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Background: Vaccine preventable diseases (VPDs) such as measles and rubella cause significant morbidity and mortality globally every year. The World Health Organization (WHO), reported vaccine coverage for both measles and rubella to be 71 % in 2019, indicating an immunity gap. Migrants in the EU/EEA may be at high risk of VPDs due to under-immunisation and poor living conditions. However, there are limited data on VPD seroprotection rates amongst migrants living in the United Kingdom (UK). Methods: We conducted an exploratory cross-sectional serosurvey amongst a sample of adult migrants living in Leicester, UK to: (a) determine seroprotection rates for measles, varicella zoster, and rubella in this group; (b) identify risk factors associated with seronegativity and, (c) understand if self-reported vaccine or diseases history is an effective measure of seroprotection. Participants gave a blood sample and completed a questionnaire asking basic demographic details and vaccine and disease history for the three VPDs. We summarised the data using median and interquartile range (IQR) for non-parametric continuous variables and count and percentage for categorical variables. We used logistic regression to establish predictors of seroprotection against these diseases. We examined the reliability of self-reported vaccination/disease history for prediction of seroprotection through a concordance analysis. Results: 149 migrants were included in the analysis. Seroprotection rates were: varicella zoster 98 %, rubella 92.6 % and measles 89.3 %. Increasing age was associated with seroprotection (OR 1.07 95 % CI 1.01-1.13 for each year increase in age). Migrants from Africa and the Middle East (aOR 15.16 95 % CI 1.31 - 175.06) and South/East Asia and Pacific regions (aOR 15.43 95 %CI 2.38 - 100.00) are significantly more likely to be seroprotected against measles as compared to migrants from Europe and Central Asia. The proportions of migrants unsure about their vaccination and disease history combined were 53.0 % for measles; 57.7 % for rubella; 43.0 % for varicella. There was no agreement between self-reported vaccination/disease history and serostatus. Conclusion: Our findings suggest lower levels of seroprotection against measles in migrants living in Leicester, UK, with younger migrants and those from Europe and Central Asia more likely to lack seroprotection. A high proportion of surveyed migrants were unaware of their vaccination/disease history and self-reported vaccine/disease was a poor predictor of seroprotection against VPDs which is important for clinical decision-making regarding catch-up vaccination in this population. Our results, although derived from a small sample, suggest that there may be gaps in seroimmunity for certain VPDs in particular migrant populations. These findings should inform future qualitative studies investigating barriers to vaccine uptake in migrants and population-level seroprevalence studies aimed at determining individualised risk profiles based on demographic and migration factors.
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In low- and middle-income countries (LMICs), the mental health consequences of trauma exposure pose a substantial personal, societal, and economic burden. Yet, the significant need for evidence-based mental health treatment remains largely unmet. To unlock the potential for mental health care for trauma survivors in lower-resource contexts, it is critical to map treatment barriers and identify strategies to improve access to evidence-based, culturally appropriate, and scalable interventions. This review, based on an International Society for Traumatic Stress (ISTSS) briefing paper, describes the treatment gap facing adults with traumatic stress in LMICs and identifies the barriers that contribute to this gap. We then highlight strategies for enhancing access to effective treatments for these populations, including task-sharing, the use of culturally adapted and multiproblem interventions, and digital tools to scale access to appropriate care. Finally, we offer recommendations for policymakers, researchers, and service providers to guide an agenda for action to close the treatment gap for trauma survivors in LMICs.
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Países en Desarrollo , Accesibilidad a los Servicios de Salud , Trastornos por Estrés Postraumático , Humanos , Trastornos por Estrés Postraumático/terapia , Servicios de Salud Mental/organización & administración , Adulto , Práctica Clínica Basada en la Evidencia , Sobrevivientes/psicologíaRESUMEN
Adrenaline auto-injectors are the first line treatment for anaphylaxis in the community setting. Both anaphylaxis and auto-injector carriage are increasing in prevalence. Adrenaline auto-injector injuries are common and most often involve the hand or digits. Such injuries carry a risk of ischemic necrosis due to profound vasoconstriction, especially if there is undying vascular pathology such as Raynaud's disease. The effects can be readily reversed with local infiltration of phentolamine. A survey was circulated to 40 clinicians working in the emergency and hand surgery departments of a major urban center. Knowledge of adrenaline duration of action and its reversal (agent, dose and location in the hospital) was assessed. All clinicians working within the two departments were eligible for participation. Only 25% of clinicians surveyed were aware of the duration of action of adrenaline. Half were aware of the correct reversal agent and only 20% knew the correct dose. Only one person was aware of phentolamine's location within the hospital. There is relatively poor clinician knowledge surrounding adrenaline reversal and a lack of easily accessible information available about dosing and drug location within the hospital. Given the time dependent nature of adrenaline auto-injector injuries Emergency Departments should consider stocking phentolamine in an emergency drugs fridge within the department along with a dosing guide. This is likely to greatly reduce time from presentation to treatment and thus the chances of digital ischemia progressing to necrosis.
