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PubMed1987

An outbreak of recurrent acute and chronic hypersensitivity pneumonitis in office workers.

Three episodes of an acute, flu-like illness, one studied in detail, were associated with manipulations on the central air handling system of an office building in Tennessee in the summer and early fall of 1981. Symptoms were compatible with acute hypersensitivity pneumonitis, although the time of onset revealed a biphasic epidemic curve. Breathing air not supplied through the central air handling system protected against disease. Ill persons had significantly more precipitins to agents cultured from the building than did controls. Symptoms suggestive of chronic hypersensitivity pneumonitis were also found. Chronic disease was associated with the presence of humidifiers at home, asthma, and longer work in the building. Acute disease occurred less frequently in smokers and persons who had previously worked in the building before 1976. Persons with acute disease were more likely to have chronic disease. No single etiologic agent could be identified. Because of difficulties with demonstrating safety for reoccupancy, the building was vacated and remains empty at this time.

Acute Disease↗

PubMed1975

Characteristics of hospital provisions for continuing education for physical therapists in California.

The authors surveyed 197 acute general hospitals in California to determine characteristics of hospital provisions for continuing education for physical therapists. Most hospitals in California were found to provide continuing education opportunities for physical therapists, but physical therapists in small hospitals and in private-profit hospitals could be at a disadvantage financially if continuing education becomes compulsory for relicensure. A relatively low proportion of physical therapy departments in hospitals with less than one hundred beds budgeted continuing education, but a relatively high proportion of the same facilities required that therapists take time off without pay or use vacation time and pay their own expenses for continuing education. Similar circumstances characterized private-profit hospitals.

California↗

PubMed1982

Neural plasticity. Part 4. Lesion-induced reorganization of the CNS: recovery phenomena.

Most patients treated by physical therapists have suffered some neurological trauma resulting from disease or injury. The traditional teaching used to be that damage of central neurons is irreversible. Within the last decade, however, it has been necessary to cast aside this traditional view because of accumulating evidence that the brain is endowed with remarkable plasticity. This paper reviews experimental evidence revealing morphological and functional changes occurring in the CNS in response to neural lesions. Morphological responses to injury include collateral and terminal sprouting, retrieval of vacated synapses, alterations in the ultrastructure of surviving synapses, and denervation supersensitivity. Functional and adaptive changes induced by injury include the unmasking of ineffective synapses, shifts in receptive fields, and reorganization or altered effectiveness of surviving neural networks. These recovery phenomena attest to the brain's dynamic properties. These new insights contradict our conventional view of the absence of growth and reorganizational capabilities in CNS neurons. These newly identified "recovery phenomena" are destined to have a significant impact on physical therapy in the future.

Afferent Pathways↗

PubMed2006

Predictors of burnout and job satisfaction among Turkish physicians.

BACKGROUND: Burnout is associated with decreased job performance and low career satisfaction. It has a special significance in health care, where staff experience both psychological-emotional and physical stress. AIM: To investigate levels of job satisfaction and burnout among Istanbul physicians, and the relationships between demographic characteristics, job characteristics, job satisfaction and burnout. DESIGN: Questionnaire-based survey. METHODS: We collected data from a randomly selected sample group of 598 physicians from different health-care institutions in Istanbul. A questionnaire regarding sociodemographic characteristics of the physicians, the Maslach Burnout Inventory (MBI) and the Minnesota Job Satisfaction Questionnaire (MSQ) were all administered during face-to-face interviews. RESULTS: Job satisfaction was inversely correlated with emotional exhaustion and depersonalization, and positively correlated with personal accomplishment. Under multilevel regression, the most significant and common predictors of all burnout dimensions and job satisfaction were the number of vacations at individual level, and public ownership of healthcare facilities at group level. Number of shifts per month was also a significant predictor of all burnout dimensions. DISCUSSION: Organizational efforts aimed at increasing the level of job satisfaction among physicians could help to prevent burnout.

Adult↗

PubMed1996

Physical education and the School Medical Service in England and Wales, 1907-1939.

