (AHPs) at five different program sites in Pennsylvania. During this three-year period, 512 social workers, clergy, dieticians, physical therapists and others received training to increase their knowledge about cancer and counseling, improve their supportive attitude regarding cancer patients and families, and decrease stress related to their work with this population. Overall, the Program was successful in reaching AHPs working with cancer clients who had little formal training in the cancer field. At the beginning of training, it was observed that AHPs with initially higher levels of education and more years of work experience with cancer patients had higher levels of counseling knowledge. Those who were women, worked in hospitals, or had worked with cancer patients longer exhibited higher levels of cancer knowledge. Participants who were women and who had more education had reported lower levels of job stress. Among those AHPs who completed the training courses, cancer knowledge increased by 14 percent. In addition, knowledge related to counseling cancer patients and their families improved by 11 percentage points. Perceived job stress among the AHPs also declined by 10 percent. Finally, participant supportive attitude concerning cancer clients improved.

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A lating to patient care. A good clinical trial must be designed with a clear hypothesis. The question(s) posed by the trial should be asked in such a way that measurable, clear, and quantitative answers will be forthcoming. Methods for collecting and analyzing the data should be described in advance. Final results of the trial should be open to full disclosure, be published in peer-reviewed journals, and be reproducible by others.Ethical concerns are always a part of clinical trials. To consider these effectively there needs to be full comprehension of the implications of the trial by both health care personnel and patients. The following characteristics were deemed important to the conduct of clinical trials.