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PubMed1998

Labour ward midwives' perceptions of stress.

This exploratory study set out to examine labour ward midwives' perceptions of stress. It utilized a combination of two self-report questionnaires, one devised by McGrath et al. and the GHQ12. Additional qualitative data were collected by asking midwives to produce narratives about recent stressful events. A convenience sample of the 43 midwives formed the study population and a response rate of 77% was achieved. Quantitative data were analysed using descriptive statistics and qualitative narratives were explored for content analysis. Midwives in this study demonstrated their awareness of stress in their working and personal lives and many took active steps to redress the negative effects with exercise, hobbies and talking with colleagues. However, the study revealed that 78% of the midwives indicated that having insufficient time to perform their duties was very stressful, paralleled by their perceived inability to influence work-based decisions. The study revealed that both medical and midwifery colleagues frustrated their endeavours to change an unsatisfactory condition. The GHQ12 revealed 30% of the midwives had scores above the threshold level of 2 indicating psychiatric morbidity and this is of major concern. The narratives revealed that lack of communication between the professionals about decision making was a major source of stress and as a result of this study efforts to improve multidisciplinary communication through the development of journal clubs and planned social activities is under consideration by the unit. Overall, the findings from this study highlight stress as a potential, occupational health problem in the working lives of some labour ward midwives.

Adult↗
PubMed2000

Stressors, moderators and stress outcomes: findings from the All-Wales Community Mental Health Nurse Study.

The All-Wales Community Mental Health Nurse Stress Study was the largest study undertaken in the UK to date to investigate stress, burnout and coping amongst the CMHN workforce. The aim of the study was to examine the variety, frequency and severity of stressors, to describe coping strategies used to reduce work-based stress, and to determine stress outcomes. Questionnaires were sent out to 614 CMHNs from ten NHS Trusts throughout Wales. The response rate was 49% (n = 301). The measures used included the Maslach Human Services Survey, the CPN Stress Questionnaire, the Psychnurse Methods of Coping Questionnaire, the Rosenberg Self-Esteem Scale and the General Health Questionnaire GHQ-12. Community mental health nurses indicated that trying to maintain a good quality service in the midst of long waiting lists, poor resources, and having too many interruptions while trying to work in the office were particularly stressful items. The coping strategies that CMHNs utilized the most were having a stable home life and looking forward to going home at the end of the day, having outside interests and hobbies and talking to people that they got on well with. Forty per cent of CMHNs tended to view themselves negatively, feeling that others did not hold much respect for them. The GHQ-12 measure indicated that 35% of CMHNs had crossed a threshold of psychiatric caseness. Measured against a normative sample of mental health workers, 51% of CMHNs were experiencing high levels of long-term emotional exhaustion. Twenty-four per cent were suffering from high levels of depersonalization burnout and were not relating well to clients, whilst 14% were experiencing severe long-term feelings of lack of personal accomplishment. The results from the study provided us with a picture of stress and coping in CMHNs in Wales. Addressing these factors may help to reduce levels of experienced stress and burnout.

Adult↗
PubMed2000

Genetic relationships in the peregrine falcon (Falco peregrinus) analysed by microsatellite DNA markers.

Microsatellite DNA markers were developed from a peregrine falcon (Falco peregrinus) and genetic relationships among peregrine falcons in southern Norway were analysed using the markers. The genomic DNA library was screened for the presence of dinucleotide microsatellite repeats. Twelve loci revealed polymorphism through the initial analysis of 24 unrelated peregrine falcons, and Mendelian inheritance was confirmed in two peregrine falcon families bred in captivity. The estimated mean probability of identical genotypes in two unrelated individuals was 3 x 10-8, and the combined exclusion probability for parentage testing was 0.99 and 0.94 for one or both parents unknown, respectively. The markers were used to investigate the parentage of peregrine broods from the same nest site from different breeding seasons, and subsequently the nest-site fidelity of the breeding peregrines. High nest-site fidelity was found by studying pairwise comparisons of relatedness (rxy) estimates among chicks at six nest sites from three different breeding seasons. Cross-species amplifications showed that most loci also appeared to amplify polymorphic products in the gyrfalcon (F. rusticolus), merlin (F. columbarius), hobby (F. subbuteo) and kestrel (F. tinnunculus), demonstrating that the loci will provide powerful genetic markers in these falcons too.

Alleles↗
PubMed2002

Nargile (Hubble-Bubble) smoking-induced hand eczema.