Historians who have examined physical education (PE) have rarely related PE to its wider social context. This article considers the development of PE in elementary schools in England and Wales between 1907 and 1939, and locates PE within the wider history of the School Medical Service. From 1907, local authorities appointed specialist staff, acquired playing fields, and sent their teachers on short vacation courses, while at a policy level the Chief Medical Officer, Sir George Newman, came to regard PE as a component of preventive medicine. In the interwar period, PE was greatly influenced by voluntary organizations, and by the physical training schemes set up by the continental dictatorships, and this culminated in the Physical Training and Recreation Act of 1937. However PE also illustrated many of the weaknesses of the School Medical Service, including striking regional variations in its provisions, and in the 1930s the emphasis on PE contrasted with the relative neglect of malnutrition. The article concludes by suggesting that the contrast between Sir George Newman's ambitious plans for PE as a branch of preventive medicine, and provision in most local authorities, illustrated the great gulf that could exist between rhetoric and reality.

Child↗

PubMed1988

Sleep need in adolescents: a longitudinal approach.

A sample of 190 male and female "high school" students completed a sleep questionnaire for the first time when they were 10 to 14 years old. The survey was repeated five times at 2 year intervals. Ninety-three subjects answered the questionnaire each time. Subjective sleep need was assessed by the indicated wish for more sleep. The wish for more sleep was very pronounced, varying between 54.3% and 74.5% across the years. Individual consistency, however, was low since only 14.5% of the adolescents indicated the wish for more sleep in each survey, emphasizing the state dependency of this variable. Within each total sample, subjects with the wish for more sleep (MSL) and with sufficient sleep (SSL) were compared. Subjective sleep need was consistently validated by a syndrome of morning-tiredness. In the last two surveys, there was reduced time in bed (TIB) on weekdays in MSL subjects and longer TIB during vacation in surveys 2 through 5. Furthermore, MSL subjects more often showed irregular sleep habits. The previous sleep history of the MSL subjects in the last survey indicated that concomitants of the wish for more sleep were already experienced earlier in adolescence. The desired sleep duration of these subjects was 1.7 h longer than their current sleep on weekdays, an amount they had not obtained on weekdays since early adolescence. It is concluded that a substantial proportion of the adolescents seem to have had difficulties adapting to the general sleep time reduction occurring in adolescence.

Adolescent↗

PubMed2006

How long and how much are nurses now working?

OBJECTIVE: Extended work schedules-those that vary from the standard eight hours per day, 35 to 40 hours per week-are common in nursing and contribute to problems with nursing recruitment and retention, in addition to compromising patient safety and the health and well-being of nurses. This study describes the nature and prevalence of such schedules across nursing settings. METHODS: Quantitative survey data collected as part of the Nurses Worklife and Health Study were analyzed. The sample consisted of 2,273 RNs. Demographic data, information about respondents' primary jobs (position, workplace, and specialty), and specific work schedule variables were analyzed, including data on off-shifts, breaks, overtime and on-call requirements, time off between shifts, and how often respondents worked more than 13 hours per day and on scheduled days off and vacation days. Respondents were also asked about activities outside of work, commuting time, and other non-nursing activities and chores. RESULTS: More than a quarter of the sample reported that they typically worked 12 or more hours per day, as did more than half of hospital staff nurses and more than a third of those with more than one job. A third of the total sample worked more than 40 hours per week, and more than a third worked six or more days in a row at least once in the preceding six months. Nearly a quarter rotated shifts. Almost one-quarter of nurses with more than one job worked 50 or more hours per week, and they were more likely to work many days consecutively, without sufficient rest between shifts, and during scheduled time off. Single parents were as likely as those with more than one job to work 13 to 15 hours per day, 50 to 60 hours or more per week, and many days consecutively. Seventeen percent of all nurses worked mandatory overtime, as did almost a quarter of the single parents. Nearly 40% of the total sample and more than 40% of hospital staff nurses had jobs with on-call requirements. CONCLUSIONS: The proportion of nurses who reported working schedules that exceed the recommendations of the Institute of Medicine should raise industry-wide concerns about fatigue and health risks to nurses as well as the safety of patients in their care.

Adult↗

PubMed1994

Tenure policies in U.S. and Canadian Medical Schools.

