Development of burnout over time and the causal order of the three dimensions of burnout among male and female GPs. A three-wave panel study

<p>Abstract</p> <p>Background</p> <p>A good understanding of the aetiology and development of burnout facilitates its early recognition, prevention and treatment. Since the prevalence and onset of this health problem is thought to differ between men and women, sex must be taken into account. This study aims to assess the prevalence and development of burnout among General Practitioners (GPs). In this population the prevalence of burnout is high.</p> <p>Methods</p> <p>We performed a three-wave longitudinal study (2002, 2004, 2006) in a random sample of Dutch GPs. Data were collected by means of self-report questionnaires including the Maslach Burnout Inventory. Our final sample consisted of 212 GPs of which 128 were male. Data were analyzed by means of SPSS and LISREL.</p> <p>Results</p> <p>Results indicate that about 20% of the GPs is clinically burned out (but still working). For both sexes, burnout decreased after the first wave, but increased again after the second wave. The prevalence of depersonalization is higher among men. With regard to the process of burnout we found that for men burnout is triggered by depersonalization and by emotional exhaustion for women.</p> <p>Conclusions</p> <p>As regards the developmental process of burnout, we found evidence for the fact that the aetiological process of burnout, that is the causal order of the three burnout dimensions, differs between men and women. These sex differences should be taken into account in vocational training and policy development, especially since general practice is feminizing rapidly.</p

Review of methods used by chiropractors to determine the site for applying manipulation

Background: With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation. Methods: Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation. Results: A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement. Conclusions: A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.https://doi.org/10.1186/2045-709X-21-3

Is prevention of sports injuries a realistic goal? A four-year prospective investigation of sports injuries among physical education students.

Is prevention of sports injuries a realistic goal? A four-year prospective investigation of sports injuries among physical education students. Twellaar M, Verstappen FT, Huson A. Department of Movement Sciences, University of Limburg, Maastricht, The Netherlands. To assess the reliability of injury registration and to determine the incidence of injury in intramural (program of the institution) and extramural (leisure time) sports activities, we prospectively recorded information on sports injuries for 4 years in a group of 136 physical education students. Registration forms were completed every 3 weeks, and data on medical consultations were recorded. During the last year, we asked 59 students to recall all injuries sustained to establish the reliability of retrospective injury registration. In the prospective study, 525 sports injuries were recorded: 58% during intramural activities and 42% during extramural. The incident rate per 1000 hours of intramural activities (1.26) was significantly lower than that for extramural activities (1.77). A gradual decline in response rate from 98.4% the 1st year to 87.7% in the final year indicated a decreasing compliance during the study period. Eighteen percent of all injuries with recorded medical consultations were not reported by the students. At the retrospective injury registration in the final year of the study, students had forgotten 54% of the recorded injuries and 50 injuries (20% of all recorded injuries) were mentioned that had not been recorded during the previous years. We conclude that, even in a well-supervised population, prospective injury registration is not complete, and the reliability of retrospective injury registration is even poorer

Isokinetic aerobic power output testing of the quadriceps muscle.

Department of Movement Sciences, University of Maastricht, The Netherlands. A stepwise increasing exercise protocol to measure the maximal aerobic power output of the quadriceps muscle is proposed for use in rehabilitation medicine. Sixteen healthy volunteers performed isokinetic knee extension/flexion exercises at an angular velocity of 180 degrees x s(-1). The protocol consisted of stages of 200 knee movements from 100 flexion to full extension, starting at 10% peak torque (PT) and increasing by 10% PT each following stage until exhaustion. Quadriceps work, oxygen uptake, heart rate, plasma lactate concentration and surface electromyography were monitored. Quadriceps power output (Pext) was highly related (r = 0.95) to the extension torque at which the subjects were instructed to exercise. The test-retest (r = 0.82) and left to right (r = 0.94) correlations of maximum quadriceps power output (Pmax) were high. Both sexes (males 43+/-9W, females 36+/-8W) achieved their Pmax at 47% PT. At submaximal power output stages oxygen uptake (r = 0.85) and EMG-amplitude (r = 0.88) were linearly related to Pext. Mechanical efficiency (optimum at 60% Pmax) showed a large variation between power output stages and between subjects. The relationship between relative oxygen uptake and heart rate or plasma lactate concentration was similar to that of whole body exercise, e.g. running. We conclude that the proposed test is reliable for assessing the maximal aerobic power output of the quadriceps muscle. This parameter of the muscle function may add useful information for assessing the rehabilitation process after knee immobilization. Publication Types: Clinical Tria

Physical fitness and sports skills in relation to sports injuries. A four-year prospective investigation of sports injuries among physical education students.

In order to study the relationship between physical fitness/sport-specific skills and sports injuries 136 physical education students were studied during their 4-years of training in a prospective investigation. Physical fitness was measured every year using a battery of fitness tests, and the performance marks of a number of sports scored at the exams of the academy were used as parameters for the sport-specific skills. Sports injuries were recorded every 3 weeks on standard forms. Relative risk ratios were calculated between the tertile groups good, average and poor for all variables of physical fitness and sport-specific skills. Injury-proneness was defined for all and for acute and chronic injuries separately near the median number of injuries sustained. In only 6 out of 126 computed relative risks was a significant difference found. Discriminant analysis revealed an explanation of 16%, 14% and 11% of the variance for respectively all, acute and chronic injuries, at which 5 or 6 variables in varying combination were included. From our findings it may be concluded that physical fitness and sport-specific skills have little impact on sports injuries for the following two main reasons. Firstly, subjects at risk for sports injuries participate per definition in sports activities and have consequently developed their fitness and skills compared to the sedentary population. Thus, the range in physical fitness or sports skills in the population at risk is relatively small (physical education students belong to the 7th-10th decile in fitness test scores within a general college student population) and therefore an effect is hard to show. Secondly, the total number of sports injuries is very small and moreover, it should be distributed over several categories for analysis. The favourable advantages of using physical education students to study intrinsic risk factors (comparable and varied sports program, excellent compliance) appeared to be insufficient to compensate for drawbacks of selection

Psychological characteristics of patients with newly developed psychogenic seizures

Methods: Using validated scales, 178 patients from the general population diagnosed with newly developed seizures were assessed, at a point in time when the nature of their seizures was yet unknown to either doctors or patients. After standardised neurological examination, 138 patients were diagnosed with non-psychogenic seizures (NPS), while 40 patients were found to have psychogenic seizures (PS). To evaluate possible differences between the genders and the diagnostic groups, univariate analyses of variance were done. Results: PS patients reported significantly more comorbid psychopathological complaints, dissociative experiences, anxiety, and self-reported childhood trauma than NPS patients. In addition, PS patients had lower quality of life ratings than NPS patients. These effects were not modulated by gender. Conclusions: The results of the present study indicate that patients with newly developed PS constitute a group with complex psychopathological features that warrant early detection and treatment

The Fold-in, Fold-out Design for DCE Choice Tasks: Application to Burden of Disease

Contains fulltext : 206731.pdf (publisher's version ) (Open Access