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PubMed1995

Effect of production environment on labor demand in Veterans Affairs medical center pharmacies.

The relationship between pharmacy production environment and labor-time requirements was estimated by using data from Veterans Affairs medical center (VAMC) pharmacies. Economic theory was used to derive equations for estimating labor-time requirements for pharmacy services that take into account differences in production environment (factors that cannot be controlled by the pharmacy manager within a given observation period, such as pharmacy service mix and distance to patient care wards). The equations were estimated by using information obtained from the Department of Veterans Affairs (VA) and from a mail survey of VAMC pharmacy chiefs. The resulting estimates of labor-time requirements were compared with pharmacy labor-time requirements produced by the VA in 1989. Labor-time requirements varied dramatically with production environment, and the labor-time requirements calculated in this study generally exceeded those used by the VA. Accurate forecasts of required pharmacist and technician labor time must take into account the production environment within each pharmacy.

Efficiency, Organizational↗

PubMed2004

Gene-environment interactions between the smoking habit and polymorphisms in the DNA repair genes, APE1 Asp148Glu and XRCC1 Arg399Gln, in Japanese lung cancer risk.

APE1 (apurinic/apyrimidinic endonuclease 1) and XRCC1 (X-ray cross-complementing group 1) are DNA repair proteins that play important roles in the base excision repair (BER) pathway. Polymorphisms in their encoding genes are associated with altered DNA repair capacity and thus may impact on cancer risk. In the present case-control study with 178 Japanese incident lung cancer cases and 449 age- and sex-matched controls, we investigated the gene-environment interaction among APE1 Asp148Glu, XRCC1 Arg399Gln and smoking habit in lung cancer risk. The results were analyzed by using conditional logistic regression models, adjusted for age, sex and smoking status. The adjusted odds ratio for the current smokers with APE1 148Asp/Asp, Asp/Glu and Glu/Glu genotype as compared with the never smokers with the Asp/Asp genotype were 3.01 (95% CI 1.39-6.51, P = 0.005), 2.73 (95% CI 1.29-5.77, P = 0.008) and 7.33 (95% CI 2.93-18.3, P < 0.001), respectively. The gene-environment interaction between current smoking and APE1 148Glu/Glu genotype was statistically significant (OR 3.59, 95% CI 1.28-10.1, P = 0.015). When APE1 Asp148Glu and XRCC1 Arg399Gln polymorphisms were evaluated together, the adjusted odds ratios for the current smokers with 0-1, 2 and 3-4 of APE1 148Glu or XRCC1 399Gln alleles as compared with never smokers with the 0 of these alleles were 2.96 (95% CI 1.57-5.58, P = 0.001), 3.86 (95% CI 1.85-8.05, P < 0.001) and 6.01 (95% CI 2.25-16.1, P < 0.001), respectively. The gene-environment interaction between current smoking and three or more APE1 148Glu or XRCC1 399Gln alleles was statistically significant (OR 2.44, 95% CI 1.00-9.22, P = 0.049). The OR for the gene-environment interaction of Glu/Glu genotype of APE1 codon 148 with heavy smoking was 1.04 (95% CI 0.38-2.90, P = 0.936) and that with light smoking was 2.67 (95% CI 1.00-7.68, P = 0.049). These results suggest that APE1 Asp148Glu and XRCC1 Arg399Gln polymorphisms might modify the risk of lung cancer attributable to cigarette smoking exposure.

Adult↗

PubMed2002

Dependence of epistasis on environment and mutation severity as revealed by in silico mutagenesis of phage t7.

Understanding how interactions among deleterious mutations affect fitness may shed light on a variety of fundamental biological phenomena, including the evolution of sex, the buffering of genetic variations, and the topography of fitness landscapes. It remains an open question under what conditions and to what extent such interactions may be synergistic or antagonistic. To address this question, we employed a computer model for the intracellular growth of bacteriophage T7. We created in silico 90,000 mutants of phage T7, each carrying from 1 to 30 mutations, and evaluated the fitness of each by simulating its growth cycle. The simulations sought to account for the severity of single deleterious mutations on T7 growth, as well as the effect of the resource environment on our fitness measures. We found that mildly deleterious mutations interacted synergistically in poor-resource environments but antagonistically in rich-resource environments. However, severely deleterious mutations always interacted antagonistically, irrespective of environment. These results suggest that synergistic epistasis may be difficult to experimentally distinguish from nonepistasis because its effects appear to be most pronounced when the effects of mutations on fitness are most challenging to measure. Our approach demonstrates how computer simulations of developmental processes can be used to quantitatively study genetic interactions at the population level.