This report presents data on tenure policies in U.S. and Canadian medical schools. The data are drawn from the findings of a larger survey of faculty appointment and tenure policies, which was mailed to each medical school dean in December 1993. The deans were asked to complete the questionnaire themselves or direct it to a staff member knowledgeable about faculty personnel policies. Non-responding institutions were sent a follow-up letter two months later. The response rate for the written survey was 96%: 137 of a possible 142 schools responded, with the remaining five schools participating in an abbreviated telephone survey. Of the 142 U.S. and Canadian medical schools, 136 (96%) have tenure systems, although nine of these schools limit the award of tenure to basic science faculty. Over three-fourths of the schools that have tenure systems define tenure to include some kind of financial guarantee. Rarely does this financial guarantee cover total salary/compensation; typically it is restricted to a "base" or university component of salary. Twenty percent of the schools have fixed pre-tenure probationary periods for clinical faculty that are longer than seven years; another 11% report having either no fixed pre-tenure probationary period or one that is unlimited. In the last five years, 10% of medical schools have terminated a tenured faculty member "for cause." Data are also examined concerning policies governing the extension of the pre-tenure probationary period, the rank at which tenure is usually granted, consequences of a negative tenure decision, caps on tenure positions, vacated tenure positions, and tenure arrangements for VA faculty and PhD faculty in clinical departments.(ABSTRACT TRUNCATED AT 250 WORDS)

Canada↗

PubMed1997

Solar ultraviolet radiation exposure does not appear to exacerbate HIV infection in homosexual men. The Multicenter AIDS Cohort Study.

OBJECTIVE: To determine the effect of sun exposure on HIV progression. DESIGN: Cross-sectional survey nested within a longitudinal cohort study. SETTING: The Multicenter AIDS Cohort Study. PARTICIPANTS: A total of 1155 white HIV-seronegative and 496 white HIV-seropositive homosexual men, of whom 142 seroconverted during the study. MAIN OUTCOME MEASURES: T-helper lymphocyte decline and AIDS. RESULTS: No positive correlation was found between the development of AIDS or loss of T-helper lymphocytes and (i) phenotypic characteristics associated with enhanced ultraviolet radiation (UVR) sensitivity (hair or eye color, skin type), or (ii) reported UVR exposure (sun lamp/tanning bed use, frequency of beach vacations, sunscreen use), or (iii) composite score of UVR sensitivity and exposure history. The composite scores and individual measures of risk were not correlated with rate of T-helper lymphocyte decline (slope) based upon rank correlation (correlation coefficient, 0.04; P = 0.32). In fact, individuals purposefully seeking the sun had slower T-helper lymphocyte declines. Sensitivity to UVR was also not significantly associated with AIDS [odds ratio (OR), 1.11 per unit of higher composite score; 95% confidence interval (CI), 0.66-1.88; P = 0.63]. Among individuals who were HIV-infected at baseline, those who have been purposely seeking sun exposure were less likely to have AIDS (OR, 0.67; 95% CI, 0.39-1.11; P = 0.12). CONCLUSIONS: These data suggest that phenotypic characteristics of high UVR sensitivity and exposure are not highly correlated with decline in T-helper lymphocyte count or with progression to AIDS.

Adult↗

PubMed1997

Decision making by elderly patients with cancer and their caregivers.

This study explored the scope of decisions encountered by elderly cancer patients and/or their family caregivers, and the types of decision-making assistance requested and required within one practice setting. Semistructured interviews were conducted with five cancer center nurse coordinators (CCNCs). The CCNCs were interviewed weekly for 16 weeks to identify decision-making topics addressed, assistance requested, and perceptions of assistance required during telephone conversations. The CCNCs' reports of 41 telephone conversations revealed 44 specific decision-making topics. Content analysis uncovered 11 categories: symptom management, use of chemotherapy, ancillary choices selection of a medical provider, planning for end-of-life care, alternative therapy, vacation planning, weekend-pass planning, discharge planning, family survivor issues, and involvement of adult children in the elder's care. Elderly patients and/or their family caregivers requested information and assistance with making decisions. CCNCs perceived that callers also needed information clarification, reassurance about their decisions, a listener, permission to change the treatment regimen, and help with communication among health professionals, the elderly patient, and the family.

Adult↗

PubMed1998

Extraordinary changes in behavior in an infant after a brief separation.

