Stress and burnout among critical care and medical surgical nurses: a comparative study.
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Biomedical subjects
Publications and source records attributed to J Bailey.
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In a preceding paper the baseline data in the Münster Arteriosclerosis Study (PROCAM study) of the levels of fibrinogen, factor VIIc and factor VIIIc were described, and their correlation of age, body weight, smoking, alcohol, pill-using and menopause discussed. In this part the relationship of these coagulation factors to blood pressure, blood glucose, uric acid and lipid parameters, which were examined in 4186 apparently healthy individuals, is presented. The correlations are described using two different statistical models, first the Pearson correlation coefficients after allowing each clotting factor for the effects of age, cigarette and alcohol consumption, body weight, menopausal state, pill using and the other clotting factors, and secondly by a multiple regression analysis. The data suggest that there are multiple interrelationships between hemostatic factors and the variables under consideration. The most striking positive correlations were found for factor VIIc to blood glucose and triglycerides in men and women and to HDL-cholesterol in women.
The Münster Arteriosclerosis Study (MAS) is a prospective, longitudinal epidemiological study on an industrial population in Westfalia aimed to establishing clinical and laboratory data with possible relationship to cardiovascular events. The data presented here describe the baseline measurements of fibrinogen, factor VIIc and factor VIIIc from the recruitment of 2880 male and 1306 female persons and their relationship to age, gender, bodyweight, smoking, alcohol, pill-using and menopause. The correlations were made by means of a multiple regression analysis. We found an increase of those coagulation factors with age, a correlation of F VII and fibrinogen with body-weight index and of fibrinogen with cigarette smoking. No correlation was found for alcohol consumption. F VIII and F VII were significantly higher after onset of menopause and F VII and fibrinogen in women using the pill.
Fertilization of the sea urchin egg results in a transient decline in the amount of phosphatidylinositol (PI) to a level equal to about 50% of that present in the unfertilized egg. This response begins as early as 15 seconds after insemination. The level of PI reaches a minimum at 30 seconds post-insemination, and returns to the original value between 2 and 5 min later. Pulse labelling studies with 32PO4 and [3H]-inositol showed that the incorporation of these two isotopes into 1-(3-sn-phosphatidyl)-L-myo-inositol 4,5-biphosphate [PtdIns(4,5)P2] increased as much as 50% within one minute after insemination. This suggests that at least part of the reduction in PI levels represents the phosphorylation of PI to form PtdIns(4,5)P2. We also found that the production of [3H]-labelled 1D-myoinositol 1,4,5 triphosphate [Ins(1,4,5)P3] present in the trichloroacetic acid (TCA) soluble fraction of eggs increased over five-fold during the first 10 min post insemination. The temporal correlation between the early burst of PtdIns(4,5)P2 and Ins(1,4,5)P3 formation and the transient increase in intracellular free calcium known to occur in the fertilized egg suggest that the production of PtdIns(4,5)P2 and ultimately Ins(1,4,5)P3 may be associated with calcium mobilization within the egg.
We have developed a new method based on total internal reflection fluorescence to map the shape of the region between glass and the lower surface of a living cell spread upon it. Fluorescently labeled nonadsorbing volume marker molecules that cannot penetrate into the cell are locally stimulated so that they fluoresce only very near the glass/medium interface. The total fluorescence intensity at any point beneath the cell depends on the cell-to-glass separation. Focal contacts appear as dark areas owing to dye exclusion, whereas when the gap exceeds approximately 150 nm, fluorescence asymptotes to the bright background level. Our technique provides greater contrast than does interference reflection microscopy and is free from errors due to cytoplasmic thickness and refractive index inhomogeneities arising from cytoplasmic inclusions. We have shown that sufficiently large molecules suffer steric exclusion from regions accessible to small molecules, which gives new information about lateral penetrability in the apposition region.
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Serum concentrations of IgG, IgA, IgM, IgE, and allergen-specific IgE were measured in presurgical serum samples from 400 women admitted to a multidisciplinary study of primary breast cancer. The relationships between the serum immunoglobulins and patient survival were analyzed with the use of a Cox proportional hazards linear model. After adjustment for TNM stage, tumor histopathologic grade, and estrogen receptor (E2R) status, lower IgM concentrations were associated with longer survival. Lower IgE concentrations were also associated with longer survival, but only in patients whose tumors were E2R positive. IgG and IgA were not related to survival. Serum IgM and IgE concentrations, allergen-specific IgE scores, and the tumor E2R status were combined to construct a three-level risk classification that was more prognostic than any of the individual components. Cox model analysis demonstrated that this combination of immunologic and hormonal variables provided significant new information beyond that obtained from TNM staging and histopathologic grading of the tumors (P = .01). This new information may be useful to physicians in advising patients with primary, operable breast cancer about the relative risks and benefits of adjuvant therapy and in designing clinical trials of adjuvant therapy.
