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Biomedical subjects

D Prosser

Publications and source records attributed to D Prosser.

16 recordsLinked to original sources
PubMed1999

Mental health, "burnout" and job satisfaction in a longitudinal study of mental health staff.

BACKGROUND: This study examines whether the adoption of a more community based model in an inner city psychiatry service is accompanied by increasing "burnout", deteriorating mental health and decreasing job satisfaction amongst staff. METHOD: Questionnaires were sent annually for 3 consecutive years to all mental health staff working in three adult mental health sectors in inner London. Main outcome measures were the 12-item General Health Questionnaire, Maslach Burn-out Inventory and a general job satisfaction measure. RESULTS: There was no significant change over time in the outcome measures, once confounding by job and demographic variables was examined. Being based in the community was associated with higher GHQ-12 scores (P = 0.02) when compared to in-patient staff over the 3 years. CONCLUSIONS: These results suggested that working in the community may be more stressful than working in in-patient services. However, there was no evidence to suggest that levels of stress are increasing over time, either in community-based or hospital-based staff.

Adult↗
PubMed1999

Explanations for stress and satisfaction in mental health professionals: a qualitative study.

BACKGROUND: High levels of burnout and poor psychological well-being, but also relatively high levels of job satisfaction, have been found among mental health staff, especially those based in community settings. AIMS: In order to investigate the basis of these findings, a qualitative interview study was carried out, exploring mental health staff's views of their work and of its effects on them. METHOD: A semi-structured interview was administered to a purposive sample of 30 professionals, including junior and senior members of each profession in both hospital and community settings. Interviews were transcribed verbatim and analysed using QSR NUD.IST software. RESULTS: For most professionals, contact with colleagues was one of the major rewards of the job. There was surprisingly little evidence of conflict or difficulties defining roles between disciplines, except for the social workers, for whom difficulty in defining roles in relation to other professions was a major preoccupation. Reported stresses differed between community and hospital staff. Community staff tended to find their contacts with patients highly rewarding, but also to feel burdened by a strong and uncomfortable sense of being constantly responsible for their clients' well-being and actions. Ward staff, on the other hand, identified as central difficulties in their job lack of autonomy, responsibility and scope for developing an independent therapeutic role. They felt demoralised by revolving door' patients and by violence and the need to restrain patients.

Burnout, Professional↗
PubMed1999

Improving support for mental health staff: a qualitative study.

BACKGROUND: High levels of both burnout and job satisfaction have been found in recent studies of mental health professionals. A qualitative methodology was used in a related study to explore reasons for these findings and to investigate staff's accounts of their strategies for coping with their work, and their views of support provided for them and how their jobs might be made less stressful and still more satisfying. METHOD: A semi-structured schedule was used to interview a purposive sample of 30 mental health staff drawn from three South London geographical sectors, selected to include junior and senior members of each profession in both hospital and community settings. Interviews were transcribed and analysed using QSR NUD.IST software. RESULTS: Informal contacts with colleagues were the most frequently mentioned way of coping with the difficult and demanding aspects of work in both hospital and community settings, closely followed by time management techniques. The main formal sources of support described by staff were individual supervision and staff support groups. Accounts of the former were generally positive, but there was great variation in opinions about whether support groups are useful. Almost all the interviewees believed that their jobs could be improved by further training. For community mental health staff the main training gaps were the development of skills in various forms of clinical intervention, whilst ward staff identified the need for further skills in diffusing potentially confrontational and aggressive situations.

Burnout, Professional↗
PubMed1997

Characterization of potential antagonists of human interleukin 5 demonstrates their cross-reactivity with receptors for interleukin 3 and granulocyte-macrophage colony-stimulating factor.

