Burnout and psychological distress among nurses in a Nigerian tertiary health institution

Background

The role of nurses in the health care delivery system cannot be overemphasized. Nurses are needed at all levels of healthcare and the profession requires a lot of dedication, time and energy with regards to patient management and service delivery. This time investment and dedication to duty is likely to lead to burnout and psychological distress among the nurses.

Objective

This study assesses the prevalence of burnout and psychological distress among nurses working in Nigerian tertiary health institution.

Method

The Maslach Burnout Inventory (MBI) and the General Health Questionnaire (GHQ-12) were used to assess 210 nurses working in this health institution for symptoms of burnout and psychological distress.

Results

High levels of burnout were identified in 42.9% of the respondents in the area of emotional exhaustion, 47.6% in the area of depersonalization and 53.8% in the area of reduced personal accomplishment, while 44.1% scored positive in the GHQ-12 indicating presence of psychological distress.

Conclusion

Prevalence of burnout and psychological distress is high among nurses.     

Importance of nitric oxide in hepatic arterial blood flow and total hepatic blood volume regulation in pigs

The importance of nitric oxide in regulating basal arterial blood flow has been examined in several different vascular beds by intra-arterial infusion of inhibitors of nitric oxide synthesis, but not in the arterial vascular bed of the liver. In the present study, N^G-nitro-L -arginine (L -NNA), in a dose of 0.5 and 1.0 μmol mL^?1 of hepatic arterial blood flow, was infused for 5 min into the hepatic artery in seven pigs anaesthetized with pentobarbital sodium. The haemodynamic effects observed by the first infusion were not further enhanced by the second infusion. Hepatic arterial resistance increased by 143 ± 38% and hepatic arterial blood flow declined by 38 ± 10%. A systemic effect due to `spillover' was observed, as evidenced by an increase in mean aortic blood pressure of 24 ± 4 mmHg. However, no significant increase in arterial mesenteric resistance was observed and total liver blood flow remained unchanged. Hepatic arterial vasodilation in response to occlusion of the portal vein, the arterial buffer response, remained intact after inhibition of nitric oxide synthesis. Liver lobe thickness, measured by an ultrasonic technique,was not found to change with inhibition of arterial nitric oxide synthesis, excluding a significant direct effect of arterial nitric oxide on liver capacitance. In conclusion, nitric oxide is an important regulator of hepatic arterial resistance, but does not mediate the hepatic arterial buffer response and was not found to play any significant role in total hepatic capacitance regulation.     

The value of local registry data for describing cervical cancer management and outcomes over three decades in Australia

Registry data on invasive cervical cancers (n = 1,274) from four major hospitals (1984‐2012) were analysed to determine their value for informing local service delivery in Australia. The methodology comprised disease‐specific survival analyses using Kaplan‐Meier product‐limit estimates and Cox proportional hazards models and treatment analyses using logistic regression. Five‐ and 10‐year survivals were 72% and 68%, respectively, equating with relative survival estimates for Australia and the USA. Most common treatments were surgery and radiotherapy. Systemic therapies increased in recent years, generally with radiotherapy, but were less common for residents from less accessible areas. Surgery was more common for younger women and early‐stage disease, and radiotherapy for older women and regional and more advanced disease. The proportion of glandular cancers increased in‐step with national trends. Little evidence of variation in risk‐adjusted survival presented over time or by Local Health District. The study illustrates the value of local registry data for describing local treatment and outcomes. They show the lower use of systemic therapies among residents of less accessible areas which warrants further investigation. Risk‐adjusted treatment and outcomes did not vary by socio‐economic status, suggesting equity in service delivery. These data are important for local evaluation and were not available from other sources.     

抗肿瘤药物的研究Ⅲ. 数种锑胺羧螯合物对实验肿瘤的作用

1.锑胺羧螯合物是一种新型的抗肿瘤药物,应用Sb-26(EDTA-SbNa)、Sb-57(PDTA-SbNa)、Sb-66(HEDT-Sb)和Sb-71(ATA-Sb)分别为15—20、30—50、25—30和20—40毫克/公斤剂量时,均能显著地抑制小白鼠Ehrlich 腹水瘤的生长,平均延长生存时间4—22天,延长率36—147%.上述剂量对大白鼠Guerin 氏癌也有抑制作用,抑制率为58—70%.后3个药物,还能使小白鼠梭形细胞肉瘤腹水型的生存时间延长5—16天,延长率50—160%,其中以Sb-71的疗效最著.Sb-26、Sb-57、Sb-71、Sb-66对肉瘤180和AK 肉瘤及前3者对Ehrlich 固体瘤和淋巴白血病固体型的实验结果,除Sb-71对肉瘤180有抑制作用外,其他均无疗效.2.4 类锑化合物:3个(月弟)酸化合物(Sb-8,Sb-11和Sb-42)及1个酒石酸锑(Sb-15),与螯合的间苯二酚锑(Sb-64)和8羟基喹啉锑(Sb-85)各1个,对Ehrlich 腹水瘤的实验结果,均无明显疗效.3.小白鼠的急性半数致死量,Sb-57和Sb-71分别为131和62毫克/公斤,亚急性半数致死量分别为75和58毫克/公斤.     

