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Zimmermann C, Waldhoer T, Schernhammer E, Strohmaier S. Mortality of working-age physicians compared to other high-skilled occupations in Austria from 1998 to 2020. Scand J Work Environ Health 2024; 50:447-455. [PMID: 38810246 PMCID: PMC11391937 DOI: 10.5271/sjweh.4169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVES Physicians have been shown to have lower mortality compared to the general population, particularly regarding lifestyle-associated causes of death. Prior literature is divided on whether this is due to higher socioeconomic position (SEP), healthier lifestyle, or other specific occupational characteristics. This study analyzed the mortality of Austrian physicians compared to the general population and other (health) professionals with a similar SEP, and investigated patterns of lifestyle-associated mortality among physicians. METHODS Data from professional associations and cause-of-death statistics were collated to determine causes of death for all occupational groups. Gender-specific age-standardized mortality rates (ASMR) and standardized rate ratios (SRR) were calculated to compare main causes of death [cancer, cardiovascular disease (CVD), external causes] among physicians to other (health) professionals and the general population. Standardized mortality ratios (SMR) were calculated for more detailed causes of death in physicians compared to the general population. RESULTS Physicians had lower all-cause mortality than the general population [SRR 0.45, 95% confidence interval (CI) 0.41-0.49 for males and SRR 0.60, 95% CI 0.54-0.66 for females] and health professionals (SRR 0.72, 95% CI 0.60-0.88 for males and SRR 0.77, 95% CI 0.63-0.93 for females), mostly due to low CVD and cancer mortality. SMR for detailed causes of death among physicians exhibited a pattern of particularly low mortality in lifestyle-associated causes of death and an increased SMR for suicide among female physicians (SMR 1.58, 95% CI 1.22-2.02). CONCLUSIONS This study confirmed lower mortality among physicians compared to the general population and compared to other (health) professionals. Low physician mortality can be primarily explained by lifestyle-associated causes of death.
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Affiliation(s)
| | | | | | - Susanne Strohmaier
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.
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2
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Diaz E, Abad-Tortosa D, Ghezal M, Davin J, Lopez-Castroman J. Role of stressful life events and personality traits on the prevalence of wish to die among French physicians. Front Public Health 2024; 12:1244605. [PMID: 38322123 PMCID: PMC10844508 DOI: 10.3389/fpubh.2024.1244605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024] Open
Abstract
Background Suicide rates are higher among physicians than in the general population. We aimed to investigate the role of stressful life events (related or not to work conditions) and personality traits on wish to die, a proxy measure of suicidal ideation. Methods This cross-sectional study took place in France from March 2018 to September 2018. Physicians completed an online questionnaire. A multiple logistic regression model estimated factors associated with wish to die. Moderated moderation models were used to assess the effect of personality traits on the relationship between stressful events and wish to die. Results 1,020 physicians completed the questionnaire. Most (75%) had endorsed a work-related stressful event and one in six (15.9%) endorsed a wish to die the year before. Wish to die was associated with burnout (OR = 2.65, 95%CI = 1.82-3.88) and work-related stressful events (OR = 2.18, 95%CI = 1.24-3.85) including interpersonal conflicts, harassment and work-overload. Emotional stability was the only personality trait associated with wish to die in the logistic regression (OR = 0.69, 95%CI = 0.59-0.82). In moderation models, we observed a significant interaction involving three personality traits-emotional stability, extraversion, and agreeableness-along with gender, influencing the impact of stressful events on the wish to die. Limitations Our study is limited by the impossibility to control for risk factors associated with suicide like psychiatric comorbidities. Conclusion Work-related stressful events significantly contribute to the manifestation of a wish to die among physicians. The impact of stressful events on the wish to die is moderated by factors such as gender and personality traits, including emotional stability and extraversion. These results are overall consistent with prior studies concerning the risk of burnout and suicide among physicians.
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Affiliation(s)
- Emmanuel Diaz
- Department of Psychiatry, Nîmes University Hospital (CHU), Nîmes, France
| | - Diana Abad-Tortosa
- Department of Psychiatry, Nîmes University Hospital (CHU), Nîmes, France
| | - Maha Ghezal
- Department of Psychiatry, Nîmes University Hospital (CHU), Nîmes, France
| | - Josephine Davin
- Department of Psychiatry, Nîmes University Hospital (CHU), Nîmes, France
| | - Jorge Lopez-Castroman
- Department of Psychiatry, Nîmes University Hospital (CHU), Nîmes, France
- IGF, CNRS-INSERM, University of Montpellier, Montpellier, France
- CIBERSAM, Madrid, Spain
- Department of Signal Theory and Communication, Universidad Carlos III, Madrid, Spain
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3
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Ryan E, Hore K, Power J, Jackson T. The relationship between physician burnout and depression, anxiety, suicidality and substance abuse: A mixed methods systematic review. Front Public Health 2023; 11:1133484. [PMID: 37064688 PMCID: PMC10098100 DOI: 10.3389/fpubh.2023.1133484] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/09/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction The World Health Organization defines burnout as a problem associated with employment, a category distinct from psychological disorders such as depression, anxiety, suicidality and disorders of substance abuse. Evaluating the association between burnout as an occupational exposure and psychological morbidity may indicate that burnout can act as an occupational risk factor for mental ill-health. The systematic review explores this relationship in physicians due to the increased risk in this population and the implications for healthcare delivery. Methods A mixed methods systematic review of the literature was conducted across Medline, Cinahl Plus, PsycInfo, Web of Science and The Cochrane Library. Databases were systematically searched using keywords relating to physician burnout and depression, anxiety, suicidality and substance abuse. Identified articles were screened for eligibility by two independent researchers. Data extraction was performed and studies assessed for risk of bias. Quantitative and qualitative results were integrated using a convergent segregated approach and results portrayed as a narrative synthesis. Results Sixty-one articles were included in the review. There was notable heterogeneity in the measurement and criteria used to define burnout limiting the assimilation of results. Despite this, all studies that measured the association between depression and burnout reported a significant association. Studies that reported association between burnout and anxiety were similarly uniformly consistent. Most studies that reported the association between burnout and suicidality indicated that a significant association exists however difficulty in measurement of suicidality may have influenced variability of results. The reported association between substance abuse and burnout was more variable, suggesting that any association is likely to be weak or influenced by other variables. Qualitative studies described the manifestations of chronic workplace stress as well as perceived links with psychological morbidity. These included lack of time for work-life balance, the contribution of professional relationships and a culture of invulnerability that exists among physicians. Conclusion The systematic review cannot conclude causality but suggests that physician burnout is associated with depression, anxiety and suicidality. Qualitative data provides insight into the nature of this association. The review indicates the need for longitudinal research and provides considerations for intervention strategies to prevent the development and progression of burnout. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172938, identifier: CRD42020172938.
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Affiliation(s)
- Emer Ryan
- Department of Cardiothoracic Anaesthesia, Auckland City Hospital, Auckland, New Zealand
- Usher Institute, University of Edinburgh, Scotland, United Kingdom
- College of Anaesthesiologists of Ireland, Dublin, Ireland
| | - Kevin Hore
- College of Anaesthesiologists of Ireland, Dublin, Ireland
- Department of Anaesthesia, Great Ormonde Street Children's Hospital, London, United Kingdom
| | - Jessica Power
- Centre for Global Health, Trinity College, Dublin, Ireland
| | - Tracy Jackson
- Usher Institute, University of Edinburgh, Scotland, United Kingdom
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4
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Avoidable mortality for causes amenable to medical care and suicide in physicians in Spain. Int Arch Occup Environ Health 2021; 95:1147-1155. [PMID: 34714394 DOI: 10.1007/s00420-021-01813-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare avoidable mortality for causes amenable to medical care and suicide in physicians versus other professionals with similar university studies and socioeconomic position in Spain. METHODS All people aged 25-64 years who were employed on 1 November 2001 (8,697,387 men and 5,282,611 women) were included. Their vital status was followed for 10 years and the cause of death of deceased was recorded. Using a Poisson regression to estimate the mortality rate ratio (MRR), we compared mortality due to causes of death amenable to medical care, all other causes, and suicide in physicians versus other professionals. Mortality in physicians was used as a reference. RESULTS The lowest MRR for causes amenable to medical care was observed in engineers/architects (men: 0.84, 95% confidence interval [CI] 0.72, 0.97; women: 0.93, 95% CI 0.64, 1.35) and healthcare professions other than physicians/pharmacists/nurses (men: 0.86, 95% CI 0.56, 1.34; women: 0.69, 95% CI 0.32, 1.46). Regarding mortality for all other causes of death, professionals from these and other occupations presented lower mortality than physicians. Other healthcare professions, entrepreneurs, and managers/executives completed suicide at a higher rate than physicians. CONCLUSION Although the accessibility to the healthcare system and to the pharmacological drugs could suggest that physicians would present low rates for causes amenable to medical care and high rates of suicide, our results show that this is not the case in Spain.
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5
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Gwiazda S, Dixon E, Cronly M, Kavanagh Y, Cullinane M, Mulligan LM. Propofol misuse in Ireland - Two case reports and a review of the literature. Forensic Sci Int 2021; 326:110909. [PMID: 34311287 DOI: 10.1016/j.forsciint.2021.110909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
Propofol is a rapidly acting sedative drug, which is usually administered intravenously. It is widely used in procedural sedation due to its rapid onset and easy reversibility. It has a good safety profile when used in combination with ventilation and monitoring. However, propofol can bring on feelings of euphoria, sexual disinhibition, tension relief and hallucinations, creating a potential for abuse. At an international level, recreational propofol use among medical staff is a growing, yet under reported problem. In order to highlight this issue in an Irish context, the case reports described are among the first recorded deaths in Ireland due to unmonitored self-administration of propofol. The difficulties facing forensic pathologists in detecting propofol and its metabolites in these cases are outlined. The potential for propofol abuse should influence healthcare facilities to make their staff aware of the risks associated with it. This in turn would promote vigilance and encourage those affected to seek treatment.
