My job impacts my sleep: signs and symptoms of insomnia among healthcare workers

Potential insomnia in healthcare workers is a public health concern as it may degrade the quality of patient care. We examined the prevalence of insomnia symptoms in healthcare workers and their perceived need for a sleep intervention. Participants were 62 nurses working full-time at a U.S. hospital. These nurses were asked about background characteristics, perceived stress, sleep concerns, and need for a sleep intervention. They also participated in 14-d ecological momentary assessment (EMA) and actigraphy sleep study. A qualitative analysis showed that the majority (92%) of participants reported at least one sleep concern with insomnia-related concerns being most prevalent (68%). Quantitative analyses indicated that those with insomnia-related concerns had higher perceived stress overall and lower EMA sleep sufficiency and sleep quality. Moreover, participants with insomnia concerns had shorter actigraphy-measured nap duration prior to non-workdays than those without. Nearly all (95%) expressed interest in participating in a sleep intervention; an online format and mindfulness contents were most preferred. Our results suggest a high prevalence of insomnia symptoms and a high interest in a sleep intervention in nurses. Information obtained from this study could be used to deliver a tailored sleep intervention for nurses whose role in public health is essential.     

Fibronectin in Meningococcal Sepsis

ABSTRACT. Plasma fibronectin was measured with Laurell's immunoelectroassay in 44 patients with meningococcal sepsis. The average value (15.0±7.9 mg/dl) was lower than that in normal children (27.4±8.7 mg/dl) (p<0.001). Fibronectin in patients correlated positively with antithrombin III (AT-III) values (p<0.02), but not with protein C (0.05+), than in those without DIC (DIC⁻) (p<0.02), but were lower in both groups than in a normal control group. A negative correlation between fibronectin and protein C was only present in DIC⁻ patients (r:-0.773=p<0.01). Fibronectin varied independent of AT-III and protein C in DIC⁺ patients. The study was repeated in 11 patients 24 hours after admission when fibronectin had decreased in 7/11 cases (mean decrease: -2.7±8.7 mg/dl). This variation correlated in a negative way with AT-III (r:-0.659=p<0.05). In meningococcal sepsis fibronectin decreases very early, even in DIC⁻ patients and its relationship to AT-III and protein C is different, depending on the presence of DIC and on the stage of evolution of the disease.     

Cardiac Resynchronization in a Child with Dilated Cardiomyopathy and Borderline QRS Duration: Speckle Tracking Guided Lead Placement

Cardiac resynchronization therapy (CRT) is proved to prevent heart transplantation in some patients with dilated cardiomyopathy and mechanical dyssynchrony. We report of the benefit of CRT accomplished by atrial synchronized single-site left ventricular pacing in an 8-year-old boy with idiopathic dilated cardiomyopathy, normal atrioventricular conduction, borderline QRS complex duration (120 ms), and marked mechanical left ventricular dyssynchrony proved by echocardiographic speckle tracking.     

Hereditary xerocytosis: a report of six unrelated Spanish families with leaky red cell syndrome and increased heat stability of the erythrocyte membrane

Summary. Hereditary xerocytosis (HX) is a rare haemolytic disease due to dehydrated red blood cells (RBCs). A unique feature of this syndrome is that affected members often show normal or near normal haemoglobin levels despite clinical and laboratory evidence of mild to moderate haemolysis. The diagnostic clue is the association of markedly increased RBC Na⁺+K⁺ fluxes with low total cation (Na⁺ +K⁺) content. 11 patients of six unrelated families of Spanish origin with HX have been studied from clinical, genetical and biological points of view. In addition, we have investigated the sensitivity of RBC membrane to heat at three different incubation times (15, 30 and 60min) and two different temperature values (46°C and 49°C). Under these conditions control RBCs (50 normal subjects) exhibited at 49°C and 30min a maximum of 30% fragmented RBCs. This value increased to 80% after 60min of incubation. In contrast, patients with HX showed significantly lower percentages of fragmented RBCs at both 30 and 60min of incubation (maximum 10% and 30%, respectively). In an attempt to determine if increased heat stability was unique to HX RBCs, several other congenital membranopathies with haemolytic anaemia were also studied. The degree of fragmentation, except in one case of HPP (which was strongly increased), did not differ from the control group. Electrophoretic studies of membrane proteins performed in RBCs of all the patients with HX did not explain any qualitative nor quantitative abnormality.
In addition to its physiopathological interest, study of RBC heat stability, together with other haematological parameters (increased MCHC and decreased RBC osmotic fragility), may be useful for HX diagnosis, especially in laboratories which are not equipped to evaluate RBC membrane permeability.     

Time to First Shock in Implantable Cardioverter Defibrillator (ICD) Patients with Chagas Cardiomyopathy

The time to first ICD shock has been extensively studied in patients with coronary artery disease (CAD). However, there are no published data on ICD shocks in patients with Chagas cardiomyopathy (ChC). The occurrence of the first appropriate ICD shock during the first 6 months of follow-up in 20 patients with ChC (group 1) and 35 CAD patients (group 2) was analyzed retrospectively. All patients had received a third-generation pectoral ICD for ventricular tachycardia or fibrillation (VT/VF). Indications for ICD implantation were refractoriness to drug therapy or noninducibility of VT/VF at EPS in cardiac arrest survivors. Results: The mean age, left ventricular ejection fraction (LVEF), and sex in groups I and II were 57.4 ± 7 years versus 64 ± 9 (P < 0.01), 30.9%± 10% versus 32.9%± 10% (P = NS), and 10 men versus 31 women (P < 0.005), respectively. Six months after ICD implantation, 85% (17/20) group I patients received appropriate ICD shocks versus 51 % (18/35) in group 2, a statistically significant difference (P < 0.02, RR: 1.65, OR: 5.35). Conclusions: The incidence of appropriate ICD shocks within the first 6 months postimplantation was significantly higher in ChC patients than in CAD patients. ChC patients were younger and more often women than CAD patients.