Bacteriophage T7↗

PubMed1997

The relationship of social environment, social networks, and health outcomes in the Seattle Longitudinal Study: two analytical approaches.

This study examined the relation of social networks and perceived social environment to health outcomes and cost utilization over a 1-year period in a community sample of 387 (173 males, 214 females). Two analytical strategies, a variable-oriented approach and a subject-oriented approach, were used to complement each other: structural equation modeling assessed the direct relationship between social relationships and health, while cluster analysis examined how social relationship patterns were related to health outcomes. Lower levels of perceived social environment were associated with an increased number of hospital visits. For unmarried individuals, increased age was associated with greater medical usage and estimated total health care cost, while low perceived social environment was related to a greater number of doctor visits. Among married individuals, women had more frequent doctor visits, medication usage, estimated outpatient costs, and primary care visits. Married individuals with low levels of social networks had increased total health care costs, outpatient costs, and primary care visits. Cluster analysis was used to group individuals by characteristics of perceived social environment and social networks. Members of the cluster groups with greater health problems were more likely to be isolated, had the least social contact, and had lower levels of education and income. Including subject-oriented approaches is useful in complementing more popular regression methods for data analysis.

Adult↗

PubMed2005

Social environments and the genetics of aging: advancing knowledge of protective health mechanisms.

We selectively review the literature in behavioral and molecular genetics, including both laboratory and epidemiologic studies, with emphasis on how social environments, particularly emotion in significant social relationships, influence gene expression. Attention is given to cross-talk between human and animal studies. Environments are pivotal in understanding phenotypic outcomes, and this demands research on gene-environment interactions. Illustrative interactions, involving both behavioral and molecular genetics, are provided. Many people with susceptibility genes for diverse diseases never proceed to disease status. Substantial associational evidence implicates social environmental factors as protective agents. Mechanistic understanding of these linkages is quite advanced in some animal populations and suggests new lines of inquiry in human studies. Developing the interface between genetics, social environments, and health will require close collaboration between those well versed in molecular biology and biochemistry and persons with expertise in genetic epidemiology and social psychology. Particularly important is the identification of environmental influences that protect susceptible persons from disease incidence.

Aged↗

PubMed2005

Mammary cancer and social interactions: identifying multiple environments that regulate gene expression throughout the life span.

Now that the human genome has been sequenced, along with those of major animal models, there is an urgent need to define those environments that interact with genes. The traditional view focuses on ways that gene products interact with the nuclear environment to regulate cell function, causing the physiologic changes, behaviors, and diseases manifest throughout development and aging. Although this view is essential, it is equally essential to understand the converse relationship, namely, to identify those environments at higher levels of organization that regulate the expression of specific genes. Given the vastness of this problem, one effective strategy is to start with a trait for which some of the genes have already been identified, such as malignant disease. In rats, social isolation and hypervigilance increase the incidence of mammary tumors, accelerate aging, and shorten the life span. We propose that similar environmental regulation of gene expression may underlie the disproportionately high mortality from premenopausal breast cancer of Blacks, a minority group that can experience high levels of loneliness and hypervigilance. Our goal is to identify which environments-social, psychological, hormonal, and cellular-regulate genetic mechanisms of mammary cancer risk as well as the specific times in the life span when they do so.

Adult↗

PubMed1995

The urban environment, poverty and health in developing countries.