The ligand-binding alpha-chain of the human interleukin 5 (IL-5) receptor was expressed in its soluble form, lacking the transmembrane and cytoplasmic domains, from recombinant baculovirus. The soluble receptor was used in a scintillation proximity assay to identify two chemical compounds that inhibit binding of human IL-5 to the soluble receptor alpha chain with IC50 of 8 microM and 11 microM. These compounds also inhibited the interaction of human IL-5 with its membrane-bound receptor, composed of the ligand-binding alpha chain and signal-transducing beta chain, and prevented signaling through the receptor. Analysis by surface plasmon resonance and matrix-assisted laser-desorption/ionization mass spectrometry showed that the identified compounds bound irreversibly to the receptor at a 1:1 (mol/mol) ratio, suggesting a covalent interaction with the alpha chain of the human IL-5 receptor. Both compounds also inhibited the interaction of the receptors for interleukin 3 (IL-3) and granulocyte-macrophage colony-stimulating factor (GM-CSF), which are involved in hematopoietic differentiation and activation of immune cells, thus eliminating them as potential therapeutic agents. The inhibition of the structurally closely related receptors for IL-5, IL-3 and GM-CSF by both compounds, while binding of interleukin-4 to its receptor was not affected, suggests that a similar reactive site exists in the ligand-binding domains of the receptors for IL-5, IL-3 and GM-CSF.

Animals↗
PubMed1997

Continuity of care for the severely mentally ill: concepts and measures.

Very few useful measures of service functioning are as yet available for the evaluation of mental health services. Continuity of care has been identified as "the strategic first choice" for the development of such process measures. The term "continuity" has been used to refer to a variety of important aspects of service functioning, including whether services maintain contact with patients, whether patients consistently see the same staff, success of transfer between services, degree to which plans for services are followed through, integration between service providers, and comprehensiveness in meeting patient's individual needs. In this paper, we reviewed the main theoretical definitions of continuity of care for the severely mentally ill, and discussed the work that has attempted to operationalise these definitions and to apply them in the study of mental health services. We concluded that whilst continuity of care has had a central place in theoretical discussions of community service planning, progress in developing and applying practical measures has so far been sporadic and limited. Obstacles to such research have included great diversity in definitions of continuity and the confounding influence of individual patient characteristics on the relationship between service process and outcome. Despite these limitations, research in this field has indicated that developing and applying measures of continuity of care may be feasible and produce useful results with findings of some of the studies suggesting a relationship between continuity of care and individual outcome.

Chronic Disease↗
PubMed1997

Perceived sources of work stress and satisfaction among hospital and community mental health staff, and their relation to mental health, burnout and job satisfaction.

This questionnaire study examined perceived sources of stress and satisfaction at work among 121 mental health staff members. Five factors were derived from principal component analysis of sources of work stress items (stress from: role, poor support, clients, future, and overload), and accounted for 70% of the total variance. Four factors were derived from the items related to sources of job satisfaction (satisfaction from: career, working with people, management, and money), accounting for 68% of the variance. The associations of these factors with sociodemographic and job characteristics were examined, and they were entered as explanatory variables into regression models predicting mental health, burnout, and job satisfaction. Stress from "overload" was associated with being based outside an in-patient ward, and with emotional exhaustion and worse mental health. Stress related to the "future" was associated with not being white. Stress from "clients" was associated with the "depersonalization" component of burnout. Higher job satisfaction was associated with "management" and "working with people" as sources of satisfaction, whereas emotional exhaustion and poorer mental health were associated with less "career" satisfaction.

Allied Health Personnel↗
PubMed1996

Suicides by burning in England and Wales.

BACKGROUND: The aim was to examine suicides by burning (SBB) occurring in England and Wales. METHOD: The method was a retrospective case note examination of death certificates, coroners inquest notes and GP notes for all SBBs registered in 1991 by OPCS in England and Wales, and an examination of SBB statistics from 1979-1992. RESULTS: In 24% of cases the incident involved others either as intended or actual victims or as witnesses, and three distinct groups (Asian-born women, schizophrenics, and homicide-suicides) were over-represented. The majority were not in contact with current psychiatric services, and 43% had never had contact with psychiatric services. There was no trend in SBB compared to other suicides in 1979-1992. CONCLUSIONS: While SBB may be associated with Asian-born women, homicide-suicide and schizophrenia, the majority of cases did not have these characteristics, and the overall psychiatric contact rate was similar to suicide by unspecified means.