A previously healthy 8-month-old infant experienced a dramatic change in affect, motor patterns, and appetite after a brief (4-day) separation from her parents. She went from being a happy, interactive, and engaging child to being withdrawn, with limited vocalization, spontaneous motor activity, or interest in her environment. For the first 3 days after her parents returned home, she refused solid food and most of the formula or water she was offered. Over the following week, her appetite increased minimally. Her parents were concerned about her apathy, excessive quietness, and lack of interest in food, toys, or their own attempts to engage her in play. At the pediatrician's office, she was significantly less interactive and playful compared with previous visits. Her temperature, heart rate, and respiratory rate were normal. Although there were no objective signs of dehydration, her weight was 8 ounces less than the previous recorded weight 1 month ago. Results of the physical examination were normal, with the exception of neurological and behavioral findings. She had mild, generalized decreased tone and strength, with normal deep tendon reflexes, a sad facial appearance with sustained furrowing of the lines in her forehead, difficulty in eliciting a social smile, and limited spontaneous sounds. There was an absence of focal neurological findings, a flat open anterior fontanel, and a head circumference measurement consistent with previous recorded results. There were no cutaneous bruises, and findings of her funduscopic examination did not reveal retinal hemorrhage. Before the 4-day holiday, child care was provided almost exclusively by her mother at home. On only two previous occasions, at 4 and 6 months of age, this first child of 20-year-old high school graduate parents was cared for by a neighbor when the parents went out to a movie theater. She cried for about 10 minutes when the parents left on these occasions. Her mother stated that she felt anxious about leaving the child for several days, but she and her husband decided that they needed a break and planned the 4-day vacation. Child care was provided by the neighbor, who did not notice any unusual behavior or refusal to feed while in her care during the parents' absence.

Anxiety, Separation↗

PubMed1999

Developmental neuropathology and impact of perinatal brain damage. III: gray matter lesions of the neocortex.

The evolving neuropathology of primarily undamaged cortical regions adjacent to the injured site has been studied in 36 infants who survived a variety of perinatally acquired encephalopathies (microgyrias, ulegyrias, multicystic encephalopathies, porencephalies, and hydranencephalies) and later died of unrelated causes. Their survival times range from hours, days, weeks, or months, to several years. Ten of these children developed epilepsy, 2 developed cerebral palsy, and several were neurologically and mentally impaired. In all cases studied, the undamaged cortex adjacent to the injured site survives, retains its intrinsic vasculature, and is capable of continuing differentiation. However, its postinjury development is characterized by progressive alterations compatible with acquired cortical dysplasia that affects the structural and functional differentiation of its neurons, synaptic profiles, fiber distribution, glial elements, and vasculature. The synaptic profiles of many neurons are transformed by an increased number of intrinsic loci that replace extrinsic ones vacated by the destruction of afferent fibers. The intrinsic fibers of layer I and some Cajal-Retzius cells survive even in severe lesions and may be capable of interconnecting cortical regions that have lost other type of connections. Some intrinsic neurons undergo postinjury structural and functional hypertrophy, acquire new morphologic and functional features, and achieve a large size (meganeurons). Probably, these meganeurons acquire their structural and functional hypertrophy by partial endomitotic DNA and/or RNA reduplication (polyploidy). These postinjury alterations are not static but ongoing processes that continue to affect the structural and functional differentiation of the still developing cortex and may eventually influence the neurologic and cognitive maturation of affected children. This study proposes that, in acquired encephalopathies, the progressive postinjury reorganization of the undamaged cortex and its consequences (acquired cortical dysplasia), rather than the original lesion, represent the main underlying mechanism in the pathogenesis of ensuing neurological sequelae, such as, epilepsy, cerebral palsy, dyslexia, cognitive impairment, and/or poor school performance.

Acute Disease↗

PubMed1981

A system for using supplemental staff.

This article has outlined the development of a system for using temporary nurses. Steps in this process include reevaluation of department philosophy; formulation of criteria for temporary staffing; development of scheduling mechanisms and policies that reflect the criteria; and finally, the development of methods for evaluation. Our system uses scheduling components previously in existence at Rush-Presbyterian-St. Luke's Medical Center. We consider the computerized system an advantage for our purposes, but it was not essential. A written schedule could then be used to meet department needs. Defining goals and then determining methods is important, since several alternative methods might be possible to meet a goal. Our system emphasizes both continuity and accountability at the unit level. Because the unit leaders have close association with temporary staff, their input is vital. The unit leaders formally evaluate the temporary personnel and are accountable for making appropriate requests for temporary staff. The judgment of need is based on such factors as patient needs, budget allocation, and staff vacations. The system outlined was the necessary by-product of the interfacing of two staffing methods, permanent and temporary. Consistency is the key to resolving problems.

Computers↗

PubMedDate not supplied

Developing a clinical site at a day camp.

In response to the changing focus of the healthcare delivery system, nursing educators have broadened clinical experiences to prepare students to deliver healthcare in community systems. Finding sites during the months of July and August is difficult because elementary and secondary schools are closed and healthcare agencies have decreased staffing because of vacations. When the philosophy of the college of nursing and the course objectives require that the clinical site must be within a specific community, the task is more difficult. The use of an inner city day camp is one way to successfully address this situation.

