Relationships between work satisfaction, emotional exhaustion and mental health among Swiss primary care physicians

Background: Work-related satisfaction is an important determinant of quality of care. However, its relationship with doctors' mental health is poorly understood. It could have an independent beneficial effect on mental health (direct association) or simply reduce the impact of work stress on mental health (moderating or ‘buffering' role). Methods: One thousand seven hundred and thirty-two Swiss primary care physicians (824 board-certified generalists, 436 general internists, 162 paediatricians, 147 internal medicine specialists and 163 physicians without specialty qualification) completed a mailed questionnaire. Previously, validated instruments were used to measure mental health (SF-12), emotional exhaustion [Maslach Burnout Inventory (MBI)] and work-related satisfaction. Linear regression models with mental health as dependant variable were used to study the relationships between these variables. Differences in mental health scores were standardized to represent a one standard deviation (SD) difference in the other scales [standardized beta coefficients (SBC)]. Results: In multivariate analyses, higher levels of mental health were found in respondents with higher work-related satisfaction with current income and social prestige (SBC 1.04) and professional relations (SBC 0.57), and in respondents with lower emotional exhaustion (SBC −4.98) and higher personal accomplishment scores (SBC 1.72). Interaction terms between these dimensions of work-related satisfaction and emotional exhaustion were significant, supporting a ‘buffering' role of these dimensions. Conclusion: Work-satisfaction with current income, social prestige and professional relations are important correlates of mental health among primary care physicians, as well as emotional exhaustion. Higher levels of these dimensions of work-related satisfaction seems to mitigate the relationship between emotional exhaustion and physicians' mental healt

Der Capability Approachein Perspektivenwechsel in der Sozialen Arbeit

Ein aktueller und international geführter Gerechtigkeitsdiskurs stellt mit dem Capability Approach (Befähigungsansatz) des Wirtschaftswissenschaftlers Amartya Sen und der Philosophin und Rechtsgelehrten Martha C. Nussbaum gängige Vorstellungen von Lebensqualität und ihrer Kriterien infrage. In der Bachelor-Arbeit wird der Capability Approach (CA) untersucht, seine Anschlussfähigkeit an zentrale Begriffe und Selbstverständnisse der Sozialen Arbeit geprüft und mit zwei konkreten Praxisbeispielen die vielseitige Anwendbarkeit des CA in der Praxis aufgezeigt. Die realen Freiheiten eines Individuums, aus wohlüberlegten Gründen eine Lebensweise gemäss den eigenen Wertvorstellungen, Präferenzen und Interessen umzusetzen oder nicht, sind im CA zentral. Professionelle der Sozialen Arbeit können wesentlich dazu beitragen, Menschen zu befähigen, ihre eigenen Vorstellungen eines guten Lebens zu entwickeln und umzusetzen. Eine minimal gerechte Gesellschaftsordnung garantiert ihren Mitgliedern ausnahmslos ein Mindestmass an Verwirklichungschancen. Der CA vereint Gegensätze, indem er ein liberales Menschenbild mit einem sozialen Gesellschaftsbild verbindet. Er strebt den handelnden und selbstständigen Menschen an und fordert gleichzeitig die gesellschaftliche Bereitstellung von Zugängen und Verwirklichungschancen, damit dieser die ihm zusagende Lebensweise frei wählen kann. Der vorgestellte Perspektivenwechsel führt zu einer neuen Legitimation der Sozialen Arbeit im sozialpolitischen Kontext und regt zu einem fach- und ideologieübergreifenden Verständnis von sozialer Gerechtigkeit an

A yeast-based bioassay for the determination of functional and non-functional estrogen receptors

The response to endocrine therapy of breast cancer is not entirely predictable from hormone receptor status alone since some point mutated or splicing variants of the estrogen receptor (ER) show altered biological activities. In order to characterize the activities of all forms of ER in a heterogeneous breast tumor, a functional assay in Saccharomyces cerevisiae was developed. Total RNA isolated from breast cancer cells and one breast cancer specimen was reverse transcribed and the ER cDNA was amplified by PCR. The products were then cloned into an expression vector by in vivo homologous recombination in yeast. The yeast strain carries a reporter gene (ADE2) coupled to an estrogen response element. Activation of the reporter by ER yielded white colonies whereas lack of ER activity produced red colonies. This permitted the testing for functionality of individual ER molecules and subsequent analysis by rescuing of the ER expression plasmids and complete DNA sequencing. This simple visual test allows discrimination between wild-type ER, constitutively active ER and inactive E

