scholarly journals Association between shift work, salivary cortisol levels, stress and fatigue in nurses: integrative review

2018 ◽  
Vol 22 (1) ◽  
Author(s):  
Dnieber Chagas de Assis ◽  
Deisy Vivian de Resende ◽  
Maria Helena Palucci Marziale
Keyword(s):  
Shift Work ◽  
Salivary Cortisol ◽  
Small Sample Size ◽  
Scientific Evidence ◽  
Small Sample ◽  
Sample Collection ◽  
Methodological Rigor ◽  
Participant Selection ◽  
Psychometric Instruments ◽  
Cortisol Levels

ABSTRACT Objective: This study aimed to identify scientific evidence about the association between shift work and changes on the cortisol circadian rhythm, stress and fatigue in nurses. Method: We found 1046 articles published between 2006 and 2016 in the Medline, LILACS, WOS, Scopus and SciElo databases, three articles were included in this review. Results: The studies presented low methodological rigor and inconclusive results due to methodological diversity and small sample size. Thus, based on the existing literature, it was not possible to determine the existence of a significant association between shift work, cortisol levels, stress and fatigue in nurses. Conclusion: The strategies required to obtain reliable and comparable results include the adoption of standard methods of participant selection, sample collection and analysis, and use of validated psychometric instruments.

scholarly journals Deficiencies in Scientific Evidence for Medical Management of Gender Dysphoria

2019 ◽  
Vol 87 (1) ◽  
pp. 34-42 ◽  
Author(s):  
Paul W. Hruz
Keyword(s):  
Gender Identity ◽  
Gender Dysphoria ◽  
Small Sample Size ◽  
Scientific Evidence ◽  
Prospective Trial ◽  
Scientific Data ◽  
Small Sample ◽  
Sex Characteristics ◽  
Biological Sex

Individuals who experience a gender identity that is discordant with biological sex are increasingly presenting to physicians for assistance in alleviating associated psychological distress. In contrast to prior efforts to identify and primarily address underlying psychiatric contributors to gender dysphoria, interventions that include uncritical social affirmation, use of gonadotropin-releasing hormone agonists to suppress normally timed puberty, and administration of cross-sex steroid hormones to induce desired secondary sex characteristics are now advocated by an emerging cohort of transgender medicine specialists. For patients with persistent gender dysphoria, surgery is offered to alter the appearance of breasts and genital organs. Efforts to address ethical concerns regarding this contentious treatment paradigm are dependent upon reliable evidence on immediate and long-term risks and benefits. Although strong recommendations have been made for invasive and potentially irreversible interventions, high-quality scientific data on the effects of this approach are generally lacking. Limitations of the existing transgender literature include general lack of randomized prospective trial design, small sample size, recruitment bias, short study duration, high subject dropout rates, and reliance on “expert” opinion. Existing data reveal significant intervention-associated morbidity and raise serious concern that the primary goal of suicide prevention is not achieved. In addition to substantial moral questions, adherence to established principles of evidence-based medicine necessitates a high degree of caution in accepting gender-affirming medical interventions as a preferred treatment approach. Continued consideration and rigorous investigation of alternate approaches to alleviating suffering in people with gender dysphoria are warranted. Summary: This paper provides an overview of what is currently known about people who experience a gender identity that differs from their biological sex and the associated desire to engage the medical profession in alleviating associated discomfort and distress. The scientific evidence used to support current recommendations for affirming one’s preferred gender, halting normally timed puberty, administering cross-sex hormones, and surgically altering primary and secondary sexual traits are summarized and critically evaluated. Serious deficits in understanding the cause of this condition, the reasons for the marked increase in people presenting for medical care, together with immediate and long-term risks relative to benefit of medical intervention are exposed.

scholarly journals Surveillance and Monitoring of Dialysis Access

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Lalathaksha Kumbar ◽  
Jariatul Karim ◽  
Anatole Besarab
Keyword(s):  
Vascular Access ◽  
Hemodialysis Patient ◽  
Small Sample Size ◽  
Scientific Evidence ◽  
Randomized Study ◽  
Small Sample ◽  
Dialysis Access ◽  
Surveillance Strategy ◽  
Randomized Controlled ◽  
Monitoring And Surveillance