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Anafilaxia , Epinefrina , Humanos , Anafilaxia/tratamiento farmacológico , Fentolamina/uso terapéutico , Mano/cirugía , Inyecciones Intramusculares , NecrosisRESUMEN
OBJECTIVE: Trauma represents a persistent threat to health and wellbeing. Yet, little research has examined links between trauma, psychopathology, and resilience in the Middle East and North Africa region outside of refugee settings, especially in Egypt. Existing studies in Egypt rarely examine trauma exposure from a polyvictimization lens, assess multiple forms of trauma-related psychopathology, or focus on dimensional symptom assessment. The current study aimed to address these gaps by (a) reporting on the diverse range of trauma exposure types, including direct, witnessed, and indirect exposure in a trauma-exposed sample; and (b) examining the associations between trauma exposure, psychopathology, and resilience. METHOD: Participants (N = 87) were drawn from the baseline survey of a randomized clinical trial for online treatment of posttraumatic stress and reported on demographics, trauma exposure, resilience, and psychopathology. RESULTS: Men reported more direct and witnessed exposure to sociopolitical violence than women, but there were no gender differences in sexual violence or total trauma exposure. Multivariate regression models examining the effect of trauma and resilience on psychopathology, controlling for age and gender, indicated that all models explained significant variance for posttraumatic stress and anxiety (F(87, 7)PTSS = 2.64, p = .022, R² = 16.5%; F(87, 7)Anx = 6.04, p < .001, R² = 31.2%) but not depression. Direct trauma exposure was associated with higher severity levels of posttraumatic stress and anxiety (ßPTSS = 1.11, p = .005; ßAnx = 1.04, p = .001). Resilience was only associated with lower levels of anxiety (ßAnx = -.22, p < .001). CONCLUSIONS: These findings suggest the high need for evidence-based care in Egypt for trauma-related psychopathology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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OBJECTIVES: Despite the known benefits of physical activity (PA) to physical and mental health, many people fail to achieve recommended PA levels. Parents are less active than non-parent contemporaries and constitute a large potential intervention population. However, little is known about the breadth and scope of parental PA research. This scoping review therefore aimed to provide an overview of the current evidence base on parental PA. METHODS: Four databases (MEDLINE, Embase, PsycINFO and Scopus) were systematically searched to identify peer-reviewed articles focusing on parental PA from 2005 onwards, including interventional, observational or qualitative study designs. Title and abstract screening was followed by duplicate full-text screening. Data extracted for all articles (100% checked by a second reviewer) included study design, proportion of fathers and ages of children. For interventional/observational studies, PA assessment method and factors examined or targeted based on the socio-ecological model were extracted, and questions addressed in qualitative studies. RESULTS: Of 14 913 unique records retrieved, 213 articles were included; 27 articles reported on more than one study design; 173 articles reported on quantitative (81 cross-sectional, 26 longitudinal and 76 interventional) and 58 on qualitative data. Most articles originated from North America (62%), and 53% included only mothers, while 2% included only fathers. Articles most frequently represented parents of infants (56% of articles), toddlers (43%), preschoolers (50%) and primary-school aged children (49%). Most quantitative articles only reported self-reported PA (70%). Observational articles focused on individual correlates/determinants (88%). Likewise, most interventions (88% of articles) targeted individual factors. Most qualitative articles explored PA barriers and facilitators (57%). CONCLUSIONS: A range of quantitative and qualitative research has been conducted on parental PA. This review highlights opportunities for evidence synthesis to inform intervention development (such as barriers and facilitators of parental PA) and identifies gaps in the literature, for example, around paternal PA. REVIEW REGISTRATION: osf.io/qt9up.
