Emotionally exhausting factors in general practitioners' work

BACKGROUND

Emotional exhaustion is central in burnout syndrome and signals its development. General practitioners' (GP) work is emotionally challenging but research on these aspects is lacking.

OBJECTIVE

To study the prevalence of emotional exhaustion among GPs and to evaluate how their characteristics and work experiences are associated with emotional exhaustion.

DESIGN AND METHODS

A questionnaire survey was carried out among GPs in Finland in 2011 in which questions were posed regarding their experience of emotional exhaustion and items related to their work experiences and professional identity. A statement "I feel burnt out from my job" (never, seldom, sometimes, quite often, or often) enquired about emotional exhaustion. Those responding quite often or often were categorized as emotionally exhausted.

RESULTS

Among the GPs, 68% responded (165/244). Of the respondents, 18% were emotionally exhausted. Emotional exhaustion was associated with older age, longer working history, experiences of having too much work, fear and reports of having committed a medical error, low tolerance of uncertainty in their work, and feeling alone at work. No differences in positive work experiences were found. In logistic regression analysis working experience > 5 years (OR 4.1, 95% CI 1.6-10.8; p = 0.0036) and feeling alone at work (OR 2.9, 95% CI 1.2-7.1; p = 0.020) predicted emotional exhaustion, having committed a medical error in the past three months predicted it marginally significantly (OR 2.4, 95% CI 1.0-5.9, p = 0.057), whereas tolerating uncertainty well protected against it (OR 0.2, 95% CI 0.09-0.7; p = 0.0098).

CONCLUSIONS

Emotional exhaustion among GPs was common and associated with longer working history, having committed a medical error, and feelings of isolation at work. GPs should receive more support throughout their careers.

Effect of pubic bone marrow edema on recovery from endoscopic surgery for athletic pubalgia

Athletic pubalgia (sportsman's hernia) is often repaired by surgery. The presence of pubic bone marrow edema (BME) in magnetic resonance imaging (MRI) may effect on the outcome of surgery. Surgical treatment of 30 patients with athletic pubalgia was performed by placement of totally extraperitoneal endoscopic mesh behind the painful groin area. The presence of pre-operative BME was graded from 0 to 3 using MRI and correlated to post-operative pain scores and recovery to sports activity 2 years after operation. The operated athletes participated in our previous prospective randomized study. The athletes with (n = 21) or without (n = 9) pubic BME had similar patients' characteristics and pain scores before surgery. Periostic and intraosseous edema at symphysis pubis was related to increase of post-operative pain scores only at 3 months after surgery (P = 0.03) but not to long-term recovery. Two years after surgery, three athletes in the BME group and three in the normal MRI group needed occasionally pain medication for chronic groin pain, and 87% were playing at the same level as before surgery. This study indicates that the presence of pubic BME had no remarkable long-term effect on recovery from endoscopic surgical treatment of athletic pubalgia.

The perceptions of a GP's work among fifth-year medical students in Helsinki, Finland

OBJECTIVE

To explore medical students' potential interest in family medicine in the future and their perceptions of a GP's work.

DESIGN

A cross-sectional survey in 2008-2010.

SETTING AND SUBJECTS

Fifth-year medical students prior to their main course in General Practice at the University of Helsinki.

MAIN OUTCOME MEASURES

The students' opinions regarding the GP's work and their perceptions of the main aims of a GP's work.

RESULTS

309/359 medical students (mean age 25.7 years, 64% females) responded to the survey. Among the students, 76% considered the most attractive feature in the GP's work to be that it is versatile and challenging. The least attractive features included: too hasty, pressing work, too lonely work, and too many non-medical problems. The majority of the students considered the main aim of a GP's work as to identify serious diseases/disorders in order to refer those patients for specialized care (82%). Treatment of chronic diseases is an important responsibility of a GP's work according to 63% of the students. Only 38% considered health promotion to be an important aim.

CONCLUSIONS

Medical students may have perceptions of the GP's work that influence their career choices to specialize in other fields.

Diet, serum fatty acids, and atopic diseases in childhood

BACKGROUND

The reasons behind the reported increase in the occurrence of childhood atopic sensitization rates are unclear. We wanted to evaluate the association between dietary fats, serum fatty acids, and the occurrence and development of atopic diseases.

METHODS

From a longitudinal database of a population-based sample, 231 sex- and age-matched pairs in 1980 and 154 pairs in 1986 were chosen, between whom we compared the dietary data, serum fatty acid composition, and occurrence of atopic diseases. The same variables were also compared between those who developed atopic disease later and those who did not during the 9-year follow-up.

RESULTS

Examination of the dietary data in 1980 for those who had developed atopic disease compared with those who had remained healthy showed that the atopic children had used less butter before the expression of atopy. According to the cross-sectional data, the children with atopic disease consumed more margarine (mean 8.6 vs 7.3 [P = 0.04]), and less butter (mean 9.4 vs 11.6 g/1000 kcal [P = 0.002]), than the nonatopic children in 1980. Differences supporting these dietary findings were similarly found in the serum fatty acid data.

