The relative importance of work-releated psychosocial factors in physician burnout

Background Identifying the most significant risk factors for physician burnout can help to define the priority areas for burnout prevention. However, not much is known about the relative importance of these risk factors. Aims This study was aimed to examine the relative importance of multiple work-related psychosocial factors in predicting burnout dimensions among physicians. Methods In a cross-sectional sample of 2423 Finnish physicians, dominance analysis was used to estimate the proportionate contribution of psychosocial factors to emotional exhaustion, depersonalization and reduced personal accomplishment. The psychosocial factors included job demands (time pressure, patient-related stress, lack of support, stress related to information systems, work-family conflict) and job resources (job control, team climate, organizational justice). Results Together, psychosocial factors explained 50% of the variance in emotional exhaustion, 24% in depersonalization and 11% in reduced professional efficacy. Time pressure was the most important predictor of emotional exhaustion (change in total variance explained Delta R-2 = 45%), and patient-related stress was the most important predictor of both depersonalization (Delta R-2 = 52%) and reduced professional accomplishment (Delta R-2 = 23%). Stress related to information systems was the least important predictor of the burnout dimensions (Delta R-2 = 1-2%). Conclusions Psychosocial factors in physicians' work are differently associated with the dimensions of burnout. Among the factors, the most significant correlates of burnout are job demands in the form of time pressure and patient-related stress.Peer reviewe

Adolescent attachment to parents and peers in singletons and twins born with assisted and natural conception

STUDY QUESTION Does adolescent attachment to parents and peers differ between singletons and twins born with ART or natural conception (NC)? SUMMARY ANSWER Adolescent attachment anxiety with the father was higher among NC singletons than among ART and NC twins, whereas attachment avoidance with the father was higher in ART singletons than in NC singletons and NC twins. No differences were found in attachment to the mother, best friend or romantic partner. WHAT IS KNOWN ALREADY Most studies have not found differences between ART and NC singletons in parent-adolescent relationships, but twin relationships may be more at risk. No previous study has examined all four groups in the same study, or specifically looked at attachment relationships. STUDY DESIGN, SIZE, DURATION This was an 18-year, prospective and controlled longitudinal study with families of 496 ART singletons, 101 ART twin pairs, 476 NC singletons and 22 NC twin pairs. Families were recruited during the second trimester of pregnancy; the ART group was recruited from five infertility clinics in Finland and the control group was recruited from a hospital outpatient clinic during a routine visit. PARTICIPANTS/MATERIALS, SETTING, METHODS Mothers and fathers gave background information for this study during pregnancy, and during the child's first year and early school age (7-8 years). For the ART group, infertility characteristics and prenatal medical information was also obtained from the patient registry of the infertility clinics. Children (originally 50% girls) filled in electronic questionnaires related to their attachment to mother, father, best friend and romantic partner (Experiences in Close Relationships-Relationship Structures) at 17-19 years of age. MAIN RESULTS AND THE ROLE OF CHANCE Adolescent attachment anxiety to father was higher in NC singletons than in ART twins, P = 0.004 and marginally higher than in NC twins, P = 0.06. Adolescent attachment avoidance to father was higher in ART singletons than in NC singletons, P = 0.006 and marginally higher than in NC twins, P = 0.055. LIMITATIONS, REASONS FOR CAUTION The sample size was small especially in the NC twin group and there was drop-out over the 18-year time period, especially among boys and families with lower parental education level. The study only included native Finnish-speaking families. The results could differ in a more diverse population. ART singletons were younger and had fewer siblings than ART twins and NC children, and ART and NC twins had more newborn health risks than ART and NC singletons. WIDER IMPLICATIONS OF THE FINDINGS The study adds to a growing body of evidence that neither ART treatments nor being a twin places mother-child relationships or peer relationships at long-term risk. However, in our study, which was the first to examine both ART and twinhood simultaneously, we found that there may be more problems in father-adolescent relationships, but only in ART singletons and only related to attachment avoidance. Our findings suggest that men, as well as women, should receive enough support in pre- and peri-natal health care during and after infertility treatments. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by Academy of Finland (grant number 2501308988), the Juho Vainio Foundation and the Finnish Cultural Foundation. The authors report no conflict of interest.Peer reviewe