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Ejercicio Físico , Padres , Niño , Estudios Transversales , Humanos , Salud Mental , Investigación CualitativaRESUMEN
The following study describes the usability and the acceptability of an online intervention for the treatment of posttraumatic stress disorder (PTSD), PTSD Coach Online that was culturally adapted and translated into local Egyptian dialect. The adapted intervention was piloted in a randomized control trial with 87 Egyptians meeting clinical criteria for a diagnosis of PTSD. Of the 41 participants who participated in the treatment condition, 15 participants (10 females, 5 males) were randomly selected to take part in a semistructured interview to explore their user experience. Favorable feedback centered on the program's ease of access, user-friendly tools, and cultural appropriateness. Participants also described benefits including increased awareness of PTSD, symptom reduction, and increased willingness to seek psychological support online or in person. In contrast, participants highlighted some drawbacks of the online program, particularly the need for further support or some kind of "human" interaction as well as feelings that the information was not sufficiently personalized and that activities could have been more interesting. The findings suggest that while the PTSD Coach Online-Arabic is unlikely to be an effective stand-alone support, approximately half of the sample indicated that the availability of online tools is important for accessibility of mental health care, particularly for those concerned with stigma. As such, it may be an important supplemental offering for other forms of ongoing care and support. Future research may consider integrated approaches to care that were highlighted as being of particular interest to participants. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Intervención basada en la Internet , Trastornos por Estrés Postraumático , Egipto , Femenino , Humanos , Masculino , Investigación Cualitativa , Estigma Social , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/terapiaRESUMEN
The purpose of the current pilot study was to determine the impact of an ambient activity technology, ABBY®, on responsive behavior and family visiting in a long-term care (LTC) home. We were also interested in family and staff perceptions of the technology. A mixed methods research study was conducted over a 6-month period and data were collected using standardized measures and focus groups. Although no significant differences were noted in responsive resident behaviors, focus group data showed the ABBY enriched the care environment and provided additional opportunities for families and staff to engage residents. Although the introduction of a new technology can create challenges for staff, with time, these challenges can be overcome. [Journal of Gerontological Nursing, 48(1), 35-41.].
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Demencia , Cuidados a Largo Plazo , Humanos , Casas de Salud , Proyectos Piloto , TecnologíaRESUMEN
Cultural adaptation of evidence-based treatments is a pressing priority for global health, and previous research has informed recommendations for guiding the process of translation and adaptation. As research in the domain of cultural adaptation and evaluation of evidence-based treatments progresses, it is critical that researchers communicate key lessons learned, so that models of adaptation can be continuously refined and reconsidered. The work described in this article aimed to translate and culturally adapt an online intervention to address symptoms of posttraumatic stress-the PTSD Coach Online-for use with young adults in Egypt. The cultural adaptation framework proposed by Bernal and colleagues (1995) was used, and focus groups and interviews with members of the target population, mental health professionals, and service users were conducted. The authors encountered a number of challenges in treatment adaptation that generated important insights for future work. Specifically, this case study highlights the importance of translation teams with diverse backgrounds and experiences, the critical nature of iterative feedback throughout the adaptation process, and the importance of a long time-horizon for optimal adaptation.
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Intervención basada en la Internet , Trastornos por Estrés Postraumático , Egipto , Grupos Focales , Humanos , Trastornos por Estrés Postraumático/terapia , Traducciones , Adulto JovenRESUMEN
The Egyptian Revolution of 2011 resulted in high-level exposure to sociopolitical violence, placing a large burden on the mental health care system that cannot be effectively met given the small number of available providers in Egypt. We conducted a nonblinded, randomized controlled pilot trial of an online, self-directed tool for managing posttraumatic stress symptoms (PTSS). The study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness of the PTSD Coach Online-Arabic. Trauma-exposed Egyptian adults with clinically significant PTSS (N = 87; intervention group: n = 41) completed assessments at baseline, weekly over the treatment period, posttest, and 3-month follow-up. Of participants who completed weekly surveys, 88.9% used the program; 22.0% of participants reported regular, weekly use. Most tools received good likeability and perceived benefit scores, but lower perceived benefit scores on three tools suggest that some content may require additional adaptation. Intent-to-treat analyses using multilevel modeling with multiple imputation to account for missing data were conducted. Effect sizes for PTSS were below the cutoff for small effects at posttest, d = -0.14, but demonstrated a small positive effect at 3-months, d = -0.25. There was a small positive effect of treatment on anxiety at posttest, d = -0.37, and a medium effect at 3-month follow-up, d = -0.49. Treatment effects for depressed mood were below the cutoff for small effects at posttest and 3-months, ds = -0.14 and -0.18. These findings suggest that the PTSD Coach Online-Arabic may be a promising supplemental resource for support in this setting.