Improvement of antibiotic prescription in outpatient care: a cluster-randomized intervention study using a sentinel surveillance network of physicians

Objectives To assess the effectiveness of implementing guidelines, coupled with individual feedback, on antibiotic prescribing behaviour of primary care physicians in Switzerland. Methods One hundred and forty general practices from a representative Swiss sentinel network of primary care physicians participated in this cluster-randomized prospective intervention study. The intervention consisted of providing guidelines on treatment of respiratory tract infections (RTIs) and uncomplicated lower urinary tract infections (UTIs), coupled with sustained, regular feedback on individual antibiotic prescription behaviour during 2 years. The main aims were: (i) to increase the percentage of prescriptions of penicillins for all RTIs treated with antibiotics; (ii) to increase the percentage of trimethoprim/sulfamethoxazole prescriptions for all uncomplicated lower UTIs treated with antibiotics; (iii) to decrease the percentage of quinolone prescriptions for all cases of exacerbated COPD (eCOPD) treated with antibiotics; and (iv) to decrease the proportion of sinusitis and other upper RTIs treated with antibiotics. The study was registered at ClinicalTrials.gov (NCT01358916). Results While the percentage of antibiotics prescribed for sinusitis or other upper RTIs and the percentage of quinolones prescribed for eCOPD did not differ between the intervention group and the control group, there was a significant increase in the percentage of prescriptions of penicillins for all RTIs treated with antibiotics [57% versus 49%, OR = 1.42 (95% CI 1.08-1.89), P = 0.01] and in the percentage of trimethoprim/sulfamethoxazole prescriptions for all uncomplicated lower UTIs treated with antibiotics [35% versus 19%, OR = 2.16 (95% CI 1.19-3.91), P = 0.01] in the intervention group. Conclusions In our setting, implementing guidelines, coupled with sustained individual feedback, was not able to reduce the proportion of sinusitis and other upper RTIs treated with antibiotics, but increased the use of recommended antibiotics for RTIs and UTIs, as defined by the guideline

mTORC1-S6K Activation by Endotoxin Contributes to Cytokine Up-Regulation and Early Lethality in Animals

Background: mTORC1 (mammalian target of rapamycin complex 1) activation has been demonstrated in response to endotoxin challenge, but the mechanism and significance are unclear. We investigated the effect of mTORC1 suppression in an animal model of endotoxemia and in a cellular model of endotoxin signaling. Methodology/Principal Findings: Mice were treated with the mTORC1 inhibitor rapamycin or vehicle prior to lethal endotoxin challenge. Mortality and cytokine levels were assessed. Cultured macrophage-like cells were challenged with endotoxin with or without inhibitors of various pathways known to be upstream of mTORC1. Activated pathways, including downstream S6K pathway, were assessed by immunoblots. We found that mTORC1-S6K suppression by rapamycin delayed mortality of mice challenged with lethal endotoxin, and was associated with dampened circulating levels of VEGF, IL-1b, IFN-c and IL-5. Furthermore, in vitro cellular studies demonstrated that LPS (lipopolysaccharide) activation of mTORC1-S6K still occurs in the presence of PI3K-Akt inhibition alone, but can be suppressed by concurrent inhibition of PI3K-Akt and MEK-ERK pathways. Conclusions/Significance: We conclude that cellular activation of mTORC1-S6K contributes to cytokine up-regulation an

Use of tobacco and alcohol by Swiss primary care physicians: a cross-sectional survey