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Affiliation(s)
- Sara Gwiazda
- Office of the State Pathologist, Griffith Avenue, Whitehall, Dublin D09RDT8, Ireland
| | - Eleanor Dixon
- Human Toxicology, The State Laboratory, Backweston Campus, Co., Kildare, Ireland
| | - Mark Cronly
- Human Toxicology, The State Laboratory, Backweston Campus, Co., Kildare, Ireland
| | - Yvonne Kavanagh
- Human Toxicology, The State Laboratory, Backweston Campus, Co., Kildare, Ireland
| | - Myra Cullinane
- FRCPI, MFFLM, Barrister-at-Law, Senior Coroner for the Dublin District, Store Street, Dublin 1, Ireland
| | - Linda M Mulligan
- Office of the State Pathologist, Griffith Avenue, Whitehall, Dublin D09RDT8, Ireland.
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6
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Plunkett E, Costello A, Yentis SM, Hawton K. Suicide in anaesthetists: a systematic review. Anaesthesia 2021; 76:1392-1403. [PMID: 34061350 DOI: 10.1111/anae.15514] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/28/2022]
Abstract
Evidence suggests that healthcare professionals are at an increased risk of dying by suicide, with anaesthetists at particularly high risk. However, much of the data on which this is based are historical. With a focus on the epidemiology and methods used, we conducted a systematic review of evidence regarding suicide and suicidal behaviour among anaesthetists to provide a more contemporary summary. The systematic review process was adapted from a previous similar study in veterinary surgeons and was consistent with recommended guidance. We identified 54 articles published in or after 1990 that had anaesthetist-specific data and met the inclusion criteria. Seven of these reported epidemiological data, of which four were published after 2000. Although none of the more recent studies reported standardised mortality rates specific to suicide in anaesthetists, the proportion of anaesthetists dying by suicide was increased with respect to comparator groups, which is consistent with previous findings. Eleven studies that included information on suicidal behaviour reported suicidal ideation in 3.2-25% of individuals (six studies) and suicide attempts in 0.5-2% (four studies). Studies reporting methods of suicide highlighted the use of anaesthetic drugs, particularly propofol, supporting the suggestion that the increased risk of suicide in anaesthetists may be related to the availability of the means. We discuss our findings in relation to other recently published data and guidance concerning mental health problems in anaesthetists.
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Affiliation(s)
- E Plunkett
- Department of Anaesthesia, University Hospitals Birmingham, Birmingham, UK
| | - A Costello
- Department of Anaesthesia, Milton Keynes University Hospitals, Milton Keynes, UK
| | - S M Yentis
- Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
| | - K Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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7
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Zacay G, Baron-Epel O, Malatskey L, Heymann A. Preferences and barriers to the utilization of primary health care by sick physicians: a nationwide survey. Fam Pract 2021; 38:109-114. [PMID: 32839825 DOI: 10.1093/fampra/cmaa090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Physicians are often dissatisfied with their own medical care. Self-prescribing is common despite established guidelines that discourage this practice. From a pilot study, we know primary care physicians' (PCP) preferences, but we lack information regarding other specialties and work places. OBJECTIVES The goal of this study was to examine whether physicians are satisfied with their personal primary care and how this could be improved. METHODS We distributed an electronic survey to all physicians registered with the Israeli Medical Association. The questionnaire examined satisfaction with medical care, preferences for using formal care versus informal care, self-prescribing and barriers to using formal care. RESULTS Two thousand three hundred and five out of 24 360 invited physicians responded. Fifty-six per cent of the respondents were satisfied with their personal primary care. Fifty-two per cent reported initiating self-treatment with a medication during the last year. Five and four per cent initiated treatment with a benzodiazepine and an antidepressant, respectively, during the last year. This was despite the fact that most physicians did not feel competent to treat themselves. Having a personal PCP was correlated with both a desire to use formal care and self-referral to formal care in practice. Regression analysis showed that the highest odds ratio (OR) for experiencing a large gap between desired and actual care were for physicians who had no personal PCP (OR = 1.92). CONCLUSIONS Physicians frequently engage in self-treatment and in informal medical care. Whether the root cause is the health care system structure that does not meet their needs or the convenience of self-treatment is not known.
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Affiliation(s)
- Galia Zacay
- Department of Family Medicine, Meuhedet Health Fund, Tel Aviv.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | | | - Lilach Malatskey
- Israeli Society of Lifestyle Medicine, Israeli Association of Family Physicians, Tel Aviv.,Azrieli Faculty of Medicine, Bar Ilan University, Ramat-Gan, Israel
| | - Anthony Heymann
- Department of Family Medicine, Meuhedet Health Fund, Tel Aviv.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
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Chartier H, Fassier P, Leuraud K, Jacob S, Baudin C, Laurier D, Bernier MO. Occupational low-dose irradiation and cancer risk among medical radiation workers. Occup Med (Lond) 2020; 70:476-484. [DOI: 10.1093/occmed/kqaa130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Medical workers are the largest group of workers occupationally exposed to low doses of ionizing radiation (IR) worldwide.
Aims
This review presents all the cohorts of medical workers exposed in the world and summarizes cancer risks associated with radiation exposure in this population.
Methods
Epidemiological studies on health professionals exposed to IR published from 1975 to 2019 were reviewed. Strength of evidence was assessed according to the modified Royal College of General Practitioners three-star system.
Results
Among the 16 epidemiological studies focusing on cancers from 11 cohorts among medical staff exposed to radiation, higher risks of cancer were observed for pre-1950 exposure and for medical workers who performed fluoroscopically guided interventional procedures or radionuclides procedures compared to those who did not. However, strength of evidence supporting the associations remains moderate as several methodological limits including the lack of dosimetry data, lifestyle factors and recent updates may obscure the link between medical occupational exposure and cancer occurrence.
Conclusions
Excess risk of cancer is suspected for high and former exposures. The more highly exposed professions, i.e. interventional physicians and nuclear medicine workers, should be monitored carefully. Collaborative projects aiming to increase the quantity and quality of information of the studied populations would be a key point
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Affiliation(s)
- H Chartier
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
- Percy Hospital, Radiological Protection Service of the Armed Forces (SPRA), Clamart, France
| | - P Fassier
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - K Leuraud
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - S Jacob
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - C Baudin
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - D Laurier
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - M-O Bernier
- PSE-SANTE/SESANE/LEPID, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
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Duarte D, El-Hagrassy MM, Couto TCE, Gurgel W, Fregni F, Correa H. Male and Female Physician Suicidality: A Systematic Review and Meta-analysis. JAMA Psychiatry 2020; 77:587-597. [PMID: 32129813 PMCID: PMC7057173 DOI: 10.1001/jamapsychiatry.2020.0011] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Population-based findings on physician suicide are of great relevance because this is an important and understudied topic. OBJECTIVE To evaluate male and female physician suicide risks compared with the general population from 1980 to date and test whether there is a reduction of SMR in cohorts after 1980 compared with before 1980 via a meta-analysis, modeling studies, and a systematic review emphasizing physician suicide risk factors. DATA SOURCES This study uses studies retrieved from PubMed, Scielo, PsycINFO, and Lilacs for human studies published by October 3, 2019, using the search term "(((suicide) OR (self-harm) OR (suicidality)) AND ((physicians) OR (doctors)))." Databases were also searched from countries listed in articles selected for review. Data were also extracted from an existing article by other authors to facilitate comparisons of the pre-1980 suicide rate with the post-1980 changes. STUDY SELECTION Original articles assessing male and/or female physician suicide were included; for the meta-analysis, only cohorts from 1980 to the present were included. DATA EXTRACTION AND SYNTHESIS The preregistered systematic review and meta-analysis followed Cochrane, PRISMA, and MOOSE guidelines. Data were extracted into standardized tables per a prespecified structured checklist, and quality scores were added. Heterogeneity was tested via Q test, I2, and τ2. For pooled effect estimates, we used random-effects models. The Begg and Egger tests, sensitivity analyses, and meta-regression were performed. Proportional mortality ratios were presented when SMR data could not be extracted. MAIN OUTCOMES AND MEASURES Suicide SMRs for male and female physicians from 1980 to the present and changes over time (before and after 1980). RESULTS Of 7877 search results, 32 articles were included in the systematic review and 9 articles and data sets in the meta-analysis. Meta-analysis showed a significantly higher suicide SMR in female physicians compared with women in general (1.46 [95% CI, 1.02-1.91]) and a significantly lower suicide SMR in male physicians compared with men in general (0.67 [95% CI, 0.55-0.79]). Male and female physician SMRs significantly decreased after 1980 vs before 1980 (male physicians: SMR, -0.84 [95% CI, -1.26 to -0.42]; P < .001; female physicians: SMR, -1.96 [95% CI, -3.09 to -0.84]; P = .002). No evidence of publication bias was found. CONCLUSIONS AND RELEVANCE In this study, suicide SMR was found to be high in female physicians and low in male physicians since 1980 but also to have decreased over time in both groups. Physician suicides are multifactorial, and further research into these factors is critical.