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Exposición a la Violencia/psicología , Automanejo/métodos , Trastornos de Estrés Traumático/terapia , Adulto , Terapia Cognitivo-Conductual/instrumentación , Egipto , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Trastornos de Estrés Traumático/psicología , TraduccionesRESUMEN
BACKGROUND: Migrants from certain regions are at increased risk of key infectious diseases (including HIV, tuberculosis (TB), hepatitis B and hepatitis C). Although guidelines increasingly recommend integrated screening for multiple infections to reduce morbidity little is known about what migrants and healthcare professionals think about this approach. METHODS: Prospective qualitative study in Leicester, United Kingdom within a novel city-wide integrated screening programme in three iterative phases to understand views about infections and integrated screening. Phase 1 focus groups (nine) with migrants from diverse communities (n = 74); phase 2 semi-structured interviews with healthcare professionals involved in the screening pathway (n = 32); phase 3 semi-structured interviews (n = 23) with individuals having tested positive for one/more infections through the programme. Analysis was informed by the constant comparative process and iterative across phases 1-3. FINDINGS: Migrants' awareness of TB, HIV and hepatitis B/C varied, with greater awareness of TB and HIV than hepatitis B/C; perceived susceptibility to the infections was low. The integrated screening programme was well-received by migrants and professionals; concerns were limited to data-sharing. As anticipated, given the target group, language was cited as a challenge but mitigated by various interpretation strategies. INTERPRETATION: This large qualitative analysis is the first to confirm that integrated screening for key infectious diseases is feasible, positively viewed by, and acceptable to, migrants and healthcare professionals. These findings support recent guideline recommendations and therefore have important implications for policy-makers and clinicians as programmes of this type are more widely implemented in diverse settings. FUNDING: National Institute for Health Research.
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OBJECTIVE: Develop a behavioural analysis of factors influencing postnatal physical activity (PA) according to the 'capability, opportunity, motivation and behaviour' (COM-B) model of behaviour to inform intervention development using the Behaviour Change Wheel (BCW). DESIGN: Cross-sectional, multi-method study using semi-structured interviews and a quantitative questionnaire. SETTING: Children's centres and mother and baby groups in Hertfordshire and Cambridgeshire, UK. PARTICIPANTS: Convenience samples of postnatal women were interviewed (n=16) and completed the questionnaire (n=158). METHODS: Semi-structured interviews followed a preprepared topic guide exploring the COM-B model components and analysed using framework analysis. The questionnaire, based on the self-evaluation of behaviour questionnaire, was adapted using patient and public involvement and findings from the interviews. Questionnaire participants rated their agreement with 22 predefined statements related to COM-B model components. Mean, SD and 95% CI were calculated and each item categorised according to importance. Demographic data were collected. RESULTS: The questionnaire identified that new mothers would be more active if they had more time, felt less tired, had accessible childcare, were part of a group, advised by a healthcare professional, able to develop a habit and had more motivation. Additional themes emerging from qualitative data were engaging in PA groups with other new mothers, limited physical stamina following complicated births, social interaction, enjoyment and parental beliefs as motivation, provision of child-friendly PA facilities and environments and babies' unpredictable routines. CONCLUSION: The behavioural analysis presented in this paper identifies and adds detail on the range of factors influencing the target behaviour. Some are unique to the target population, requiring targeted interventions for postnatal women, whereas some are individualised, suggesting the need for individually tailored interventions. We will use the behavioural analysis presented to design an intervention using the subsequent steps in the BCW.