自血混合丙球穴位注射对哮喘豚鼠肺超微结构变化的观察

目的与方法　利用透射式电子显微镜观察自血混合丙球穴位注射对过敏性哮喘豚鼠肺超微结构变化情况。结果　丙球穴注组豚鼠肺组织内EOS、纤维组织减少;自血穴注组比丙球穴注组疗效好,而自血混合丙球穴注组过敏性豚鼠肺组织内EOS基本消失,基底膜无增厚,胶原纤维无增生,镜下观察与正常组基本无区别。结论　自血混合丙种球蛋白穴位注射治疗哮喘有可靠的超微结构依据。     

Distinct prevalence of the CYP19 Delta3(TTTA)(7) allele in premenopausal versus postmenopausal breast cancer patients,but not in control individuals

The CYP19 gene encodes the enzyme aromatase, which plays a key role in the conversion of androgens to oestrogens. A polymorphism in CYP19 in intron 4 (TTTA)n has been reported to be associated with breast cancer (BC) risk, although conflicting evidence has also been published. Here, we employ a non-traditional, highly demonstrative design of a molecular epidemiological study, where the comparison of BC cases and healthy middle-aged female donors was supplemented by an analysis of groups with extreme characteristics of either BC risk (bilateral breast cancer (biBC) patients) or cancer tolerance (tumour-free elderly women aged >or=75 years). None of the (TTTA)n polymorphic variants was significantly overrepresented among the affected women compared with any of the control groups. However, a 3-bp deletion/insertion CYP19 polymorphism, which is located in the same intron approximately 50 bp upstream to the (TTTA)n repeat, was evidently associated with the menopausal status in both the BC and biBC cohorts. In particular, the Delta3(TTTA)(7) allele occurred significantly more frequently in premenopausal than in postmenopausal BC patients (65/172 (38%) versus 67/310 (22%); P=0.0001; Odds Ratio (OR)=2.20 (95% Confidence Interval (CI) 1.46-3.32)), while the perimenopausal cases demonstrated an intermediate value (9/34 (26%)). In the biBC cohort, women who developed both tumours during their premenopausal period had a significantly higher prevalence of the Delta3(TTTA)(7) allele than patients with a postmenopausal onset of bilateral disease (16/46 (35%) versus 8/50 (16%); P=0.035; OR=2.80 (1.08-7.23)); those biBC patients, whose tumours were diagnosed before and after the cessation of menses, displayed an intermediate occurrence of the Delta3(TTTA)(7) allele (7/32 (22%)). Similar tendencies in the Delta3(TTTA)(7) allele distribution in BC and biBC patients suggest that its association with the menopausal status of the patients is truly non-random and thus this observation deserves further detailed investigation.     

强直性脊柱炎后凸畸形矫形临床路径实施的变异程度分析

目的 通过分析强直性脊柱炎后凸畸形矫形临床路径实施的变异程度,研究该临床路径可能存在的不足并提出适当的改进方案。方法 收集自2012年1月至2013年12月的350例符合强直性脊柱炎后凸畸形矫形临床路径适应证的患者的资料,并根据变异的标准及类型进行统计分析。结果 350例病例中有290例发生变异,包括了16种变异情况,类型以负性变异、患者病情变化、不可控变异为主。结论 强直性脊柱炎后凸畸形矫形临床路径需要完善运行流程、制定详细的纳入和排除标准、同时加强社区医院及康复医院的相应诊疗过渡,从而更好地开展强直性脊柱炎后凸畸形矫形临床路径,最终提高患者医护质量、减少住院天数、降低住院费用。     