A 65-year-old retired man with hand eczema presented to the Dermatology clinic in October of 2001. He complained of scaly, fissured plaque-type lesions over the radial margin of his right index finger and thumb (Fig. 1). He first noticed these changes 2 years ago. There was no history of irritation from his occupation. None of the other family members were affected. There was no history of atopy or psoriasis. The physical examination was remarkable for scaly, fissured, hyperkeratotic patches on the palms and palmar surfaces of the finger tips of the right hand. No nail changes were noted. The other fingers were free from lesions. There were no changes on the feet or soles. A diagnosis of eczema was suspected. Hobbies and repeated trauma to the hands were investigated. He had a habit of "nargile" smoking,starting at 35 years of age and he was using this apparatus more than 2 h a day. We performed patch tests with European standart test serial and they were negative. Yeast examination using KOH was negative. The diagnosis of Nargile (Hubble-bubble) eczema was made. It was advised that he stop smoking. Mild topical corticosteroids and emollient with urea were started. Clinical evaluation demonstrated resolution of the lesions after 2 weeks of therapy.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Vision impairment and handicap: The RVIB Employment Survey. The Steering Committee for the RVIB Employment Survey.

PURPOSE: The purpose of this study was to examine the association between type of vision impairment and disability and the handicap or impact of vision loss on functioning. METHODS: Participants were interviewed for the Royal Victorian Institute for the Blind Employment Survey, and asked to self-report whether totally blind or not (vision impaired). Causes of visual impairment were also reported. Eyesight was rated on a scale from 0 (completely blind) to 10 (best possible eyesight). Difficulty with mobility, personal care, household activities, work and hobbies and social interactions were also rated. Participants with vision impairment also rated their level of disability in reading and seeing other people's reactions using the same scale. RESULTS: Of the 250 participants, 39 self-reported total blindness. Participants with vision impairment experienced greater levels of difficulty in almost all areas than people who self-reported total blindness. People with vision impairment due to glaucoma and macular degeneration reported significantly more difficulty with reading newspapers, while there was a borderline significant relationship between difficulty with seeing people's reactions and macular degeneration. CONCLUSIONS: In summary, we found that difficulty associated with everyday tasks was greater than might be expected from self-report of vision. This study confirms the need for visual function tools to supplement the use of objective visual acuity measurements in people with vision impairment.

Activities of Daily Living↗
PubMedDate not supplied

Knuckle pads: does knuckle cracking play an etiologic role?

Very little has been published on knuckle pads and the cosmetic and psychological effects they can have. In children, most knuckle pads are considered to be idiopathic; however, familial cases as well as those caused by trauma have been described. We report a 14-year-old African American girl with a 3-year history of slowly enlarging hyperkeratotic nodules over multiple finger joints and on the lateral aspects of several fingers. These lesions were initially confined to the patient's left hand but subsequently involved the right hand. The patient and her mother denied any unusual hobbies or sports in which the patient's fingers might be traumatized. The patient, however, was noted to crack her knuckles during her clinic visit. To the mother's surprise, the patient admitted to doing this quite frequently on a daily basis. A diagnosis of knuckle pads was made and confirmed histologically. To our knowledge, this is the first reported case of knuckle pads with cracking of the knuckles as the possible etiology.

Adolescent↗
PubMed2003

Quality of life while dying: a qualitative study of terminally ill older men.

OBJECTIVES: To characterize the experience of quality of life while dying from the perspective of terminally ill men. DESIGN: Descriptive study involving semistructured interviews. SETTING: Patients attending clinics at two university-affiliated medical centers were interviewed in a private conference room or in their homes. PARTICIPANTS: Twenty-six men identified by their physicians as having terminal heart disease or cancer. Eligible participants acknowledged that they had serious illness. MEASUREMENTS: The interview contained open-ended questions such as: "What are the most important things in your life right now?" The interview also contained closed-ended questions about symptom intensity, presence of depressed mood, and other items related to overall quality of life. The open-ended questions were tape-recorded, transcribed, and analyzed using grounded theory methods. The closed-ended questions were analyzed using descriptive statistics. RESULTS: Participants believed that death was near. Participants saw engaging in hobbies and other enjoyable activities as an alternative to moving into the final stage of illness, in which they saw themselves as actively dying. They admitted to occasionally ignoring prescribed diets; these actions improved their overall quality of life but worsened symptoms. New symptoms brought concerns about progression to active dying. They anticipated what their dying would be like and how it would affect others. Participants believed that their actions in the present could improve the quality of their dying and lessen the burden of their deaths on others. Many participants therefore were preparing for death by engaging in such tasks as putting their finances in order and planning their funerals, to relieve anticipated burden on loved ones. CONCLUSION: To help terminally ill patients plan for the end of life, clinicians are encouraged to become familiar with their patients' experiences of living with terminal illness, to identify each patient's unique priorities, and to incorporate that information into care plans aimed at maximizing quality of life at the end of life.