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Aptitud , Ejercicio Físico , Cuidado del Lactante , Motivación , Resistencia Física , Periodo Posparto , Adolescente , Adulto , Femenino , Hábitos , Humanos , Lactante , Persona de Mediana Edad , Modelos Teóricos , Investigación Cualitativa , Participación Social , Encuestas y Cuestionarios , Reino Unido , Adulto JovenRESUMEN
BACKGROUND: Migration is a major global driver of population change. Certain migrants may be at increased risk of infectious diseases, including tuberculosis (TB), HIV, hepatitis B and hepatitis C, and have poorer outcomes. Early diagnosis and management of these infections can reduce morbidity, mortality and onward transmission and is supported by national guidelines. To date, screening initiatives have been sporadic and focused on individual diseases; systematic routine testing of migrant groups for multiple infections is rarely undertaken and its impact is unknown. We describe the protocol for the evaluation of acceptability, effectiveness and cost-effectiveness of an integrated approach to screening migrants for a range of infectious diseases in primary care. METHODS AND ANALYSIS: We will conduct a mixed-methods study which includes an observational cohort with interrupted time-series analysis before and after the introduction of routine screening of migrants for infectious diseases (latent TB, HIV, hepatitis B and hepatitis C) when first registering with primary care within Leicester, UK. We will assess trends in the monthly number and rate of testing and diagnosis for latent TB, HIV, hepatitis B and hepatitis C to determine the effect of the policy change using segmented regression analyses at monthly time-points. Concurrently, we will undertake an integrated qualitative sub-study to understand the views of migrants and healthcare professionals to the new testing policy in primary care. Finally, we will evaluate the cost-effectiveness of combined infection testing for migrants in primary care. ETHICS AND DISSEMINATION: The study has received HRA and NHS approvals for both the interrupted time-series analysis (16/SC/0127) and the qualitative sub-study (16/EM/0159). For the interrupted time-series analysis we will only use fully anonymised data. For the qualitative sub-study, we will gain written, informed, consent. Dissemination of the results will be through local and national meetings/conferences as well as publications in peer-reviewed journals.
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Control de Enfermedades Transmisibles , Enfermedades Transmisibles/diagnóstico , Tamizaje Masivo , Atención Primaria de Salud , Migrantes , Control de Enfermedades Transmisibles/economía , Enfermedades Transmisibles/epidemiología , Análisis Costo-Beneficio , Accesibilidad a los Servicios de Salud , Humanos , Análisis de Series de Tiempo Interrumpido , Tamizaje Masivo/economía , Investigación CualitativaRESUMEN
BACKGROUND CONTEXT: Patient expectations have been demonstrated to influence recovery following spine surgery. Addressing patient expectations specifically in regards to pain and postsurgical healing is an important factor in improving recovery patterns. Presurgical education can potentially help manage patient expectations. PURPOSE: The primary objective was to determine if participation in a single preoperative multidisciplinary educational session would result in reduced patient dissatisfaction with surgical expectations. A secondary objective was to determine if participation resulted in improvements in postsurgical pain, disability, and reductions in emergency room visits following surgery. STUDY DESIGN: A retrospective cohort study utilizing data from the Canadian Spine Outcomes and Research Network (CSORN) registry and hospital electronic medical records. PATIENT SAMPLE: Participants were patients receiving elective spinal fusion for 2-5 levels (N=206). Cohort 1 included patients who participated in preoperative multidisciplinary education (n=103). Cohort 2 included patients who opted out of the educational session (n=103). OUTCOME MEASURES: Outcomes measured included the Oswestry Disability Index (ODI), NRS scales for back and leg pain (NRS-B/NRS-L), CSORN questions pertaining to patient satisfaction with surgery and whether or not the surgery met expectations. Electronic chart review quantified emergency room visits following surgery. METHODS: Spinal fusion patients are encouraged to attend a one time, two-hour education session 3-6 weeks prior to their surgery. The education session includes interactive discussions with nursing, physiotherapy, and occupational therapy staff concentrating on what patients should expect, how to best prepare for surgery and proper care postsurgery. A one-way ANOVA was conducted for continuous variables of interest (age, number of levels operated on, ASA score, and number of visits to the emergency room following surgery). Chi-squared analysis was conducted for categorical variables of interest (pathology, gender, patient satisfaction, and patient expectations). A two (Cohort; education: no education) × 2 (Time; baseline: follow-up) repeated measure ANOVA was conducted for NRS-B, NRS-L, and ODI. Significance was set at p<.05. RESULTS: Patients (n=103) who took part in the presurgical education sessions were significantly more satisfied with their surgery compared to the control cohort (p=.014). Patients (n=103) who did not participate in the education session failed to have their expectations met in terms of improvement in daily activities (p=.03), improvement in walking capacity (p=.03) and their expectation of back pain reduction (p=.001). There was a statistically significant effect of participation in the educational session reducing postoperative back pain (p=0.03), although this improvement did not reach a minimally clinically important difference. Number of visits to the emergency room in the 12 weeks following spine surgery was significantly lower (p=.04) for patients in the education cohort. CONCLUSIONS: Reduced emergency room utilization, improved patient satisfaction, achievement of expected improvements and alleviation of back pain were documented with greater success following participation in a single 2-hour educational session prior to surgery. A single education session is a viable tool for improving patient outcomes due to its low administrative burden.