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Affiliation(s)
- Dante Duarte
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Mirret M. El-Hagrassy
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | | | - Wagner Gurgel
- University of São Paulo, São Paulo, São Paulo, Brazil
| | - Felipe Fregni
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Humberto Correa
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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10
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Comments on a Thought-Provoking Article about Occupational Radiation Injury. J Vasc Interv Radiol 2020; 31:49-50. [DOI: 10.1016/j.jvir.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 11/18/2022] Open
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Dutheil F, Aubert C, Pereira B, Dambrun M, Moustafa F, Mermillod M, Baker JS, Trousselard M, Lesage FX, Navel V. Suicide among physicians and health-care workers: A systematic review and meta-analysis. PLoS One 2019; 14:e0226361. [PMID: 31830138 PMCID: PMC6907772 DOI: 10.1371/journal.pone.0226361] [Citation(s) in RCA: 228] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/24/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Medical-related professions are at high suicide risk. However, data are contradictory and comparisons were not made between gender, occupation and specialties, epochs of times. Thus, we conducted a systematic review and meta-analysis on suicide risk among health-care workers. METHOD The PubMed, Cochrane Library, Science Direct and Embase databases were searched without language restriction on April 2019, with the following keywords: suicide* AND (« health care worker* » OR physician* OR nurse*). When possible, we stratified results by gender, countries, time, and specialties. Estimates were pooled using random-effect meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Suicides, suicidal attempts, and suicidal ideation were retrieved from national or local specific registers or case records. In addition, suicide attempts and suicidal ideation were also retrieved from questionnaires (paper or internet). RESULTS The overall SMR for suicide in physicians was 1.44 (95CI 1.16, 1.72) with an important heterogeneity (I2 = 93.9%, p<0.001). Female were at higher risk (SMR = 1.9; 95CI 1.49, 2.58; and ES = 0.67; 95CI 0.19, 1.14; p<0.001 compared to male). US physicians were at higher risk (ES = 1.34; 95CI 1.28, 1.55; p <0.001 vs Rest of the world). Suicide decreased over time, especially in Europe (ES = -0.18; 95CI -0.37, -0.01; p = 0.044). Some specialties might be at higher risk such as anesthesiologists, psychiatrists, general practitioners and general surgeons. There were 1.0% (95CI 1.0, 2.0; p<0.001) of suicide attempts and 17% (95CI 12, 21; p<0.001) of suicidal ideation in physicians. Insufficient data precluded meta-analysis on other health-care workers. CONCLUSION Physicians are an at-risk profession of suicide, with women particularly at risk. The rate of suicide in physicians decreased over time, especially in Europe. The high prevalence of physicians who committed suicide attempt as well as those with suicidal ideation should benefits for preventive strategies at the workplace. Finally, the lack of data on other health-care workers suggest to implement studies investigating those occupations.
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Affiliation(s)
- Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Occupational and Preventive Medicine, WittyFit, Clermont-Ferrand, France
- Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria, Australia
| | - Claire Aubert
- Université de Versailles Saint-Quentin-en-Yvelines, Faculty of Health Science Simone Veil, Versailles, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Biostatistics Unit, the Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Michael Dambrun
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, Clermont-Ferrand, France
| | - Fares Moustafa
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Emergency, Clermont-Ferrand, France
| | - Martial Mermillod
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Marion Trousselard
- French Armed Forces Biomedical Research Institute-IRBA, Neurophysiology of Stress, Neuroscience and Operational Constraint Department, Brétigny-sur-Orge, France
| | - François-Xavier Lesage
- University of Montpellier, Laboratory Epsylon EA, Dynamic of Human Abilities & Health Behaviors, CHU Montpellier, University Hospital of Montpellier, Occupational and Preventive Medicine, Montpellier, France
| | - Valentin Navel
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France
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Ko DT, Chu A, Austin PC, Johnston S, Nallamothu BK, Roifman I, Tusevljak N, Udell JA, Frank E. Comparison of Cardiovascular Risk Factors and Outcomes Among Practicing Physicians vs the General Population in Ontario, Canada. JAMA Netw Open 2019; 2:e1915983. [PMID: 31755946 PMCID: PMC6902820 DOI: 10.1001/jamanetworkopen.2019.15983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Although cardiovascular disease is the leading cause of death in most developed countries, little is known about current physicians' cardiovascular health and outcomes. OBJECTIVE To compare cardiac risk factor burden, health services use, and major cardiovascular event incidence between physicians and the general population. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from practicing physicians and nonphysicians without cardiovascular disease aged 40 to 75 years in Ontario, Canada. Cohorts were assembled beginning January 1, 2008, and were followed up to December 31, 2015. Data analysis was performed between November 2017 and September 2019. EXPOSURE Being a practicing physician. MAIN OUTCOMES AND MEASURES The primary outcome was 8-year incidence of a major cardiovascular event (ie, cardiovascular death or hospitalization for myocardial infarction, stroke, heart failure, or coronary revascularization). Secondary outcomes included health services used, such as physician assessments and guideline-recommended tests. RESULTS The cohort comprised 17 071 physicians (mean [SD] age, 53.3 [8.8] years; 11 963 [70.1%] men) and 5 306 038 nonphysicians (mean [SD] age, 53.7 [9.5] years; 2 556 044 [48.2%] men). Physicians had significantly lower baseline rates of hypertension (16.9% vs 29.6%), diabetes (5.0% vs 11.3%), and smoking (13.1% vs 21.6%), while having better cholesterol profiles (total cholesterol levels >240 mg/dL, 13.3% vs 16.5%; low-density lipoprotein cholesterol >130 mg/dL, 33.2% vs 36.8%); age- and sex-adjusted differences were even larger. Physicians also had lower rates of periodic health examinations (58.9% [95% CI, 57.5%-60.4%] vs 67.9% [95% CI, 67.8%-67.9%]), hyperlipidemia screening (76.3% [95% CI, 74.7%-78.0%] vs 83.8% [95% CI, 83.7%-83.9%]), and diabetes screening (79.0% [95% CI, 77.3%-80.8%] vs 85.3% [95% CI, 85.2%-85.4%]), but higher rates of cardiologist consultations (25.2% [95% CI, 24.2%-26.3%] vs 19.5% [95% CI, 19.4%-19.5%]). The 8-year age- and sex-standardized primary outcome incidence was 4.4 major cardiovascular events per 1000 person-years for physicians and 7.1 major cardiovascular events per 1000 person-years for the general population. After adjusting for age, sex, socioeconomic status, and cardiac risks and comorbidities, physicians had a 22% lower hazard (hazard ratio, 0.78; 95% CI, 0.72-0.85) of experiencing the primary outcome compared with the general population. CONCLUSIONS AND RELEVANCE Practicing physicians in Ontario had fewer cardiovascular risk factors, underwent less preventive testing, and were less likely to experience major adverse cardiovascular outcomes than the general population.
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Affiliation(s)
- Dennis T Ko
- ICES, Toronto, Ontario, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Sharon Johnston
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Departmentof Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Idan Roifman
- ICES, Toronto, Ontario, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Jacob A Udell
- ICES, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Erica Frank
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Dresner Y, Frank E, Shani M, Vinker S. Physicians’ personal health practices and their effect on their patients‘ health practices. MEDICAL SCIENCE PULSE 2019. [DOI: 10.5604/01.3001.0013.1658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Although much has been written about the potential power of the association between physicians’ personal health practices and those of their patients, we found few objective studies of this relationship. We therefore investigated this association using objectively measured health care indicators. Aim of the study: The aim of the study was to show the association between physicians’ own screening/immunization practices and their patients screening/immunization practices. Material and methods: We assessed 8 indicators of quality of health care (screening and vaccination practices) for primary care physicians (n=1488) and their adult patients (n = 1 886 791) in Israel’s largest health maintenance organization. The physicians were also patients in this health care system Results: For all 8 indicators, patients whose physicians were compliant with the preventive practices were more likely (p < 0.05) to also have undergone these preventive measures than patients with noncompliant physicians. We also found that more similar preventive practices showed somewhat stronger relations. For example, among patients whose physician had received the influenza vaccine, 49.1% of eligible patients received influenza vaccines compared to 43.2% of patients whose physicians did not receive the vaccine (5.9% absolute difference, 13.7% relative difference). This is twice the relative difference (7.2%) shown for pneumococcal vaccine—eligible patients of influenza-vaccinated versus non vaccinated physicians (60.9 vs 56.8%).When we examined the rates of un-related practices, we found that, for example,mammography rates were identical for patients whose physicians did and did not receive the influenza vaccine Conclusions: We found a consistent, positive relation between physicians’ and patients’preventive health practices. Objectively establishing this healthy doctor—healthy patient relationship should encourage preventionoriented health care systems to better support and evaluate the effects on patients of improving the physical health of medical students and physicians.
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Affiliation(s)
- Yizchak Dresner
- Sackler School of Medicine, Family Medicine Department, Tel Aviv University, Tel Aviv, Israel, Clalit Health Services, Israel
| | - Erica Frank
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Michal Shani
- Sackler School of Medicine, Family Medicine Department, Tel Aviv University, Tel Aviv, Israel, Clalit Health Services, Israel
| | - Shlomo Vinker
- Sackler School of Medicine, Family Medicine Department, Tel Aviv University, Tel Aviv, Israel, Leumit Health Services, Israel
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Solenova LG, Nekrasova LA. Healthcare workers: occupational carcinogenic factors and cancer risk. ADVANCES IN MOLECULAR ONCOLOGY 2018. [DOI: 10.17650/2313-805x-2018-5-3-25-39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The number of healthcare workers is over two million in Russia. Many of them are exposed to hazardous physical, chemical and biological occupational factors acting along with psychological strain. The results of large epidemiological studies carried out in various countries revealed greater cancer risk in physicians and nurses: cancer of the breast, skin, brain and other sites. Higher cancer risk of lung, breast, uterine, ovary, brain is considered to be associated with ionizing radiation. The female healthcare workers who handle antineoplastic drugs showed a greater risk of birth defects in offspring, spontaneous abortions and breast cancer. In Russia, the growing number of accidents among healthcare workers following transmission of infection by carcinogenic biological factors such as HBV and HIV is observed. Higher risk of reproductive impairments, hyperplasia of the breast and uterine tissues, breast cancer are revealed in nurses working the night shift. In Russia, there is lack of epidemiological studies of cancer risk among healthcare workers, the number of medical personal exposed to occupational carcinogens is unknown. That all does not show the actual situation in our country and does not allow setting priorities in cancer prevention among medical workers.