Aged↗
PubMed2000

Long-term sequelae of fasciotomy wounds.

A retrospective study of patients admitted to an Orthopaedic Trauma Unit over an 8-year period requiring fasciotomies, of either upper or lower limb, to reduce the risk of compartment syndrome was performed. Sixty patients were studied, of which 49 had an underlying fracture. The long-term morbidity of the wounds was studied. Ongoing symptoms such as pain related to the wound occurred in six patients (10%) and altered sensation within the margins of the wound occurred in 46 patients (77%). Examination revealed 24 patients (40%) with dry scaly skin, 20 patients (33%) with pruritus, 18 patients (30%) with discoloured wounds, 15 patients (25%) with swollen limbs, 16 patients (26%) with tethered scars, eight patients (13%) with recurrent ulceration, eight patients (13%) with muscle herniation and four patients (7%) with tethered tendons. The appearance of the scars affected patients such that 14 (23%) kept the wound covered, 17 (28%) changed hobbies and seven (12%) changed occupation. This study reveals a significant morbidity associated with fasciotomy wounds. In light of these findings, further consideration should be given to techniques that reduce both the symptoms and examination findings mentioned above and the aesthetic insult to the affected limb.

Adolescent↗
PubMed2000

Expression of one group of genes maintains one unit of long-term memory in a brain model.

In a brain model, a unit of long-term memory is stored in the encoding synapses of a neuron as a presynaptic axonal 'on-off' pattern through the establishment of long-term potentiation (LTP) and long-term depression (LTD). Repetitive activation of one presynaptic axonal 'on-off' pattern speeds up the subsequent re-activation of the same pattern by inducing expression of a corresponding group of genes in support of the enzymes, protein substrates, and second messengers for the LTP and LTD that encode the unit of long-term memory. Phantom limb pains are memorized and re-activated through the expression of the corresponding group of genes, and re-experiencing the stressful event in post traumatic stress syndrome results from the expression of another group of genes. The sense of requiring less time to experience the content of a successfully retrieved long-term memory reflects an increased speed of re-activating the presynaptic axonal 'on-off' patterns of the memory, or an increased speed of thinking. Giving rise to a sense of familiarity with new things, déjà vu may also be a mental state with increased speed of thinking. The speed of thinking may be decreased in jamais vu that is opposite to déjà vu. Progressive increases in the speed of thinking when engaging in a hobby may open up a previously unused neural pathway that turns a previously happy feeling into an aversive one.

Gene Expression↗
PubMed2001

Pearls and pitfalls in the approach to patients with neurotoxic syndromes.

Neurotoxins are an important cause of neurologic disorders. A vast number of potentially neurotoxic compounds exist, including prescription drugs, illicit substances, and exposures through the workplace, residence, hobbies, and the environment. Effects of neurotoxins can mimic neurologic illnesses; therefore, it is important to consider neurotoxins in the differential diagnosis of any patient with neurological dysfunction. Paramount to the diagnosis of a possible neurotoxic syndrome is establishing causation. This can be done by a systematic approach utilizing principles in epidemiology and applying them to the individual patient. This approach is discussed in the following article in an attempt to bring structure to solving problems in a complex area of medicine.

Adult↗
PubMed2002

[Hemochromatosis or hemosiderosis? Initial misinterpretation of clinical symptoms and laboratory findings in a 62-year-old patient].