Vascular access is the lifeline of a hemodialysis patient. Currently arteriovenous fistula and graft are considered the permanent options for vascular access. Monitoring and surveillance of vascular access are an integral part of the care of hemodialysis patient. Although different techniques and methods are available for identifying access dysfunction, the scientific evidence for the optimal methodology is lacking. A small number of randomized controlled trials have been performed evaluating different surveillance techniques. We performed a study of the recent literature published in the PUBMED, to review the scientific evidence on different methodologies currently being used for surveillance and monitoring and their impact on the care of the dialysis access. The limited randomized studies especially involving fistulae and small sample size of the published studies with conflicting results highlight the need for a larger multicentered randomized study with hard clinical end points to evaluate the optimal surveillance strategy for both fistula and graft.

scholarly journals A meta-analysis of the diagnostic accuracy of dengue virus-specific IgA antibody-based tests for detection of dengue infection

2015 ◽  
Vol 144 (4) ◽  
pp. 876-886 ◽  
Author(s):  
K. ALAGARASU ◽  
A. M. WALIMBE ◽  
S. M. JADHAV ◽  
A. R. DEOSHATWAR
Keyword(s):  
Diagnostic Accuracy ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Dengue Infection ◽  
Immunoglobulin A ◽  
Diagnostic Odds Ratio ◽  
Small Sample ◽  
Significant Heterogeneity ◽  
Sample Collection ◽  
Likelihood Ratios

SUMMARYImmunoglobulin A (IgA)-based tests have been evaluated in different studies for their utility in diagnosing dengue infections. In most of the studies, the results were inconclusive because of a small sample size. Hence, a meta-analysis involving nine studies with 2096 samples was performed to assess the diagnostic accuracy of IgA-based tests in diagnosing dengue infections. The analysis was conducted using Meta-Disc software. The results revealed that IgA-based tests had an overall sensitivity, specificity, diagnostic odds ratio, and positive and negative likelihood ratios of 73·9%, 95·2%, 66·7, 22·0 and 0·25, respectively. Significant heterogeneity was observed between the studies. The type of test, infection status and day of sample collection influenced the diagnostic accuracy. The IgA-based diagnostic tests showed a greater accuracy when the samples were collected 4 days after onset of symptoms and for secondary infections. The results suggested that IgA-based tests had a moderate level of accuracy and are diagnostic of the disease. However, negative results cannot be used alone for dengue diagnosis. More prospective studies comparing the diagnostic accuracy of combinations of antigen-based tests with either IgA or IgM are needed and might be useful for suggesting the best strategy for dengue diagnosis.

scholarly journals Problem-based learning in medical degree teaching: a scoping review

2021 ◽  
Author(s):  
Joan Carles Trullas ◽  
Carles Blay ◽  
Elisabet Sarri ◽  
Ramon Pujol
Keyword(s):  
Scoping Review ◽  
Postgraduate Medical Education ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Scientific Evidence ◽  
Problem Based Learning ◽  
Knowledge Retention ◽  
Small Sample ◽  
Continuous Training ◽  
Randomized Design

Abstract Problem-based learning (PBL) is a pedagogical approach that shifts the role of the teacher to the student (student-centred) and is based on self-directed learning. Although PBL has been adopted in undergraduate and postgraduate medical education, the effectiveness of the method is still under discussion. We employed a scoping review to appraise available international evidence concerning to the effectiveness and usefulness of PBL methodology in undergraduate medical teaching programs. We applied the Arksey and O’Malley framework to undertake a scoping review. A search of literature published in English and Spanish identified one hundred and twenty four publications eligible for this review. Despite the fact that this review includes many studies, their design is heterogeneous and only a few provide a high scientific evidence methodology (randomized design and/or systematic review with meta-analysis). Furthermore, most are single-center experiences with small sample size and there are no large multi-center studies. PBL methodology obtains a high level of satisfaction, especially among students. It is more effective than other more traditional (or lecture-based methods) at improving social and communication skills, problem-solving and self-learning skills. Knowledge retention and academic performance are no worse (and in many studies are better) than with traditional methods. PBL is not universally widespread, probably because it requires greater human resources and continuous training for its implementation. More comparative and randomized studies and/or other systematic reviews and meta-analysis are required to determine which educational strategies are the most suitable for training the doctors of the future.