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Affiliation(s)
- L. G. Solenova
- Research Institute of Carcinogenesis, N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - L. A. Nekrasova
- Research Institute of Carcinogenesis, N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
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Abstract
BACKGROUND Physicians in Taiwan work in stressful workplaces and have heavy workloads, both of which may contribute to the occurrence of a stroke. However, it is not clear whether they have a higher risk of stroke. Therefore, we conducted a population-based cohort study to compare the risks of stroke between physicians and the general population and among subgroups of physicians in Taiwan. METHODS In the National Health Insurance Research Database of Taiwan, we identified 28,062 physicians and selected 84,186 age- and sex-matched nonmedical staff beneficiaries as the references. Using conditional logistic regression, we compared the prevalence of stroke between physicians and references. In addition, we made comparisons among subgroup of physicians defined by age, sex, comorbidity, specialty, and the level of hospital. RESULTS During the study period, physicians had higher prevalence rates of hypertension (23.6% vs. 19.1%), hyperlipidemia (21.4% vs. 12.9%), and coronary artery disease (CAD) (6.4% vs. 5.7%) than the referent group, but they had a lower risk of stroke with an odds ratio of 0.61 (95% confidence interval = 0.55, 0.66) after adjusting for hypertension, diabetes, hyperlipidemia, CAD, and active worker. Among physicians, the risks were higher in those who were older or had hypertension, diabetes, hyperlipidemia, or CAD. CONCLUSIONS Despite having higher prevalence rates of hypertension, hyperlipidemia, and CAD and working in stressful workplaces with heavy workloads, our study suggests that physicians in Taiwan have a lower risk of stroke compared with the general population. These results may indicate the benefits of higher awareness and more knowledge of diseases.
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Siriwardhana C, Lim E, Aggarwal L, Davis J, Hixon A, Chen JJ. Racial/Ethnic and County-level Disparity in Inpatient Utilization among Hawai'i Medicaid Population. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2018; 77:103-113. [PMID: 29761028 PMCID: PMC5945927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We investigated racial/ethnic and county-level disparities in inpatient utilization for 15 clinical conditions among Hawaii's Medicaid population. The study was conducted using inpatient claims data from more than 200,000 Hawai'i Medicaid beneficiaries, reported in the year 2010. The analysis was performed by stratifying the Medicaid population into three age groups: children and adolescent group (1-20 years), adult group (21-64 years), and elderly group (65 years and above). Among the differences found, Asians had a low probability of inpatient admissions compared to Whites for many disease categories, while Native Hawaiian/Pacific Islanders had higher probabilities than Whites, across all age groups. Pediatric and adult groups from Hawai'i County (Big Island) had lower probabilities for inpatient admissions compared to Honolulu County (O'ahu) for most disease conditions, but higher probabilities were observed for several conditions in the elderly group. Notably, the elderly population residing on Kaua'i County (Kaua'i and Ni'ihau islands) had substantially increased odds of hospital admissions for several disease conditions, compared to Honolulu.
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Affiliation(s)
- Chathura Siriwardhana
- Department of Complementary and Integrative Medicine, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (CS, EL, JD, JJC)
- Department of Family Medicine & Community Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (LA, AH)
| | - Eunjung Lim
- Department of Complementary and Integrative Medicine, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (CS, EL, JD, JJC)
- Department of Family Medicine & Community Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (LA, AH)
| | - Lovedhi Aggarwal
- Department of Complementary and Integrative Medicine, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (CS, EL, JD, JJC)
- Department of Family Medicine & Community Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (LA, AH)
| | - James Davis
- Department of Complementary and Integrative Medicine, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (CS, EL, JD, JJC)
- Department of Family Medicine & Community Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (LA, AH)
| | - Allen Hixon
- Department of Complementary and Integrative Medicine, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (CS, EL, JD, JJC)
- Department of Family Medicine & Community Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (LA, AH)
| | - John J Chen
- Department of Complementary and Integrative Medicine, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (CS, EL, JD, JJC)
- Department of Family Medicine & Community Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI (LA, AH)
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Loas G, Lefebvre G, Rotsaert M, Englert Y. Relationships between anhedonia, suicidal ideation and suicide attempts in a large sample of physicians. PLoS One 2018; 13:e0193619. [PMID: 29584785 PMCID: PMC5870971 DOI: 10.1371/journal.pone.0193619] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 02/14/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The relationships between anhedonia and suicidal ideation or suicide attempts were explored in a large sample of physicians using the interpersonal psychological theory of suicide. We tested two hypotheses: firstly, that there is a significant relationship between anhedonia and suicidality and, secondly, that anhedonia could mediate the relationships between suicidal ideation or suicide attempts and thwarted belongingness or perceived burdensomeness. METHODS In a cross-sectional study, 557 physicians filled out several questionnaires measuring suicide risk, depression, using the abridged version of the Beck Depression Inventory (BDI-13), and demographic and job-related information. Ratings of anhedonia, perceived burdensomeness and thwarted belongingness were then extracted from the BDI-13 and the other questionnaires. RESULTS Significant relationships were found between anhedonia and suicidal ideation or suicide attempts, even when significant variables or covariates were taken into account and, in particular, depressive symptoms. Mediation analyses showed significant partial or complete mediations, where anhedonia mediated the relationships between suicidal ideation (lifetime or recent) and perceived burdensomeness or thwarted belongingness. For suicide attempts, complete mediation was found only between anhedonia and thwarted belongingness. When the different components of anhedonia were taken into account, dissatisfaction-not the loss of interest or work inhibition-had significant relationships with suicidal ideation, whereas work inhibition had significant relationships with suicide attempts. CONCLUSIONS Anhedonia and its component of dissatisfaction could be a risk factor for suicidal ideation and could mediate the relationship between suicidal ideation and perceived burdensomeness or thwarted belongingness in physicians. Dissatisfaction, in particular in the workplace, may be explored as a strong predictor of suicidal ideation in physicians.
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Affiliation(s)
- Gwenolé Loas
- Department of Psychiatry & Laboratory of Psychiatric Research (ULB 266), Cliniques universitaires de Bruxelles, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
- * E-mail:
| | - Guillaume Lefebvre
- Department of Psychiatry & Laboratory of Psychiatric Research (ULB 266), Cliniques universitaires de Bruxelles, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Marianne Rotsaert
- Department of Psychiatry & Laboratory of Psychiatric Research (ULB 266), Cliniques universitaires de Bruxelles, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Yvon Englert
- Department of Psychiatry & Laboratory of Psychiatric Research (ULB 266), Cliniques universitaires de Bruxelles, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
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Botelho RV, Jardim Miranda BC, Nishikuni K, Waisberg J. Life Expectancy of Brazilian Neurosurgeons. World Neurosurg 2018; 114:e857-e860. [PMID: 29572173 DOI: 10.1016/j.wneu.2018.03.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Life expectancy (LE) refers to the number of years that an individual is expected to survive. Emphasis is frequently placed on the relationship between LE and the conditions under which a population lives, but fewer studies have investigated the relationship between stress factors associated with specific professions and their effects on LE. The aim of this study is to evaluate Brazilian neurosurgeons' life expectancies (BNLEs) and compare them with those of physicians (both Brazilian and foreign) from other fields, as well as with Brazilian nondoctors. METHODS The Brazilian Society of Neurosurgery death registry was used to obtain data that compared LEs from non-neurosurgeon physicians, as described in the national and international literature. BNLEs were also compared with the LEs of Brazilian citizens. RESULTS Fifty-one neurosurgeons died between 2009 and 2016. All were males. The mean age at death was 68.31 ± 17.71 years. Among all-cause mortality, the breakdown was 20% cardiovascular diseases, 39% malignancies, 10% external factors, 6% gastrointestinal disorders, 12% neurologic illnesses, and 14% unknown causes. BNLE was shorter than LE of male Brazilian citizens. CONCLUSIONS LE was similar among neurosurgeons and other doctors but shorter compared with Brazilian citizens. Further research is needed to provide data that can add to and confirm these results.
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Affiliation(s)
- Ricardo Vieira Botelho
- Post-graduation in Health Sciences-IAMSPE-Hospital do Servidor Público Estadual, São Paulo, Brazil.
| | | | - Koshiro Nishikuni
- Post-graduation in Health Sciences-IAMSPE-Hospital do Servidor Público Estadual, São Paulo, Brazil
| | - Jaques Waisberg
- Post-graduation in Health Sciences-IAMSPE-Hospital do Servidor Público Estadual, São Paulo, Brazil
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Zacay G, Hershkowitz Sikron F, Heymann AD. Israeli general practitioners’ dissatisfaction with their own primary healthcare. Occup Med (Lond) 2018. [DOI: 10.1093/occmed/kqy037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Galia Zacay
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel Aviv, Israel
- Department of Family Medicine, Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | | | - Anthony David Heymann
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel Aviv, Israel
- Department of Family Medicine, Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
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Abstract
Although the physical health of doctors is largely better than that of the general population, they continue to have high levels of stress, depression and substance misuse. These aspects of mental ill health are particularly elevated in psychiatrists, and in a number of studies psychiatrists have also been found to be those doctors most likely to face disciplinary proceedings. This article explores the individual and organisational causes of these problems and the ways they may interact within the psychiatrist's work role, and suggests a variety of possible interventions to improve the mental health of doctors in psychiatry.
