Because most turnover studies focus on certified nursing assistants (CNAs), licensed vocational nurses (LVNs), and administrators, little is known about registered nurses' (RNs) higher turnover. This study builds on the current body of knowledge about turnover among RN supervisors in nursing homes. The article discusses a survey of RN nurse supervisors administered in more than 1,000 nursing homes that was merged with the 2003 Texas Medicaid cost report and the area resource file. Two 2-stage models are developed to predict RN turnover rates. RNs' intent to leave predicts RN turnover through job satisfaction, perceived empowerment, and education level. High LVN and CNA turnover and high Medicare census are associated with higher turnover. Implications are that participation in management decisions and perceived wage competitiveness are an important determinant of RN retention in nursing homes. Future research should focus why RN supervisors with higher levels of education leave nursing homes.Keywords: RN intent to leave; nurse supervisor turnover; job satisfaction; nurse empowerment; RN characteristics T he U. S. health care delivery system, especially the nursing home sector, is struggling with high turnover rates among registered nurses (RNs). This instability in RN staffing and the resulting shortage of RNs is Manuscript

Formative research was conducted in the Republic of the Marshall Islands to help develop a diabetes prevention intervention. Methods included in-depth interviews, semistructured interviews, and direct observation of household behaviors in urban and remote settings. Foods were classified into two main conceptual spheres: foods from the islands/Marshallese foods and imported/American foods. Diabetes (nanimij in tonal) is a highly salient illness and is believed to be caused by foods high in fat and sugar, consumption of imported/American foods, family background, and the atomic bomb testing. Physical activity and eating a traditional diet were viewed as important for preventing diabetes. The traditional belief system links a large body with health, and a thin body with illness; however, perceptions are changing with increased acculturation and education about the health risks of obesity. These findings were used to develop a diabetes prevention home visit intervention currently being implemented and evaluated in Marshallese households.This article presents formative research on the prevention of non-insulin-dependent diabetes mellitus (NIDDM) in the Republic of the Marshall Islands. NIDDM is a major cause of debilitating morbidity and mortality in industrialized countries and increasingly in nonindustrialized countries. As the onset of diabetes in the nonindustrialized world is linked with lifestyle changes associated with the globalization of the world economy and acculturative Western influence, effective primary prevention strategies are desperately needed.1,2 Unfortunately, interventions aimed at the primary prevention

Injuries occur at a higher proportion abroad than in the United States. Motor vehicle crash and drowning fatalities are of particular concern. Improved data quality and surveillance of deaths would help government agencies create more evidence-based country advisories.

Drowning is a serious worldwide, mostly preventable injury problem, particularly among international travelers. In 2000, approximately 449,000 people have drowned worldwide, and the exact number of travelers is not precisely known. Although comprehensive infectious disease information has been available to international travelers for many years, advice on injury risk and prevention, more specifically on drowning prevention, has received little attention. The goals of this review were to develop research-based drowning prevention and water-safety recommendations for travelers and to identify research needs for future recommendations. A group of injury-prevention and travel-medicine experts conducted several rounds of voting and ranking of the strength and evidence of drowning-prevention recommendations. Each of the thirty-two recommendations created have also been categorized using the Committee to Advise on Tropical Medicine and Travel scale and have been framed in the context of preevent, event, and postevent categories commonly used in injury-control theory and Haddon's Matrix. These recommendations were developed for use by travel-medicine professionals or others who prepare individuals for travel. Several of the identified interventions to prevent drownings lack conclusive scientific evidence of their effectiveness and warrant further studies to better understand their true effectiveness. Furthermore, funding for the studies of intervention effectiveness and the implications of these interventions for international travelers are essential, yet insufficient.