The exact differential diagnosis of iron overload syndromes is mandatory as important therapeutic consequences may derive from a correct diagnosis, especially when hemochromatosis is present. To facilitate diagnostic and therapeutic decisions algorithms and probabilistic calculations based on different frequencies of clinical symptoms and typical laboratory findings of the diseases in question have been proposed. Overestimation and/or underestimation of clinical symptoms and/or laboratory findings in using such calculations, however, may lead to incorrect diagnosis and therapy as demonstrated in this case. We report on a 62-year-old patient with arthralgia, pathologic glucose metabolism, brown skin pigmentation and excessively elevated ferritin and transferrin saturation levels, which initially were interpreted as signs of the assumed underlying disease (hemo-chromatosis) based on a high initial suspicion level and further corroborated by Bayesian probability analysis yielding a probability 99.0 % for the presence of hemochromatosis. Because of this high probability and the patient's wish for treatment phlebotomy was started, but stopped after having obtained negative results of genetic testing and normal quantitative liver iron values. The diagnosis of hemochromatosis had to be revised and symptoms and laboratory findings of this patient were found to be compatible with chronic fatty liver and pathologically altered iron metabolism due to chronic alcohol intake which the patient has initially concealed. The joint pain was explained in terms of chronic degenerative bone destruction, the impaired glucose tolerance seen as the consequence of obesity and the skin pigmentation was ascribed to sun exposure due to the patient's outdoor activities as a hobby farmer not evaluated during initial presentation. The implications and importance of unbiased history taking, critical interpretation of clinical symptoms and laboratory findings in using probabilistic calculations and diagnostic decision analysis are emphasized and the different mechanisms of iron metabolism in hemochromatosis and hemosiderosis are discussed.

Biopsy, Needle↗
PubMed2002

[Synovial chondromatosis as an unusual cause for subacromial impingement in a tennisplayer].

On the one hand synovial chondromatosis is a rare disorder and usually involves the knee and hip but rarely the shoulder joint. On the other hand bursal causes of impingement are rare too. We report a case of synovial osteochondromatosis presenting as chronic impingement syndrome in a 44 year old hobby tennis player. In the course of four years impingement problems and a "tumorous" growth on the outer surface attacked attraction to the patient. An MRI presented several nodular structures with sclerosis in the anteriomedial region of the shoulder joint. The mass was completely removed by operative treatment. The histological result showed a synovial chondromatosis with chronical synovitis. After the operative exstirpation of the calcified bodies the patient had no discomfort for 15 months and is now able to play tennis again.

Adult↗
PubMed2004

[Rudolf Schindler (1888--1968)--"father" of gastroscopy].

Rudolf Schindler was born in Berlin and achieved his international reputation with the textbook "Lehrbuch und Atlas der Gastroskopie", written in Munich. This was the first book containing excellent endoscopic pictures. He was the first to report on more than four hundred gastroscopies performed without complications. 1928 to 1932, he developed the first semi-flexible gastroscope together with the technical designer Georg Wolf from Berlin. This became the lasting standard for about twenty-five years. In 1934, Schindler emigrated to Chicago after being released as a Nazi prisoner. In 1937, he was awarded the gold medal for his research on gastritis by the American Medical Association. He became the leading person among American gastroscopists for many years and, in 1941, the first president of the American Gastroscopic Club. After 1943 he moved to California to work and live. He also received awards from the American Societies for Gastroscopy and Gastrointestinal Endoscopy in 1953 and 1962. He spent his last years in Munich. His honorary titles of father, architect or super salesman of gastroscopy describe the spectrum of his personality. He was an endoscopist with outstanding technical and diagnostic skills and knew particularly how to deal with patients, how to develop endoscopes as well as being a highly qualified teacher, author and scientist. He also had many hobbies, in particular playing and conducting music perfectly.

Gastroscopes↗
PubMed2004

[Epidemiology of open globe eye injuries: analysis of 1026 cases in 18 years].

BACKGROUND: Ocular trauma has significant impact on the patient's future quality of life. Progress in the treatment of ocular trauma may ameliorate the outcome, but preventive measures are more effective. However, prevention of ocular trauma can only be effective when the current epidemiology of ocular trauma is known. Therefore, we have now collected data on ocular trauma over nearly 20 years. This paper provides an overview on the development of open globe injuries in the past 20 years. PATIENTS: The records of 1026 patients with open globe injuries who were primarily treated at the Universities of Freiburg and Würzburg between January 1, 1981 and December 31, 1999, were sufficiently analyzed. The following parameters were evaluated: age, extent of injury, sex, cause. and activity at the time of injury. RESULTS: After correction for demographic distribution, the risk for open globe injury was highest for young adults and lowest for seniors. In recent years, the risk for severe eye injury is more equally distributed and is increasing for old people. We noted decreasing injuries at work and during traffic accidents, especially for young female front-seat passengers. On the other hand, we observed an increasing proportion of domestic eye injuries related to hobby activities. With increasing age we noted more posterior segment injuries. 9 % of all open globe injuries occurred among seniors (> 65 years old), but 41 % of all ruptures occurred in this age group. Preceding cataract surgery was identified as a risk factor. 38 % of injured persons in this age group had already had intraocular surgery. After the introduction of small incision techniques at the beginning of the 1990 s, the frequency of globe ruptures began to decrease again. 3.6 % of the injured eyes developed an endophthalmitis, in agricultural injuries the rate of endophthalmitis was 12 %. CONCLUSION: There is a relative constant incidence of 3.0 open globe injuries per 100,000 population. The circumstances of the injuries underwent major changes within the period of these observations.