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Affiliation(s)
| | - Aoife Ni Chorcorain
- 2 Department of Psychiatry, Cork University Hospital, University College Cork, Cork, Ireland
| | - James V Lucey
- 3 Trinity College Dublin, The University of Dublin, Dublin, Ireland.,4 St. Patrick's Mental Health Services, St. Patrick's University Hospital, Dublin, Ireland
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22
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Marcu LG. Photons – Radiobiological issues related to the risk of second malignancies. Phys Med 2017; 42:213-220. [DOI: 10.1016/j.ejmp.2017.02.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/21/2017] [Accepted: 02/14/2017] [Indexed: 12/23/2022] Open
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Ohtonen P, Alahuhta S. Mortality rates for Finnish anaesthesiologists and paediatricians are lower than those for the general population. Acta Anaesthesiol Scand 2017; 61:880-884. [PMID: 28782108 DOI: 10.1111/aas.12936] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/12/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies on mortality among anaesthesiologists in the Nordic countries have reported inconsistent results. In an effort to examine mortality patterns among Finnish anaesthesiologists, we compared anaesthesiologists and paediatricians with the general population. METHODS The year of birth and mortality data for anaesthesiologists and paediatricians deceased during the period 1996-2014 were assembled from the membership files maintained by the Finnish Medical Association. Data for the general population and causes of death were obtained from the database of Statistics Finland. Standardized mortality ratios (SMR) for anaesthesiologists and paediatricians were calculated using the general population as a reference. RESULTS During the follow-up period, there were 62 deaths among anaesthesiologists and and 95 among peadiatricians. Anaesthesiologists had a lower mean age at death (66.9 years) than did peadiatricians (76.2 years). Standardized mortality ratios for both the groups were well below 1.0. The rate of suicides for anaesthesiologists was more than three times higher than that for paediatricians and more than five times higher for that of the general population. DISCUSSION We found no evidence of increased mortality for anaesthesiologists or paediatricians. The number of suicides among anaesthesiologists was higher than among paediatricians and the general population.
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Affiliation(s)
- P Ohtonen
- Department of Anaesthesiology, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - S Alahuhta
- Department of Anaesthesiology, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Shlebak AA, Bain BJ. Training future haematologists, a privilege or a burden? “A trainer's view”. Br J Haematol 2017; 178:501-507. [DOI: 10.1111/bjh.14697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Abdul A. Shlebak
- Department of Haematology; Imperial College Healthcare NHS Trust Hospitals; London UK
| | - Barbara J. Bain
- Centre for Haematology; St Mary's Hospital campus of Imperial College London; St Mary's Hospital; London
- Department of Haematology; Imperial College Healthcare NHS Trust Hospitals; London UK
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Damasceno KS, de Sousa Barbosa É, Pimentel JVC, Júnior AGT, de Meneses ACP, Júnior JG, de Sousa DF, da Costa Lima PS, Sales IB, Gouveia AS, Biruel EP, Neto MLR, do Nascimento VB. Suicide among Physicians and Methodological Similarities of MEDLINE/PubMED and BVS/BIREME Open Access Bibliographic Databases: A Systematic Review with Metanalysis. Health (London) 2017. [DOI: 10.4236/health.2017.92025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Huang HL, Kung CY, Pan CC, Kung PT, Wang SM, Chou WY, Tsai WC. Comparing the mortality risks of nursing professionals with diabetes and general patients with diabetes: a nationwide matched cohort study. BMC Public Health 2016; 16:1054. [PMID: 27716138 PMCID: PMC5053173 DOI: 10.1186/s12889-016-3734-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Nursing professionals have received comprehensive medical education and training. However, whether these medical professionals exhibit positive patient care attitudes and behaviors and thus reduce mortality risks when they themselves are diagnosed with chronic diseases is worth exploring. This study compared the mortality risks of female nurses and general patients with diabetes and elucidated factors that caused this difference. Methods A total of 510,058 female patients newly diagnosed with diabetes between 1998 and 2006 as recorded in the National Health Insurance Research Database were the participants in this study. Nurses with diabetes and general population with diabetes were matched with propensity score method in a 1:10 ratio. The participants were tracked from the date of diagnosis to 2009. The Cox proportional hazards model was utilized to compare the mortality risks in the two groups. Results Nurses were newly diagnosed with diabetes at a younger age compared with the general public (42.01 ± 12.03 y vs. 59.29 ± 13.11 y). Nevertheless, the matching results showed that nurses had lower mortality risks (HR: 0.53, 95 % CI: 0.38–0.74) and nurses with diabetes in the < 35 and 35–44 age groups exhibited significantly lower mortality risks compared with general patients (HR: 0.23 and 0.36). A further analysis indicated that the factors that influenced the mortality risks of nurses with diabetes included age, catastrophic illnesses, and the severity of diabetes complications. Conclusion Nurses with diabetes exhibited lower mortality risks possibly because they had received comprehensive medical education and training, may had more knowledge regarding chronic disease control and change their lifestyles. The results can serve as a reference for developing heath education, and for preventing occupational hazards in nurses.
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Affiliation(s)
- Hsiu-Ling Huang
- Department of Aged Welfare and Social Work, Toko University, Taiwan, Republic Of China.,Department of Public Health and Department of Health Services Administration, China Medical University, Taiwan, Republic Of China
| | - Chuan-Yu Kung
- Department of Nursing, Hengchun Tourism Hospital, Ministry of Health and Welfare, Taiwan, Republic Of China
| | - Cheng-Chin Pan
- Department of Urology, Hengchun Tourism Hospital, Ministry of Health and Welfare, Taiwan, Republic Of China
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, Republic Of China
| | - Shun-Mu Wang
- Department of Aged Welfare and Social Work, Toko University, Taiwan, Republic Of China
| | - Wen-Yu Chou
- Department of Health Services Administration, China Medical University, 91, Hsueh-Shih Road, Taichung, Taiwan, 40402, Republic Of China
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, 91, Hsueh-Shih Road, Taichung, Taiwan, 40402, Republic Of China.
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Innos K, Rahu K, Baburin A, Rahu M. Cancer incidence and cause-specifi c mortality in male and female physicians: a cohort study in Estonia. Scand J Public Health 2016. [DOI: 10.1177/14034948020300020701] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: To evaluate whether the presumed knowledge of physicians about healthier lifestyle decreases their risk of cancer and mortality, a retrospective cohort study of male and female physicians was conducted in Estonia. Methods: The cancer incidence and cause-specifi c mortality of 3,673 physicians (870 M, 2,803 F ) in Estonia was compared with the rates of the general population. Information on cancer cases and deaths in the cohort between 1983 and 1998 was obtained from the Estonian Cancer Registry and the mortality database of Estonia. Results: The standardized incidence ratio (SIR) for all cancers was 1.32 (95% confi dence interval (CI) 1.15-1.48) in women and 0.92 (95% CI 0.73-1.13) in men. Female physicians had an elevated risk for breast cancer (SIR 2.03, 95% CI 1.62-2.51) and myeloid leukaemia (SIR 3.69, 95% CI 1.35-8.02). Male physicians had an excess of skin melanoma (SIR 4.88, 95% CI 1.58-11.38). A large defi cit of lung cancer was observed (SIR 0.24, 95% CI 0.11-0.48). The very low all-cause mortality in the cohort (standardized mortality ratio 0.55, 95% CI 0.50-0.61) was mainly due to large defi cits in deaths from lung cancer, cardiovascular diseases and external causes. The suicide rate in the cohort was lower than in the general population. Conclusions: No health risks were observed in the cohort that could be linked to the occupational exposures of physicians. The pattern of cancer incidence and mortality seen in physicians in Estonia is similar to the pattern seen among professional classes in other countries.
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Affiliation(s)
- Kaire Innos
- Institute of Experimental and Clinical Medicine, Tallinn, Estonia
| | - Kaja Rahu
- Institute of Experimental and Clinical Medicine, Tallinn, Estonia
| | - Aleksei Baburin
- Institute of Experimental and Clinical Medicine, Tallinn, Estonia
| | - Mati Rahu
- Institute of Experimental and Clinical Medicine, Tallinn, Estonia,
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Vinson AE, Zurakowski D, Randel GI, Schlecht KD. National Survey of US academic anesthesiology chairs on clinician wellness. J Clin Anesth 2016; 34:623-31. [PMID: 27687461 DOI: 10.1016/j.jclinane.2016.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/24/2016] [Accepted: 06/15/2016] [Indexed: 12/01/2022]
Abstract
STUDY OBJECTIVE The prevalence of anesthesiology department wellness programs is unknown. A database of wellness programs is needed as a resource for departments attempting to respond to the Accreditation Council for Graduate Medical Education Anesthesiology Milestones Project. The purpose of this study was to survey academic anesthesiology chairs on wellness issues, characterize initiatives, and establish wellness contacts for a Wellness Initiative Database (WID). DESIGN An Internet-based survey instrument was distributed to academic anesthesiology department chairs in the United States. SETTING On-line. PATIENTS None. INTERVENTIONS None. MEASUREMENTS Analysis for continuous variables used standard means, modes, and averages for individual responses; 95% confidence intervals for proportions were calculated by Wilson's method. MAIN RESULTS Seventy-five (56.4%) responses (of a potential 133 programs) were obtained. Forty-one (of 71 responders; 57.8%) expressed interest in participating in a WID, and 33 (44%) provided contact information. Most (74.7%) had recently referred staff for counseling or wellness resources, yet many (79.5% and 67.1%, respectively) had never surveyed their department's interest in wellness resources. Thirty-four percent had a wellness resources repository. Of 22 wellness topics, 8 garnered >60% strong interest from respondents: Addiction Counseling, Sleep Hygiene, Peer Support Program, Stress Management, Conflict Management, Burnout Counseling, Time Management, and Dealing with Adverse Events Training. There was a statistically significant difference in interest between those willing to participate or not in the WID across most topics but no significant difference based on need for recent staff referral. CONCLUSIONS The majority of chairs needed to recently refer a department member to wellness resources or counseling. Most were interested in participating in a WID, whereas a minority had gauged staff interest in wellness topics or had a wellness resource repository. Highest interest was in topics most related to function as an anesthesiologist. Those willing to participate in the database had statistically significant differences in interest across most wellness topics.
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Affiliation(s)
- Amy E Vinson
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115.
| | - David Zurakowski
- Departments of Anesthesia and Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115.
| | - Gail I Randel
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E Huron St, F5-704, Chicago, IL 60611.
| | - Kathy D Schlecht
- Department of Anesthesiology, Oakland University William Beaumont School of Medicine, 2200 N Squirrel Rd, Rochester, MI 48309.