BACKGROUND: Health behaviours among doctors has been suggested to be an important marker of how harmful lifestyle behaviours are perceived. In several countries, decrease in smoking among physicians was spectacular, indicating that the hazard was well known. Historical data have shown that because of their higher socio-economical status physicians take up smoking earlier. When the dangers of smoking become better known, physicians began to give up smoking at a higher rate than the general population. For alcohol consumption, the situation is quite different: prevalence is still very high among physicians and the dangers are not so well perceived. To study the situation in Switzerland, data of a national survey were analysed to determine the prevalence of smoking and alcohol drinking among primary care physicians. METHODS: 2'756 randomly selected practitioners were surveyed to assess subjective mental and physical health and their determinants, including smoking and drinking behaviours. Physicians were categorised as never smokers, current smokers and former smokers, as well as non drinkers, drinkers (AUDIT-C < 4 for women and < 5 for men) and at risk drinkers (higher scores). RESULTS: 1'784 physicians (65%) responded (men 84%, mean age 51 years). Twelve percent were current smokers and 22% former smokers. Sixty six percent were drinkers and 30% at risk drinkers. Only 4% were never smokers and non drinkers. Forty eight percent of current smokers were also at risk drinkers and 16% of at risk drinkers were also current smokers. Smoking and at risk drinking were more frequent among men, middle aged physicians and physicians living alone. When compared to a random sample of the Swiss population, primary care physicians were two to three times less likely to be active smokers (12% vs. 30%), but were more likely to be drinkers (96% vs. 78%), and twice more likely to be at risk drinkers (30% vs. 15%). CONCLUSION: The prevalence of current smokers among Swiss primary care physicians was much lower than in the general population in Switzerland, reflecting that the hazards of smoking are well known to doctors. However, the opposite was found for alcohol use, underlining the importance of making efforts in this area to increase awareness among physicians of the dangers of alcohol consumption

Le phénomène d'hypohaptoglobinémie comme indicateur épidémiologique du paludisme

Le phénomène Hp 0, décrit tout d'abord par les généticiens, est principalement rencontré dans les régions du monde où le paludisme sévit de manière endémique. Sa relation étroite avec cette affection et ses variations d'une fréquence et d'une amplitude considérables le désignait comme un indicateur épidémiologique potentiel. Les études réalisée au Mali, en zone soudano-sahélienne de méso-endémie palustre, ont permis de mieux définir les liens qui existent entre le phénomène Hp 0 et le paludisme, et de tester sa valeur d'indicateur en le comparant aux indicateurs paludométriques classiques. Un indice Hp a été défini de manière à disposer d'un outil de travail épidémiologique comparable aux indices parasitaires et sérologiques

Dimensional Analysis of Negative Stiffness Bilinear Systems under Pulse Like Excitations

Rocking has been proposed as a seismic design strategy for bridges and buildings, as rocking structures experience minimal residual displacements. In order to provide redundancy to rocking systems and to control their displacements, researchers in New Zealand and the USA have proposed to use unbonded restraining tendons within the rocking elements. In parallel, in the former USSR and currently in former USSR countries, a rocking solution has been used, where the rocking elements are extended with curved wedges to increase their displacement capacity, without increasing the design forces of the superstructure. In terms of their pushover curves, the above two systems are similar, as they present an initial relatively stiff branch followed by a linear branch that can be of positive or negative stiffness, depending on the stiffness of the tendon or the curvature of the curved wedge. Unloading follows the same branch without any hysteretic energy dissipation (unless the structure is equipped with extra energy dissipaters). Energy dissipation happens instantaneously during impact. Opting for positive stiffness is the current state of the practice. However, a negative stiffness design would lead to a smaller design moment for both the superstructure and the foundation, potentially not requiring piles. Therefore, there is a need to better understand the dynamics of negative stiffness systems with instantaneous damping. This paper studies the general bilinear negative stiffness oscillator. It uses dimensional analysis to determine the nondimensional quantities that better describe the problem, and presents response spectra for analytical pulses. It shows that for negative stiffness systems, the addition of flexible tendons or large curvature wedges increases the displacement capacity of the system, while it keeps the displacement demand almost constant. Moreover, it discusses the influence of the characteristics of the first branch of the bilinear curve on the overall response of the system

Nouveautés du Plan vaccinal suisse 2019 : Sept nouvelles recommandations et implications pratiques pour les praticiens

Le Plan de vaccination 2019 comprend sept nouveautés: 1) la vaccination DTPa-IPV-Hib-HBV chez le nourrisson avec le schéma simplifié à « 2+1 » doses; 2) la recommandation de la vaccination contre la rougeole, les oreillons et la rubéole (ROR) à 9 et 12 mois; 3) la vaccination contre les pneumocoques chez les enfants de moins de 5 ans comme recommandation de base; 4) le remplacement du vaccin conjugué monovalent contre le méningocoque C par le vaccin conjugué quadrivalent ACWY (Menveo); 5) l'élargissement de la vaccination contre l'encéphalite à tique verno-estivale (FSME) à tout le territoire suisse, à l'exception des cantons de Genève et du Tessin, chez les sujets présentant un facteur de risque d'exposition; 6) le remplacement de Gardasil par Gardasil 9 depuis janvier 2019 et 7) la recommandation de la vaccination contre l'hépatite B pour les nourrissons