The process of urbanization could be described as one of the major global environmental changes directly affecting human health today. Populations particularly affected are in developing countries where rapid urban growth has been accompanied by massive urban poverty. Urban environmental health impacts, particularly the impact on adults of an environment of poverty, are still poorly understood. Definitions of the urban environment tend to be physical, excluding the complex ramifications of a social setting of disadvantage. This paper provides a brief overview of existing knowledge on the links between environment, poverty and health in urban areas of developing countries, with an emphasis on the policy implications implied by research on health differential between groups within cities. The paper argues that urban poverty and inequalities in conditions between groups within cities present a central crisis confronting urban policy in terms of human health and quality of life. The paper suggests that definitions of the urban environment tend to consider only the physical, and not the social complexity of the urban setting. The review concludes that the scale and the complexity of the urban crisis in developing countries demands a real commitment to re-thinking the management of cities to address multiple deprivation. The paper suggests that this challenges urban professionals who continue to act with a bias towards unintegrated single sector solutions despite claims to the contrary.

Developing Countries↗

PubMed2004

Influence of work environment on emotional health in a health care setting.

BACKGROUND: Radical changes are taking place in health care services and might be expected to cause job dissatisfaction, absenteeism, somatic complaints and mental health problems. Research in this area is limited and focused primarily on nurses. AIM: To understand the impact of the work environment on the emotional health of doctors and nurses in a general hospital setting. METHODS: Cross-sectional study using self-reported questionnaires including the General Health Questionnaire, the Posttraumatic Stress Disorder (PTSD) Checklist for Civilians, the Trauma Experiences and Work Environment Scale. RESULTS: The response rates for the study were 28% (60) for doctors and 54% (431) for nurses. Whilst the prevalences of psychiatric disorder, anxiety, depression and PTSD were higher for doctors compared with nurses, this was not statistically significant. Both groups reported witnessing someone badly injured or killed as their most distressing experience (doctors 46% versus nurses 41%). Using multiple logistic regression, significant predictors of emotional health was task orientation for doctors (OR = 1.96, 95% CI = 1.1-3.6), and PTSD (OR = 17.2, 95% CI = 6.0-49.6), work pressure (OR = 1.2, 95% CI = 1.01-1.4) and innovation (OR = 0.81, 95% CI = 0.70-0.94) for nurses. CONCLUSION: The prevalence of psychiatric disorder among the doctors and nurses was similar to that in Britain. Elements of the work environment did impact on the emotional health of health care workers. Organizational development initiatives should include employee mental health issues in order to create a more positive work environment.

Adult↗

PubMed1999

Method to detect genotype-environment interactions for quantitative trait loci in association studies.

Khoury et al. (Am J Hum Genet 1988;42:89-95 and Am J Epidemiol 1993;137:1241-50) presented an epidemiologic approach to examine genotype-environment interaction in situations where the disease is either present or absent. In this article, the author extends the approach of Khoury et al. to quantitative outcome variables. This extension is relevant for diseases that are extremes on a continuum or when continuous risk factors are studied. To account for a possible admixture of subgroups in the sample, tests for genotype-environment interaction are discussed for designs with parents as controls as well as without parents as controls. Assuming two environmental conditions, the author demonstrates how the power of these tests can be calculated and used to estimate the sample sizes needed to detect genotype-environment interaction in a variety of conditions. In addition, he analyzes simulated data to demonstrate the detection of different mechanisms of genotype-environment interaction and to study the effectiveness of this approach to identify the correct mechanism. Finally, extensions to multiple environmental conditions and designs with multiple subjects per family are discussed.

Analysis of Variance↗

PubMed2005

Effects of the home environment on school-aged children's sleep.

STUDY OBJECTIVE: Examine the relationship between the sleep behavior of elementary school-aged children and characteristics of the home environment. DESIGN: Cross-sectional analysis of children participating in a cohort study. SETTING: Cleveland Children's Sleep and Health Study, an ethnically mixed, urban, community-based cohort. PARTICIPANTS: Four hundred forty-nine children (50% girls, 46% African-American) aged 8 to 11 years. MEASUREMENTS AND RESULTS: Sleep and health data were obtained from a child-completed 7-day sleep journal and caregiver-completed health and sleep questionnaire. Home-environment predictors were Middle-Childhood Home Observation for Measurement of the Environment (MC-HOME) total score and Encouragement of Maturity and Physical Environment subscale scores. Sleep outcomes were mean nightly sleep duration, night-to-night variation in sleep duration, and bedtime of 11 PM or later. Adjusted analyses showed that higher Encouragement of Maturity subscale scores were associated with longer sleep duration (P < .05) and decreased odds of a bedtime at 11 PM or later (odds ratio = .74, 95% confidence interval, .58-.95). In girls, higher Encouragement of Maturity scores were also associated with decreased nightly variation in mean sleep duration (P < .001). Increases in total MC-HOME score were associated with increased mean sleep duration among African-American children only (P < .05). CONCLUSION: Collectively, results indicate that a parenting style encouraging social maturity in children is linked to healthier sleep patterns.

