Emotional distress,occupational stress and burnout among Family Doctors in Europe: Monitoring and testing of interventions is required

In recent years, the medical literature from a wide range of medical specialities has exploded with publications on the theme of emotional distress, stress and burnout in the practice of medicine. Improving the work-life of health care providers is necessary to optimise health system performance. COVID-19 has caused considerable additional pressure on health services across Europe and there have been calls for interventions to address the psychological and occupational stress caused by the pandemic. Although there is an ongoing need to monitor these factors among family physicians, and other staff working in primary care across Europe, we must also identify supports and promote them. Further research is needed to explore causative factors and provide convincing evidence in relation to effective interventions.     

核与辐射事故卫生应急预案技术操作方案和关键技术

介绍了核事故与辐射事件卫生应急预案技术操作方案和关键技术研究项目,该项目是卫生行业科研专项项目"基于卫生应急关键技术集成与创新的应急能力在线培训与演练信息平台构建及示范区建设"的一个子项目。项目研制并完善了核与辐射事故卫生应急预案技术操作方案,以及个人防护、隔离、现场检伤分类、现场医学救援、样本采集、剂量估算以及应急现场辐射监测等7项关键技术,并进而集成了知识点库、培训资料库、技术标准(指南)库、案例库、考试题库和演练脚本库。项目成果为建设全国突发公共卫生事件在线培训和演练平台提供了基础性资料。     

Health among hospital employees in Europe: a cross-national study of the impact of work stress and work control

This article analyses the effect of working conditions on the health of hospital employees across Europe. Hospital employees often have demanding jobs that increase their stress levels and, consequently, their risk of health problems. Work control - typified by employee autonomy and working time flexibility - helps them cope with high levels of work stress. Researchers have traditionally studied the relationship between working conditions, coping strategies and occupational health from an individual perspective. We argue that the individual work-health relationship is closely connected with the social and institutional context. This study explores how work stress and work control influence the health of hospital employees and aims to understand cross-country differences in this respect. Using data on over 1500 hospital employees who participated in the study 'Quality of work and life in a changing Europe' (2007) in eight European countries, we used ordinal regression analyses to test a range of hypotheses. The results show that work stress has a negative effect on the health of hospital employees, while work control is not found to have any effect on their health. Comparative analyses reveal that the effects of working conditions on health vary across European countries. While working overtime is more closely related to poorer health in Eastern European countries, we found evidence of a positive relationship between job autonomy and health in Western Europe only, indicating that circumstances in the working environment have differing effects on employee health in Eastern and Western Europe.     

在线肺癌病例数据库系统的建立

目的为了进行临床与科研工作时能够及时获取关联信息,建立一个在线肺癌病例数据库,便于肺癌临床流行病学及疗效预后等统计分析。方法在对本院肺癌病例数据信息的汇总、分类与分析基础上,通过迭代的需求分析,设计出基于B/S(浏览器/服务器)模式,以PHP+Apache+Mysql为核心软件技术的在线肺癌病例数据库管理平台,并录入本院近十年的肺癌病例基本信息及相关临床资料。结果建成一个人机界面友好、肺癌病例数据丰富的包含有血清及组织标本库的在线肺癌病例数据库系统。结论在线肺癌病例数据库数据全面、应用面广、专业性强、可扩展性好,不仅有助于医疗人员对肺癌病例信息的管理与查询,更有助于对肺癌病例的分析与数据挖掘研究。     

The management of influenza in people of working age

Influenza is common, causing considerable morbidity and sickness absence from work in most winters. Influenza vaccines have been available for >40 years, but are not extensively used in the workforce (in the UK). Amantadine has been available for 25 years as a treatment and prophylactic against influenza A infection, but has scarcely been used. In the last 3 years, two neuraminidase inhibitor antivirals, zanamivir and oseltamivir, have been introduced to the market for the treatment and prophylaxis of influenza A and B infections. This review focuses on aspects of prevention and treatment of influenza appropriate to people of working age. Decisions based on the cost-effectiveness of prevention and treatment options differ when viewed from the perspective of the healthcare provider, the employer or the employee. Options currently available need to be directed to a wider range of people than those conventionally regarded as the target risk group.     

Taming the tools of violence

This article summarizes why firearms are the most lethal tools of violence, and some pertinent issues public health professionals face when working to ameliorate the effects of gun violence. It surveys large gaps in data and understanding regarding the African context--most research has hitherto been conducted in developed countries. And it reviews international agreements that could be used to mobilize support for public health approaches. Although none focus explicitly on public health, some agreements offer commitments that can be used by people working to improve public health.     

