Resilience and workplace stress in Australian and New Zealand obstetrics and gynaecology trainees: A cross-sectional survey

BACKGROUND

Obstetrics and gynaecology training is a demanding vocation; there is a paucity of data on trainee resilience and well-being in this field.

AIM

To investigate resilience, support and perceived levels of stress and burnout in Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees.

MATERIALS AND METHODS

A cross-sectional survey of RANZCOG trainees in Australia and New Zealand (n = 638) was distributed electronically in May 2018.

RESULTS

Two-hundred and thirty-one (36%) valid responses were received. The mean resilience score was moderate (mean = 77; SD = 11). Resilience was significantly associated with general health (F = 7.5, P = 0.007), depression in the last two weeks (F = 4.4, P = 0.013) and seriously considering leaving the program at some point (F = 15.4, P < 0.001). Most participants (204; 88%) stated improvements could be made to the level of trainee support; with over half identifying the support they received from RANZCOG to be low or very low (132; 57%). One-third of participants (76; 33%) rated the support from their direct supervisor as low to very low. Over half of all participants identified high to very high responses to: burnout (127; 55%); personal stress (134; 58%); workplace stress (143; 62%) and depression (103; 45%).

CONCLUSION

RANZCOG trainees exhibit moderate resilience levels, yet they report high levels of perceived stress, depression and burnout and low-level support from direct supervisors. This may highlight the need for enhanced support and working conditions to allow trainees to remain resilient and thrive in their careers.

Male partner voluntary counselling and testing associated with the antenatal services in Kinshasa, Democratic Republic of Congo: a randomized controlled trial

Low male participation in voluntary counselling and testing (VCT) services at antenatal clinics (ANCs) represents a lost HIV-prevention opportunity. A three-arm randomized controlled trial (RCT) was conducted that offered VCT at a neighbourhood health centre, bar or church to the male partners of pregnant women attending a maternity unit in Kinshasa, Democratic Republic of Congo (DRC). The primary outcome was the proportion of male participation at VCT; secondary outcomes were uptake of couple counselling and determinants of male and couple participation. From a total of 2706 women included in the study, 591 male partners (22%) attended one of the three venues. Male participation was significantly higher in bars (26%, P < 0.001), and higher but not statistically significant in church-based VCT (21%, P = 0.163) compared with health centre VCT (18%). Male participation in VCT associated with ANCs was higher in non-health service settings, particularly in bars. A combination of different strategies rather than single targeted interventions will be needed to increase VCT uptake in male partners of women seeking VCT at ANCs.

A community nurse clinical competency framework

This article describes a dynamic initiative in community nursing education across the South West Peninsula. A group of educationalists from three community health services have written a framework of clinical competences to support community nurses in their professional development, providing career progression. The framework comprises of three sections: a preceptorship for nurses novice to community nursing; a section where experienced community nurses record their achieved knowledge, skills and competences, complemented by a validated, academic, 40 credit, degree module; and a developmental role (identified as a 'band 5+') in which the nurse demonstrates a range of knowledge and competences in order to progress onto a higher band such as a team leader. This framework is currently being piloted in four NHS community health services/trusts and it is expected that an evaluation will be undertaken within 12 months of implementation.

TB and HIV in St Petersburg, Russia: a looming catastrophe?

BACKGROUND

After decades of improved tuberculosis (TB) control in Russia, notification rates started to rise in 1992. Russia also faces a fast growing human immunodeficiency virus (HIV) epidemic.

OBJECTIVE

To document the extent and characteristics of HIV co-infection in TB patients in St Petersburg, Russia.

DESIGN

A prospective cross-sectional study of HIV coinfected culture-positive TB cases. Between 15 June 2002 and 31 March 2003, TB cases at the St Petersburg City TB hospitals and dispensaries were screened for HIV infection. At the HIV Prevention and Treatment Center, HIV-infected individuals were offered TB screening.

RESULTS

Forty-nine HIV-infected culture-positive TB cases were identified, mainly at TB hospitals and dispensaries. Most were new pulmonary TB cases. The majority were young (69% < or = 30 years of age), male (84%), unemployed (94%) individuals with a history of injection drug use (IDU) (92%), and, in 35% of cases a history of incarceration. Active case finding was high among contacts of cases (9%), but was not successful in HIV-infected IDUs.