Child↗

PubMedDate not supplied

Staff nurse perceptions of the work environment: a comparison among ethnic backgrounds.

This study examined the relationship among ethnicity and perceptions of the work environment among staff nurses in a large urban hospital in Northern California. Moos' Work Environment Scale, System Maintenance and Change Dimensions, was used to investigate staff nurse perception of the work environment related to role clarity, managerial control, and innovation. Findings of this study suggest statistically significant differences in the way Caucasian and non-Caucasian nurses viewed the extent to which management used rules and pressures. The perception of control in the work environment is an important factor in retention and in maintaining a quality workplace.

Adult↗

PubMed1991

Preferred hearing aid gain in everyday environments.

Thirty-three hearing-impaired individuals were each fitted with three hearing aids. The instruments conformed to three frequency-gain prescriptions, differing by a total of 8 dB/octave, with the middle prescription derived using the MSU version 3.0 procedure. The subjects were divided into three matched groups of eleven. Each group used the fitted hearing aids in one of three everyday listening environments representing quiet, reverberant, and noisy situations, respectively. In each listening environment, preferred hearing aid gain for conversationally produced speech was measured in each hearing aid condition for each subject. Preferred gain in daily listening situations was compared to prescribed gain. Results indicated that: (1) preferred gain averaged across all three environments was about equal to prescribed gain, (2) mean preferred gain in each separate environment was substantially different from the prescribed level, (3) volume control adjustments of about +/- 8 dB relative to the prescribed level would be necessary to accommodate the preferred gain settings of the typical hearing aid wearer in daily life. Guidelines are presented for establishing recommended volume control settings for hearing aid users who may be unable to set the volume control independently.

Acoustics↗

PubMed2002

Characteristics of nurses and hospital work environments that foster satisfaction and clinical expertise.

OBJECTIVE: The purpose of this aspect of a larger study was to describe characteristics of nurses and their work environment at two military hospitals. BACKGROUND: Few studies have explored characteristics among nurses who practice in military hospitals. There is reason to believe that differences exist between nurses who work in military and civilian hospitals, some of which are required educational level, leadership experience, officer status, and career development opportunities. METHODS: A descriptive design was used to address how military and civilian nurses who work in military hospitals describe their autonomy, control over practice, nurse-physician collaboration, and clinical expertise and what relationships exist among these variables. RESULTS: Scores on autonomy, control over practice, and nurse-physician relationships all were above midpoint for all respondents as a group, indicating positive work environments in both of the military hospitals studied. Scores from the clinical expertise instrument were well above midpoint, indicating a desirable level of clinical expertise. These findings all reflect favorably on the military hospital work environment. CONCLUSIONS/IMPLICATIONS: This information will help to make a case for instituting or preserving those nursing processes that are effective and for identifying and working to change nursing processes that are not effective. Nurses will benefit by having a more collaborative work environment.

Adult↗

PubMed2006

A road map for creating a Magnet work environment.

OBJECTIVE: The authors examine the relationship between working environment and the developmental level of the workforce, against the backdrop of the American Nurses Credentialing Center Magnet Recognition Program, to provide a road map for creating a positive work environment. BACKGROUND: With the daily demands on nurse managers, there is a need to identify focused strategies to achieve a Magnetized, high-performing work environment. METHODS: The American Nursing Association Magnet survey was administered to nurses at a large healthcare system. Patient units at each hospital were categorized as reactive, responsive, proactive, or high performing. Similar categories of units across all 6 hospitals were analyzed. Analysis of variance was performed on each Force of Magnetism by developmental level. RESULTS: Mean scores measuring the Forces of Magnetism were statistically significant between reactive and responsive units. Likewise, mean scores between responsive and proactive units were also statistically significant. Between reactive and responsive units, there were 3 statistically significant forces of Magnetism: organizational structure, management style, and interdisciplinary relations. These are labeled primary priority forces. Between responsive and proactive units, there were 6 statistically significant forces of Magnetism labeled secondary priority forces: policies and programs; professional models of care; quality of care; consultation and resources; autonomy; and interdisciplinary relations. CONCLUSIONS: Nursing staff perceive the "Magnetism" of the work environment differently, depending on the developmental level of the unit. Nurse managers with reactive units should focus on the 3 Forces of Magnetism identified as the primary priority forces, in order to help develop their unit to the next level of responsive. Once a responsive level has been achieved, the next 6 forces should be addressed.

