Investigating stress effect patterns in hospital staff nurses: Results of a cluster analysis

A comprehensive and reliable assessment of work stress, burnout, affective, and physical symptomatology was conducted with 260 hospital nurses. As previous attempts to categorize nursing stress and burnout by ward type have yielded inconsistent results, an alternative method for grouping nursing stress effects was sought. Cluster analysis was chosen as it offers a statistically sound means of delineating natural groupings within data. Sets of questionnaires measuring burnout, work stressors, and physical and emotional symptomatology were sent to all staff nurses at a large university hospital. Of 709 nurses employed there, a total of 260 nurses returned completed questionnaire packets. These nurses were separated into two equal groups using random sampling procedures. Cluster analysis of this data revealed groupings which were based on nursing stressors (particularly workload and conflict with physicians), social support, and patient loads. These cluster-analytic findings were replicated on both samples, and validated using data not used in the original cluster analysis. Results suggest that the effects of stress have more to do with the characteristics of the work environment and overall workload than with the degree of specialization on the unit. Results also suggest that intraprofessional conflict (i.e. with other nurses) is less psychologically damaging than is interprofessional conflict (i.e. conflict with physicians). Findings are discussed with respect to the burnout process and possible interventions.     

Sexually transmitted diseases control in developing countries.

Sexually transmitted diseases (STDs) are a major public health problem now compounded by the advent of AIDS and HIV infection. The size of the problem represented by STDs and HIV is unknown however it is estimated that there are 333 million new cases of STD per annum and currently 15-20 million people infected worldwide with HIV. Control programmes for STDs must prevent the acquisition of STDs, their complications and sequelae and interrupt and reduce transmission. They can also reduce the incidence of HIV infection. Such programmes must place emphasis on health education, condom usage, altering health seeking behaviour and providing case management. The syndromic approach currently offers the most realistic, and cost effective, way in which to treat patients.     

Risk factors for delayed immunization among children in an HMO.

OBJECTIVES. Improving the timely delivery of childhood immunizations has become a national imperative. This study aimed to identify nonfinancial predictors of delayed immunization among patients with good financial access to preventive care. METHODS. This prospective cohort study used telephone interviews and a computerized immunization tracking system to evaluate 13-month-old children (n = 530) in a regional group-model health maintenance organization. RESULTS. More than one third of parents interviewed did not know when the next immunization was due. Thirteen percent were late for the measles-mumps-rubella immunization, recommended at 15 months of age, by 90 days or more. Independent predictors of delayed immunization included having a larger number of children (odds ratio [OR] = 1.4, P < .01), not having a regular doctor (OR = 2.9, P < .05), not knowing when the shot was due (OR = 2.0, P < .01), and not worrying about the risks of shots (OR = 1.4, P < .05). CONCLUSIONS. Financial access alone does not guarantee timely childhood immunization. In managed care settings, which may cover increasing numbers of children under health care reform, interventions are needed to better inform parents of when immunizations are due.     

Involved field radiation, fractionated total body irradiation, high dose cyclophosphamide, and autologous bone marrow transplantation in the treatment of malignant lymphomas

We report the results of intensive therapy and autologous bone marrow transplantation (BMT) in 23 patients with malignant lymphoma (eight Hodgkin's disease and 15 non-Hodgkin's lymphoma) who failed primary therapy. All patients had evidence of disease prior to transplant therapy: 10 had never achieved a complete remission and 13 were in relapse. The preparative regimen included involved field radiation followed by fractionated total body irradiation and high dose cyclophosphamide. A complete remission was achieved in 15 patients, 11 of whom continue in unmaintained complete remission from 27 to 72 months after BMT (median follow-up of 52 months). Of the remaining patients, five did not achieve a complete remission and three died of early toxicity. The event-free survival of the entire group is 47%. Disease status at the time of BMT was significantly correlated with patient outcome. The event-free survival of 13 patients in whom there was no objective evidence of tumor growth on conventional dose therapy was 77% compared with only 10% in patients with tumors progressing on conventional dose therapy (p less than 0.002). All six patients transplanted in untreated relapse continue in unmaintained remission, suggesting that debulking chemotherapy may not be necessary before BMT. Alternative approaches are needed in patients whose tumors progress on conventional dose therapy.     

Implications of remarriage and stepfamily formation for marriage education*

Couples in remarriages with stepchildren are a significant portion of the marriage population and have unique educational needs regarding aspects of couple functioning within the context of stepfamily development. From a review of the literature, we examine current curricula focused on these couples. Information is offered on implementation issues regarding recruitment, delivery context, facilitator and participant characteristics, and evaluation.     