CONCLUSION

The diet of the atopic children differed from that of the nonatopic children in the consumption of polyunsaturated fat.

Nasopharyngeal eosinophil cationic protein in bronchiolitis: relation to viral findings and subsequent wheezing

A prospective 4-month follow-up of children hospitalized with bronchiolitis revealed that high concentrations of eosinophil cationic protein (ECP) in nasopharyngeal aspirates (NPA) are predictive of wheezing after bronchiolitis. In the 29 patients who received no anti-inflammatory therapy the median concentration of NPA ECP was 882 ng/g in those with physician-diagnosed wheezing (P = 0.02). The NPA ECP concentration of the whole study group of 88 children with and without subsequent hospital admissions for wheezing were 531 and 299 ng/g, respectively (P = 0.02). At entry the children with negative viral findings had significantly higher concentrations of respiratory tract ECP than those with positive viral findings (515 vs. 240 ng/g; P = 0.01). The concentration of ECP in respiratory secretions decreased significantly after bronchiolitis (P = 0.01) provided that no new viral or mycoplasmal infection occurred. NPA ECP values decreased in relation to time regardless of whether anti-inflammatory therapy was used or not. Children with high concentrations of respiratory tract ECP seemed to benefit from anti-inflammatory therapy with nebulized cromolyn sodium or budesonide; both drugs significantly decreased the number of subsequent physician-diagnosed bronchial obstruction (P = 0.0006), and they tended to decrease the number of hospital admissions for wheezing (P = 0.08). Our results suggest that high concentrations of ECP in respiratory tract secretions in children with bronchiolitis reflect the presence of eosinophilic inflammation also seen in asthma.

Serum eosinophil cationic protein as a predictor of wheezing after bronchiolitis

We have evaluated the role of eosinophil cationic protein (ECP) concentrations in serum in predicting wheezing after bronchiolitis, during infancy and early childhood. A prospective study at a university hospital serving all pediatric patients in a defined area was designed. Serum ECP concentrations were measured in 92 infants under the age of 2 years on admission for acute bronchiolitis, and 6 and 16 weeks after hospitalization. Nebulized anti-inflammatory therapy was initiated during hospitalization: 32 patients received cromolyn sodium and 32 patients received budesonide for 16 weeks; 30 control patients received no maintenance therapy. The numbers of subsequent physician-diagnosed wheezing episodes and hospital admissions for obstructive airway disease were recorded during 16 weeks of follow-up. At entry, 14 of 92 (15%) children had high (> or = 16 micrograms/L) levels of ECP in their serum. During the 16-week follow-up period, this group of patients had significantly more physician-diagnosed episodes of wheezing (86% vs. 43%, P < 0.01) and hospital admissions for wheezing (64% vs. 19%, P = 0.001) than those with serum levels of ECP < 16 micrograms/L. The number of patients with serum ECP > or = 8 micrograms/L was 25 (27%); 76% of this group developed physician-diagnosed wheezing (P < 0.01), and 48% had hospital admissions for wheezing (P < 0.01). Serum ECP levels decreased significantly with respect to time after bronchiolitis and did not differ among the three intervention groups. We conclude that a high serum ECP concentration during the acute phase of bronchiolitis is a specific but insensitive predictor of wheezing after bronchiolitis.

Anti-inflammatory therapy reduces wheezing after bronchiolitis

OBJECTIVE

To evaluate whether early anti-inflammatory therapy with nebulized cromolyn sodium or budesonide reduces wheezing after bronchiolitis.

DESIGN AND SETTING

A randomized, controlled study in a university hospital that provides primary hospital care for all pediatric patients in a defined area.

PATIENTS

One hundred consecutive infants younger than 24 months treated in the hospital for acute bronchiolitis.

INTERVENTIONS

Thirty-four patients received cromolyn sodium, 20 mg four times a day for 8 weeks and 20 mg three times a day for 8 weeks, and 34 patients received budesonide, 500 micrograms twice a day for 8 weeks and 250 micrograms twice a day for 8 weeks, by a foot pump with a face mask; 32 patients in the control group received no therapy.

MAIN OUTCOME MEASURES

Numbers of physician-diagnosed wheezing episodes, hospital admissions for bronchial obstructions, and symptomatic days recorded by the parents.

RESULTS

Children in the cromolyn sodium (19%) and budesonide (16%) groups had significantly fewer physician-diagnosed wheezing episodes than those in the control group (47%) during the second 8-week period (P < .05). A significant reduction in hospital admissions for bronchial obstructions was seen in the budesonide group and in the children with atopy in both treatment groups (P < .05). The children with atopy had significantly more subsequent wheezing episodes and hospital admissions than those without atopy (P < .05). The numbers of symptomatic days did not differ significantly among the three groups.

