Riboflavin phosphorylation is the crucial event in riboflavin transport by isolated rat enterocytes

In isolated rat enterocytes, both normoenergized (normal) and de-energized with rotenone, riboflavin intracellular metabolic processes, operating in association with a membrane-specific transport mechanism, were investigated. The contents of unlabeled (endogenous) and labeled (exogenous) flavins [riboflavin (RF), flavin mononucleotide (FMN), flavin adenindinucleotide (FAD)] were determined by HPLC before and after incubation with tritiated RF. In normoenergized enterocytes, total labeled RF content (i.e., total uptake, the sum of RF membrane transport and intracellular metabolism) increased steadily to a plateau after 20 min incubation; FMN and FAD contents reached a plateau between 3 and 20 min, whereas free RF content increased constantly. The phosphorylated forms prevailed over the free form ( approximately 60% of total flavins). In de-energized enterocytes, RF total uptake was significantly lower than in normoenergized enterocytes and reached a plateau after only 3 min incubation. FMN and FAD contents were significantly lower than in normoenergized enterocytes, and free RF represented the prevailing form of flavins (70% of total RF ). In both normoenergized and de-energized enterocytes, the contents of unlabeled total RF, FMN and FAD decreased significantly after 20 min incubation, whereas free RF increased significantly only in normoenergized enterocytes. After 20 min incubation, the RF structural analog 8-dimethyl-amino-8-demethyl-RF caused a significant decrease of all flavin contents, whereas 5'-deoxy-RF decreased only the total and free RF contents. Results directly confirmed the leading role of metabolic processes such as phosphorylation in RF transport by isolated small intestinal enterocytes.     

Neuroendocrine dysfunctions and their consequences following traumatic brain injury

Posttraumatic hypopituitarism is of major public health importance because it is more prevalent than previously thought. The prevalence of hypopituitarism in children with traumatic brain injury is unknown. Most cases of posttraumatic hypopituitarism remain undiagnosed and untreated in the clinical practice, and it may contribute to the severe morbidity seen in patients with traumatic brain injury. In the acute phase of brain injury, the diagnosis of adrenal insufficiency should not be missed. Determination of morning serum cortisol concentration is mandatory, because adrenal insufficiency can be life threatening. Morning serum cortisol lower than 200 nmol/L strongly suggests adrenal insufficiency. A complete hormonal investigation should be performed after one year of the trauma. Isolated growth hormone deficiency is the most common deficiency after traumatic brain injury. Sports-related chronic repetitive head trauma (because of boxing, kickboxing, football and ice hockey) may also result in hypopituitarism. Close co-operation between neurosurgeons, endocrinologists, rehabilitation physicians and representatives of other disciplines is important to provide better care for these patients.     

早期护理干预在预防重型颅脑伤患者肺部感染中的作用

目的 分析重型颅脑伤患者肺部感染的危险因素,探讨有效预防和控制肺部感染的护理措施.方法 选择2008年1月-2009年12月神经外科重症监护病房(NICU)收治的356例重型颅脑伤患者,按收治时间顺序分为对照组和干预组;对照组患者给予脑外科常规护理;干预组患者针对重型颅脑伤患者肺部感染的高危因素和薄弱环节,实施早期护理干预.结果 对照组和干预组的肺部感染发生率分别为18.24％、10.75％,干预组的肺部感染发生率显著低于对照组(P＜0.05).结论 运用早期护理干预,加强对侵入性操作和消毒隔离的管理控制,对于重型颅脑伤患者肺部感染的预防具有重要意义.     

Life event timing and the emotional consequences of surgical menopause for Asian-Pacific women in Guam

Using Behavior Risk Factor Survey data (N = 398), this study tests the age-norms hypothesis by examining the emotional consequences of the timing of surgical menopause for women in Guam's Asian-Pacific community. The results of the study are supportive of the hypothesis that off-scheduled life events result in considerable emotional trauma, and show that women in Guam who are 44 years of age or younger are significantly more likely than older women to suffer psychological distress and unhappiness when they report experiencing surgical menopause. We discuss the potential implications of these findings for theory and future research.     

Payment reform to support lasting practice reform in primary care

Establishing and sustaining patient-centered medical homes will require new investments in primary care. The Payment Reform Task Force of the Patient-Centered Primary Care Collaborative consensus statement recommends a blend of different payment strategies for the majority of patients in a practice along with risk adjustment. It also recommends shifting focus to value, ensuring that the working environment for primary care is improved, optimizing administrative practicality and relying on pilots with systematic evaluation and review to evolve the best strategy.     