The planning of cervical cancer screening programmes in Eastern Europe: is viral testing a suitable alternative to smear testing?

Cervical cancer screening with human papillomavirus (HPV) DNA testing has potential advantages over conventional smear testing in that it can predict cases in which invasive cancers are more likely to develop, may be cheaper to implement and improve compliance. In areas of the world where little formalised cervical cancer screening takes place, or where health resources are limited, HPV testing has been suggested as a possible alternative for primary screening. In this paper we demonstrate the use of mathematical modelling to evaluate the effects of setting up screening programmes in Eastern Europe with HPV DNA testing as the primary screening tool and compare it with conventional smear testing. The impact of screening is measured in terms of the life years gained and the resulting resource usage and cost. We investigate several screening options with different screening intervals and age ranges for the target population. This revised version was published online in July 2006 with corrections to the Cover Date.     

The telehealth divide: disparities in searching public health information online

This article explores e government inequalities to searching Medicare and Medicaid information online. Telehealth, a branch of e government, can bring public health service and insurance information to the citizen. The Centers for Medicare and Medicaid Services website, among others, has critical information for potential beneficiaries and recipients of services. Using Pew survey data and multivariate regression analysis we find people in most need of Medicare and Medicaid information online (the elderly and poor) are accessing it, and people with years of online experience are strong proponents of online searches. Despite being less likely to have broadband services, individuals in rural areas were not found to be less likely to search for information online. In conclusion, some disparities are narrowing as the elderly and poor in need of access to public health insurance are searching for it online. However, people without Internet access and experience (perhaps the oldest and poorest) remain disadvantaged with respect to accessing critical information that can link them to needed health care services.     

The assets-based approach: furthering a neoliberal agenda or rediscovering the old public health? A critical examination of practitioner discourses

The ‘assets-based approach’ to health and well-being has, on the one hand, been presented as a potentially empowering means to address the social determinants of health while, on the other, been criticised for obscuring structural drivers of inequality and encouraging individualisation and marketisation; in essence, for being a tool of neoliberalism. This study looks at how this apparent contestation plays out in practice through a critical realist-inspired examination of practitioner discourses, specifically of those working within communities to address social vulnerabilities that we know impact upon health. The study finds that practitioners interact with the assets-based policy discourse in interesting ways. Rather than unwitting tools of neoliberalism, they considered their work to be about mitigating the worst effects of poverty and social vulnerability in ways that enhance collectivism and solidarity, concepts that neoliberalism arguably seeks to disrupt. Furthermore, rather than a different, innovative, way of working, they consider the assets-based approach to simply be a re-labelling of what they have been doing anyway, for as long as they can remember. So, for practitioners, rather than a ‘new’ approach to public health, the assets-based public health movement seems to be a return to recognising and appreciating the role of community within public health policy and practice; ideals that predate neoliberalism by quite some considerable time.     

Workforce planning. Catching the drift

NHS workforce planning has traditionally ignored the role of doctors and nurses trained in continental Europe and Scandinavia. At present doctors trained in the European Economic Area make up 10 per cent of senior house officers in England and Wales. But the numbers coming to the UK are falling. Falling medical unemployment in Europe will mean these doctors have less incentive to come to the UK, leaving a considerable gap in the NHS workforce. More local research is needed into working patterns and career plans of European-trained nurses and doctors.     

The Telemedicine Information Exchange: 10 years' experience

The Telemedicine Information Exchange (TIE) Website has provided information on telemedicine since 1995. The site could be considered successful from its longevity alone; however, it can also be considered a success using other measures. The usage of the site has grown steadily over the years, to more than 20,000 visitors per month by 2005. The Bibliographic database has over 16,000 telemedicine-related citations, more than found anywhere else, and is the most visited section of the Website. The second most visited database, Active Telemedicine Programs, is the result of 10 years of tracking activity and growth using a voluntary online survey. This continuous monitoring of telemedicine literature and activity has allowed TIE research staff to anticipate user needs and interests. For instance, a Home Telehealth section was initiated after it became apparent that interest in the subject was increasing. Longevity also provides a perspective about the best ways of maintaining a content-heavy online resource. Efforts to augment federal funding (the TIE's sole source of support) by selling packaged information products have taught us that online users will not pay for information. Our raison d'être for the past 10 years has been the provision of credible, up-to-date information, and our reward has been positive feedback from thousands of TIE users.     