Adolescent↗

PubMed1978

Natural history of male psychological health, IV: what kinds of men do not get psychosomatic illness.

This article reports on interrelationships between the medical and emotional health of 95 men who were prospectively followed from age 18 to 53. Fifty of these originally healthy men developed illness patterns sometimes called psychosomatic (ulcer, colitis, allergy, hypertension, musculo-skeletal disorders). These men were compared with the other 45 similarly studied men who never developed such illnesses. Although men who developed "psychosomatic" illnesses were more likely to seek medical or psychiatric attention, they exhibited only slightly more psychopathology. Both as children and as adults they had more physical illness of all kinds. They were less likely to indulge in vacations and athletics and more likely to use tranquilizers and excessive alcohol. Men with "psychosomatic" illnesses experienced a greater variety of somatic symptoms under stress, but the loci of these somatic symptoms shifted over time and were not significantly associated with the sites of psychosomatic illness. Premorbidly, the 20 men who were eventually to develop serious irreversible physical illness of any kind reflected far more psychopathology than the 45 men who developed psychosomatic illness.

Adaptation, Psychological↗

PubMed1997

Esophageal 'stars': a sinister foreign body ingestion.

This paper describes an "epidemic" of foreign body ingestion in six consecutive prisoners from the same jail. The resulting esophageal perforations won all patients "temporary vacations" from prison. The nature of the ingested foreign body (hypodermic needles fashioned into a "star") guaranteed perforation of the esophagus. All six patients had emergency esophagotomy for foreign body removal. In the only case of significant morbidity, suture line disruption with mediastinitis and empyema led to esophagectomy, cervical esophagostomy, and tube gastrostomy. This patient survived and subsequently had uncomplicated esophagocoloplasty. Foreign objects of this type have not been described in the literature. Because of their specific design, they necessitate immediate and aggressive surgical management.

Adult↗

PubMed2002

Sunbathing intentions in Irish people travelling to Mediterranean summer holiday destinations.

As exposure to UV light is thought to be the most significant environmental and behavioural risk factor for avoiding skin cancer, we have analysed the sunbathing intentions and attitudes of Irish people travelling to Mediterranean and Iberian holiday destinations. Ninety per cent of respondents planned to get a suntan on their vacation with 44% likely to burn their skin in the process. Although all intended to apply sun cream on holiday only 40% would apply >SPF 15. Sixty-four per cent planned to sunbathe between 11.00 am and 3.00 pm, with 25% intending to spend <5 hours in the sun. One-third of those intending to sunbathe for >6 hours per day were aged between 16 and 24 years. Approximately eight out of 10 people thought suntans made them feel healthier or attractive. Fifty-six per cent regularly checked their moles but men were less likely to check their skin for pigment changes. The results provide baseline information on sunbathing attitudes of Irish people. They show that while most people feel they adopt a careful approach to sunbathing, the experiences and intentions, especially in younger people, are influenced by the desirability of a suntan, and reflect a behaviour that increases their risk of skin cancer.

Adolescent↗

PubMed2003

Hidden financial costs in treatment for childhood cancer: an Australian study of lifestyle implications for families absorbing out-of-pocket expenses.

PURPOSE: The impact of out-of-pocket expenses on five domains of family lifestyle were explored: social, assets, credit, utilities, and charity. METHODS: Using a cross-sectional survey, 100 parents of pediatric cancer patients reported on the types of out-of-pocket expenses incurred and the perceived lifestyle impact of meeting those expenses. RESULTS: Eighty percent of the sample reported a minimum of five different out-of-pocket expenses (total mean value = 19,064 Australian dollars; approximately 9,723 US dollars). The majority reflected travel, accommodation, and communication costs, use of work-related entitlements, and changes in paid employment. In lifestyle terms, the area of greatest impact was found for the social domain, such as cancelling vacations and giving up recreational pleasures and social expenditure. Those families living furthest from the major cancer treatment center reported the greatest range of out-of-pocket expenses and subsequent lifestyle impact. While there were few differences as a function of cancer type, results suggested that families most vulnerable to financial distress tended to be those whose child had spent relatively longer on treatment. CONCLUSIONS: In meeting out-of-pocket expenses, parents primarily seek ways to "trim the fat" off existing family expenditure. While all families may incur extra expenses, parents of patients located a significant distance from the cancer treatment center remain especially vulnerable (despite increased government allowances). Creative solutions for addressing some expenses may include applications of telemedicine to augment outreach services.

Adolescent↗