Academic Medical Centers↗
PubMed2006

[Recurrent nosebleeds in patients with hereditary hemorrhagic telangiectasia].

BACKGROUND AND OBJECTIVE: Hereditary hemorrhagic telangiectasia (HHT) is an inherited autosomal dominant vascular disease, which can cause multiple symptoms, the cardinal one being chronic recurrent nosebleeds. The aim of this study was to determine, whether these chronic recurrent episodes are felt by the patients to be merely isolated episodes or affect their quality of life (QoL). Also assessed was the extent to which QoL is more impaired in patients with HHT than in those with other chronic diseases. PATIENTS AND METHODS: This prospective cross-sectional study was based on a German questionnaire, "Profile of Quality of Life of Chronically Ill Patients"(PLC) together with a newly formulated questionnaire dealing with HHT-specific symptoms. Comparisons were made with German normative reference data, as well as with data from randomly selected patients with various chronic diseases. RESULTS: 90% of patients with HHT considered their recurrent nosebleeds to be the most disturbing symptom, interfering with hobbies and leisure time in 63% of them. Those with HHT had worse results in 5 of 6 PLC scales than those with other chronic diseases such as cardiomyopathy or rheumatic disease. 73% of the patients stated that they would appreciate new ways of treating these nosebleeds. CONCLUSION: There is a great need for optimizing the treatment of chronic recurrent nosebleeds. Lasting reduction of such bleeds by new therapeutic methods seems unlikely to happen in the near future. For this reason multimodal treatment options, including psychological and relaxation techniques, should be considered. Such an approach may reduce the stress on patients (and subsequent nosebleeds) and result in a direct improvement of their quality of life.

Adult↗
PubMed1994

Overuse syndromes among endoscopists.

A survey of 400 gastroenterological endoscopists was carried out to determine what kinds of overuse syndromes they suffer from as a result of doing endoscopic procedures. The response rate was 72%. Thumb pain, hand pain, elbow pain, low back pain, and possibly shoulder pain all appear to be caused by endoscopy to at least some extent. Physicians who perform the most procedures tend to have the highest risk of developing such problems. Age, sex, practice setting, and hobbies did not seem to have an impact on the overuse conditions identified. These conditions are most likely due to the equipment and technique of endoscopy. Further study is needed to determine the anatomic lesions causing the various pain states, so that they can be treated or prevented.

Cumulative Trauma Disorders↗
PubMed1999

[Mouth guard protection for prevention of athletic injuries to teeth, mouth and jaw].

Sport is well known as a common cause of dental and oral injuries. Sports-related injuries account for 13% to 39% of all trauma cases in this area. The knowledge about prevention of dental and oral injuries among hobby and professional athletes can be regarded as not satisfactory yet. Mouth guards are considered as one of the most effective means for injury prevention. However, no statements or recommendations regarding use of mouth guards in sports have been published in German language literature yet. The following review article describes several types of available mouth guards and discuss their advantages and disadvantages. Guidelines concerning indications and use of mouth guards are presented.

Athletic Injuries↗
PubMed1999

[Injury mechanisms in windsurfing regatta].

In a retrospective study, we evaluated the injuries of 44 semi-professional competitors for the German Windsurf Cup, which were suffered from during one windsurfing season. This Cup is the national qualification tour for the annual "production fun board world championship". The subjects, participating in our study were randomly chosen. There were no surf-specific differences between the two groups. The average age was 24.63% had competitive surfing as their hobby, 37% were professional or semi-professional board sailors. The subjects surfed an average of 85 days in 1995. 23 (52%) windsurfers did not get hurt during the entire season. 21 (48%) of them got injured during the 1995 windsurf season. This is an incidence of only one injury per 174 windsurfing days. Only three windsurfers were injured during a competition. The other 18 occurred during training sessions. Most accidents happened because of an overpower situation, i.e. the sail was too big for the wind force (43%), or through negligence on the part of the windsurfer (19%). The most frequent type of the accident was the so called catapult crash (57%). The most common injuries were ligament ruptures of the lower leg (33%) and head burst wounds (19%). Compared with other competitive fun sports (e.g. snow boarding), windsurfing has a lower injury risk. In regard to the injury mechanisms, prophylactic recommendations are made.

Adolescent↗