Clastogenicity of diepoxybutane in bone marrow cells and male germ cells of mice

The bifunctional metabolite of 1,3-butadiene, 1,2:3,4-diepoxybutane(DEB), was tested in the mouse bone marrow micronucleus assayand in male mouse germ cell tests, namely the analysis of firstcleavage divisions and the dominant lethal assay. All experimentswere performed with single intraperitoneal treatment of theanimals. In the micronucleus test, DEB doses of 4.5, 9.0, 18.0and 36.0 mg/ kg body weight were tested at a sampling intervalof 24 h for bone marrow. The dose response for the inductionof micronuclei in polychromatic erythrocytes was linear withthe lowest effective dose of 9.0 mg/kg body weight No sensitivitydifference was observed between male and female mice. The cytogeneticanalysis of first cleavage division chromosomes was performedafter treatment of male mice with 17, 26, 34, 43 and 52 mg/kgbody weight of DEB and mating the males to hormonally stimulatedfemales on days 7, 14, 21 and 28 after treatment The two higherdoses caused general toxicity evidenced by the poor mating behaviorof the males. Only 13 and 20% of the mated females were fertilizedon day 7 after treatment of the males with 43 and 52 mg/kg bodyweight of DEB, respectively. An increased number of unfertilizedoocytes was obtained from fertilized females on day 7 aftertreatment of the males with 34 mg/kg body weight of DEB. Witha dose of 26 mg/kg body weight, it was demonstrated that chromosomalaberrations were only induced in spermatozoa (mating on day7 after treatment) while spermatids (mating on days 14 and 21)and spermatocytes (mating on day 28) were not susceptible tothe clastogenic effect of DEB. The response in spermatozoa inthe dose range 17–34 mg/kg body weight was linear up to26 mg/kg body weight and reached a plateau thereafter. The resultsof the dominant lethal experiments performed in the dose range18–54 mg/kg body weight gave results similar to the cytogeneticstudy. With the highest dose tested, the toxicity and cytotoxicityduring the first 8 mating days after treatment dramaticallyreduced the number of pregnant females and, consequently, thetotal implantations, so that no significant dominant lethaleffect could be assessed. During mating days 9–12 (treatedlate spermatids), a significant dominant lethal effect was observed.With the two lower doses (18 and 36 mg/kg body weight), thedominant lethal effect was restricted to spermatozoa. The goodcorrelation of the chromosomal aberrations with dominant lethalmutations confirms the chromosomal origin of dominant lethaleffects. The clastogenic effect of DEB in somatic cells andin germ cells of mice was of the same order of magnitude. ³To whom correspondence should be addressed     

Diagnostic value of sialochemistry. Results of an albumin study

In 196 patients suffering from disease of the cephalic salivary glands and in 57 healthy controls the concentration of albumin in parotid and submandibular saliva was measured by the immunodiffusion technique. To summarize the results, albumin seems to be a reliable marker of inflammations of the salivary glands even in the early stages and is therefore recommended for the primary diagnostic and the follow-up of acute and chronic inflammatory conditions of the major cephalic salivary glands. In combination with the evaluation of the flow rate, other sialochemic parameters like phosphohexose isomerase and kallikrein activity, B-mode sonography and fine needle aspiration biopsy the frequency of x-ray examination of the radiosensitive salivary glands may be reduced.     

Diagnosis and evaluation of adults with attention-deficit/hyperactivity disorder.

Although some areas of adult ADHD knowledge remain unclear, there isa strong sense of how to proceed with diagnosis using current DSM-IV criteria as a guide. Thorough clinical interview, aided by the use of rating scales for current symptoms and collateral information about childhood from parents or siblings, forms the backbone of the assessment. The poor psychosocial outcomes of patients with ADHD. often a consequence of unrecognized,untreated disorder manifestation, also can serve as a diagnostic indicator. Diagnostic and symptom assessment scales also can be a significant helpin diagnosing and establishing the symptoms of ADHD in adults. It is important to remember that according to DSM-IV, the cardinal criteria for making the diagnosis are the presence of sufficient current symptoms and impairment in two realms (home, school/work, and social interactions). Accordingly, adult ADHD remains a clinical diagnosis, and the clinician-administered interview remains the cornerstone of diagnostic evaluation.