CONCLUSION

Although the HIV seroprevalence rate is rising among TB patients, HIV does not yet appear to be driving the St Petersburg TB epidemic. Aggressive collaborative TB-HIV control efforts may still avert adverse effects of HIV on the TB epidemic.

Comparison of anaerobic treatment alternatives for brandy distillery process water

This paper compares the conceptual design of anaerobic treatment alternatives for brandy distillery process water from the production of wine, brandy, high proof alcohol, and cleanup activities that will be land applied. The results of process water characterization and treatability testing are included. The wine industry's sustainable practices movement and recent tightening of the State of California requirements for land application of food and beverage processing wastewater, have forced facilities to reevaluate the characteristics, segregation options, and treatability requirements for recycling, reuse, or discharge of effluent to land treatment facilities. The treatment alternatives, results of characterization, and bench- and pilot-scale treatability testing for solids, organics, and nutrient removal using anaerobic and aerobic biological and physical-chemical treatment methods are presented. Based on test results and evaluation, we developed a conceptual design and cost estimates for process water treatment systems to remove solids, organics and nutrients that include energy recovery and produce effluent of improved quality for land application.

The impact of human immunodeficiency virus infection on the epidemiology and treatment of Trypanosoma brucei gambiense sleeping sickness in Nioki, Zaire

To determine if there is an association between human immunodeficiency virus type 1 (HIV-1) infection and Trypanosoma brucei gambiense sleeping sickness, all incident cases of trypanosomiasis and a control group of blood donors presenting to the same rural hospital in Zaire were tested for anti-human immunodeficiency virus type 1 (anti-HIV-1) antibodies. There was no significant difference in the prevalence of HIV-1 infection between the two groups (7 of 220, [3.2%] for the incident cases and 8 of 388 [2.1%] for the blood donors; P = 0.56). Among the three HIV-1 seropositive incident cases of trypanosomiasis treated with difluoromethylornithine, two (67%) relapsed after treatment compared with four of 39 (10%) HIV-1 seronegative incident cases treated with the same drug (P = 0.05). These findings suggest that at the present time, HIV-1 infection is not having a significant impact on the incidence of T. brucei gambiense sleeping sickness in rural Zaire, but the possibility that incident cases of trypanosomiasis concurrently infected with HIV-1 may be at higher risk of treatment failure warrants further investigation.

Effect of daily immersion on the edema of pregnancy

To evaluate whether pregnant women become refractory to the effects of immersion, we studied 11 healthy women from 26 to 38 weeks' gestation, immersed in 34 degrees C shoulder-deep water for 4 or 5 consecutive days. The daily immersion diuresis showed no change throughout the study (p = 0.98: mean, 145 ml, 159 ml, 159 ml, 173 ml, 184 ml, day 1 through day 5, respectively). The range of urine volumes was broad, 35 to 675 ml, depending on the subject's degree of edema. Immersion produced a significantly larger diuresis compared with preimmersion values, 162 ml versus 110 ml. Maternal blood pressure and heart rate consistently fell during immersion, and this effect was maintained for each day studied. The subjects' hematocrit, hemoglobin, and total protein were unchanged from a preimmersion sample on day 1 to a postimmersion sample on the last day of the study. The results of this study indicate that pregnant women do not become refractory to the hemodynamic and diuretic effects of immersion.

Seroconversion rate, mortality, and clinical manifestations associated with the receipt of a human immunodeficiency virus-infected blood transfusion in Kinshasa, Zaire

To evaluate the consequences of receiving human immunodeficiency virus type 1 (HIV-1)-seropositive blood, 90 HIV-1-seronegative recipients of HIV-1-seropositive blood (case patients) and 90 HIV-1-seronegative recipients of HIV-1-seronegative blood, matched for age, sex, number of transfusions, diagnosis, and severity of illness (controls), were followed for 12 months after transfusion at Mama Yemo Hospital in Kinshasa, Zaire. Of case patients and controls, 72% were children transfused for anemia caused by malaria. Of the 46 case patients case patients alive 6 months after transfusion and for whom HIV-1 serologic results were obtained, 44 (96%) had seroconverted. Significantly more case patients (47%) than controls (16%) died within 1 year after transfusion (P less than .001). In the first 3 months after transfusion, fatigue, diarrhea, fever, cough, pruritus, pallor, oral candidiasis, polyadenopathy, hepatosplenomegaly, and rhinorrhea were observed more often among seroconverters than controls (P less than .04). Six percent of case patients and no controls had developed clinical AIDS after 12 months of follow-up. These findings underscore the urgent need for appropriate HIV screening facilities in transfusion centers worldwide.