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Cumberbatch MG, Windsor-Shellard B, Catto JWF. The contemporary landscape of occupational bladder cancer within the United Kingdom: a meta-analysis of risks over the last 80 years. BJU Int 2016; 119:100-109. [DOI: 10.1111/bju.13561] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Little M, Paul K, Jordens CF, Sayers EJ. Vulnerability in the Narratives of Patients and their Carers: Studies of Colorectal Cancer. Health (London) 2016. [DOI: 10.1177/136345930000400405] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vulnerability is susceptibility to any kind of harm, whether physical, moral or spiritual, at the hands of an agent or agency. It is related to disempowerment and loss of autonomy. It is also a relational category that appears repeatedly in the narratives of colorectal cancer patients and their carers. Although one conventionally associates vulnerability with being ill and needing health care, the practice of health care has its own vulnerabilities that emerge as important in the biographies of health care workers. Vulnerability needs to be recognized and negotiated in health care transactions. This article examines a process of ‘reading-for’ vulnerability, and suggests a classification of vulnerability, at least as it appears in the narratives of cancer patients and their carers. Methods of managing vulnerability are also examined and categorized. Reading for vulnerability brings insight into an important aspect of the health care process. Recognition of its importance should translate into changes in medical education and patient information.
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Kim HL, Park HJ, Sim YH, Choi EY, Shim KW, Lee SW, Lee HS, Chun H. Cancer Prevalence among Physicians in Korea: A Single Center Study. Korean J Fam Med 2016; 37:91-6. [PMID: 27073607 PMCID: PMC4826997 DOI: 10.4082/kjfm.2016.37.2.91] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 08/16/2015] [Accepted: 09/27/2015] [Indexed: 12/02/2022] Open
Abstract
Background There is little research regarding whether working as a physician affects cancer risk. Moreover, there is no research on cancer prevalence among physicians in Korea. This study utilized the Korea National Cancer Incidence Database to determine whether the prevalence of cancer among physicians differs from the prevalence of cancer within the general population. Methods We analyzed the medical records of a representative sample of 382 doctors who underwent a health examination between 2010 and 2013 at a health examination center in a Ewha Womans University Medical Center.Cancer incidence was measured as cases that were eventually diagnosed as cancer according to a biopsy. Results We collected medical records from 382 physicians (mean age, 51.9±8.1 years) and calculated the standardized prevalence ratios compared to the general population. Thirty physicians (9 male and 21 female) were identified as having cancer. Physicians had a significantly higher prevalence of cancer compared to the general population.Cancer prevalence in male physicians was found to be 2.47 times higher than the prevalence expected within the general population (P=0.006). Among female physicians, cancer prevalence was 3.94 times higher than that in the general population (P<0.001). Conclusion This study revealed that physicians had a higher prevalence of cancer compared to the general population in Korea, which suggests that there may be a problem present in the health care of physicians. Changes to the working environment of physicians will be needed to reduce the high prevalence of cancer among physicians.
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Affiliation(s)
- Hye Lin Kim
- Department of Family Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hae Jin Park
- Department of Family Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Yun Hye Sim
- Department of Family Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Eun Young Choi
- Department of Family Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Kyung Won Shim
- Department of Family Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Sang Wha Lee
- Department of Family Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hong Soo Lee
- Department of Family Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyejin Chun
- Department of Family Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
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Győrffy Z, Dweik D, Girasek E. Workload, mental health and burnout indicators among female physicians. HUMAN RESOURCES FOR HEALTH 2016; 14:12. [PMID: 27039083 PMCID: PMC4818422 DOI: 10.1186/s12960-016-0108-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 03/23/2016] [Indexed: 05/06/2023]
Abstract
BACKGROUND Female doctors in Hungary have worse indicators of physical and mental health compared with other professional women. We aimed to cast light on possible indicators of mental health, workload, and burnout of female physicians. METHODS Two time-points (T) were compared, in 2003 (T1 n = 408) and 2013 (T2 n = 2414), based on two nationally representative surveys of female doctors, and comparison made with data from other professional control groups. Independent samples t test or chi-squared test was used both for the two time-point comparison and the comparison between the index and the control groups. The background factors of sleep disorders and burnout were assessed by binary logistic regression analysis. RESULTS No significant differences in the rates of depressive symptoms and suicidal thoughts and attempts were detected between the 2003 and 2013 cohorts, but the prevalence of sleep disorders increased. The workload increased, and there was less job satisfaction in 2013 than in 2003, coupled to more stressful or difficult work-related situations. The personal accomplishment component of burnout significantly decreased in line with the declining work-related satisfaction. Compared to the professional control groups, the prevalence of depressive symptoms, suicide attempts, and sleep disorders was higher among female physicians at both time-points. The number of workplaces, frequency of work-related stressful situations, and intensive role conflict was associated with sleep disorders and decreased personal accomplishment. CONCLUSIONS In comparison with the other professional groups, female doctors had worse mental health indicators with regard to depression, suicidal ideas, and sleep disorders both in 2003 and 2013 while within professional strata the changes seemed to be less. Increasing workload had a clear impact on sleep disorders and the personal accomplishment dimension of burnout.
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Affiliation(s)
- Zsuzsa Győrffy
- />Institute of Behavioural Sciences, Semmelweis University, Nagyvárad square 4, Budapest, H-1089 Hungary
| | - Diana Dweik
- />Department of Obstetrics and Gynecology, University of Szeged, Semmelweis st. 1, Szeged, H-6725 Hungary
| | - Edmond Girasek
- />Health Services Management Training Centre, Semmelweis University, Kútvölgyi st 2, Budapest, H-1125 Hungary
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Is aneurysm surgery too exciting for our own good? Acta Neurochir (Wien) 2016; 158:217-9. [PMID: 26711288 DOI: 10.1007/s00701-015-2685-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
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Holleyman R, Vann Jones S. Location, vocation, procreation: how choice influences life expectancy in doctors. Occup Med (Lond) 2016; 66:276-278. [PMID: 26732180 DOI: 10.1093/occmed/kqv207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Stress and mortality are negatively correlated and it is generally accepted that certain professions are more stressful than others. Medical graduates begin as a relatively homogenous population who then choose vastly different career options making doctors an ideal population in which to try to assess whether job stress is likely to be causal to increased mortality. AIMS To establish the influence of various modifiable risk factors on the life expectancy of UK doctors. METHODS We analysed a decade of obituaries from the British Medical Journal published between January 2003 and December 2012. Data included age at death (AAD), specialty, region (deanery), marriage status and children. RESULTS A total of 3068 obituaries were eligible for inclusion. Mean AAD was 78.5 years. Male sex was associated with a significantly increased AAD by an additional 3.8 years (95% CI 2.4-5.2 years, P < 0.001). Public health, obstetrics and gynaecology and laboratory medicine specialties were all associated with significantly increased AAD (P < 0.05). London and Northern Ireland deaneries were both associated with significantly increased AAD (P < 0.05). Each additional child was associated with a relative increase in AAD of +1.1 years (95% CI 0.7-1.4 years, P < 0.001). CONCLUSIONS Our results show that location and career choices may affect life expectancy. While this does not necessarily reflect quality of life, the additional years of life gained from having extra children have a positive effect on your quantity of life.
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Affiliation(s)
- R Holleyman
- Royal Victoria Infirmary, Newcastle upon Tyne, Tyne and Wear NE1 4LP, UK
| | - S Vann Jones
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
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Van Poppel F, Bijwaard G, Van Lieburg M, Van Lieburg F, Hoekstra R, Verkade F, Guerrouche K. L’espérance de vie des professions médicales aux Pays-Bas du xvie au xxe siècle. POPULATION 2016. [DOI: 10.3917/popu.1604.0659] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
The interpersonal psychological theory of suicidal behavior (IPTS) offers a potential means to explain suicide in physicians. The IPTS posits three necessary and sufficient precursors to death by suicide: thwarted belongingness, perceived burdensomeness, and acquired capability. The present study sought to examine whether provocative work experiences unique to physicians (e.g., placing sutures, withdrawing life support) would predict levels of acquired capability, while controlling for gender and painful and provocative experiences outside the work environment. Data were obtained from 376 of 7723 recruited physicians. Study measures included the Acquired Capability for Suicide Scale, the Interpersonal Needs Questionnaire, the Painful and Provocative Events Scale, and the Life Events Scale-Medical Doctors Version. Painful and provocative events outside of work predicted acquired capability (β=0.23, t=3.82, p<0.001, f(2)=0.09) as did provocative work experiences (β=0.12, t=2.05, p<0.05, f(2)=0.07). This represents the first study assessing the potential impact of unique work experiences on suicidality in physicians. Limitations include over-representation of Caucasian participants, limited representation from various specialties of medicine, and lack of information regarding individual differences.
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Chiou SJ, Kung PT, Naessens JM, Huang KH, Chang YC, Wang YH, Tsai WC. Do physicians with diabetes have differences in dialysis use and survival than other patients with diabetes. Diabetes Res Clin Pract 2014; 105:382-90. [PMID: 25088403 DOI: 10.1016/j.diabres.2014.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/10/2014] [Accepted: 07/05/2014] [Indexed: 11/24/2022]
Abstract
AIMS To assess whether the increased knowledge and resources available to physicians led to differences in dialysis and survival rates between physicians and non-physician patients with diabetes. METHODS All newly diagnosed (1997-2009) type 2 diabetes patients aged ≥35 years from the National Health Insurance Program of Taiwan database were included. After propensity score matching (1:10), we estimated the relative risk of dialysis and death using Cox proportional hazards model adjusted for demographic characteristics and comorbidities. RESULTS Physicians with diabetes were more likely to start dialysis than general patients, with a 48% increased hazard risk (HR) (P=0.006). Physicians with diabetes had significantly lower risk of death (HR: 0.88; P=0.025). However, those requiring dialysis had a non-significant increased risk of death (HR: 1.19). There was an increased HR for death in older physicians (HR: 1.81; P<0.001) and those with cancer or catastrophic illness. The HR of dialysis (7.89; P<0.0001) increased dramatically with increasing Charlson Comorbidity Index scores. CONCLUSIONS Physicians with DM survived longer than other patients with diabetes, likely benefiting from their professional resources in disease control and prevention. Nonetheless, they displayed no advantage from their medical backgrounds compared with the general patients if they developed end stage renal disease.