Adult↗
PubMed1996

Drug and alcohol problems among individuals with severe mental illness in south London.

BACKGROUND: High rates of comorbid alcohol and drug disorders have previously been found among individuals with severe mental illnesses such as schizophrenia and bipolar affective disorders. Clinical and social outcomes have been reported to be worse in this group and service costs greater than in individuals with severe mental illness only. These 'dual diagnosis' patients have mainly been investigated in the USA, and there has been very little research in Europe, where patterns of substance abuse may be different. METHOD: All patients with psychotic illnesses who had any contact with the mental health services in a geographically defined sector in South London over a specified period were studied. Individuals with problems related to alcohol or drugs were identified using standardised interviews with subjects and their keyworkers. Data on psychiatric service use during the previous 2 years were also obtained. RESULTS: One hundred and seventy-one subjects with psychotic illnesses were interviewed (response rate: 78.4%). The one-year prevalence rate for any substance problem was 36.3% (95% CI = 29.1-43.5), for alcohol problems it was 31.6% (95% CI = 24.6-38.5), and for drug problems 15.8% (95% CI = 10.3-21.3). Young male subjects were at higher risk of having substance problems. Patients with substance problems had spent almost twice as many days in hospital as those without such problems over the previous two years (difference = 26.3 days, 95% CI = 3.8-48.7). CONCLUSIONS: The prevalence of substance problems among people suffering from severe mental disorders is high, and seems to be associated with greater use of in-patient services. This is a significant clinical problem, with cost implications. Further investigation is needed for adequate service provision.

Adolescent↗
PubMed1996

Mental health, "burnout' and job satisfaction among hospital and community-based mental health staff.

BACKGROUND: Concerns have been expressed that staff burnout may make community mental health care difficult to sustain. This study compares stress and job satisfaction between community and hospital-based staff. METHOD: The GHQ-12, the Maslach Burnout Inventory and a job satisfaction measure were used to study 160 Inner London staff. RESULTS: Community staff scored significantly higher on the GHQ-12 and the "emotional exhaustion' component of the Maslach Burnout Inventory than hospital-based in-patient, day care or out-patient staff. Satisfaction did not vary significantly between settings. CONCLUSIONS: These results may be explained in several ways. Community work may be inherently more stressful than hospital work, or may currently be stressful because of inadequate resources, training or supervision. The results may also reflect widespread recent changes in community services or the specific effects of working in a deprived area.

Adult↗
PubMed1981

Adrenaline depletion in the hypothalamus of the rat after chronic alpha-methyldopa.

1. Individual anterior hypothalamic-preoptic nuclei were dissected from the brains of control and alpha-methyldopa treated (2 x 40 mg/kg, 5 days) rats, and the concentrations of adrenaline and other catecholamines were estimated. 2. By a combination of radioenzymatic assay and paper chromatography the concentrations of adrenaline, noradrenaline, dopamine, alpha-methylnoradrenaline and alpha-methyldopamine were determined concurrently in the same sample. 3. alpha-Methyldopa reduced the adrenaline levels of the hypothalamic nuclei by 47--68% of control concentrations. 4. A differential displacement of the parent catecholamines was observed and the depletions were ranked: adrenaline less than dopamine less than noradrenaline. 5. alpha-Methylnoradrenaline and alpha-methyldopamine were found in all hypothalamic nuclei. 6. The depletion of hypothalamic adrenaline by alpha-methyldopa could represent a pharmacological mechanism contributing to the antihypertensive action of the drug.

Animals↗