Cortisolontregeling bij werknemers met burnout; een pilotstudy

2004 ◽  
Vol 17 (1) ◽  
Author(s):  
Paula Mommersteeg ◽  
Cobi Heijnen ◽  
Ger Keijsers ◽  
Marc Verbraak ◽  
Lorenz van Doornen
Keyword(s):  
Pilot Study ◽  
Job Stress ◽  
Matched Control ◽  
Small Sample Size ◽  
Small Sample ◽  
Control Group ◽  
Stress Hormone ◽  
Stress Response System ◽  
Cortisol Levels ◽  
Initial Measurement

Cortisol disturbance in employees suffering burnout; a pilot study Cortisol disturbance in employees suffering burnout; a pilot study P. Mommersteeg, C. Heijnen, G. Keijsers, M. Verbraak & L. van Doornen, Gedrag & Organisatie, volume 17, February 2004, nr. 1, pp. 18-31. Burnout symptoms are the result of chronic job stress and insufficient recovery. Deviations in the secretion level of the stress hormone cortisol are associated with chronic stress and stress-related health problems. This study examined whether burnout subjects show a disturbed cortisol profile immediately after awakening, and whether a recovery of the deviating cortisol profile coincides with the relief of burnout symptoms after therapy. In this study the cortisol levels of both a clinical burnout group of employees (n=22) who were treated for their symptoms, and a matched control group (n=21) were determined, half an hour after awakening. The burnout group was sampled once more after 14 treatment sessions over approximately 6 months. At the initial measurement the burnout group showed lower cortisol levels after awakening in comparison to the control group. After treatment the burnout group reported fewer complaints whereas elevated levels of cortisol were found. Paradoxically, the rise in cortisol after therapy seems mainly attributable to subjects showing the least improvement in symptoms of exhaustion. Small sample size and the complexity and dynamics of this stress-response system complicate a clear interpretation of these findings.

scholarly journals Microbial population shift and metabolic characterization of silver diamine fluoride treatment failure on dental caries

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0242396
Author(s):  
Bidisha Paul ◽  
Maria A. Sierra ◽  
Fangxi Xu ◽  
Yasmi O. Crystal ◽  
Xin Li ◽  
...  
Keyword(s):  
Dental Caries ◽  
Small Sample Size ◽  
Small Sample ◽  
Sample Collection ◽  
Phosphotransferase System ◽  
Differential Abundance ◽  
Silver Diamine Fluoride ◽  
Linear Discriminant ◽  
Fluoride Treatment ◽  
Carious Lesions

The objective of this pilot study was to describe the microbial profiles present in the plaque and saliva of children who continued to develop new carious lesions following treatment with silver diamine fluoride (“nonresponders”) compared to caries active, caries-free, and children immediately receiving SDF treatment for untreated caries in order to identify potential microbial differences that may relate to a re-incidence of caries. Saliva and plaque samples from infected and contralateral sites were obtained from twenty children who were either caries free, had active carious lesions, were caries active and received SDF treatment immediately before sampling, or had previously received SDF treatment and developed new caries. In total, 8,057,899 Illumina-generated sequence reads from 60 samples were obtained. Reads were processed using the Quantitative Insights Into Microbial Ecology pipeline. Group differences were assessed using Analysis of Variance Models and Tukey Honest Significant Differences. To identify significant taxa between treatment groups, Linear discriminant analysis Effect Size (LefSe) and Analysis of Differential Abundance Taking Sample Variation Into Account were used. Differential abundant analysis indicated that members of the Lachnospiraceae family were significantly enriched in non-responders and the genus Tannerella and species Granulicatella adiances were also highly abundant in this group. LefSe analysis between non-responders and SDF-treated groups revealed that genera Leptotrichia and Granulicatella were enriched in non-responders. We observed the highest abundance of phosphotransferase system and lowest abundance of lipopolysaccharide synthesis in non-responders. The microbiome in dental biofilms is responsible for initiation and progression of dental caries. SDF has been shown to be effective in arresting the progression carious lesions, in part due to its antimicrobial properties. Findings suggest that the differential abundance of select microbiota and specific pathway functioning in individuals that present with recurrent decay after SDF treatment may contribute to a potential failure of silver diamine fluoride to arrest dental caries. However, the short duration of sample collection following SDF application and the small sample size emphasize the need for further data and additional analysis.

