Mental Health Symptoms and Work-Related Stressors in Hospital Midwives and NICU Nurses: A Mixed Methods Study.

Hospital midwives and neonatal intensive care (NICU) nurses frequently encounter work-related stressors and are therefore vulnerable to developing mental health problems, such as secondary traumatic stress, burnout, anxiety, and depression. However, so far, the exact nature of these work-related stressors (traumatic vs. non-traumatic stressors) has not been investigated. This concurrent triangulation mixed methods cross-sectional study aimed to compare mental health symptoms in hospital midwives and NICU nurses, and to identify and compare work-related traumatic and non-traumatic stressors for both professional groups. 122 midwives and 91 NICU nurses of two Swiss university hospitals completed quantitative measures (Secondary Traumatic Stress Scale, STSS; Hospital Anxiety and Depression Scale, HADS; Maslach Burnout Inventory, MBI) and one qualitative question in an online survey. When controlling for socio-demographic variables, NICU nurses had a higher STSS total score and higher STSS subscales scores and less HADS anxiety subscale scores than hospital midwives. Work-related stressors were classified into five themes: "Working environment," "Nursing/midwifery care," "Dealing with death and dying," "Case management" and "Others." Forty-six (46.3%) percent of these were classified as traumatic work-related stressors. NICU nurses reported more traumatic stressors in their working environment but no other differences between professional groups regarding the total number of work-related traumatic vs. non-traumatic stressors were found. Measures, such as teaching strategies to amend the subjective appraisal of the traumatic stressors or providing time to recover in-between frequently occurring work-related traumatic stressors might not only improve the mental health of professionals but also decrease sick leave and improve the quality of patient care

Heterogeneity in endothelium-derived nitric oxide-mediated relaxation of different sized pulmonary arteries of newborn lambs.

Endothelium-derived nitric oxide (EDNO) plays a pivotal role in regulating pulmonary circulation. To determine whether there is a heterogeneity in EDNO-mediated responses of different sized pulmonary vessels, we studied small and large isolated pulmonary arteries of newborn lambs (diameter, 0.4-0.7 and 1.5-2.5 mm, respectively). The isometric tension of vessel rings were recorded while suspended in organ chambers filled with modified Krebs-Ringer bicarbonate solution (95% O2-5% CO2, 37 degrees C). In vessels preconstricted with norepinephrine, acetylcholine and bradykinin induced a greater relaxation of small pulmonary arteries than of large pulmonary arteries. Acetylcholine, bradykinin, and nitric oxide also induced a greater increase in cGMP content in small arteries than in large ones. The responses to acetylcholine and bradykinin were endothelium-dependent and inhibited by nitro-L-arginine, an inhibitor of nitric oxide synthase. In vessels without endothelium, the response to nitric oxide was inhibited by 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one, an inhibitor of soluble guanylate cyclase. The activity of soluble guanylyl cyclase of small arteries was greater than that of large arteries under basal conditions and after stimulation with S-nitroso-N-acetylpenicillamine, a nitric oxide donor. These results demonstrate that heterogeneity exists in EDNO-mediated relaxation of small and large pulmonary arteries in newborn lambs. A difference in the soluble guanylate cyclase activity of vascular smooth muscle may have contributed to this phenomenon

Antenatal betamethasone therapy augments isoproterenol and prostaglandin E2-mediated relaxation of preterm ovine pulmonary veins

Antenatal glucocorticoid therapy improves pulmonary function in preterm newborns. We have determined the effect of antenatal glucocorticoid therapy on isoproterenol and prostaglandin (PG) E2-mediated relaxation in preterm ovine pulmonary veins after birth. Ovine fetuses (121 and 126 d of gestation; term = 150 d) received an ultrasound guided intramuscular injection of betamethasone, 0.5 mg/kg, or saline. Lambs were delivered 15 or 48 h later, ventilated for 3 h, and killed. Isolated fourth generation pulmonary veins were suspended in organ chambers filled with modified Krebs-Ringer solution (95% O2, 5% CO2) at 37 degrees C, and their isometric tension was recorded. During contractions to U46619, isoproterenol and PGE2 induced greater relaxations of pulmonary veins of betamethasone-treated lambs than those of control. Forskolin, an activator of adenylate cyclase, caused greater relaxation in veins of betamethasone-treated lambs than in those of controls. A greater relaxation of veins treated with betamethasone than that of control veins also occurred in the presence of isobutylmethylxanthine, an inhibitor of phosphodiesterases. All vessels relaxed similarly to 8-bromo-cAMP, a cell membrane-permeable analog of cAMP. When stimulated with isoproterenol, PGE2, and forskolin, adenylate cyclase activity of crude membrane preparations of pulmonary veins treated with betamethasone was greater than that of controls. These results demonstrate that antenatal betamethasone therapy potentiates isoproterenol and PGE2-mediated relaxation of pulmonary veins of preterm lambs; an enhanced adenylate cyclase activity explain in part the effect of antenatal glucocorticoid therapy on pulmonary veins of preterm lambs