Prevalence of HIV-1 p24 antigenemia in African and North American populations and correlation with clinical status

Sera from 622 individuals and culture supernatants from three HIV-1 viral isolates were assayed for HIV-1 p24 antigen to investigate the frequency of p24 antigenemia in African and North American populations using three commercial HIV-1 p24 antigen assays (Coulter, Du Pont, and Abbott). The prevalence of p24 antigenemia in 89 hospitalized Zairian AIDS patients was significantly lower than in 47 clinically comparable AIDS patients in the USA (17 versus 48%, P less than 0.0001). Prevalence of p24 antigenemia in sera from 200 asymptomatic HIV-1-infected individuals was also lower in individuals from Zaire compared with 83 individuals in the USA (3.5 versus 7%). In African individuals, antigenemia prevalence increased with advanced clinical status: 8% in ambulatory AIDS patients, 17% in hospitalized AIDS patients and 18% in postmortem AIDS patients. Acid hydrolysis treatment of sera from 63 Zairian AIDS patients initially negative for p24 antigen showed an 11% positivity rate confirmed by neutralization, suggesting that immune complexing of p24 antigen may play a role in the observed lower p24 antigenemia rates reported for African individuals.

Knowledge, attitudes and beliefs about HIV infection and AIDS among healthy factory workers and their wives, Kinshasa, Zaire

As a first step in designing an AIDS prevention program at a large factory in Kinshasa, Zaire, we collected information on attitudes towards human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) from factory foremen and their wives. Trained moderators conducted twelve focus group discussions (from November through December 1987) that addressed knowledge, attitudes and beliefs about HIV infection and AIDS. In general, participants were familiar with HIV infection and AIDS and considered these conditions leading health problems in Kinshasa. Although participants had a fairly accurate understanding of the causes of HIV infection, modes of transmission and preventive measures, many myths and misconceptions existed. Many participants did not believe that condom use would consistently prevent infection through sexual intercourse. Participants strongly favored the counseling of seropositive persons but showed less consensus about whether the spouse of a seropositive person should be notified of the partner's test result. Participants predicted that couples in which one member is seropositive and the other is not would experience marital discord and friction with family, neighbors and co-workers. These findings were applied to the development of a counseling and educational program for seropositive factory employees and their spouses.

Incidence of malaria and efficacy of oral quinine in patients recently infected with human immunodeficiency virus in Kinshasa, Zaire

There is concern that the impaired cell mediated immunity caused by the human immunodeficiency virus may increase the risk of severity of Plasmodium falciparum infection and could lead eventually to a decreased response to standard antimalarial treatment. In 1986, at Mama Yemo Hospital, Kinshasa, Zaire, the incidence of malaria was determined in a cohort of 59 patients who had recently acquired HIV-I infection through blood transfusion and in a cohort of 83 HIV-I seronegative controls who were recipients of HIV-I seronegative blood. All cohort patients were asked to visit the study physician whenever they developed fever. On each of these occasions thick film was examined for the presence of malarial parasites. HIV-I seropositive patients presented more often with episodes of fever per person month observation than HIV-I seronegative patients (P = 0.003). The total number of positive thick films per person months observation was significantly higher among HIV-I seropositive patients than among the HIV-I seronegative ones, but percentages of positive thick films per episode of fever were the same in both groups (46%). During a 5 month period, cohort patients presenting with a moderate attack of malaria were treated with oral quinine 20 mg/kg daily in two doses for 5 days. Twenty-three (92%) of 25 HIV-I seropositive patients and 28 (82%) of 34 HIV-I seronegative patients had a negative film 7 days after starting treatment. This study suggests that there seems to be no direct interaction of major clinical importance between HIV infection and malaria.

