Exploring within- and between-gender differences in burnout: 8 different occupational groups

Objectives  

The aim of this study was to examine gender differences in burnout within and between occupations using latent mean analysis.     

Duration of Central Action of Angiotensin II Estimated by its Interaction with CSF Na+

In pre-hydrated goats, an urge to drink persisted for approximately half an hour after combined infusions of angiotensin II and hypertonic (0.5 M) NaCl into the lateral or third cerebral ventricle. The intraventricular infusion of angiotensin/glucose solution, having no dipsogenic action of its own, markedly accentuated the dipsogenic and antidiuretic effects of the subsequent intraventricular infusion of hypertonic NaCl. The possibility is discussed that angiotensin may be bound at periventricular receptor sites where it continues to interact with Na⁺ in eliciting thirst and ADH release for about half an hour.     

Improvement of Physical Activity by a Kiosk-based Electronic Screening and Brief Intervention in Routine Primary Health Care: Patient-Initiated Versus Staff-Referred

Background

Interactive behavior change technology (eg, computer programs, Internet websites, and mobile phones) may facilitate the implementation of lifestyle behavior interventions in routine primary health care. Effective, fully automated solutions not involving primary health care staff may offer low-cost support for behavior change.

Objectives

We explored the effectiveness of an electronic screening and brief intervention (e-SBI) deployed through a stand-alone information kiosk for promoting physical activity among sedentary patients in routine primary health care. We further tested whether its effectiveness differed between patients performing the e-SBI on their own initiative and those referred to it by primary health care staff.

Methods

The e-SBI screens for the physical activity level, motivation to change, attitudes toward performing the test, and physical characteristics and provides tailored feedback supporting behavior change. A total of 7863 patients performed the e-SBI from 2007 through 2009 in routine primary health care in Östergötland County, Sweden. Of these, 2509 were considered not sufficiently physically active, and 311 of these 2509 patients agreed to participate in an optional 3-month follow-up. These 311 patients were included in the analysis and were further divided into two groups based on whether the e-SBI was performed on the patient´s own initiative (informed by posters in the waiting room) or if the patient was referred to it by staff. A physical activity score representing the number of days being physically active was compared between baseline e-SBI and the 3-month follow-up. Based on physical activity recommendations, a score of 5 was considered the cutoff for being sufficiently physically active.

Results

In all, 137 of 311 patients (44%) were sufficiently physically active at the 3-month follow-up. The proportion becoming sufficiently physically active was 16/55 (29%), 40/101 (40%), and 81/155 (52%) for patients with a physical activity score at baseline of 0, 1 to 2, and 3 to 4, respectively. The patient-initiated group and staff-referred group had similar mean physical activity scores at baseline (2.1, 95% confidence interval [CI] 1.8-2.3, versus 2.3, 95% CI 2.1-2.5) and at follow-up, (4.1, 95% CI 3.4-4.7, vs 4.2, 95% CI 3.7-4.8).

Conclusions

Among the sedentary patients in primary health care who participated in the follow-up, the e-SBI appeared effective at promoting short-term improvement of physical activity for about half of them. The results were similar when the e-SBI was patient-initiated or staff-referred. The e-SBI may be a low-cost complement to lifestyle behavior interventions in routine primary health care and could work as a stand-alone technique not requiring the involvment of primary health care staff.     

Simple search techniques in PubMed are potentially suitable for evaluating the completeness of systematic reviews

ObjectiveThe Institute for Quality and Efficiency in Health Care (IQWiG) assesses the added benefit of new drugs by means of company dossiers. The pharmaceutical company performs the information retrieval, which is then assessed by IQWiG. Our aim was to determine whether PubMed's Related Citations (RelCits) and/or a simple-structured Boolean search (SSBS) are efficient and reliable search techniques to assess the completeness of an evidence base consisting of published randomized controlled trials (RCTs).Study Design and SettingRetrospective analysis of citations included as relevant in systematic reviews (SRs) of drugs. The proportion of relevant citations identified by the above-mentioned search techniques was determined. Relative sensitivity, precision, and the number needed to read (NNR) were then calculated.ResultsA total of 19 SRs included 330 relevant PubMed citations. The single techniques yielded either insufficient completeness, reliability, or efficiency. The first 20 RelCits plus SSBS achieved high completeness and reliability (sensitivity: 98.1%, range: 80–100%) and sufficient efficiency (precision: 5.0%, NNR: 25). The first 50 RelCit plus SSBS achieved slightly better completeness and reliability, but slightly worse efficiency.ConclusionCombining the first 20 RelCits and an SSBS in PubMed is a suitable method to assess the completeness of an evidence base of published RCTs.     

Neuron specific enolase and S-100B as predictors of outcome after cardiac arrest and induced hypothermia

Aim

To assess the prognostic value of repetitive serum samples of neuron specific enolase (NSE) and S-100B in cardiac arrest patients treated with hypothermia.

Methods

In a three-centre study, comatose patients after cardiac arrest were treated with hypothermia at 33 °C for 24 h, regardless of cause or the initial rhythm. Serum samples were collected at 2, 24, 48 and 72 h after the arrest and analysed for NSE and S-100B in a non-blinded way. The cerebral performance categories scale (CPC) was used as the outcome measure; a best CPC of 1–2 during 6 months was regarded as a good outcome, a best CPC of 3–5 a poor outcome.