Data Collection↗

PubMedDate not supplied

The effect of environment on body site temperatures in full-term neonates.

The effect of environment on temperature was examined by comparing tympanic, rectal, inguinal, and axillary temperatures for 63 term infants in three environments: incubator, bassinet, and radiant warmer. Tympanic temperatures were collected with a FirstTemp (Intelligent Medical Systems, Carlsbad, CA) infrared thermometer in the cal-tympanic mode. Rectal, inguinal, and axillary temperatures were collected with an IVAC digital thermometer (San Diego, CA) in the predictive mode. There were moderate correlations between the body site temperatures. The environment significantly influenced temperature readings at the different sites. Temperatures assessed in the superheated environments of the radiant warmer and the incubator were consistently higher than temperatures in the bassinet.

Analysis of Variance↗

PubMed2001

Differences in locomotor response to an inescapable novel environment predict sensitivity to aversive effects of amphetamine.

Differences in locomotor response to an inescapable novel environment have previously been shown to predict sensitivity to amphetamine reward, where high responders (HR), compared to low responders (LR), showed greater initial sensitivity to amphetamine self-administration. The present experiments sought to extend these findings and assessed the relationship between locomotor response to an inescapable novel environment and conditioned taste aversion (CTA) with amphetamine and lithium chloride (LiCl). Male Sprague-Dawley rats were tested for their locomotor response to an inescapable novel environment and divided into high (HR) or low (LR) responders, based on whether their locomotor scores were above or below the median activity level of the subject sample. After several days, the animals were tested in a CTA procedure and conditioned with either amphetamine or lithium chloride. Compared to HR rats, LR rats showed greater sensitivity to amphetamine CTA at the doses tested. In contrast, the results with LiCl showed no relationship between locomotor response to an inescapable novel environment and CTA. Taken together, the present results suggest that LR, compared to HR, rats show less sensitivity to the rewarding effects of amphetamine because they are more sensitive to aversive effects of amphetamine, as reflected in CTA. In contrast, HR rats display less sensitivity to aversive effects of amphetamine, which may explain their greater propensity to self-administer amphetamine.

Animals↗

PubMed1986

Human-environment process: a test of Rogers' principle of integrality.

Rogers' principle of integrality was examined through testing the hypothesis that healthy subjects who are confined to bed in a varied harmonic environment will perceive themselves to be more rested than those subjects confined to bed in quiet ambient environment. A two-group pretest-posttest design was used to gather data to test the hypothesis. The findings of the study revealed that the hypothesis was supported beyond the 0.05 level of significance. The integrity of the mutual human-environment field process was strengthened with an environment of varied harmonic sounds.

Adolescent↗

PubMed2001

Rethinking the critical care environment: luxury or necessity?

Rethinking the critical care environment, an implicit call to change, can catalyze a return to nursing's intellectual roots. Healing environments, as envisioned by Florence Nightingale, involve system-level changes that require effective negotiations on behalf of our patients and ourselves. The nurse-patient relationship is central to the patient's environment and requires a comprehensive understanding of healing. Only nurses can articulate the changes necessary to ensure quality nursing care, and our collective "silencing" must be confronted if it is to change. Nurses' tendency to avoid, accommodate, or compromise when faced with conflict also must change. Giving voice to nursing concerns itself becomes a call to excellence, and those unwilling to change are best excluded. Although all of this is difficult, it is no more difficult than the nonhealing environments where we now work, and at least gives promise of more positive outcomes.

Critical Care↗