Work at sea: a study of sleep,and of circadian rhythms in physiological and psychological functions,in watchkeepers on merchant vessels

Summary Daily diary records of sleep and activity, and 4-h measurements of body temperature, performance and subjective alertness were collected on board ship from 15 watchkeepers on the 4-on/8-off system, and from 28 dayworkers, on both westward and eastward transatlantic voyages. The data from a balanced sample of the subjects were analysed over selected 8-d periods of the voyages where four or five time zones were crossed. During these periods the average amount of daily sleep obtained by dayworkers on the eastward voyage was more than 1 h less than that on the westward voyage, and its quality was rated lower. Watchkeepers' main sleep was also shorter when travelling eastward, but this reduction was partially compensated for by a slightly longer secondary sleep. With the exception of subjective alertness on the eastward voyage, the basic phase of the circadian rhythms in the measured variables adjusted appropriately to the clock changes associated with the time zone crossings. The normal shape of the average daily curves was, however, altered differentially in the two directions of travel; as a result, morning levels of all variables were lower on the eastward voyage than on the westward, but evening levels were higher. These distortions of rhythm waveforms, which probably arose from a combination of endogenous and exogenous factors, add another dimension to the basic problem caused by the effects of circadian rhythms on operational efficiency in the shipboard situation. This problem can only be solved by the development of alternative watchkeeping systems which take full account of these rhythms.Partly supported by a grant from the West German Ministry for Technology and Research, Project Schiff der Zukunft, Part ET 83b     

Acute effects from occupational exposure to antineoplastic drugs in a para-professional health care worker

BACKGROUND: While health risks from occupational exposure of nursing and pharmacy staff have been recognized, exposure of para-professional health care workers (HCW) has received little attention. METHODS: This case report describes a patient care assistant who developed allergic reactions subsequent to exposure to urine of oncology patients who had been treated with antineoplastics. RESULTS: The patient care assistant on two occasions developed a pruritic, disseminated rash shortly after emptying commodes containing the urine of oncology patients treated with Vincristine and Adriamycin (doxorubicin). CONCLUSIONS: Increased attention should be focused on the occupational exposures of para-professional HCWs to potentially hazardous antineoplastics.     

Health needs of prisoners in England and Wales: the implications for prison healthcare of gender, age and ethnicity

This paper aims to provide evidence of the healthcare needs of prisoners in relation to gender, age and ethnicity, drawing from a larger systematic overview of the policy and research literature concerning primary care nursing in prisons in England and Wales. The literature overview shaped the initial stages of a research project funded by the Department of Health to examine the views and perspectives of prisoners and nurses working in prisons, and to identify good primary care nursing in the prison environment. At total of 17 databases were searched using search terms related to primary healthcare in prisons (health, nurs*, primary care, healthcare, family medicine, prison*, offender*, inmate*) with terms truncated where possible in the different databases. Following this, a sifting phase was employed using inclusion/exclusion criteria to narrow and focus the literature perceived as relevant to the research questions. All papers were critically appraised for quality using standardised tools. Findings from the literature overview show that prisoners are more likely to have suffered some form of social exclusion compared to the rest of society, and there are significantly greater degrees of mental health problems, substance abuse and worse physical health in prisoners than in the general population. Women, young offenders, older prisoners and those from minority ethnic groups have distinct health needs compared to the prison population taken as a whole, with implications for the delivery of prison healthcare, and how these needs are met effectively and appropriately.     

Partnerships and pathways of dissemination: The National Institute on Drug Abuse—Substance Abuse and Mental Health Services Administration Blending Initiative in the Clinical Trials Network

Since 2001, the National Drug Abuse Treatment Clinical Trials Network (CTN) has worked to put the results of its trials into the hands of community treatment programs, in large part through its participation in the National Institute on Drug Abuse—Substance Abuse and Mental Health Services Administration Blending Initiative and its close involvement with the Center for Substance Abuse Treatment's Addiction Technology Transfer Centers. This article describes (a) the CTN's integral role in the Blending Initiative, (b) key partnerships and dissemination pathways through which the results of CTN trials are developed into blending products and then transferred to community treatment programs, and (c) three blending initiatives involving buprenorphine, motivational incentives, and motivational interviewing. The Blending Initiative has resulted in high utilization of its products, preparation of more than 200 regional trainers, widespread training of service providers in most U.S. States, Puerto Rico, and the U.S. Virgin Islands and movement toward the development of Web-based implementation supports and technical assistance. Implications for future directions of the Blending Initiative and opportunities for research are discussed.     

Psychological disability in women who relinquish a baby for adoption

During 1986, approximately 2000 women in Australia are likely to relinquish a baby for adoption. A study is presented of 20 relinquishing mothers that demonstrates a very high incidence of pathological grief reactions which have failed to resolve although many years have elapsed since the relinquishment. This group had abnormally high scores for depression and psychosomatic symptoms on the Middlesex Hospital questionnaire. Factors that militate against the resolution of grief after relinquishment are discussed. Guidelines for the medical profession that are aimed at preventing psychological disability in relinquishing mothers are outlined.     