Comparison of sensitivities and specificities of latex agglutination and an enzyme-linked immunosorbent assay for detection of antibodies to the human immunodeficiency virus in African sera

The sensitivities, specificities, and positive and negative predictive values of the Cambridge BioScience Corp. (Worcester, Mass.) human immunodeficiency virus latex agglutination assay were compared by using three different blood preparations. By using the manufacturer's standard test method with diluted sera, the sensitivity of latex agglutination was 100%, the specificity was 99.58%, and the positive and negative predictive values were 99.26 and 100%, respectively. Use of diluted whole blood or undiluted whole blood did not significantly affect the sensitivity (mean, 99.72%), specificity (mean, 99.47%), positive predictive value (mean, 99.07%), or negative predictive value (mean, 99.89%). The latex agglutination assay is a simple, rapid assay for the detection of human immunodeficiency virus that would be useful in Third World countries or other areas where enzyme-linked immunosorbent assays are not available or cannot be used.

Renal response to intravenous somatostatin in insulin-dependent diabetic patients and normal subjects

The acute effects of iv somatostatin (SRIH; 100 micrograms/h) on the urinary flow (Uvol), effective renal plasma flow (RPF), and glomerular filtration rate (GFR) were compared with those of a control infusion of 0.15 M NaCl in nine insulin-dependent diabetic (IDD) patients of less than 10 yr disease duration and six normal subjects (NS). RPF and GFR were measured using a standard primed constant isotope infusion of [125I]iodohippurate and [51Cr]chromium EDTA. Uvol, RPF, and GFR were measured during 20-min clearance periods. During the NaCl infusion mean Uvol, RPF, and GFR were 14.1 +/- 0.2 (+/- SEM), 708 +/- 4, and 150 +/- 1 mL/min in the IDD group and 12.7 +/- 0.4, 568 +/- 5, and 110 +/- 2 mL/min in the NS group, respectively. In the IDD patients Uvol, RPF, and GFR decreased from 16.6 +/- 1.8, 670 +/- 30, 146 +/- 4 mL/min pre-SRIH to 9.2 +/- 1 (P less than 0.001), 553 +/- 25 (P less than 0.001), and 130 +/- 5 (P less than 0.001) mL/min, respectively, at 120 min during the SRIH infusion. Similarly, in the NS group mean Uvol, RPF, and GFR were 14.2 +/- 0.6, 552 +/- 15, and 112 +/- 5 mL/min pre-SRIH and decreased to 7.4 +/- 0.6 (P less than 0.001), 422 +/- 7 (P less than 0.001), and 93 +/- 3 (P less than 0.001) mL/min, respectively, after 120 min of the SRIH infusion. SRIH, therefore, had a profound effect on renal function in both IDD patients and NS, resulting in a reduction in RPF, GFR, and, as a consequence, Uvol.

Effect of somatostatin on renal function

Somatostatin has profound effects on both splanchnic and portal vascular beds. The effects of intravenous somatostatin (100 micrograms/h) on urinary volume, effective renal plasma flow, and glomerular filtration rate were compared with the effects of a control infusion of physiological saline in six normal subjects. Renal plasma flow and glomerular filtration rate were measured by primed constant isotope infusions of iodine-125 iodohippurate and chromium-51 edetic acid. Urinary volume, renal plasma flow, and glomerular filtration rate were measured during 20 minute clearance periods. During the control infusion urinary volume, renal plasma flow, and glomerular filtration rate remained essentially unchanged at 254 (SEM 3) ml/20 min, 568 (5) ml/min/1.73 m2, and 110 (2) ml/min/1.73 m2 respectively. From similar basal values the infusion of somatostatin led to a rapid decrease in all three variables. After 120 minutes of infusion of somatostatin urinary volume, renal plasma flow, and glomerular filtration rate were reduced to 148 (17) ml/20 min (p less than 0.01), 422 (7) ml/min/1.73 m2 (p less than 0.001), and 93 (3) ml/min/1.73 m2 (p less than 0.05) respectively. This effect on renal function should be borne in mind whenever somatostatin is used.

