The factors associated to psychosocial stress among general practitioners in Lithuania. Cross-sectional study

Background  

There are number of studies showing that general practice is one of the most stressful workplace among health care workers. Since Baltic States regained independence in 1990, the reform of the health care system took place in which new role and more responsibilities were allocated to general practitioners' in Lithuania. This study aimed to explore the psychosocial stress level among Lithuanian general practitioner's and examine the relationship between psychosocial stress and work characteristics.     

北京某三甲医院心脏外科医生职业倦怠与压力水平的关系

目的调查安贞医院心脏外科医生的职业倦怠状况,探讨职业倦怠与压力水平的关系。方法采用Maslach倦怠量表(MBI-GS)和职业压力指标问卷(OSI-2)中的压力源分量表对66名心脏外科医生进行调查。结果 47%的被试者有一定程度的情绪衰竭;39.4%的被试者有一定程度的情感疏远;10.6%的被试者职业效能感较低。年龄、受教育程度与心脏外科医生的职业倦怠相关(P<0.05);工作10～15年者职业倦怠程度显著高于其他人群;婚姻状况与职业倦怠无显著相关。工作负荷对情绪衰竭具有正相关作用;人际关系对情感疏远具有正相关作用;日常烦忧、管理角色对职业效能具有负相关作用。结论部分心脏外科医生有一定程度的职业倦怠;不同来源的压力源对职业倦怠的三个维度具有不同的影响作用。     

Modifiable risks for cardiovascular disease among general practitioners in Wales

A random cluster sample of 520 general practitioners in Wales was invited to complete a postal questionnaire providing information on personal health status, and practice organisation and activities relating to the prevention of cardiovascular disease. Survey participants were also asked to provide a blood sample together with details of independently measured height, weight and blood pressure. 310 (60%) provided usable information and 280 (54%) provided blood samples. General practitioners in the study generally had better lifestyles and fewer coronary risk factors than the general population in Wales. Only 17% (43/251) of males were regular smokers, and 56% (134/239) of males and 32% (18/68) of females regularly take exercise. Few and uncontrolled elevated blood pressure. However, 39% (97/248) of males and 29% (15/52) of female GPs were overweight, and more than 40% (19/42) of male GPs aged 40-64 had cholesterol levels above 6.5 mmol. Six per cent (6/99) of male GPs aged 40-54 consumed greater than 35 units of alcohol each week. It is suggested that GPs have responded well to the challenges of reducing smoking among themselves and their patients, but that they have yet to recognise fully the risks to personal health associated with elevated cholesterol levels and high alcohol consumption.     

Dutch occupational physicians and general practitioners wish to improve cooperation

OBJECTIVES: To investigate cooperation between occupational physicians (OPs) and general practitioners (GPs). METHODS: Literature review; structured interviews; questionnaires sent to randomised samples of OPs (n = 232) and GPs (n = 243). RESULTS: Actual cooperation is poor. However, more than 80% of both groups responded that they want to improve their cooperation, aiming at better quality of care. Obstacles identified by OPs include insufficient knowledge among GPs about occupational health services (OHSs) (57%) and their patients' working conditions (52%). OPs also consider that GPs suspect them of serving employers more than employees (44%) and of verifying reasons of absence, with information from GPs (34%). Responses from GPs confirm these two suspicions (48%, response 58%), adding obstacles like commercialisation of OHS, lack of financial incentives, etc. Both groups are unanimous about prerequisites for improvement, especially guaranteeing the professional autonomy of OPs (OPs 86%, GPs 76%). CONCLUSION: As a first step to overcome obstacles to cooperation, OPs must clarify their position to GP colleagues. Initiatives have been taken after presenting this study.

 

     

Dealing with sickness certification – a survey of problems and strategies among general practitioners and orthopaedic surgeons

Background  

In order to get sickness benefit a sick-listed person need a medical certificate issued by a physician; in Sweden after one week of self-certification. Physicians experience sick-listing tasks as problematic and conflicts may arise when patients regard themselves unable to work due to complaints that are hard to objectively verify for the physician. Most GPs and orthopaedic surgeons (OS) deal regularly with sick-listing issues in their daily practice. The aim of this study was to explore perceived problems and coping strategies related to tasks of sickness certification among general practitioners (GP) and orthopaedic surgeons (OS).     