scholarly journals Factors affecting lactoferrin concentration in human milk: how much do we know?

2017 ◽  
Vol 95 (1) ◽  
pp. 12-21 ◽  
Author(s):  
Aasith Villavicencio ◽  
Maria S. Rueda ◽  
Christie G. Turin ◽  
Theresa J. Ochoa
Keyword(s):  
Breast Milk ◽  
Small Sample Size ◽  
Small Sample ◽  
Sample Collection ◽  
Exclusion Criteria ◽  
Multicenter Studies ◽  
Factors Affecting ◽  
Lactation Stage ◽  
Clinically Significant ◽  
Significant Factors

Lactoferrin (LF) is a breast milk glycoprotein with antimicrobial and anti-inflammatory effects. Its beneficial properties in infants, especially in those born preterm, are currently being studied in clinical trials. However, the maternal and nursing infant factors that may affect LF concentration in breast milk are still not clear. We conducted a systematic review to investigate the factors that may affect the concentration of LF in breast milk. We used a 2-step approach to identify the eligible studies according to inclusion/exclusion criteria, and to determine which studies would be considered. We included 70 qualified articles from 29 countries with publication dates ranging from 1976 to 2015. We described the correlation between LF concentration in breast milk and lactation stage; 10 maternal factors, such as race, parity, among others; and 2 infant factors: infections and prematurity. Colostrum has the highest LF levels, but they decrease with days postpartum. No other factor has been consistently associated with LF concentration. A major limitation of the majority of the published studies is the small sample size and the different methods used to measure LF concentration. Therefore, there is a need for large, multicenter studies with standardized study design, sample collection, and LF measurement methods to identify clinically significant factors associated with LF expression in breast milk, which will help promote exclusive breastfeeding in preterm infants.

scholarly journals Effects of Pet Therapy in Elderly Patients with Neurocognitive Disorders: A Brief Review

2021 ◽  
pp. 198-206
Author(s):  
Chiara Sbrizzi ◽  
Walter Sapuppo
Keyword(s):  
Small Sample Size ◽  
Neurocognitive Disorders ◽  
Small Sample ◽  
Pet Therapy ◽  
Methodological Rigor ◽  
Database Research ◽  
Scientific Papers ◽  
Communication Competencies ◽  
Research Criteria ◽  
Animal Assisted Intervention

<b><i>Introduction:</i></b> Neurocognitive disorders (NCDs) are disturbances highly related to age. This means that, with the increasing trend in life expectancy, there is also an increase in this diagnosis, although NCDs are not exclusively found in the population over 65 years old. Likely, they will increase in the coming years together with improvements in diagnosis. In addition to the use of medicines and rehabilitative techniques, pet therapy is also used. Pet therapy makes use of animals with therapeutic, rehabilitative, educational, and recreational purposes for people affected by physical, neuromotor, and psychiatric disorders. Pet therapy seems to be functional for increasing social and communication competencies, facilitating verbal and body language, increasing self-esteem, improving quality of life, and reducing anxiety/stress. <b><i>Methods:</i></b> This study was based on scientific papers and publications obtained from the PubMed and Google Scholar databases. Moreover, other articles from further cross-references were included. Specific database research criteria were (a) articles published in 2018 or later, (b) samples containing only adults over 65 years old, (c) written in English or Italian, and (d) on the topic of animal-assisted intervention. <b><i>Results:</i></b> Uncertain results were obtained. Although a positive effect was found, the included articles were of insufficient methodological rigor. <b><i>Discussion/Conclusion:</i></b> Although many studies reported positive results, these could not be generalized because of the numerous biases present (e.g., small sample size, lack of methodological rigor, lack of protocol, etc.). Future studies, therefore, should seek to address the limitations found in the analyzed studies.