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Educación del Paciente como Asunto/métodos , Medición de Resultados Informados por el Paciente , Complicaciones Posoperatorias/psicología , Fusión Vertebral/psicología , Canadá , Femenino , Humanos , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Satisfacción del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Periodo Preoperatorio , Fusión Vertebral/efectos adversosRESUMEN
Previous studies have demonstrated that chronic dietary salt loading causes hypertension and a decreased sensitivity of the systemic vasculature to α-adrenergic stimulation and other hypertensive stimuli (e.g. hypercapnia) in rainbow trout (Oncorhynchus mykiss). This reduced sensitivity to hypertensive stimuli is consistent with a possible blunting of homeostatic responses normally aimed at raising blood pressure. To test this idea, we examined the consequences of long-term salt feeding and the associated hypertension on the interactive capacities of the renin angiotensin system (RAS) and adrenergic systems to elevate blood pressure in trout. Secretion of catecholamines in response to a range of doses of homologous ANG II in vivo and in situ (using a perfused posterior cardinal vein preparation) was reduced in the salt-fed fish. The reduced sensitivity to ANG II could not be explained by alterations in stored catecholamine (adrenaline or noradrenaline) levels or the general responsiveness of the chromaffin cells to depolarizing stimuli (60 mmol/l KCl). Despite the decreased responsiveness of the chromaffin cells to ANG II, plasma catecholamines were increased to a greater extent in the salt-fed fish during acute hypoxia (a condition that activates the RAS). Interestingly, the pressor effects of ANG II in vivo were actually heightened in the salt-fed fish. The increased pressor response to exogenous ANG II was likely attributable to its direct interaction with vascular ANG II receptors because the effect persisted even after blockade of α-adrenergic receptors. Treating fish with the vascular smooth muscle relaxant papaverine caused similar reductions in blood pressure and increases in plasma ANG II levels regardless of diet. Similarly, inhibition of angiotensin converting enzyme with lisinopril reduced blood pressure equally in control and salt-fed fish. These results indicate that, while long-term dietary salt loading blunts the response of trout chromaffin cells to ANG II, the RAS itself appears to be unaffected. Indeed, the capacity of ANG II to elevate blood pressure is not compromised nor do fish exhibit a reduced capacity to mount an acute humoral adrenergic stress response during acute hypoxia.
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Fibras Adrenérgicas/metabolismo , Presión Sanguínea , Hipertensión/metabolismo , Oncorhynchus mykiss/metabolismo , Sistema Renina-Angiotensina , Cloruro de Sodio Dietético , Fibras Adrenérgicas/efectos de los fármacos , Antagonistas Adrenérgicos alfa/farmacología , Análisis de Varianza , Angiotensina II/sangre , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Animales , Antihipertensivos/farmacología , Presión Sanguínea/efectos de los fármacos , Células Cromafines/metabolismo , Modelos Animales de Enfermedad , Epinefrina/sangre , Femenino , Hipertensión/inducido químicamente , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Hipotensión/metabolismo , Hipotensión/fisiopatología , Hipoxia/metabolismo , Hipoxia/fisiopatología , Masculino , Norepinefrina/sangre , Oncorhynchus mykiss/sangre , Sistema Renina-Angiotensina/efectos de los fármacos , Factores de TiempoRESUMEN
Nursing Standard profiles five nursing students who embarked on their studies at the University of Liverpool in September 2008. Readers will be able to find out about their experiences half way through the course and again at the end.