The association between cheese consumption and cardiovascular risk factors among adults

Background Although current dietary guidelines recommend limiting foods high in fat and saturated fat, such as high‐fat dairy, the effect of cheese consumption on body composition and cardiovascular risk factors is largely unknown. Methods Participants from a US population‐based survey, NHANES III, aged 25–75 years who completed a food frequency questionnaire and had measures of body composition and cardiovascular risk factors were included (n = 10 872). Linear regression was used to compare anthropometrics, blood lipids, blood pressure and blood glucose across categories of cheese consumption (combined full and low‐fat). Results In women, more frequent cheese consumption was associated with higher HDL‐C and lower LDL‐C (p for trend, < 0.05). However, in men, more frequent cheese consumption was associated with a higher body mass index (BMI), waist circumference, HDL‐C and LDL‐C, and diastolic blood pressure (p for trend, < 0.05). Men consuming 30 + servings/month had significantly higher BMI, waist circumference, and diastolic blood pressure compared to nonconsumers (P < 0.05). Conclusions More frequent cheese consumption was associated with less favourable body composition and cardiovascular risk profile in men, but with a more favourable cardiovascular risk profile in women. However, the type of cheese consumed by men and women may have differed resulting in opposing trends on body composition and cardiovascular risk factors.     

中老年人群高尿酸血症与心血管危险因素关系

目的探讨中老年人群高尿酸血症与心血管危险因素及聚集性之间的关系,为高尿酸血症的防治提供有效的策略和依据。方法采用随机整群抽样方法抽取在广州军区广州总医院健康管理体检中心接受长期定期体检的14个体检单位1 176名45~75岁人群进行问卷调查、体格检查和实验室检测。结果中老年人群男性高尿酸血症患病率为55.7%,标化患病率为37.7%,女性高尿酸血症患病率为46.5%,标化患病率为40.7%;男女性高尿酸血症组年龄、甘油三酯、血肌酐、体质指数、腰臀比及高血压患病率均高于非高尿酸血症组,高密度脂蛋白胆固醇低于非高尿酸血症组,女性高尿酸血症组糖尿病患病率高于非高尿酸血症组,差异均有统计学意义（P<0.05）;多因素logistic回归分析显示,调整年龄和饮酒后,甘油三酯含量较高（OR=1.923,95%CI=1.304~2.834）、腹型肥胖（OR=1.482,95%CI=1.001~2.194）是中老年男性高尿酸血症患病的危险因素;血肌酐含量较高（OR=1.061,95%CI=1.037~1.086）、肥胖（OR=6.345,95%CI=2.524~15.952）是中老年女性高尿酸血症患病的危险因素,高密度脂蛋白胆固醇含量较高（OR=0.387,95%CI=0.222~0.676）是中老年女性高尿酸血症患病的保护因素;随着心血管危险因素的增多,高尿酸血症患者所占比例也随之增多（P<0.05）;校正年龄、饮酒、性别等混杂因素后,随着个体存在心血管危险因素的增多,高尿酸血症的患病风险也随之升高,具有1、2、≥3个心血管危险因素的个体患高尿酸血症的危险性分别是无危险因素个体的1.557、1.688、2.666倍。结论中老年男性高尿酸血症的影响因素为甘油三酯、腰臀比,中老年女性高尿酸血症的影响因素为血肌酐、体质指数、高密度脂蛋白胆固醇;高尿酸血症患者具有心血管危险因素聚集性。     

Musculoskeletal complaints and psychosocial risk factors among Chinese hospital nurses

BACKGROUND: Musculoskeletal complaints represent a common occupational problem for health care workers throughout the world. Despite their sizeable numbers, however, few epidemiological studies have investigated musculoskeletal complaints among Chinese hospital nurses. Objective To assess the prevalence of, and risk factors for, musculoskeletal complaints among hospital nurses in mainland China. METHODS: A total of 282 female, registered nurses were surveyed (92% response rate) using a modified Chinese-language version of the Standardized Nordic Questionnaire. Body sites were divided into the neck, shoulder, upper back and lower back regions. RESULTS: The 12 month period-prevalence of musculoskeletal complaints at any of the four regions was 70%. The lower back was the most commonly reported body site (56%), followed by the neck (45%), shoulder (40%) and upper back (37%). High mental pressure, boring or tedious tasks and limited work support were identified as significant risk factors (adjusted odds ratios: 1.79-2.52). No correlations were found between manual handling or perceived physical exertion and increased reporting of musculoskeletal complaints. CONCLUSION: This study has shown that musculoskeletal complaints are prevalent among Chinese hospital nurses. The correlation with various psychosocial factors is also consistent with evidence from other countries.     