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Affiliation(s)
- Shang-Jyh Chiou
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, No. 89, Nei-Chiang Street, Taipei 10845, Taiwan, ROC; Department of Healthcare Administration, Asia University, 500, Lioufeng Road, Wufeng, Taichung 41354, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, 500, Lioufeng Road, Wufeng, Taichung 41354, Taiwan, ROC
| | - James M Naessens
- Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, ROC
| | - Yu-Chia Chang
- Department of Healthcare Administration, Asia University, 500, Lioufeng Road, Wufeng, Taichung 41354, Taiwan, ROC
| | - Yueh-Hsin Wang
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, ROC.
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Rodseth RN, Biccard BM. Living longer as an anaesthetist: The ‘magic’ lifestyle or the ‘lifestyle polypill’. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2009.10872610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Brenner DJ. What we know and what we don't know about cancer risks associated with radiation doses from radiological imaging. Br J Radiol 2014; 87:20130629. [PMID: 24198200 PMCID: PMC4064597 DOI: 10.1259/bjr.20130629] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Quantifying radiation-induced cancer risks associated with radiological examinations is not easy, which has resulted in much controversy. We can clarify the situation by distinguishing between higher dose examinations, such as CT, positron emission tomography-CT or fluoroscopically guided interventions, and lower dose "conventional" X-ray examinations. For higher dose examinations, the epidemiological data, from atomic bomb survivors exposed to low doses and from direct epidemiological studies of paediatric CT, are reasonably consistent, suggesting that we do have a reasonable quantitative understanding of the individual risks: in summary, very small but unlikely to be zero. For lower dose examinations, we have very little data, and the situation is much less certain, however, the collective dose from these lower dose examinations is comparatively unimportant from a public health perspective.
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Affiliation(s)
- D J Brenner
- Center for Radiological Research, Columbia University Medical Center, New York, NY, USA
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Wilson E, Randall C, Patterson S, Emmerson B, Moudgil V, Weaver T. Monitoring and management of metabolic abnormalities: mixed-method evaluation of a successful intervention. Australas Psychiatry 2014; 22:248-253. [PMID: 24696414 DOI: 10.1177/1039856214529000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the process and impact of a service-level intervention on metabolic monitoring and follow-up of patients of a mental health service who were prescribed clozapine, and describe the metabolic health of these patients. METHODS The intervention - Let's Get Physical - involved designating two months annually as 'physical health months', during which revised service protocol required metabolic monitoring for all eligible patients. Mixed methods were used to assess rates of monitoring at baseline, during the two physical health months, and follow-up and factors influencing practice. Data was analysed using a descriptive statistics and framework approach. RESULTS Monitoring was completed for around two thirds of eligible patients during each physical health month, representing a statistically significant increase (approximately fourfold) from baseline. Perceptions regarding scope of practice and perceived competency managing metabolic abnormalities were key determinants of clinicians' practice. Low rates and inconsistency of follow-up were observed. CONCLUSION Let's Get Physical is cost effective in enhancing adherence to monitoring guidelines. The use of clinical algorithms supporting timely response to abnormalities should be considered. Ongoing education, role clarity and dedicated resources are required if psychiatrists are to contribute meaningfully to improving the physical health of people with mental illness.
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Affiliation(s)
- Eleanor Wilson
- Psychiatric Registrar, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Christopher Randall
- Psychiatric Registrar, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Sue Patterson
- Principal Research Fellow, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Brett Emmerson
- Executive Director, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, and University of Queensland, Brisbane, QLD, Australia
| | - Vikas Moudgil
- Clinical Director, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Tim Weaver
- Senior Lecturer, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia and; Imperial College London, Centre for Mental Health, London, UK
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Affiliation(s)
- Carmelle Peisah
- Specialist Mental Health Services for Older People; Mental Health and Drug and Alcohol; University of Sydney; Sydney New South Wales Australia
- School of Psychiatry; University of New South Wales; Sydney New South Wales Australia
- Capacity Australia; Sydney New South Wales Australia
- Adaptations to Aging Advisory Group; Australia
| | - Chanaka Wijeratne
- School of Psychiatry; University of New South Wales; Sydney New South Wales Australia
- Capacity Australia; Sydney New South Wales Australia
- Adaptations to Aging Advisory Group; Australia
| | - Bruce Waxman
- Academic Surgical Unit; Monash Health; Monash University; Sydney New South Wales Australia
- Adaptations to Aging Advisory Group; Australia
| | - Marianne Vonau
- Queensland Health; University of Queensland; Sydney New South Wales Australia
- Adaptations to Aging Advisory Group; Australia
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Hikiji W, Fukunaga T. Suicide of physicians in the special wards of Tokyo Metropolitan area. J Forensic Leg Med 2013; 22:37-40. [PMID: 24485419 DOI: 10.1016/j.jflm.2013.12.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 12/01/2013] [Accepted: 12/07/2013] [Indexed: 09/30/2022]
Abstract
Numerous studies on physician suicide in various countries have been reported but no data from Japan on the issue can be found to date. In this study, physician suicides in the special wards of Tokyo Metropolitan area in 1996-2010 were investigated retrospectively. A total of 87 cases were enrolled. The results suggested that physician suicide has been linked to pre-existing psychiatric illnesses and occupational problems, and that psychiatrists have a relatively higher suicide risk compared to those majoring in other specialities of medicine. A distinctive feature was that 19 cases had used either drugs or devices which were accessible due to their profession some time during the process of committing suicide. Another notable feature was that 4 out of 5 anaesthesiologists enrolled in the study had chosen poisoning for their suicide method, with the drugs frequently used in their speciality. The findings advocate strongly for efficient suicide prevention measures for physicians including an early detection and treatment of psychiatric illnesses, as well as an urgent need for a more effective pharmacy management in applicable institutions together with the implementation of self discipline on each physician. This is the first broad academic study on physician suicide in Japan.
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Affiliation(s)
- Wakako Hikiji
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, 4-21-18 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan.
| | - Tatsushige Fukunaga
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, 4-21-18 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan.
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Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study. Spine (Phila Pa 1976) 2013; 38:617-25. [PMID: 23026867 DOI: 10.1097/brs.0b013e318275ca58] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study. OBJECTIVE The purpose of this study was to determine the radiation dose to which the surgeons are exposed during percutaneous endoscopic lumbar discectomy (PELD) and to calculate the allowable number of cases per year. SUMMARY OF BACKGROUND DATA Transforaminal PELD is a minimally invasive technique for soft disc herniation. Minimal invasiveness can be achieved through the use of fluoroscopy and endoscopy. The radiation dose to the surgeon during PELD is unknown. METHODS The occupational radiation dose absorbed by 3 spinal surgeons performing 30 consecutive PELDs (33 levels) during a 3-month period was evaluated. Transforaminal PELDs were performed according to the standard technique. The radiation exposure of the neck, chest, arm, and both hands of the surgeons was measured. Occupational exposure guidelines of National Council on Radiation Protection & Measurements were used to calculate the allowable number of procedures per year. RESULTS The mean operation time was 49.8 minutes, and the mean fluoroscopy time was 2.5 minutes. No significant correlations were found between operation time and fluoroscopy time. The calculated radiation doses per operated level were as follows: neck, 0.0785 mSv; chest, 0.1718 mSv; right upper arm, 0.0461 mSv; left ring finger, 0.7318 mSv; and right ring finger, 0.6694 mSv. The protective effects of a lead collar and lead apron were demonstrated by the reduction of the radiation dose by 96.9% and 94.2%, respectively. Therefore, with regard to whole-body radiation, 5379 operations can be performed per year using a lead apron, whereas only 291 operations can be performed without using a lead apron. Moreover, 1910 operations can be performed within the occupational exposure limit for the eyes (150 mSv), and 683 operations can be performed within the occupational exposure limit for the hands (500 mSv). CONCLUSION Without radiation shielding, a surgeon performing 291 PELDs annually would be exposed to the maximum allowable radiation dose. Given the measurable lifetime radiation hazards to the surgeon, the use of adequate protective equipment is essential to reducing exposure during PELD.
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Alexander BH, Mandel JH, Scott LLF, Ramachandran G, Chen YC. Brain cancer in workers employed at a specialty chemical research facility. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2013; 68:218-227. [PMID: 23697694 DOI: 10.1080/19338244.2012.701248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
ABSTRACT This study evaluated unique exposures and their relationship to brain cancer mortality in employees of a specialty chemical research facility. Following an exposure assessment that concerned compounds distinct to this facility, the authors conducted a cohort mortality study of 5,284 workers to assess mortality in reference to the general population and a nested case-control study to evaluate brain cancer risk associated with specific jobs and unique chemical exposures. Four hundred eighty-six deaths, including 14 brain cancer deaths, were identified. Overall mortality was lower than expected. Brain cancer mortality was elevated (standardized mortality ratio [SMR] = 2.02, 95% confidence interval [CI] = 1.11-3.40). Exposures to 5 specific chemical categories were assessed. Exploration of work history and the specific chemical exposures did not explain the brain cancer cases. No clear occupational etiology was identified.