Results

One centre was omitted in the NSE analysis due to missing 24 and 48 h samples. Two partially overlapping groups were studied, the NSE group (n = 102) and the S-100B group (n = 107). NSE at 48 h >28 μg/l (specificity 100%, sensitivity 67%) and S-100B >0.51 μg/l at 24 h (specificity 96%, sensitivity 62%) correlated with a poor outcome, and so did a rise in NSE of >2 μg/l between 24 and 48 h (odds ratio 9.8, CI 3.5–27.7). A majority of missing samples (n = 123) were from the 2 h sampling time (n = 56) due to referral from other hospitals or inter-hospital transfer.

Conclusion

NSE was a better marker than S-100B for predicting outcome after cardiac arrest and induced hypothermia. NSE above 28 μg/l at 48 h and a rise in NSE of more than 2 μg/l between 24 and 48 h were markers for a poor outcome.     

Catecholamine and cortisol reaction to childbirth

One way to study the stressfulness of childbirth is to examine the output of stress hormones. In this study, urinary catecholamines and salivary cortisol from 50 primiparous women were collected for 1 day during gestational weeks 37 to 39, hourly during labor and delivery, and 2 hr and 2 days postpartum. All three stress hormones increased statistically significantly from pregnancy to labor. The increase in adrenaline and cortisol was more than 500%, and the increase in noradrenaline was about 50%. After labor, the output decreased but not statistically significantly below the levels during late pregnancy. Hormone levels during late pregnancy, during labor and delivery, and during the period postpartum mostly did not correlate systematically. However, noradrenaline and adrenaline, as well as adrenaline and cortisol, were positively correlated during labor. After administration of epidural analgesia, there was a moderate but significant decrease in noradrenaline and adrenaline, whereas cortisol did not change. In conclusion, the results of this study support the assumption that childbirth is a very stressful event and that the stress responses vary considerably among women. The substantial increase of adrenaline and cortisol compared with noradrenaline indicates that mental stress is more dominant than physical stress during labor. This study was fundedbyresearch grants from the Swedish Foundation for Health Care Sciences and Allergy Research, and The Bank of Sweden Tercentenary Foundation.     

Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study

Purpose

To assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA).

Methods

We performed a prospective international multicenter study (10 centers) in adult comatose CA patients. Quantitative NPi and standard manual pupillary light reflex (sPLR)—blinded to clinicians and outcome assessors—were recorded in parallel from day 1 to 3 after CA. Primary study endpoint was to compare the value of NPi versus sPLR to predict 3-month Cerebral Performance Category (CPC), dichotomized as favorable (CPC 1–2: full recovery or moderate disability) versus unfavorable outcome (CPC 3–5: severe disability, vegetative state, or death).

Results

At any time between day 1 and 3, an NPi?≤?2 (n?=?456 patients) had a 51% (95% CI 49–53) negative predictive value and a 100% positive predictive value [PPV; 0% (0–2) false-positive rate], with a 100% (98–100) specificity and 32% (27–38) sensitivity for the prediction of unfavorable outcome. Compared with NPi, sPLR had significantly lower PPV and significantly lower specificity (p? <?0.001 at day 1 and 2; p ?=?0.06 at day 3). The combination of NPi?≤?2 with bilaterally absent somatosensory evoked potentials (SSEP; n?=?188 patients) provided higher sensitivity [58% (49–67) vs. 48% (39–57) for SSEP alone], with comparable specificity [100% (94–100)].

Conclusions

Quantitative NPi had excellent ability to predict an unfavorable outcome from day 1 after CA, with no false positives, and significantly higher specificity than standard manual pupillary examination. The addition of NPi to SSEP increased sensitivity of outcome prediction, while maintaining 100% specificity.

     

Parenteral nutrition in patients with liver cirrhosis. Effects on circulating levels of glucose and hormones and on cerebral function

The effects of 2 and 5 days of total parenteral nutrition (TPN; 70 g amino-acids, 100 g fat, 150 g glucose) on carbohydrate, fat and amino-acid levels and on cerebral function were investigated in 10 patients with alcoholic cirrhosis and 7 age-matched healthy controls. The results were compared to those after a standardised oral diet. During TPN, glucose concentrations increased slightly in both groups. Insulin concentrations also rose in both groups, but the rise was more pronounced in the patients, resulting in a 10-fold difference between the two groups after 6.5 hours (patients: 281 +/- 81 U/l; controls: 28 +/- 5 U/l; p < 0.02). Glucagon increased significantly during TPN in the patients only (33%, p < 0.05). Similar but less pronounced patterns were observed after the oral diet. The basal concentrations of free fatty acids and 3-OH-butyrate were higher in the patients than in the controls. However, during both oral and parenteral nutrition, the concentrations fell in both groups. For 3-OH-butyrate the difference between the groups disappeared, while the free fatty acid levels remained higher in the patients throughout the TPN administration. Basal triglyceride levels were similar in patients and controls and rose to a similar extent in both groups during TPN. Plasma amino-acid concentrations were typical for cirrhotic patients in the basal state: low levels of the branched-chain amino-acids (BCAA) and high concentrations of the aromatic amino-acids (AAA). During TPN BCAA, as well as AAA, increased in both patients and controls, resulting in unaltered BCAA AAA ratio. All patients performed poorly on psychometric tests (Number Connection Tests A and B; Digit Symbol) before the study, indicating subclinical encephalopathy. However, no deterioration was observed in any of the tests during five days of TPN. Similarly, EEG and visual evoked potentials were unchanged during the study, demonstrating that patients with severe alcoholic liver disease tolerate a balanced intravenous nutrition without adverse effects on cerebral function.