Nurses' health, age and the wish to leave the profession--findings from the European NEXT-Study

BACKGROUND AND OBJECTIVES: In many industrialised countries the number of workers with low health is expected to increase in the nursing profession. This will have implications for occupational health work in health care. The European NEXT-Study (www. next-study. net, funded by EU) investigates working conditions of nurses in ten European countries and provides the opportunity to evaluate the role of health with respect to age and the consideration of leaving nursing. METHODS: 26,263 female registered nurses from Belgium, Germany, Finland, France, England, Italy, Netherlands, Poland and Slovakia were eligible for analysis. RESULTS: In most countries, older nurses considered leaving the profession more frequently than younger nurses. 'Health' was--next to 'professional opportunities' and 'work organisational factors'--strongly associated with the consideration of leaving nursing. However, more than half of all nurses with low health wanted to remain in the profession. This group reported rather positive psychosocial working conditions--but also the highest fear for unemployment. CONCLUSIONS: The findings indicate that 'the nurse with low health' is reality in many health care settings. Both positive supporting working conditions but also lack of occupational alternatives and fear of unemployment may contribute to this. Current economic, political and demographic trends implicate that the number of active nurses with low health will increase. Occupational health surveillance will be challenged by this. But NEXT findings implicate that prevention also will have to regard work organisational factors if the aim is to sustain nurses' health and to enable nurses to remain healthy in their profession until retirement age.     

Assessment of the diagnostic performances of IgA heavy and light chain pairs in patients with IgA monoclonal gammopathy

ObjectivesPreliminary results of the IgA Hevylite? assay including the establishment of the 95% reference interval and assessment of the specificity and sensitivity in different populations are reported.Design and methodsThe concentrations of IgA heavy and light chains (HLC) enabling to determine an IgAκ/IgAλ ratio were quantified in 119 apparently healthy individuals to generate 95% reference intervals. The specificity of this assay was assessed in 48 patients with an isolated polyclonal IgA increase. In a retrospective analysis of 68 patients with a monoclonal component type IgA (MC-IgA) identified by serum immunofixation (IFE), IgA HLC ratio values were compared with known results for serum protein electrophoresis (SPE) and free light chain (FLC) ratios.ResultsThe 95% reference range obtained in 119 controls (0.91–2.04) was close to that quoted by the manufacturer (0.80–2.04). Eight of the 48 patients (16.7%) with a polyclonal IgA increase had an IgA HLC ratio above the upper limit of the 95% reference interval.The IgA HLC ratio identified 65 (95.6%) among 68 patients with MC-IgA identified on the basis of IFE. For 34 of these patients (50%), MC-IgA was not detected by SPE due to its co-migration with alpha-2 or beta-globulins.ConclusionsCompared with serum IFE, the IgA HLC ratio has a sensitivity of 95.6%. Further studies are needed to assess the specificity of the IgA HLC ratio in patients with an isolated polyclonal increase of serum IgA.     

The Imposter in the Land of Illusion

This is the story of Fred, a city banker who came for psychotherapy when he was on the verge of a nervous breakdown. Fred styled himself as an alchemist who could turn dross metal into gold and had achieved remarkable success until global recession hit. Fred's psychopathology had driven him to believe that he had supernatural powers – and this made him special. He instinctively gravitated to a world in which his magical powers would be admired and rewarded – the world of derivatives. Here Fred excelled. Every deal turned into a river of gold that, seemingly, had no end. But just as Fred's success had been meteoric, his downfall was catastrophic. The false self he had created crumbled and he catapulted into the void without bearings, surrounded by the flotsam of dead objects. With this terrible loss, his journey towards life had only just begun. Fred's story is a modern day allegory for the psychopathology that has infected the major financial institutions over the last twenty years, creating a precarious world based on illusion. Fred's trajectory illustrates not only the powerful lure of illusion but also how a perverse system is structured with the implicit aim of attacking mind and reality.     

Populism and The Danger of Illusion

We are living in a time of increasing economic inequalities, disaffection, and fear of powerlessness of global proportions. The response is isolationism, nationalism, and paranoia of what is foreign and other. Fantasies of returning to a time of greatness and supremacy are propounded by politicians in the face of facts. Knowledge and expertise has been corrupted and only emotions tell the truth. The allure of a fantastic leader who offers to “fix” it all is irresistible. The denigration of thought, as we have witnessed throughout history, opens the way to an absolutist, fascist state of mind; reality must conform to fantasy. Is this the start of an era of paranoia? And will the real enemy be the failure to think? This article explores how this political dynamic is implicitly sanctioning the enactment of alt-right fantasies and the serious consequences of a leadership that denies loss and change.     

Physician supply forecast: better than peering in a crystal ball?

Background  

Anticipating physician supply to tackle future health challenges is a crucial but complex task for policy planners. A number of forecasting tools are available, but the methods, advantages and shortcomings of such tools are not straightforward and not always well appraised. Therefore this paper had two objectives: to present a typology of existing forecasting approaches and to analyse the methodology-related issues.     

Genetic polymorphisms and bronchiolitis obliterans syndrome after lung transplantation: promising results and recommendations for the future

Survival rates after lung transplantation are the lowest among solid organ transplantations. Long-term survival is limited by the development of chronic rejection, known as bronchiolitis obliterans syndrome (BOS). Risk factors, such as acute rejection and cytomegalovirus infection, contribute to the development of BOS. However, these risk factors alone do not explain the interindividual variability seen in the development of BOS. There is growing evidence that genetic variations might contribute to an individual's susceptibility to rejection. In this systematic review, based on a literature search through Medline and Embase, an overview is given of the genetic polymorphisms that have been investigated in lung transplant recipients in relation to the devlopment of BOS. Functional genetic polymorphisms in the genes of IFNG (+874 A/T), TGFB1 (+915 G/C), and IL6 (-174 G/C) have been found to be associated with the development of BOS and allograft fibrosis after lung transplantation. However, confirmation was not consistent across all studied cohorts. Genetic polymorphisms in the genes of several Toll-like receptors, mannose-binding lectin, CD14, killer immunoglobulin-like receptors, and matrix metalloproteinase-7 were also found to be associated with the development of BOS, but these studies need to be replicated in independent cohorts. This review shows that there may be involvement of genetic polymorphisms in the development of BOS. Genetic risk profiling of lung transplant recipients could be a promising approach for the future, enabling individualized risk stratification and personalized immunosuppressive treatment after transplantation. Further studies are needed to define risk alleles.