Circadian rhythm of cortisol and estradiol in healthy women

ABSTRACT CIRCADIAN RHYTHM OF CORTISOL AND ESTRADIOL IN HEALTHY WOMEN by KARYN G. BUTLER AUGUST 2011 Advisor: Dr. Jean E. Davis Major: Nursing Degree: Doctor of Philosophy Daily variation in human processes and behaviors has been identified for centuries. Study of these circadian rhythms demonstrates their role in human health. Sickness behaviors include alterations in affect, sleep quality and energy. The study of the relationship between circadian rhythms has been limited to isolated rhythms. The role of temporal relationships among rhythms has received little attention. Sickness behaviors are prevalent in many disorders including depression, cancer, and autoimmune disorders. Two hormones that have been shown to play a role in the manifestation of sickness behaviors are cortisol and estradiol. To date the role of the relationship between cortisol and estradiol circadian rhythms and sickness behaviors remains unknown. The purpose of this study is to explore the temporal relationship between the rhythms of cortisol and estradiol and its relationship to sickness behaviors. It was hypothesized that a cortisol-estradiol phase angle difference (PAD) would exist that would correlate with optimal affect, sleep quality and energy. A small scale, comparative, correlational design was used to test the hypothesis. A sample of twenty-three university women (11 morning-types and 12 evening-types) between the ages of twenty to thirty-five were recruited from an urban university. Salivary samples were collected every two hours for a twenty-four hour period. Subjective measures of affect, sleep quality and energy were recorded. Salivary samples were assayed for cortisol and estradiol levels and fitted to a cosinor model with ultradian harmonics for each participant. Relationships between the cortisol-estradiol PAD and affect, sleep quality and energy measures were evaluated using a second degree polynomial equation. Results showed a significant correlation in affect measures (p \u3c 0.05), but not sleep quality or energy. An optimal PAD was identified for affect at 3.6 hours. The phase relationship between cortisol and estradiol may play a role in the development of alterations in affect which manifest in many disorders. These findings are based on a small homogeneous sample of university women. More research is needed in a larger, more heterogeneous group of women

Relationship Between the Cortisol-Estradiol Phase Difference and Affect in Women

Affective disorders impact women’s health, with a lifetime prevalence of over twelve per cent. They have been correlated with reproductive cycle factors, under the regulation of hormonal circadian rhythms. In affective disorders, circadian rhythms may become desynchronized. The circadian rhythms of cortisol and estradiol may play a role in affective disorders. The purpose of this study was to explore the temporal relationship between the rhythms of cortisol and estradiol and its relationship to affect. It was hypothesized that a cortisol-estradiol phase difference (PD) exists that correlates with optimal affect. A small scale, comparative, correlational design was used to test the hypothesis. Twenty-three women were recruited from an urban university. Salivary samples were collected over a twenty-four-hour period and fitted to a cosinor model. Subjective measures of affect were collected. Relationships between the cortisol-estradiol PD and affect were evaluated using a second-degree polynomial equation. Results demonstrated a significant correlation in affect measures (p \u3c 0.05). An optimal PD was identified for affect to be 3.6 hours. The phase relationship between cortisol and estradiol may play a role in the development of alterations in affective disorders

Provider Adherence to JNC 7 Guidelines and Blood Pressure Outcomes in African Americans

Objective: To measure provider adherence with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and assess whether adherence is associated with improved blood pressure (BP) control among low-income African-American patients. Design: Chart review. Setting and participants: A primary care clinic for low-income patients within an urban, university health center. Data were obtained from charts of 128 hypertensive African-American patients enrolled in a larger study. Measures: The Hypertension Quality Chart Review Index was used to measure adherence in the areas of cardiovascular risk assessment, lifestyle modification, pharmacologic treatment, and follow-up care. Patient BP was also recorded. Results: Overall provider adherence averaged 76%. Mean adherence scores were 85% for cardiovascular risk assessment, 57% for lifestyle intervention, 69% for pharmacologic treatment, and 80% for follow-up care. Adherence to follow-up care was significantly related to BP goal attainment (r = 0.23; p \u3c 0.05). Mean BP values decreased but the changes were not significant. Nurse practitioners had higher total quality scores, while physicians achieved greater decreases in diastolic BP. There were no significant differences in BP goal attainment by provider type. Conclusion: Fairly high adherence with JNC 7 guidelines was noted, but it was not related to BP goal attainment. Lower adherence scores may reflect problems with documentation rather than practice

Innovative Lesson Plans for Active Learning: Teaching Nursing Research and Evidence-Based Practice

Innovative Lessons Plans for Active Learning: Teaching Research and Evidence-Based Practice is a resource in research and evidence-based practice for active learning in the undergraduate nursing classroom. It is meant to supplement any nursing research text. Designed to provide educators with creative teaching ideas, this text includes a variety of lessons on nursing research topics. Topics include bias, measurement, sampling, theory and more. Lessons provide active learning for in-class, hybrid, and online formats. Each lesson includes objectives, overview, and detailed steps. As an open access resource, the text is continuously in-process. Designed to be independent of any published text, the book compliments any nursing research and evidence-based course. This text is also a suitable resource for introductory research in other disciplines. Each chapter is an activity designed to supplement didactic andragogy. The activities develop creativity and facilitate engagement in the nursing research content. Through creative engagement, students access learning areas of the brain that otherwise remain unstimulated. Organized by the order in which they might be discussed in class, each chapter builds upon previous learning. In chapter two students are introduced by creating puppets to develop research questions and study ideas. Chapter three focuses specifically on generating problem and purpose statements. Culture shots in chapter five engages students in understanding theory generation, qualitative research and ethics in data collection. Chapters six and seven build upon and strengthen theory understanding through creating concepts and challenging assumptions. In chapter eight, biases and threats to validity are investigated through the use of parody. Sampling is addressed in chapters nine through eleven. Chapter twelve reinforces learning on measurement error. The last four chapters use creative games to help students pull it all together. Chapters thirteen and fourteen utilize existing free resources to enhance the learning experience. Chapters fifteen and sixteen allow students to work together to create understanding for themselves and other students. We hope you enjoy the book as much as we enjoyed creating it. We would love to hear your comment and ideas for improvement. Please also view our video introduction at https://youtu.be/x9NDv2H_Cdg.https://scholarworks.gvsu.edu/books/1016/thumbnail.jp