CONCLUSIONS

Early anti-inflammatory therapy with nebulized cromolyn sodium or budesonide reduces the number of wheezing episodes and hospital admissions after bronchiolitis. Children with atopy are at high risk of subsequent wheezing episodes, and they particularly benefit from anti-inflammatory therapy.

Preventive therapy for asthma in children; a 9-year experience in eastern Finland

The long-term treatment modalities of bronchial asthma were studied in children from a defined Finnish population from 1985 to 1993, with special reference to changes during the study period. The data on maintenance drugs in children with asthma from five years (1985, 1987, 1989, 1991 and 1993) were retrospectively retrieved from the computerized registers. The reliability of the data for the diagnosis and basic treatment of asthma was checked by one of the authors, who compared the data with the patient cards from the hospital. The number of children with doctor-diagnosed asthma increased continuously during the surveillance period. The proportion of children receiving preventive medication increased concomitantly; this increase was most pronounced between 1987 and 1989. The most common preventive drug was sodium cromoglycate; its use increased from 14% in 1985 to 58% in 1993. The use of inhaled steroids remained stable at 17-19% in all surveillance years. Our treatment policy is in accordance with the international consensus statement published in 1989; however, the change towards preventive medication occurred before its publication.

Bronchial asthma and hyperreactivity after early childhood bronchiolitis or pneumonia. An 8-year follow-up study

OBJECTIVE

To determine the infantile risk factors and long-term outcome up to 8 to 10 years of age for bronchial asthma and hyperreactivity in children with early-childhood bronchiolitis or pneumonia.

DESIGN

Prospective follow-up of three groups of children.

SETTING

University hospital providing primary hospital care and outpatient consultations for all pediatric patients in a defined area.

INTERVENTIONS

None.

PATIENTS

The study groups consisted of 62 children with early-childhood bronchiolitis, 29 children with early-childhood pneumonia with no wheezing, and 52 control children.

METHODS

Infantile risk factors were prospectively registered until 2 years of age. Clinical examination, performed 7 to 8 years later, included recording of atopic and asthmatic symptoms from the preceding 12 months. The methacholine inhalation challenge test was used to assess bronchial hyperreactivity, and mean midexpiratory flow results were used to assess bronchial obstruction.

MAIN RESULTS

Bronchial asthma was present in nine (15%) of the 62 children from the bronchiolitis group, compared with 7% in the pneumonia group and 2% in the control group. Bronchial hyperreactivity indicated by methacholine inhalation challenge was far more common; it was present in 62% of the bronchiolitis group and in 45% of the pneumonia group. Both groups differed significantly from the control group. Decreased mean midexpiratory flow values were observed in 29% and 21% of the bronchiolitis and pneumonia groups, respectively. All 10 asthmatic patients had bronchial hyperreactivity, but only 20% of hyperreactive children had asthma. An analysis of infantile risk factors disclosed only one, an early onset of wheezing, with a significant effect on bronchial hyperreactivity at school age. Elevated IgE values measured during infancy were associated with the development of clinical asthma.

CONCLUSIONS

The risk of bronchial asthma was increased after infantile bronchiolitis. Moreover, bronchial hyperreactivity was increased after both infantile bronchiolitis and pneumonia. Methacholine inhalation challenge was a sensitive but nonspecific test for diagnosing bronchial asthma. Both bronchiolitis and pneumonia resulting in hospitalization in early childhood distinguish a group of children with an increased risk for long-term lung function abnormalities and pulmonary illnesses.

Bronchial asthma after early childhood wheezing: a follow-up until 4.5-6 years of age

Over a period of 12 months from 1981 to 1982, 83 patients aged less than 2 years were treated in hospital for acute bronchiolitis. The children were followed-up prospectively; 68 (83%) completed the study until 4.5-6.0 years of age. At this age, 17 (25%) of the 68 children with bronchiolitis still suffered from wheezing attacks. These 17 asthmatics suffered from both atopic dermatitis (29 versus 6%) and allergic rhinitis (29 versus 8%) more frequently than non-asthmatic children. In contrast, positive results in the skin prick tests were almost equally common (29 and 20%) in asthmatic and non-asthmatic children. In these tests, allergies to birch pollen, timothy grass pollen and house dust mite were most common; asthma was particularly associated with house dust mite allergy. The presence of atopic dermatitis, elevated immunoglobulin E values and repeated wheezing episodes between 1 and 2 years of age were significant risk factors for later asthma. In conclusion, the risk for later asthma is increased after early childhood bronchiolitis; the frequency of asthma was 25% in the present study. Our results confirm that atopics are at a greater risk of developing asthma later in childhood than non-atopics; the risk was significant from 1 year of age onwards.