Correlation between dietary glycemic index and cardiovascular disease risk factors among Japanese women

OBJECTIVE: To examine the correlation between dietary glycemic index (GI) and cardiovascular disease (CVD) risk factors among subjects who consume white rice as a staple food. DESIGN: A cross-sectional study was conducted to explore the associations between dietary GI, dietary glycemic load (GL) and dietary intakes, and CVD risk factors. Dietary GI and GL were calculated from a 3-day (including two consecutive weekdays and one holiday) dietary records. SETTING: A weight-reduction program at a municipal health center in Tokyo, Japan. SUBJECTS: A total of 32 women aged 52.5+/-7.2 y participated in the weight-reduction program. RESULT: The GI food list made for the current study calculated for 91% of carbohydrate intakes measured. The mean dietary GI was 64+/-6, and the mean dietary GL was 150+/-37. Individuals in the highest tertile of GI consumed more carbohydrate, mostly from white rice (P<0.001), and less fat (P<0.01). Individuals in all three groups by tertile of GL showed similar tendencies. In the lowest GI tertile, the highest concentration of HDL-cholesterol and lowest concentration of triacylglycerol and immunoreactive insulin were observed (P<0.01). In the lowest GL tertile, the highest concentration of HDL-cholesterol and the lowest concentration of triacylglycerol were observed (P<0.05). CONCLUSION: Calculated dietary GI and GL were positively associated with CVD risk factors among the Japanese women who consumed white rice as a staple food.     

Comparison of cardiovascular risk factors between sri lankans living in kandy and oslo

Background  

South Asians living in western countries are known to have unfavourable cardiovascular risk profiles. Studies indicate migrants are worse off when compared to those living in country of origin. The purpose of this study was to compare selected cardiovascular risk factors between migrant Sri Lankans living in Oslo, Norway and Urban dwellers from Kandy, Sri Lanka.     

Preventive and other interactional skills of general practitioners, surgeons, and physicians: perceived competence and endorsement of postgraduate training

BACKGROUND: Perceived competencies and support for formal postgraduate training across a range of preventive and other interactional skills were examined in three medical groups. METHODS: All eligible final year students and recent graduates of the three major Australian medical colleges (n = 767) were mailed a questionnaire examining communication skills in four domains: preventive, educational, therapeutic, and general. RESULTS: Overall consent rate was 45%. For most items, at least one-third of each group reported low competence. On preventive items, low competence ratings ranged from 5 to 39% in general practice, 38 to 67% in surgery, and 33 to 51% in the speciality physician group. Significant intergroup differences occurred on eight competence items. Agreement with training on preventive topics ranged from 80 to 91% in general practice, 48 to 69% in surgery, and 72 to 82% in the specialty physician group. On all 11 training items where significant differences occurred, the general practice group reported the highest level and the surgeon group the lowest level of endorsement for formal training and assessment. CONCLUSIONS: Substantial proportions in the general practice, surgery, and the physician specialty report lack of competence in common interactional skills. There were high levels of support for formal training in preventive and other interactional skills. The strong endorsement supports the development of effective, tailored interactional skills training programs.     

Relationship between hyperuricemia and other cardiovascular disease risk factors among adult males in Taiwan

Hyperuricemia is associated with cardiovascular disease risk factors such as obesity, impaired glucose tolerance, hypertension, and hyperlipidemia. However, this relationship between serum uric acid (SUA) concentrations and cardiovascular disease (CVD) is a controversial one, especially among males. The purpose of this study is to evaluate the association between SUA concentrations and other CVD risk factors among adult males in Taiwan. After multi-stage sampling procedures, we randomly selected 1743 Taiwanese males with a mean age of 35 years (from 22 to 54) in this study. Anthropometric, blood pressure and biochemical variables, including serum uric acid, glucose, total cholesterol and triglyceride concentrations, were measured. Among the study population, the mean SUA concentration was 6.5 ± 1.5 mg/dl. There were 290 (16.6%) subjects with SUA concentrations 8.0 mg/dl (defined as hyperuricemia). Compared to normouricemic subjects, hyperuricemic subjects had significantly greater age-adjusted body weight (75.3 vs. 69.2 kg, p < 0.001), body mass index (BMI, 25.5 vs. 23.6 kg/m², p < 0.001), higher blood pressure (BP, 120.2 vs. 115.2 mmHg for systolic BP and 78.5 vs. 75.3 mmHg for diastolic BP, both p < 0.001) and blood lipid concentrations (193.8 vs. 182.1 mg/dl for total cholesterol and 123.7 vs. 94.4 mg/dl for triglycerides, both p < 0.001). SUA concentration was positively correlated with body weight, BMI, BP and serum lipid concentrations (all p < 0.001). In multivariate regression analyses, after adjusting for potential confounders, SUA concentration was significantly positively associated with diastolic BP, serum total cholesterol and triglyceride concentrations. An increase of 1 mg/dl of SUA was associated with a 2.1 mg/dl elevation in serum total cholesterol (p < 0.001) and a 5.4 mg/dl increase in triglyceride (p < 0.001). From this study, we found that hyperuricemia in subjects is associated with being overweight, and having high blood pressure and hyperlipidemia. There is a significantly positive association between SUA concentration and other CVD risk factors among adult males in Taiwan.     