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The authors examined dexamethasone suppression test (DST) and thyrotropin-releasing hormone (TRH) test results in 32 chronic alcoholics without depression or hepatic disease to see if alcoholism alone might lead to positive test results. After 3 weeks of sobriety there were no DST abnormalities, but blunted TRH test results were observed in eight of the 32 alcoholics. More of the 15 patients also tested during alcohol withdrawal than of the 20 normal subjects or the 32 alcoholics without alcohol withdrawal had DST and TRH test abnormalities. When performed after 3 weeks of sobriety, the DST but not the TRH test has potential as a specific laboratory adjunct in the diagnosis of depression in alcoholics.
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In a prospective double-blind trial we examined the affective morbidity and side-effects of 72 patients who were randomly allocated either to continue with their usual dose of lithium or to receive either a 25% or 50% reduction in lithium dosage. Patients who underwent a dosage reduction with consequently lower plasma lithium levels (0.45-0.79 mmol/l) had significantly decreased affective morbidity. Thyroid stimulating hormone levels were also significantly decreased in this group. Total subjective side-effects score and tremor were also reduced. No change in affective morbidity was observed during the trial in patients whose dosage was not altered. These changes were observed in both unipolar and bipolar patients. It was concluded that a once a day dosage with a sustained release lithium preparation that maintained a 12-h plasma level of about 0.6 mmol/l is both more effective and produces less side effects than does conventional dosages.
The interaction of Legionella micdadei with human polymorphonuclear neutrophils (PMNs) and serum was investigated to determine their roles in host defense against this organism. Serum and PMNs from normal donors having no antibody to L micadei were used. PMNs phagocytized once-agar-passaged (74.6% +/- 6.5%) and twice-agar-passaged (87.3% +/- 1.0%) L micdadei less (P less than 0.05) than L micdadei passaged multiple times on agar (97.5% +/- 1.0%) or Staphylococcus aureus (98.3% +/- 0.5%). Under the same conditions, no phagocytosis of Legionella pneumophila occurred. Use of heat-inactivated serum abolished phagocytosis. PMN killing of once-agar-passaged (1.5% +/- 1.5%) and twice-agar-passaged (0) L micdadei was less (P less than 0.001) than that of L micdadei passaged multiple times on agar (88.6% +/- 4.0%) or S aureus (96.8% +/- 0.5%). L micdadei was not killed by fresh serum, although, in contrast to L pneumophila, it was opsonized by C3. Thus virulent L micdadei is phagocytized, but not killed, by human PMNs, with complement being the major opsonin.
The prevalence of an abnormal response to the dexamethasone suppression test (DST) was examined in 119 in-patients suffering from a major depressive disorder and in 79 normal controls. Only 11 per cent of controls showed an abnormal DST as against 70 per cent of depressed patients. The specificity of the DST was examined by testing patients with other psychiatric disorders. Abnormal responses were found in one-fifth of a sample of schizophrenics, over one-quarter of abstinent alcoholics, two-fifths of neurotics (including neurotic depressives) and almost half of senile dements. Abnormal DST was also found in 33 per cent of patients receiving prophylactic lithium for recurrent affective disorders.
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The activity of bovine liver glutamate dehydrogenase is affected in several ways depending on substrate concentrations and pH. At ph 6.5 and below, both oxidative deamination and reductive amination reactions are inhibited by ADP. At pH 7.0 and above both activatory and inhibitory effects can be observed depending on substrate concentrations. The effects are explicable in terms of a model with ADP binding at both a regulatory site and competing with coenzyme at the active site. The activatory effects of ADP result from destabilization of various abortive complexes by ADP binding to its regulatory site. The concerted effects of pH and ADP lead to a potentiation of either activation effects or inhibition effects depending on conditions. A consideration of in vivo concentrations of the various substrates involved and intramitochondrial pH and adenine nucleotide levels suggests that in vivo the reductive amination reaction is favored. It is suggested that glutamate dehydrogenase may be intimately involved with regulation of the urea cycle by responding to changes in the mitochondrial ammonia levels.
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We evaluated a new homogeneous immunoprecipitation assay for phenytoin in human serum. No sample dilution or pretreatment is required. The new method is based on spectrophotometry of the inhibition by free phenytoin of the precipitating reaction between anti-phenytoin antibody and a phenytoin-human serum albumin conjugate. A serum test sample is simultaneously mixed with the phenytoin-albumin conjugate and rabbit antiserum to phenytoin in a centrifugal analyzer, and the subsequent reaction is monitored at 3 min. Within-run and between-run coefficients of variation were well below 7%. The relation between results for patients' test sample as determined by immunoprecipitation assay (y) and an enzyme immunoassay (x) can be expressed as y = 1.10x + 1.1 (r = 0.966, n = 66).