Structural analysis of hepatitis B surface antigen by monoclonal antibodies

A method has been developed for the analysis of hepatitis B surface antigen (HBsAg) antigenic structure at the molecular level that creates "fingerprints" or "signatures" of various hepatitis B viral (HBV) strains. This technique employs high affinity IgM and IgG monoclonal antibodies (anti-HBs) directed against distinct and separate determinants on HBsAg. In performing this antigenic structural analysis, separate binding curves for different monoclonal anti-HBs are generated by measuring immunoreactivity in serial dilutions of HBsAg-positive serum by radioimmunoassay. Since the HBsAg concentration in serum is unknown, the binding profiles of groups of samples are aligned by an iterative least-squares procedure to generate the numerical signature characteristic of the viral strain. The numerical signatures are then displayed on a computer-graphic plot. The signature profiles of HBsAg subtypes are a true reflection of their antigenic structure, and in vertical and horizontal transmission studies the molecular characteristics of the viral epitopes are conserved. By signature analysis we found substantial antigenic heterogeneity among the ayw3 strain both in the U.S. and France, as well as in populations of the Far East and Africa. Populations in Ethiopia, Gambia, and the Philippines were infected with two antigenically distinct HBV strains. In some newly identified HBV strains, it was found that epitopes identified by some monoclonal antibodies were absent or substantially reduced, which suggested that a genetic mutation may have occurred. Thus this study suggests that there is far more antigenic heterogeneity in HBV than previously recognized. These variants are antigenically distinct from each other at the epitope level, and were heretofore unrecognized by polyvalent anti-HBsAg antibodies.

Post-mortem study of emphysema in coalworkers and non-coalworkers

A post-mortem survey of emphysema in coalworkers and non-coalworkers was carried out in men aged 50-70 years dying of ischaemic heart disease (IHD). It was determined that in such men selection for necropsy was similar in coalworkers and non-coalworkers. All lungs were examined in a standard way and the amounts of centrilobular and panacinar emphysema were scored on numerical scales. Emphysema in men dying of IHD was significantly more frequent in coalworkers than in non-coalworkers even after age and smoking habits were accounted for by stratification. In the coalworkers, the severity of emphysema was related to the amount of dust in simple foci in the lungs. Because both groups were selected similarly from their parent populations the relative frequency of emphysema found in this study reflects that in the whole populations of coalworkers and non-coalworkers in the study area and confirms an excess of emphysema in coalworkers. This excess is likely to be due to occupational factors.

Heat-labile enterotoxin production in isolates from a shipboard outbreak of human diarrheal illness

As reported elsewhere, an enterotoxigenic strain of Escherichia coli serotype O25:K98:NM was epidemiologically incriminated as the etiological agent in a shipboard outbreak of diarrheal illness. This enterotoxigenic E. coli strain and possibly other enteric isolates were found to produce heat-labile toxin and not heat-stable toxin. Since previous genetic analyses of enterotoxigenic E. coli strains producing heat-labile and heat-stable toxins have shown a plasmid location for both toxin determinants and since in this outbreak more than one bacterial strain appeared to produce only heat-labile toxin, the possibility of an extrachromosomal heat-labile toxin determinant was investigated. Results of endonuclease cleavage and hybridization experiments, as well as apparent heat-labile toxin phenotypic instability, strongly suggest a plasmid mediation of toxin production. Additionally, the stability of this heat-labile toxin production was evaluated after several traditional methods of bacterial cell preservation.

Pulmonary disability in coal workers' pneumoconiosis

Results from a correlation survey which compared radiological and physiological findings during life with detailed morbid anatomical findings in the lungs of 247 deceased miners and ex-miners with pneumoconiosis were used to assess the extent and significance of their pulmonary disability.Coal workers' pneumoconiosis usually caused progressive impairment of ventilation, which in the simple type of disease was not related to radiological category. In such cases the presence of emphysema was found to be a more important factor in determining the impairment of ventilation than the radiological category of simple pneumoconiosis.

Emphysema in coal workers' pneumoconiosis

A correlation survey has been carried out between the pathological, physiological, and radiological findings pertaining to emphysema in 247 deceased coal miners and ex-miners, most of whom had been diagnosed as suffering from coal workers' pneumoconiosis during life. The pathological findings, which included large lung sections and detailed histology in every case, were compared with similar findings in a contrast non-mining population matched for age and sex.The results indicated that emphysema was much more common among the coal miners, both with simple and with complicated pneumoconiosis, than among the contrast group. In addition the extent of the emphysema as measured by a recognized "counting" method carried out on paper-mounted lung sections was remarkably closely related to ventilatory impairment as evidenced by the forced expiratory volume in one second.Extensive emphysema was more commonly found in those pneumoconiosis cases, both simple and complicated, showing the finer punctiform type of radiological change than in cases showing the larger micronodular and nodular opacities.