Declining Intensive Care Unit Mortality of COVID-19: A Multi-Center Study

Background: Coronavirus disease 2019 (COVID-19) mortality has waned significantly over time; however, factors contributing towards this reduction largely remain unidentified. The purpose of this study was to evaluate the trend in mortality at our large tertiary academic health system and factors contributing to this trend. Methods: This is a retrospective cohort study of intensive care unit (ICU) patients diagnosed with COVID-19 between March and August 2020 admitted across 14 hospitals in the Philadelphia area. Collected data included demographics, comorbidities, admission risk of mortality score, laboratory values, medical interventions, survival outcomes, hospital and ICU length of stay (LOS) and discharge disposition. Chi-square (χ2) test, Fisher exact test, Cochran-Mantel-Haenszel method, multinomial logistic regression models, independent sample t-test, Mann-Whitney U test and one-way analysis of variance (ANOVA) were used. Results: A total of 1,204 patients were included. Overall mortality was 39%. Mortality declined significantly from 46% in March to 14% in August 2020 (P \u3c 0.05). The most common underlying comorbidities were hypertension (60.2%), diabetes mellitus (44.7%), dyslipidemia (31.6%) and congestive heart failure (14.7%). Hydroxychloroquine (HCQ) use was more commonly associated with the patients who died, while the use of remdesivir, tocilizumab, steroids and duration of these medications were not significantly different. Peak values of ferritin, lactate dehydrogenase (LDH), C-reactive protein (CRP) and D-dimer levels were significantly higher in patients who died (P \u3c 0.05). The mean hospital LOS was significantly longer in the patients who survived compared to the patients who died (18 vs. 12, P \u3c 0.05). Conclusions: The mortality of patients admitted to our ICU system significantly decreased over time. Factors that may have contributed to this may be the result of a better understanding of COVID-19 pathophysiology and treatments. Further research is needed to elucidate the factors contributing to a reduction in the mortality rate for this patient population

Health and wellbeing implications of adaptation to flood risk

Adaptation strategies to ameliorate the impacts of climate change are increasing in scale and scope around the world, with interventions becoming a part of daily life for many people. Though the implications of climate impacts for health and wellbeing are well documented, to date, adaptations are largely evaluated by financial cost and their effectiveness in reducing risk. Looking across different forms of adaptation to floods, we use existing literature to develop a typology of key domains of impact arising from interventions that are likely to shape health and wellbeing. We suggest that this typology can be used to assess the health consequences of adaptation interventions more generally and argue that such forms of evaluation will better support the development of sustainable adaptation planning

Fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin with gemtuzumab ozogamicin improves event-free survival in younger patients with newly diagnosed aml and overall survival in patients with npm1 and flt3 mutations

Purpose To determine the optimal induction chemotherapy regimen for younger adults with newly diagnosed AML without known adverse risk cytogenetics. Patients and Methods One thousand thirty-three patients were randomly assigned to intensified (fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin [FLAG-Ida]) or standard (daunorubicin and Ara-C [DA]) induction chemotherapy, with one or two doses of gemtuzumab ozogamicin (GO). The primary end point was overall survival (OS). Results There was no difference in remission rate after two courses between FLAG-Ida + GO and DA + GO (complete remission [CR] + CR with incomplete hematologic recovery 93% v 91%) or in day 60 mortality (4.3% v 4.6%). There was no difference in OS (66% v 63%; P = .41); however, the risk of relapse was lower with FLAG-Ida + GO (24% v 41%; P < .001) and 3-year event-free survival was higher (57% v 45%; P < .001). In patients with an NPM1 mutation (30%), 3-year OS was significantly higher with FLAG-Ida + GO (82% v 64%; P = .005). NPM1 measurable residual disease (MRD) clearance was also greater, with 88% versus 77% becoming MRD-negative in peripheral blood after cycle 2 (P = .02). Three-year OS was also higher in patients with a FLT3 mutation (64% v 54%; P = .047). Fewer transplants were performed in patients receiving FLAG-Ida + GO (238 v 278; P = .02). There was no difference in outcome according to the number of GO doses, although NPM1 MRD clearance was higher with two doses in the DA arm. Patients with core binding factor AML treated with DA and one dose of GO had a 3-year OS of 96% with no survival benefit from FLAG-Ida + GO. Conclusion Overall, FLAG-Ida + GO significantly reduced relapse without improving OS. However, exploratory analyses show that patients with NPM1 and FLT3 mutations had substantial improvements in OS. By contrast, in patients with core binding factor AML, outcomes were excellent with DA + GO with no FLAG-Ida benefit

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Patient Centered Critical Care: A SWOT Analysis

Objectives To recognize the strengths of a patient centered approach to critical care To identify the weaknesses of a patient centered approach to critical care To identify opportunities for improvement in critical care To become familiar with threats to a patient centered approach to critical car