scholarly journals Towards Non-Invasive Methods in Measuring Fish Welfare: The Measurement of Cortisol Concentrations in Fish Skin Mucus as a Biomarker of Habitat Quality

Animals ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. 939 ◽  
Author(s):  
Carbajal ◽  
Soler ◽  
Tallo-Parra ◽  
Isasa ◽  
Echevarria ◽  
...  
Keyword(s):  
Freshwater Fish ◽  
Habitat Quality ◽  
Small Sample Size ◽  
Hematological Parameters ◽  
Relative Proportion ◽  
Small Sample ◽  
Fish Skin ◽  
Fish Welfare ◽  
Skin Mucus ◽  
Cortisol Levels

Cortisol levels in fish skin mucus have shown to be good stress indicators in farm fish exposed to different stressors. Its applicability in free-ranging animals subject to long-term environmental stressors though remains to be explored. The present study was therefore designed to examine whether skin mucus cortisol levels from a wild freshwater fish (Catalan chub, Squalius laietanus) are affected by the habitat quality. Several well-established hematological parameters and cortisol concentrations were measured in blood and compared to variations in skin mucus cortisol values across three habitats with different pollution gradient. Fluctuations of cortisol in skin mucus varied across the streams of differing habitat quality, following a similar pattern of response to that detected by the assessment of cortisol levels in blood and the hematological parameters. Furthermore, there was a close relationship between cortisol concentrations in skin mucus and several of the erythrocytic alterations and the relative proportion of neutrophils to lymphocytes. Taken together, results of this study provide the first evidence that skin mucus cortisol levels could be influenced by habitat quality. Although results should be interpreted with caution, because a small sample size was collected in one studied habitat, the measurement of cortisol in skin mucus could be potentially used as a biomarker in freshwater fish.

Probing the ultrastructure of the mitotic and meiotic spindle in eggs: An expeditious approach based on semi-thin (0.25 μm) serial sections

1983 ◽  
Vol 41 ◽  
pp. 552-555
Author(s):  
Conly L. Rieder ◽  
S. Bowser ◽  
R. Nowogrodzki ◽  
K. Ross ◽  
G. Sluder
Keyword(s):  
Small Sample Size ◽  
Small Sample ◽  
Meiotic Spindle ◽  
Serial Sections ◽  
Mitotic Apparatus ◽  
Thin Sections ◽  
Cell Cycles ◽  
Ultrastructural Studies

Eggs have long been a favorite material for studying the mechanism of karyokinesis in-vivo and in-vitro. They can be obtained in great numbers and, when fertilized, divide synchronously over many cell cycles. However, they are not considered to be a practical system for ultrastructural studies on the mitotic apparatus (MA) for several reasons, the most obvious of which is that sectioning them is a formidable task: over 1000 ultra-thin sections need to be cut from a single 80-100 μm diameter egg and of these sections only a small percentage will contain the area or structure of interest. Thus it is difficult and time consuming to obtain reliable ultrastructural data concerning the MA of eggs; and when it is obtained it is necessarily based on a small sample size.We have recently developed a procedure which will facilitate many studies concerned with the ultrastructure of the MA in eggs. It is based on the availability of biological HVEM's and on the observation that 0.25 μm thick serial sections can be screened at high resolution for content (after mounting on slot grids and staining with uranyl and lead) by phase contrast light microscopy (LM; Figs 1-2).

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