Mechanisms involved in the action of serotonin-induced stimulation of progesterone production by bovine luteal cells in vitro

Serotonin (5-HT)-induced stimulation or progesterone (P4) production by bovine luteal cells was characterized with respect to the receptor subtype mediating this response, the steroidogenic response to 5-HT metabolites, the role of adenylate cyclase, and the 5-HT concentration of bovine luteal tissue. Addition of 5-HT (10(-5) M) stimulated the production of P4 (P less than 0.05) and this stimulation was inhibited by the 5-HT antagonist mianserin at a concentration of 10(-5) M (P less than 0.05), but not at a mianserin concentration of 10(-7) M. Additionally, the response to 5-HT could not be inhibited by ketanserin (10(-5) M), a 5-HT2 receptor antagonist. Incubation of luteal cells with a specific 5-HT1 agonist, (+/-)-8-hydroxydipropylaminotetralin HBr (DPAT) (10(-4) M), stimulated the production of P4 (P less than 0.05) and this response could not be blocked by mianserin at 10(-7) M or by ketanserin, but was inhibited by mianserin at 10(-5) (P less than 0.05). The addition of the 5-HT metabolite 5-methoxytryptamine (5-MTA) stimulated P4 production (P less than 0.05) and this response could be inhibited by mianserin (10(-5) M, P less than 0.05). Neither, N-acetyl-5-HT nor 5-methoxytryptophan significantly affected P4 production. The addition of the phosphodiesterase inhibitor 3-isobutyl-methylxanthine (IBMX, 0.1 mM) potentiated the effects of 5-HT and DPAT (P less than 0.05), but this effect was additive rather than synergistic. In contrast, the addition of luteinizing hormone (10 ng/ml) plus IBMX resulted in a significant synergistic response (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Jejunostomy. A rarely indicated procedure

Jejunostomy is an alternative for alimentation in patients who cannot be fed orally. Seventy-three patients from the Medical College of Wisconsin Hospitals, Milwaukee, who underwent jejunostomy for gastrointestinal tract obstruction or dysfunction (28 patients), carcinoma (23 patients), neurologic disorders (13 patients), and other indications (nine patients) by the Stamm (46 patients), Witzel (17 patients), and Maydl (nine patients) techniques were studied. Forty-four patients survived and were discharged, while 29 died in the hospital. Fifty-three complications were documented among 34 patients. The jejunostomy was actually used for feeding in only 48 patients, and only 18 were discharged while receiving maintenance enterostomy feedings. Seven patients died as a direct result of complications of the jejunostomy. Jejunostomy is not an innocuous procedure; it carries a substantial risk of death and complications. Jejunostomy should be performed for alimentation only in patients with clear indications and a high potential for long-term use.     

Factors impacting on shared care working relationships between practice nurses and general practitioners: a literature review

Practice nurses have worked in general practice for many years yet little is known or published in Australia about their work. Recent health care reforms in Australia, particularly the establishment of the Divisions of General Practice and various best-practice innovations linked to the National GP Strategy have seen an increase in the role of practice nurses. Despite this GPs in Australia are cautious about the role of practice nurses. Much of this caution arises from reform in general practice in Britain particularly the establishment of fund-holding for general practice. This article reviews the literature on practice nurses in Britain and Australia within the framework of the health reforms in general practice in both countries.     

Factors that adolescent males take into account in decisions about an unplanned pregnancy

Little is known about what factors adolescent males consider important when making decisions concerning the resolution of an unplanned pregnancy with a teenage partner. Young men's influence on pregnancy outcome decisions can play an important part in the subsequent psychological adjustment of the female. The present report draws on data from a larger study with teenage males [Condon, J. T., Corkindale, C. J., Russell, A., & Quinlivan, J. A. (2006). Processes and factors underlying adolescent males' attitudes and decision-making in relation to an unplanned pregnancy. Journal of Youth and Adolescence, 35, 447–458], and extends the findings of that study.Using a 25-item scale embedded in an electronic role-play, data were obtained from 330 male Australian school students on their priorities and concerns in relation to possible outcomes of a partner's pregnancy.Common factors taken into account by almost the entire adolescent sample related to the negative effects of becoming a teenage father. The differences between participants were identified using cluster analysis, which produced three groupings. The majority group was characterised as ‘well-balanced’ (80.6%), and the two minority groups as ‘unwilling/unready’ (10.9%) and ‘family-centred’ (8.5%). Group membership was strongly predictive of the males' final decision regarding the hypothetical pregnancy outcome. Understanding adolescent attitudes and beliefs when faced with this decision may assist practitioners in their guidance of the young couple and help prevent negative psychological sequelae.     

A novel technique for repair of iatrogenic tracheal tear complicating three-stage oesophagectomy

We report a rare case of iatrogenic tracheal tear during a three-stage oesophagectomy in a 76-year-old woman and review current literature. The tear occurred due to trauma from a double lumen endotracheal tube. We used a novel technique of repairing the tear, which extended to the carina, avoiding a second thoracotomy or full sternotomy by using the laparoscopic suturing instruments.