The inequity of informal payments for health care: the case of Hungary

As in most countries of Central and Eastern Europe, informal payments have been a characteristic feature of the Hungarian health care system both during and since the demise of Soviet type socialist rule. Although informal payments continue to be so characteristic in the region, little empirical evidence exists on their scope or working. As far as equity is concerned, it has sometimes been suggested that physicians play a 'Robin Hood' role and subsidise the poor at the expense of the rich. With the aid of an interview survey of a representative sample of the Hungarian population, we examine the distribution of the burden of informal payments across income groups. Results indicate that informal payments are a highly regressive way of funding health care, with Kakwani progressivity indices of -0.38, -0.39, -0.35 and -0.36 for GP, outpatient specialist, hospital, and total care, respectively. The finding that people with lower income pay proportionally more for public health care through informal payments underlines the emptiness of the 'Robin Hood' claims and the need for reform.     

The future of work hours--the European view

In Europe the way work hours are handled varies between different countries. However, there are some issues that dominate the discussion in Europe and seem representative for what is happening. One such is the reduction of working hours--which was attempted in several countries but which now seems to be backfiring--probably related to the competition from countries outside Europe. Another area is compressed work hours--the drive towards maximizing the hours per work day in order to increase the number of days off. The health effects are debated--some find clear positive effects. A third area is company oriented flexible work hours, permitting the employer to make moderate changes in work hours when needed. The health impacts have not been evaluated but the loss of individual influence at work is obvious. In some parts of Europe self-determined work hours have been tried with very positive effects. The EU work hour directive is intended to provide uniformity but permits a counterproductive "opting out", creating problems of imbalance.     

Procuring organs for transplantation -- a European perspective

Background: The shortage of organs for transplant In Europehas been considerable for many years. A number of differentpolicies have been implemented in an attempt to address thisproblem. These have had varying degrees of success from countryto country. Methods: This article provides an up-to-date reviewof organ procurement policies throughout Europe. Alternativeand In some cases controversial organ procurement programmesare also considered to establish whether the increasing demandfor organs can be met elsewhere. Results: Transplant waitinglists are the greatest by far for those patients waiting fora kidney replacement. Norway has best managed to address thisneed through adopting a positive policy choice towards livedonation whilst still maintaining an active cadaveric donationpolicy. Conclusion: With the lowering of both physical and socialbarriers In Europe, there has been a recent shift towards co-operationbetween some European countries in promoting transplant activity.This ensures that if an organ becomes available in one countryand has no suitable recipient, then it can be used elsewhere.The future may show and increasing trend towards this levelof European cooperation in order to make transplant activitymore efficient.     

Doing synchronous online focus groups with young people: methodological reflections

Although online focus groups are emerging as a worthwhile methodological approach for qualitative researchers, reporting has been constrained in several ways. The majority of studies report asynchronous groups, whereas others employ synchronous exchanges, the efficacy of which with young people has seldom been explored. Considering the popularity of the Internet as a communication tool for young people, this missed opportunity is surprising. Based on a series of synchronous online focus groups with young people, the authors explore why this approach might be an effective way of engaging young people with appearance-related concerns in research. In this article, they discuss the process of hosting and moderating synchronous online focus groups, highlighting some of the ethical, pragmatic, and personal challenges that might face researchers using this method. Through a reflexive approach, they intend to inform and encourage qualitative researchers to consider alternative ways of engaging young people in research.     

Increase in the Prevalence of Online Pornography Use: Objective Data Analysis from the Period Between 2004 and 2016 in Poland

Despite the considerable amount of attention presently devoted to the high accessibility of online pornography, very little formal analyses have been carried out to show how the advent and proliferation of Internet technology has changed the prevalence of pornography use in populations. We conducted a preliminary analysis based on objective website traffic data, representing the changes in the number of (1) Internet users generally and (2) online pornography users specifically, between 2004 and 2016 in Poland. We observed a clear increase in the estimated number of people using online pornography in the analyzed period. The estimated number of general population members viewing pornography on the Internet increased over three times (310%) between October 2004 and October 2016–starting from an estimated 2.76 million in the first period to 8.54 million in the last. At the same time, we did not observe a clear increase in the percentage of Internet users who viewed online pornography in the same time period. Additionally, pornography viewership on the Internet was almost 2 times more prevalent among male (47%) than female Internet users (27%), and most popular in the 18–27 age group. Since our analysis is based on objective data, it does not share the limitations inherent in self-reports. However, our approach also has several important limitations (e.g., the analysis does not include online activity generated on mobile devices and under a private browsing mode); thus, the results should be interpreted with caution.