T_3对人神经干细胞分化过程中甲状腺激素受体表达的影响

目的　探讨三碘甲状腺原氨酸 (T3)在神经干细胞 (NSC)分化中的作用以及甲状腺激素受体(TR)mRNA在NSC分化过程中的表达变化。方法　在体外成功诱导扩增NSC ,用T3 对NSC进行诱导分化 ,半定量RT PCR法检测NSC在分化前后TRsmRNA的表达变化 ,免疫细胞化学方法鉴定分化后的细胞类型。结果　T3 可诱导NSC分化为神经元、少突和星形胶质细胞 ,其中髓鞘碱性蛋白 (MBP)阳性细胞约占 80 %。当NSC分化时存在不同的TRsmRNA的时间顺序表达。结论　T3 能诱导NSC向胶质细胞分化 ,是少突胶质细胞分化的重要调控因子 ,并通过TRs的时间顺序表达来发挥其重要生理作用     

辛伐他汀对冠心病患者血管内皮细胞功能障碍的治疗作用（英文）

目的：研究辛伐他汀对冠心病患者血管内皮细胞功能障碍的干预作用。方法：90例冠心病患者按LDL-C水平分为三组：辛伐他汀20mg组（37例,LDL-C≥2.5mmol/L）,辛伐他汀10mg组（35例,2.5mmol/L〉LDL-C≥1.8mmol/L）,常规治疗组（18例,LDL-C〈1.8mmol/L,未服辛伐他汀）,疗程均为8周。应用彩色多普勒超声诊断仪测量受试者肱动脉血流介导的舒张功能（FMD）。应用硝酸还原酶法检测受试者一氧化氮（NO）的含量。常规检测血清TC、TG、LDL-C及HDL-C的浓度。结果：8周后,与治疗前比较,辛伐他汀20mg,10mg组TC、TG和LDL-C浓度明显下降（P均〈0.05）,而HDL-C明显升高（P均〈0.05）;辛伐他汀20mg组与10mg组间各指标差异无显著性（P〉0.05）;与常规治疗组比较,辛伐他汀20mg、10 mg组FMD[（6.01±0.49）%比（9.01±0.39）%比（9.01±0.47）%]明显改善（P均〈0.01）、血清NO含量[（38.97±8.89）μmol/L比（47.67±10.89）μmol/L比（45.61±9.09）μmol/L]明显升高（P均〈0.05）,辛伐他汀20mg、10 mg组两组间NO和FMD亦无显著差异（P〉0.05）。结论：辛伐他汀可增加冠心病患者一氧化氮含量,改善血管内皮细胞功能,其作用机制与降低血清总胆固醇、甘油三酯和低密度脂蛋白可能有一定关系,但该作用无明显的量效关系,可能独立于降脂作用之外。     

Baroreflex improvement in shr after ace inhibition involves angiotensin-(1-7)

ACE inhibitors are extensively used in the treatment of hypertension mainly because of their efficiency in reducing blood pressure levels and decreasing vascular and cardiac hypertrophy. In addition, ACE inhibitors improve baroreceptor reflex control. Chronic inhibition of ACE produces (in addition to decreased angiotensin II levels) a severe increase in angiotensin-(1-7) [Ang-(1-7)] levels in several species. We have previously shown that Ang-(1-7) produces a facilitation of the baroreflex control of heart rate. In this study, we evaluated the participation of endogenous Ang-(1-7) in the improvement of baroreflex sensitivity in spontaneously hypertensive rats after central infusion of ramiprilat, an ACE inhibitor. Reflex changes in heart rate were elicited, in conscious rats, by bolus injections of phenylephrine (baroreflex bradycardia) before and after intracerebroventricular infusion of (1) saline (8 microL/h), 4 hours (n=5); (2) ramiprilat (14 microg/h), 4 hours (n=6); (3) ramiprilat for 2 hours, followed by ramiprilat combined with A-779 (4 microg/h), a selective Ang-(1-7) antagonist, for an additional 2 hours (n=6); and (4) A-779 for 2 hours, followed by A-779 combined with ramiprilat for an additional 2 hours (n=5). Intracerebroventricular infusion of ramiprilat produced an important increase ( approximately 40%) in baroreflex sensitivity (evaluated as the ratio between changes in heart rate and changes in mean arterial pressure) that was completely reversed by A-779. Furthermore, intracerebroventricular infusion of A-779 prevented the improvement of the baroreflex sensitivity produced by ramiprilat. Intracerebroventricular infusion of saline or A-779 alone did not significantly alter the baroreflex sensitivity. These results suggest that endogenous Ang-(1-7) is involved in the improvement of baroreflex sensitivity observed in spontaneously hypertensive rats during central ACE inhibition.