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Affiliation(s)
- Bruce H Alexander
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA
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Kalapos MP. Investigation of the frequency of alcohol related problems in Józsefváros, Budapest. Data and conclusions of three surveys undertaken among doctors and out-patients. Orv Hetil 2012; 153:1263-80. [DOI: 10.1556/oh.2012.29422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The role of permanent alcohol consumption in the development of diseases is well-known. Aims: To study the occurence of alcohol related problems among patients of a municipal pulmonology out-patient clinic as well as in the family practice of three physicians. In addition, a survey was performed among physicians of a municipal health service and also among family practitioners working in the same district by investigating health problems, habits and professional careers of physicians, and their addictive problems, their attitude toward addict patients and their opinion upon chemical dependency. Methods: CAGE-test was used to examine the presence of alcohol problem and a questionnaire was constructed for the study undertaken among physicians. Results: The response rate was 60.18% and 32.98% among patients who visited the pulmonology out-patient clinic and their family physician, respectively. Among those who responded to the test, as many as 6.02% and 4.82% of the cases would need a further medical examination to make clear whether alcohol related health problem was present or not, whilst 9.77% and 11.67% of the patients proved to be alcohol dependent, respectively. The response rate in the survey among physicians was 41.28%. As stated, physicians not only screen the patients for alcohol and drug dependence, but also refer them to a specialist. The general experience seems to oppose this statement. The majority of health professionals considered chemical dependence as a chronic disease, whereas a kind of moral judgment of the problem was also seen, particularly among family physicians. If they had the opportunity to choose whom to treat: an alcoholic or a drug dependent patient, the majority of them would treat patients brought under the first category. The CAGE test revealed alcohol problem in three family physicians, but none in specialists. Nearly all physicians consumed coffee, but the majority of them were non-smokers. As the risk for committing suicide is higher among physicians than in the general population, physicians were interviewed in this regard, too. Three physicians in the sample reported an attempt of suicide, and eleven physicians had suicidal ideas in the past. Although the majority of physicians were satisfied with their physical and mental health, several of them had serious health problems or were treated with depression. At the same time, the majority of physicians were unsatisfied with their financial and professional respect, and had the opinion that a career is unlikely to depend on the professional knowledge. Discussion: Although the relatively low rate of physicians answering the questions did not make it possible to reveal the interrelationships among different variables, the study was able to direct the attention to the risk existing among physicians to commit suicide or use chemical substances. A proposal is made to establish an effective, but discreet and easy way to acquire psychiatric-addictological support. To avoid mental health problems among professionals working in psychiatry, organization of groups headed by someone not belonging to the same institute would be warmly encouraged. Parallel to these, the requirements and the conditions of making a career have to be made clear. On the basis of these surveys, as well as literature data, a continuous test examination of alcohol problem is recommended in the practice of family physicians as well as in the out-patient clinic of such disciplines like pulmonology and gastroenterology. Orv. Hetil., 2012, 153, 1263–1280.
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Affiliation(s)
- Miklós Péter Kalapos
- Budapest és Józsefvárosi Egészségügyi Szolgálat, VIII. TÁMASZ Gondozó Elméleti Biológiai Kutatócsoport Budapest Korányi Sándor utca 3/A 1089
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Skowronski GA, Peisah C. The greying intensivist: ageing and medical practice - everyone's problem. Med J Aust 2012; 196:505-7. [PMID: 22571306 DOI: 10.5694/mja11.11579] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 03/22/2012] [Indexed: 11/17/2022]
Abstract
The medical profession is ageing in parallel with the wider community, with more Australian doctors working into their 70s. This has implications for workforce planning and raises questions about competence. However, no Australian specialist college has policies relating to the special circumstances of ageing practitioners. Ageing practitioners are affected by a number of age-related sensory and neurocognitive changes, including a decline in processing speed, reduced problem-solving ability and fluid intelligence, impaired hearing and sight, and reduced manual dexterity. A policy of mandatory retirement is not consistent with the wide individual variations in cognitive ageing. However, there may be an age ceiling, which varies by medical specialty and individual. Studies show the older doctors in several specialties perform worse than their younger colleagues. Older doctors, many of whom are found to be cognitively impaired, are more likely to be reported to the authorities for poor performance. The wisdom and experience of older doctors is of great value. However, work adaptations may need to be considered. For intensivists, these could include part-time work towards retirement, reduced after-hours call and shift work, and reduced exposure to acute crisis intervention, with an increased focus on mentoring, teaching, administration and research.
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Mahmood T. Dealing with trainees in difficulty. Facts Views Vis Obgyn 2012; 4:18-23. [PMID: 24753884 PMCID: PMC3991443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Doctors are highly valued in every society as they are expected to serve humanity with dedication, commitment and motivation within professional boundaries. Those working within acute specialities are increasingly coming under public microscope. As the public expectations of a quality assured high quality services delivered by the doctors-- is increasing, so does the pressure on doctors to deliver these services. Our doctors in training are on the front line to deal with the initial assessment of acutely sick women and therefore may be exposed to stressful situations with little support. All doctors in training require support from their trainers and clinical supervisors but more support is needed for trainees who are struggling to cope with the pressure and are in difficulty. This paper examines underlying factors which need to be clearly understood before planning a remedial strategy for this group of doctors. They should be handled sensitively but pro actively.
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Affiliation(s)
- T Mahmood
- Consultant Obstetrician & Gynaecologist,Victoria Hospital, Kirkcaldy, KY2 5RA Scotland
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Aasland OG, Hem E, Haldorsen T, Ekeberg Ø. Mortality among Norwegian doctors 1960-2000. BMC Public Health 2011; 11:173. [PMID: 21426552 PMCID: PMC3070654 DOI: 10.1186/1471-2458-11-173] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 03/22/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To study the mortality pattern of Norwegian doctors, people in human service occupations, other graduates and the general population during the period 1960-2000 by decade, gender and age. The total number of deaths in the study population was 1 583 559. METHODS Census data from 1960, 1970, 1980 and 1990 relating to education were linked to data on 14 main causes of death from Statistics Norway, followed up for two five-year periods after census, and analyzed as stratified incidence-rate data. Mortality rate ratios were computed as combined Mantel-Haenzel estimates for each sex, adjusting for both age and period when appropriate. RESULTS The doctors had a lower mortality rate than the general population for all causes of death except suicide. The mortality rate ratios for other graduates and human service occupations were 0.7-0.8 compared with the general population. However, doctors have a higher mortality than other graduates. The lowest estimates of mortality for doctors were for endocrine, nutritional and metabolic diseases, diseases in the urogenital tract or genitalia, digestive diseases and sudden death, for which the numbers were nearly half of those for the general population. The differences in mortality between doctors and the general population increased during the periods. CONCLUSIONS Between 1960 and 2000 mortality for doctors converged towards the mortality for other university graduates and for people in human service occupations. However, there was a parallel increase in the gap between these groups and the rest of the population. The slightly higher mortality for doctors compared with mortality for other university graduates may be explained by the higher suicide rate for doctors.
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Affiliation(s)
- Olaf G Aasland
- The Research Institute, Norwegian Medical Association, Oslo, Norway.
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Freour T, Dessolle L, Jean M, Barriere P. Smoking among French infertility specialists: habits, opinions and patients' management. Eur J Obstet Gynecol Reprod Biol 2010; 155:44-8. [PMID: 21112685 DOI: 10.1016/j.ejogrb.2010.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 08/09/2010] [Accepted: 10/30/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The deleterious effects of tobacco on fertility are now largely demonstrated. Little is known, however, about how infertility doctors communicate on smoking and about their own smoking habits. In this study, we examined smoking habits among French infertility specialists and their attitudes towards infertile couples' exposure to tobacco. STUDY DESIGN A postal survey was sent in 2009 to the 803 French certified physicians (gynaecologists, urologists, endocrinologists and embryologists) specializing in infertility. Demographical data, smoking habits and attitude towards patients' smoking were recorded. Statistical analysis and multiple correspondence analysis were performed in order to identify differences among physicians according to age, gender, occupation or smoking status. RESULTS Response rate was 42.3%. Half of the respondents were male, 41% were under 45 years, 37% were embryologists and 53.3% were gynaecologists. Thirteen percent reported current smoking. More than 80% always asked their patients about smoking status and cannabis consumption. Most physicians specifically informed infertile couples on tobacco, advised them to quit and proposed smoking cessation therapies. Only 24% refused care unless smoking cessation occurred. Statistical analysis showed some differences among subgroups according to gender, occupation or age. Surprisingly, results were comparable according to smoking status. CONCLUSION Most infertility specialists are aware of the deleterious effects of tobacco on fertility and ask their patients to quit. The heterogeneity in infertile patients' management, however, underlines the need for better professional and patients' information on smoking.
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Affiliation(s)
- Thomas Freour
- Service de Médecine de la Reproduction et Biologie du Développement, Hôpital Mère et Enfant, CHU de Nantes, Nantes, France.
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Abstract
BACKGROUND Working in clinical practice involves exposure to many hazards, resulting in ongoing concerns regarding mortality in doctors when compared with the general public. AIMS To evaluate the survival data of all Taiwanese doctors and to ascertain whether doctors experience premature mortality. METHODS Death and census data from 1990 to 2006 were obtained for all practising doctors in Taiwan. Cause-specific standardized mortality ratios (SMRs) were calculated via the Life Table Analysis System using the general population of Taiwan as the reference. RESULTS All the SMRs of different medical specialties were below 0.34. Doctors in Taiwan were found to be less likely to die from all causes, including suicide and drug abuse. The SMRs for suicide and drug abuse were generally below 0.50 [SMR = 0.14, 95% confidence interval (CI) 0.09-0.21 and SMR = 0.16, 95% CI 0.07-0.32, respectively]. CONCLUSIONS The risks of all-cause and cause-specific mortality of doctors were found to be lower than those of the general population in Taiwan.
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Affiliation(s)
- T-F Shang
- Bureau of International Cooperation, Department of Health, Executive Yuan, 36 Tacheng Street, Taipei City 103, Taiwan
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