Sairauspoissaolotarpeen määrittäminen : Kyselytutkimus lääkäreille

Kelan tutkimusosasto ja Suomen Lääkäriliitto toteuttivat vuonna 2014 lääkäreille kohdistetun kyselyn, jonka tarkoituksena on kartoittaa lääkäreiden näkemyksiä ja kokemuksia sairauspoissaoloihin liittyvistä käytännöistä ja kehittämistarpeista. Kysely perustuu vuonna 2012 Ruotsissa tehtyyn kyselyyn. Vastaava kysely toteutettiin myös Norjassa. Kysymykset on muokattu kunkin maan järjestelmään sopiviksi. Kyselylomake lähetettiin 8 867 lääkärille loppuvuodesta 2014, ja siihen saattoi vastata joko paperisella tai sähköisellä lomakkeella. Vastausprosentti oli 34,8. Rakenteeltaan aineisto edusti perusjoukkoa, joskin työterveyshuolto oli hieman yliedustettuna. Lääkärit pitivät julkisen sektorin palvelujen saatavuutta keskeisenä syynä sairauspoissaolojen pitkittymiseen. Myös vajaakuntoisten työntekijöiden työssä jaksamista tukevien toimenpiteiden saatavuus vaikutti sairauspoissaolojen kirjoittamiseen. Kelalta toivottiin enemmän palautetta lääkärien omasta toiminnasta. Lääkärien osaamisen kehittämistarpeet korostuivat erityisesti terveyskeskuksissa, mutta koulutusta tarvitsevien osuus on varsin suuri muillakin toimintasektoreilla. Lääkärit toivoivat laajasti, erikoistumisalasta tai toimipaikasta riippumatta, vähintäänkin joitakin sairauksia koskevia kansallisia suosituksia sairauspoissaolojen kestosta. Nykyisiä käytettävissä olevia ohjeita ja suosituksia monet lääkärit pitivät tärkeinä. Työterveyslääkärit erottuivat monissa kohdin omaksi ryhmäkseen. He näyttävät hallitsevan työkyvyn ja sairauspoissaolon tarpeen arviointiin liittyvät tehtävät parhaiten. Suomalaiset lääkärit kokivat ruotsalaisia ja norjalaisia perusterveydenhuollon lääkäreitä vähemmän ongelmia sairauspoissaoloon liittyvissä asioissa. Tutkimuksen perusteella annetuissa suosituksissa esitetään puuttumista jatkohoidon ja kuntoutukseen pääsyn viiveisiin, työkyvyn arviointiin liittyvän koulutuksen lisäämistä, sairauspoissaolotarpeen siirtämistä enemmän työterveyshuollon vastuulle sekä sairauspoissaolojen kestoa koskevien suositusten laatimista ainakin joistakin sairauksista

What predicts doctors’ satisfaction with their chosen medical specialty? A Finnish national study

Background In Finland the number of medical specialists varies between specialties and regions. More regulation of the post-graduate medical training is planned. Therefore, it is important to clarify what predicts doctors’ satisfaction with their chosen specialty. Methods A random sample contained 50 % of all Finnish doctors under 70 years of age. The respose rate was 50.5 %. Working-age specialists were asked to value their motives when choosing a specialty. They were also asked if they would choose the same specialty again. The odds ratios for not choosing the same specialty again were tested. Results Diversity of work was the most important motive (74 % of respondents). Seventeen percent of GPs would not choose the same specialty again, compared to 2 % of ophthalmologists and 4 % of pediatricians. A major role of Diversity of work and Prestigious field correlated with satisfaction whereas Chance with dissatisfaction with the specialty. Discussion Motives and issues related to the work and training best correlate with satisfaction with the specialty. Conclusions When the numbers of Finnish postgraduate medical training posts become regulated, a renewed focus should be given to finding the most suitable speciality for each doctor. Information about employment and career advice should play an important role in this.BioMed Central open acces

How do early family systems predict emotion recognition in middle childhood?

