A process model of shiftwork and health.

The authors developed and tested a process model of adaptation to shiftwork, which hypothesizes that various individual and situational variables influence the development of sleep and social and domestic disturbances. Both types of disturbances trigger various types of coping behavior, leading to several proximal outcomes. The end result is the development of chronic health problems in the form of digestive and cardiovascular symptoms. The model was tested with survey data collected from 2 samples of nurses (N = 1,532) in the United Kingdom and was cross-validated against a 3rd sample of industrial workers (N = 370). Results indicate support for the model across the 3 samples, although some sample-specific and subgroup effects were found. Results have direct implications for the development of shiftwork theory and interventions.     

Improving and sustaining outpatient cancer screening by medicine residents

The sustained effectiveness in improving resident performance of breast, cervical, and colorectal cancer screening examinations in the medicine outpatient department (OPD) was studied. Residents were divided into two groups: an intervention group, which received lectures presenting cancer screening rationale and recommendations, followed by chart reminders for three months, and a control group with no intervention. Charts were reviewed for cancer screening performance before, and one and six months after the intervention. Results showed increased performance of Pap smears (50% vs 22%, P less than .04 at one month and 46% vs 23%, P less than .08 at six months) and rectal examinations (73% vs 58%, P less than 0.2 at six months) by the intervention group. There was no improvement in breast examination performance over baseline (39%). Other screening examinations were rarely done. Future outpatient practice will include preventive health care, and greater emphasis must be devoted to increasing and sustaining residents' cancer screening performance to improve these results.     

Experimental study of morphological changes after gastroplasty

Twelve rabbits were sacrificed one and three days, one, two, four and eight weeks after horizontal gastroplasty in order to investigate morphological changes after operation. Histology of the proximal pouch of the stomach showed various degrees of mucosal damage and a close relationship between its severity and high pH of the pouch. This suggested the usefulness of pH measurement of the gastric juice in the proximal pouch as an indicator of mucosal damage after gastroplasty.     

Residents' use of humanistic skills and content of resident discussions in a support group.

In a 1983 position paper, the American Board of Internal Medicine stressed the importance of teaching humanistic skills to residents; however, how to teach or measure these skills is not well defined. In this study, the content of discussion (personal and professional problems) and processing of four humanistic skills (empathy, level of regard, unconditionality, and congruence) by Bowman Gray School of Medicine first year general medicine residents was observed. Fourteen videotapes of support group meetings from 1986 to 1988 were reviewed for humanistic relationship behaviors using the Barrett-Lennard Relationship Inventory and for the types of personal and professional problems discussed using a content inventory. Barrett-Lennard Relationship Inventory scores for empathy and regard paralleled increases in the number of professional problems raised at midyear, a time of maximum stress for residents. Congruence scores became flat after an initial peak while unconditionality scores remained low. Interventions designed to improve residents' use of humanistic skills could take into account residents' need for support and education, as well as the natural flow of humanistic behaviors within residency programs.     

The effects of methadone on maternal-fetal interactions in the rat.

Female Sprague-Dawley rats received methadone (25 mg/kg/day) by gavage throughout gestation. Water-gavaged rats served as controls. Fetuses were delivered by cesarean section when parturition was imminent. Our results indicate that methadone may interfere with fetal development and maternal-fetal interactions to some degree. The observed alterations were as follows: fetal growth retardation, an interference with the triggering of parturition once normal delivery size is attained and possible positional malformations.     

Thrombosis due to permanent pacemaker and oral contraceptives

Upper-extremity deep venous thrombosis, an uncommon complication of oral contraceptive therapy, has not been described in patients with permanent pacemakers. The following case, clearly related to initiation of oral contraceptive therapy, points out perhaps another small but significant patient population in which this method of birth control is contraindicated.