Relationships among black families' cardiovascular disease risk factors

BACKGROUND. As participants in the District of Columbia Studies of Children's Activity and Nutrition (D.C. SCAN), 262 black mothers and two of each mother's children (3-4 and 8-10 years of age) were measured in their homes for selected cardiovascular disease risk factors: serum total cholesterol, systolic and diastolic blood pressures, height and weight for body mass index, fitness (sum of pulses), activity, and triceps and subscapular skinfolds. RESULTS. For each measure, mothers in the highest quartile were more likely to have children who were also in the highest quartile, and mothers in the lowest quartile were more likely to have children who were in the lowest quartile. For the physiological measures, (with the exception of systolic blood pressure), correlations tended to be stronger between the siblings than between the younger child and the mother, and older siblings' physiological measures contributed to the prediction of younger siblings' physiological measures after controlling for mothers' physiological measures. Relationships between family cardiovascular disease risk factor history and children's serum total cholesterol, and systolic and diastolic blood pressure levels tended to be gender related; i.e., family cardiovascular disease risk factors on the mother's side were more likely to be related to levels among the female but not the male children and vice versa. When personal characteristics were controlled for, the family's cardiovascular disease history was related more strongly to the younger than to the older sibling's systolic and diastolic blood pressure levels. CONCLUSIONS. Results tend to substantiate the importance of screening and counseling other family members, especially a child of the same gender as the parent with a cardiovascular disease or an elevated risk factor level.     

低胆固醇与心血管危险因素相关性研究

目的探讨低胆固醇者与血脂代谢水平、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、血糖、血尿酸、尿素氮、肌酐水平,体重及体质指数、脂肪肝发生率,心电图改变的关系。方法随机收集海南医学院附属医院体检者中低胆固醇者206例,以及胆固醇正常者100例,抽血检测其血脂代谢水平甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL）、高密度脂蛋白胆固醇（HDL）以及ALT、AST、血糖、血尿酸、尿素氮、肌酐水平和B超检出脂肪肝水平,心电图检查,同时测量血压、体重及体质指数。采用Excel 2003统计软件进行统计学分析,计量资料符合正态分布者数据用均数±标准差（x±s）表示,构成比用χ2检验,以P〈0.05为有差异有统计学意义。结果和胆固醇正常者相比,低胆固醇者的TG、TC、ALT、AST、血糖、血尿酸、肌酐、尿素氮水平及脂肪肝患病率、体重及体质指数、血压低于胆固醇正常者,其中,两组间ALT、AST比较,u=2.049、2.555,P均〈0.05,两组间体重及体质指数、血压、TG、TC、血糖、血尿酸、肌酐、尿素氮水平、脂肪肝患病率比较,χ2/u=6.66、7.562、5.634、4.798、6、22.885、4.724、2.584、3.043、2.819、44.156,P均〈0.01,差异有统计学意义。低胆固醇者HDL、心电图异常率高于胆固醇正常者,两组间HDL比较,u=5,P〈0.01,心电图异常率比较,χ2=4.71,P〈0.05,差异有统计学意义。结论低胆固醇者的脂肪肝患病率、体重及体质指数、TG、TC、ALT、AST、血糖、血尿酸、尿素氮、肌酐水平、血压明显低于胆固醇正常者,而HDL和心电图异常率明显高于胆固醇正常者。     

Subjective social status and psychosocial and metabolic risk factors for cardiovascular disease among African Americans in the Jackson Heart Study

Subjective social status has been shown to be inversely associated with multiple cardiovascular risk factors, independent of objective social status. However, few studies have examined this association among African Americans and the results have been mixed. Additionally, the influence of discrimination on this relationship has not been explored. Using baseline data (2000-2004) from the Jackson Heart Study, an African American cohort from the U.S. South (N=5301), we quantified the association of subjective social status with selected cardiovascular risk factors: depressive symptoms, perceived stress, waist circumference, insulin resistance and prevalence of diabetes. We contrasted the strength of the associations of these outcomes with subjective versus objective social status and examined whether perceived discrimination confounded or modified these associations. Subjective social status was measured using two 10-rung "ladders," using the U.S. and the community as referent groups. Objective social status was measured using annual family income and years of schooling completed. Gender-specific multivariable linear and logistic regression models were fit to examine associations. Subjective and objective measures were weakly positively correlated. Independent of objective measures, subjective social status was significantly inversely associated with depressive symptoms (men and women) and insulin resistance (women). The associations of subjective social status with the outcomes were modest and generally similar to the objective measures. We did not find evidence that perceived racial discrimination strongly confounded or modified the association of subjective social status with the outcomes. Subjective social status was related to depressive symptoms but not consistently to stress or metabolic risk factors in African Americans.