Professional quality of life and organizational changes: a five-year observational study in Primary Care

<p>Abstract</p> <p>Background</p> <p>The satisfaction and the quality of life perceived by professionals have implications for the performance of health organizations. We have assessed the variations in professional quality of life (PQL) and their explanatory factors during a services management decentralization process.</p> <p>Methods</p> <p>It was designed as a longitudinal analytical observational study in a Health Area in Madrid, Spain. Three surveys were sent out during an ongoing management decentralization process between 2001 and 2005. The professionals surveyed were divided into three groups: Group I (97.3% physicians), group II (92.5% nurses) and group III (auxiliary personnel). Analysis of the tendency and elaboration of an explanatory multivariate model was made. The PQL -35 questionnaire, based on Karasek's demand-control theory, was used to measure PQL. This questionnaire recognizes three PQL dimensions: management support (MS), workload (WL) and intrinsic motivation (IM).</p> <p>Results</p> <p>1444 responses were analyzed. PQL increased 0.16 (CI 95% 0.04 – 0.28) points in each survey. Group II presents over time a higher PQL score than group I of 0.38 (IC 95% 0.18 – 0.59) points. There is no difference between groups I and III.</p> <p>For each point that MS increases, PQL increases between 0.44 and 0.59 points. PQL decreases an average of between 0.35 and 0.49 point, for each point that WL increases.</p> <p>Age appears to have a marginal association with PQL (CI 95% 0.00 – 0.02), as it occurs with being single or not having a stable relationship (CI 95% 0.01 – 0.41). Performing management tasks currently or in the past is related to poorer PQL perception (CI 95% -0.45 – -0.06), and the same occurs with working other than morning shifts (CI 95% -0.03 – -0.40 points).</p> <p>PQL is not related to sex, location of the centre (rural/urban), time spent working in the organization or contractual situation.</p> <p>Conclusion</p> <p>With the improvement in work control and avoiding increases in workloads, PQL perception can be maintained despite deep organizational changes at the macro-management level. Different professional groups experience different perceptions depending on how the changes impact their position in the organization.</p

Interaction among general practitioners age and patient load in the prediction of job strain, decision latitude and perception of job demands. A Cross-sectional study

BACKGROUND: It is widely recognized and accepted that job strain adversely impacts the workforce. Individual responses to stressful situations can vary greatly and it has been shown that certain people are more likely to experience high levels of stress in their job than others. Studies highlighted that there can be age differences in job strain perception. METHODS: Cross-sectional postal survey of 300 Lithuanian general practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the Karasek scale. The analysis included descriptive statistics; logistic regression beta coefficients to find out predictors and interactions between characteristics and predictors. RESULTS: Response rate was 66% (N = 197). Logistic regression as significant predictors for job strain assigned – duration of work in primary care; for job demands- age and duration of working in primary care; for decision latitude- age and patient load. The interactions with regard to job strain showed that GP's age and job strain are negatively associated to a low patient load. Lower decision latitude for older GP age is strongly related to higher patient load. Job demands and GP age are slightly positively related at low patient load. CONCLUSIONS: Lithuanian GP's have high patient load and are at risk of stress, they have high job demands and low decision latitude. Older GP's perceive less strain, lower job demands and higher decision latitude in case of low patient load. Young GP's decision latitude has week association to patient load. Regarding to the changes in patient load younger GP's perceive it more sensitively as changes in job demands

Variaciones en la aplicación de técnicas médicas en atención primaria.

Objectives: To describe the application of medical techniques (ATM) in Spain and to analyze the relationship with diverse characteristics related to general practitioners and the center of primary health care. Design: Multicenter cross-sectional study. Setting: Three hundred nineteen general practitioners working in primary care centers in the restructured public sector of the Autonomous Communities of Andalusia, Basque Country and Catalonia in Spain. Main measurements: Structured and validated questionnaire comprising 100 items in four sections: general charateristics of the physician and health center, task profile, and job satisfaction. The questionnaire was sent by mail to the health center (Andalusia and Basque Country) or to the home (Catalonia). For the analysis an index variable was created from the answers to the questions on AMT. Results: The index variable of AMT obtained a mean value of 10.02 (SD=4.55). Andalusia obtained the highest value (median: 11.11; SD: 4.33) of the three Autonomous Communities in the study (p=.012). AMT acquired significantly higher values when associated with: masculine sex (sample from the three autonomous communities: p=.046), rural environment, teamwork, availability of basic equipment, fewer patients, and reduced work load. Conclusions: Index of ATM in Spain is significantly different in the three Spanish communities under study. The quality of the sanitary services evaluated from the dimension of the ATM seems to be much related with demographic characteristics, the readiness in the consultations of ascientific-technical stuff and the appropriate time for medical consultations. (aut.ref.