The experiences and consequences of a multiple trauma event from the perspective of the patient

This was an ethnographic investigation with the aim of comprehending the meanings of the trauma experience among multiple trauma patients. The following techniques were used for data collection: direct observation, semi-structured interview and field diary. Biographical narratives were obtained from eleven trauma victims, and ten relatives as secondary informants. The data analysis considered the set of data of each participant and all data of all subjects, searching for differences and similarities. The meanings attributed to the trauma experience are associated with interrelated feelings of fear, insecurity, anger, vulnerability and suffering and to the meanings of quality of life that converge to valorize health and work appreciation and support by social networks. This analysis shows that the concepts and experiences of the trauma are conditioning factors of the health-disease process and they are essential in planning public health actions to meet the needs of individuals.     

Employee orientation: the key to lasting and productive results

A large body of research emphasizes the importance of planning, commitment, and communication of the corporate culture, and the role of key personnel, supervisors, and colleagues in shaping the attitude of the new employee. Ineffective orientation programs usually fall short in meeting these requirements and therefore are costly to the organization. An endless cycle ensues: recruitment, selection, ineffective orientation, improper training, job dissatisfaction, poor performance, turnover, and loss of productivity; recruitment, selection, and so on. Effective orientation programs are designed as a process, customized to meet the needs of the organization, and they consider all of the requirements needed to be successful. The resulting picture can be painted differently: recruitment, selection, effective orientation, training, job satisfaction, improved performance, retention, and increased productivity. Of course this cycle also must be repeated under certain circumstances, but not for the same reasons and certainly not as often. Instead of increased costs, there is actually a cost savings.     

The hospital library is crucial to quality healthcare

In a 1988 report, an advisory committee of the Medical Library Association (MLA) wrote that "no one would argue against information as the foundation for efficient cost-effective business or against access to knowledge as a prerequisite for developing new knowledge." Yet the increasing number of threats to the hospital library--largely from within the industry--suggest that many hospitals do not value information in the same way their counterparts in other businesses do. In the first of two articles in this issue on hospital library and information services, the executive director of the MLA uses the MLA's experience and a variety of research findings to restate the case for the hospital library's vital role in quality care.     

Barriers in the care of patients who have experienced a traumatic event: the perspective of general practice

BACKGROUND: Previous research has indicated that GPs encounter barriers in the care of patients who have experienced a traumatic event. OBJECTIVES: The aims of the present study were to map barriers GPs encounter in the care of patients who experience a traumatic event and solutions for these barriers, and to estimate the influence of GP characteristics on the number of barriers experienced. METHODS: Telephone interviews were conducted among a sample of 500 Dutch GPs stratified by sex. Topics covered barriers in the care of victims of: accidents, incest in the past, ongoing physical or sexual abuse of adults, and ongoing physical or sexual abuse of children. RESULTS: The response rate was 44%. GPs are regularly confronted with patients who have experienced a traumatic event. GPs experience 10% barriers in care of patients who have difficulties getting over an accident, 13% in the care of incest victims, 16% in the care of adults who are physically or sexually abused, and 20% in the care of physically or sexually abused children. Most of the GPs recently updated their knowledge of care of victims of traumatic events, but still the majority feel in need of additional expert training. CONCLUSION: GPs experience the greatest number of barriers in the care of children who are abused. GP characteristics were not related to the number of barriers. However, seeing more victims was related to fewer barriers. To facilitate GP care of victims of traumatic events, GP training and continuing medical education should focus especially on skills education regarding the detection and initial treatment of traumatic events of ongoing physical or sexual abuse.     

Victimization from workplace bullying after a traumatic event: time-lagged relationships with symptoms of posttraumatic stress

Objective

This study examined relationships between victimization from bullying and symptoms of posttraumatic stress (PTSS) after exposure to a terror attack at the workplace. It was hypothesized that (1) victims of bullying report higher and more stable levels of PTSS over time compared to their non-bullied colleagues and (2) that PTSS provides an increased risk of subsequent victimization from bullying.

Methods

The hypotheses were tested in a two-wave prospective sample comprising 2337 employees from Norwegian governmental ministries who were exposed to the 2011 Oslo terror attack. The two waves of data collection were conducted 10 and 22 months after the terror attack.

Results

Hypothesis 1 was partially supported: victims of bullying reported significantly higher levels of PTSS than non-bullied employees at both measurement points, but bullying was not related to the stability in PTSS over time. In support of hypothesis 2, PTSS at 10 months was significantly associated with an increased risk of feeling victimized by bullying 1 year later.

Conclusions

The results indicate that victimization from bullying is associated with elevated levels of PTSS in the aftermath of a workplace terror attack, but that bullying does not have any impact on the long-term development of PTSS. PTSS may be a potential antecedent of bullying. These findings suggest that organizations must give high priority to the psychosocial work environment of traumatized employees to prevent further detrimental health consequences.