Facial emotion recognition (FER) is a fundamental element in human interaction. It begins to develop soon after birth and is important in achieving developmental tasks of middle childhood, such as developing mutual friendships and acquiring social rules of peer groups. Despite its importance, FER research during middle childhood continues to be rather limited. Moreover, research is ambiguous on how the quality of one's early social-emotional environment shapes FER development, and longitudinal studies spanning from infancy to later development are scarce. In this study, we examine how the cohesive, authoritarian, disengaged and enmeshed family system types, assessed during pregnancy and infancy, predict children's FER accuracy and interpretative biases towards happiness, fear, anger and sadness at the age of 10 years (N = 79). The results demonstrated that children from disengaged families (i.e., highly distressed relationships) show superior FER accuracy to those from cohesive families (i.e., harmonious and stable relationships). Regarding interpretative biases, children from cohesive families showed a greater fear bias compared to children from disengaged families. Our findings suggest that even in a relatively low-risk population, variation in the quality of children's early family relationships may shape children's subsequent FER development, perhaps as an evolution-based adaptation to their social-emotional environment

Young masculinities, purity and danger: Disparities in framings of boys and girls in policy discourses of sexualisation

One of the reasons why it is ‘hard to explain’ the lack of attention to boys in discourses in sexualisation is that approached head-on, it appears that the focus on girls has no logic and is merely accidental. One might point to the research that is beginning to emerge on the increased visibility of the male body in visual cultures (e.g. Gill, 2009) and to boys’ fashion and embodiment (e.g. Vandenbosch and Eggermont, 2013). However, we propose that the tendency towards a problematisation of girls’ fashion and deportment and the invisibility of boys within policy and media discourses on ‘sexualisation’ is a systemic effect of constructions of gender and sexual subjectivity. In our society, we argue, signifiers of feminine purity operate as a form of symbolic capital, a construction that is not attributed to boys and which is integral scaffolding for the depiction of a subject as threatened by sexualisation. To illustrate our theorising regarding the ‘sexualisation of boys’, we shall examine an apparent exception to the rule: the Papadopoulos Review (2010), which explicitly attends to the sexualisation of boys and ends up re-emphasising rather than analysing the gendered and classed discourses of sexualisation. The Papadopolous Review indicates a moment at which a problematisation of the sexualisation of boys could have been triggered – since attention to both boys and girls was specifically part of the remit of the review – but was not, for specific sociological reasons to do with which subjects are assessed against the criterion of innocence

Pentraxin 3 (PTX3) Is Associated with Severe Sepsis and Fatal Disease in Emergency Room Patients with Suspected Infection: A Prospective Cohort Study

Background Early diagnostic and prognostic stratification of patients with suspected infection is a difficult clinical challenge. We studied plasma pentraxin 3 (PTX3) upon admission to the emergency department in patients with suspected infection. Methods The study comprised 537 emergency room patients with suspected infection: 59 with no systemic inflammatory response syndrome (SIRS) and without bacterial infection (group 1), 67 with bacterial infection without SIRS (group 2), 54 with SIRS without bacterial infection (group 3), 308 with sepsis (SIRS and bacterial infection) without organ failure (group 4) and 49 with severe sepsis (group 5). Plasma PTX3 was measured on admission using a commercial solid-phase enzyme-linked immunosorbent assay (ELISA). Results The median PTX3 levels in groups 1–5 were 2.6 ng/ml, 4.4 ng/ml, 5.0 ng/ml, 6.1 ng/ml and 16.7 ng/ml, respectively (p<0.001). The median PTX3 concentration was higher in severe sepsis patients compared to others (16.7 vs. 4.9 ng/ml, p<0.001) and in non-survivors (day 28 case fatality) compared to survivors (14.1 vs. 5.1 ng/ml, p<0.001). A high PTX3 level predicted the need for ICU stay (p<0.001) and hypotension (p<0.001). AUCROC in the prediction of severe sepsis was 0.73 (95% CI 0.66–0.81, p<0.001) and 0.69 in case fatality (95% CI 0.58–0.79, p<0.001). PTX3 at a cut-off level for 14.1 ng/ml (optimal cut-off value for severe sepsis) showed 63% sensitivity and 80% specificity. At a cut-off level 7.7 ng/ml (optimal cut-off value for case fatality) showed 70% sensitivity and 63% specificity in predicting case fatality on day 28.In multivariate models, high PTX3 remained an independent predictor of severe sepsis and case fatality after adjusting for potential confounders. Conclusions A high PTX3 level on hospital admission predicts severe sepsis and case fatality in patients with suspected infection.Public Library of Science open acces