Nursing professionals' anxiety and feelings in terminal situations in oncology Ansiedades y sentimientos de los profesionales de enfermería en situaciones de terminalidad en oncología Ansiedades e sentimentos de profissionais da enfermagem nas situações de terminalidade em oncologia

This study aimed to investigate, through a cross-sectional study, factors that influence anxiety levels and feelings of a nursing team who care for terminal patients with cancer. The sample consisted of 50 Nursing Assistants and Technicians from the Hospital reference on cancer care in Rio Grande do Norte, Brazil. Data were collected through the State-Trait Anxiety Inventory. Results showed that 69.8% of the professionals have medium anxiety levels and 30.2% have high levels of anxiety. The Number of Patients attended and "Working in another Institution" interfered in the anxiety levels. The most remarkable professionals' feelings were suffering and sadness, and Child was the most difficult age group to care for. Studies which develop support strategies to those health professionals are necessary to reduce and/or to prevent high anxiety and stress levels.<br>Se trata de una investigación transversal que evaluó el nivel de ansiedad del equipo de enfermería que se dedica al enfermo terminal con cáncer, investigando los factores que influencian este equipo, así como los sentimientos de los profesionales ante la atención a estos enfermos. Fueron analizados 50 auxiliares y técnicos de enfermería del hospital de referencia de atención al cáncer de Rio Grande do Norte, Brasil. Datos fueron recolectados a través de un cuestionario y del Inventario de Ansiedad Rasgo-Estado. Resultados revelaron que el 69,8% posee ansiedad-estado media y el 30,2% alta. El número de enfermos atendidos y 'trabajar en otra institución' interfirieron en el nivel de ansiedad-estado. Los sentimientos más destacados fueron sufrimiento y tristeza, y 'niño' fue indicado como el grupo de edad más difícil de dedicarse. Se verifica la necesidad de estrategias de apoyo para los profesionales a fin de reducir y/o prevenir altos niveles de ansiedad y estrés.<br>Trata-se de investigação de caráter transversal que avaliou o nível de ansiedade da equipe de enfermagem que lida com o paciente terminal com câncer, procurando identificar os fatores que a influenciam, bem como os sentimentos dos profissionais frente ao atendimento destes pacientes. Foram analisados 50 auxiliares e técnicos de enfermagem do hospital de referência de atendimento ao câncer do Rio Grande do Norte. Os dados foram coletados através de questionário e do Inventário de Ansiedade Traço-Estado. Os resultados revelaram que 69,8% dos profissionais possuem Ansiedade-Estado média e 30,2% alta. O número de pacientes atendidos e 'trabalhar em outra instituição' interferiram na Ansiedade-Estado. Os sentimentos mais destacados foram sofrimento e tristeza, e 'criança' foi apontada como sendo a faixa-etária mais difícil de se lidar. Verifica-se a necessidade de realização de estratégias de apoio para profissionais a fim de reduzir e/ou prevenir altos níveis de ansiedade e estresse

Football hooliganism as a transnational phenomenon: Past and present analysis: A critique – More specificity and less generality

Despite the ongoing globalization of football culture and societies at large, there remain important cross-national and cross-local variations in the level and forms of football hooliganism. These dissimilarities thwart efforts to conceptualize and explain football hooliganism as a homogeneous phenomenon and, more specifically, seriously limit the applicability of dominant sociological theories on the subject. The author illustrates his argument with an examination of international research literature and empirical data on the social composition of one Spanish and one Dutch hooligan group. He argues that comparative research into football hooliganism should move beyond general explanations in terms of societal fault lines and towards a more detailed analysis of hooligans' subcultural identities and social interactions