     

Exploring improvement plans of fourteen European integrated care sites for older people with complex needs

Integrated care programmes are increasingly being put in place to provide care to older people living at home. However, knowledge about further improving integrated care is limited. In fourteen integrated care sites in Europe, plans to improve existing ways of working were designed, implemented and evaluated to enlarge the understanding of what works and with what outcomes when improving integrated care. This paper provides insight into the existing ways that the sites were working with respect to integrated care, their perceived difficulties and their plans for working towards improvement. The seven components of the Expanded Chronic Care Model provided a conceptual framework for describing the fourteen sites. Although sites were spread across Europe and differed in basic characteristics and existing ways of working, a number of difficulties in delivering integrated care were similar. Existing ways of working and improvement plans mostly focused on three components of the Expanded Chronic Care Model: delivery system design; decision support; self-management. Two components were represented less frequently in existing ways of working and improvement plans: building healthy public policy; building community capacity. These findings suggest that broadly-based prevention efforts, population health promotion and community involvement remain limited. From the Expanded Chronic Care Model perspective, therefore, opportunities for improving integrated care outcomes may continue to be restricted by the narrow focus of developed improvement plans.     

The defining characteristics of Web 2.0 and their potential influence in the online vaccination debate

The emergence of Web 2.0 has led to more and more Web-based resources demonstrating three defining characteristics: user participation, openness and network effects. This paper discusses these characteristics in the context of the online vaccination debate, explores how they structurally alter the way people might interact with vaccination information online, and describes ways in which such characteristics support particular tendencies in human decision making processes. Specifically, user participation supports the influence of narratives and personal accounts, openness shapes expectations for greater levels of detail and movement toward models of informed decision making, and network effects demonstrate the social nature of decision making, the influence of like-minded others and thus, the pitfalls of polarization in the online vaccination debate. Web 2.0 means that concerns about vaccination information online must expand beyond simply the possibility that people might access information of varying quality to incorporate a more comprehensive understanding of how people use current Web functionality, how such usage influences expectations about information sources and decision making processes, and the implications for communication strategies about vaccination.     

Mental health promotion in the Internet age: a consultation with Australian young people to inform the design of an online mindfulness training programme

Mindfulness training (MT) has been shown to lead to significant improvements in psychological distress and emotion regulation skills. The Internet has many advantages as a medium for building emotional skills in young people. The aim of this study was to involve young people in designing an online MT programme. A draft programme was initially designed based on a review of the literature and an established face-to-face programme for medical students. Twenty young people were then recruited through online advertising and 13 (age 16-26) interviewed. They were asked to comment on how useful, easy to use and enjoyable they found the proposed programme and how the draft version and its planned evaluation strategy could be improved. Interviewee responses were independently processed by two of the authors within a qualitative thematic analysis paradigm. The results showed that young people were eager to engage with the design of this health promotion programme and provided valuable input. All interviewees believed that young people would find the programme desirable. They provided a variety of suggestions about how training structure and content could be improved, how best it could be evaluated and how young people could be encouraged to engage with and complete the programme. It thus appears that online MT is a feasible mental health promotion strategy for young people and that it can be evaluated in a controlled trial. The result of this consultation process was the Mindful Awareness Training and Education (MATE) programme, which has been detailed.     

Health risks of occupational exposure to anticancer (antineoplastic) drugs in health care workers]

In Europe and America, many health care workers have concerns about the risks to their health of handling anticancer drugs. The findings of the risks were reported in the late 1970's, and guidelines for the safe handling of anticancer drugs were established in the 1980's. The conditions of wearing personal protective equipment and of the working environment have improved dramatically as a result of introduction of the guidelines. Furthermore, researches and studies into the health effects of occupational exposure to anticancer drugs have been pursued actively. In Japan, the society of hospital pharmacists established guidelines for the safe handling of anticancer drugs in 1991. Since then, mainly nurses have been concerned about the safe handling of anticancer drugs, but in the medical setting, the present situation surrounding the safe handling of anticancer drugs has hardly changed. In the industrial hygiene field, the safe handling and the occupational exposure to anticancer drugs have been seldom reported and researched. The actual potential hazards to occupational exposure of anticancer drugs have not yet been determined. Nevertheless, the reduction of occupational exposure to anticancer drugs in health care workers has been an important challenge for the industrial hygiene field. In Japan, we need to promote action to spread the use of the appropriate personal protective equipment and the appropriate working environment. We also have to rethink the safe handling of anticancer drugs. We hope that the Japanese government will establish an effective authorized guideline as has been done in Europe and America.