Stress from uncertainty from graduation to retirement--a population-based study of Swiss physicians.
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ABSTRACT:
SUBMITTER: Bovier PA
PROVIDER: S-EPMC1855273 | biostudies-other | 2007 May
REPOSITORIES: biostudies-other
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Project description:ObjectiveSeverity of the COVID-19 has been previously reported in terms of absolute mortality in SARS-CoV-2 positive cohorts. An assessment of mortality relative to mortality in the general population is presented.DesignRetrospective population-based study.SettingIndividual information on symptomatic confirmed SARS-CoV-2 patients and subsequent deaths from any cause were compared with the all-cause mortality in the Swiss population of 2018. Starting 23 February 2020, mortality in COVID-19 patients was monitored for 80 days and compared with the population mortality observed in the same time of year starting 23 February 2018.Participants5 102 300 inhabitants of Switzerland aged 35-95 without COVID-19 (general population in spring 2018) and 20 769 persons tested positively for COVID-19 during the first wave in spring 2020.MeasurementsSex-specific and age-specific mortality rates were estimated using Cox proportional hazards models. Absolute probabilities of death were predicted and risk was assessed in terms of relative mortality by taking the ratio between the sex-specific and age-specific absolute mortality in COVID-19 patients and the corresponding mortality in the 2018 general population.ResultsAbsolute mortalities increased with age and were higher for males compared with females, both in the general population and in positively tested persons. A confirmed SARS-CoV-2 infection substantially increased the probability of death across all patient groups at least eightfold. The highest relative mortality risks were observed among males and younger patients. Male COVID-19 patients exceeded the population hazard for males (HR 1.21, 95% CI 1.02 to 1.44). An additional year of age increased the population hazard in COVID-19 patients only marginally (HR 1.00, 95% CI 1.00 to 1.01).ConclusionsHealthcare professionals, decision-makers and societies are provided with an additional population-adjusted assessment of COVID-19 mortality risk. In combination with absolute measures of risk, the relative risks presented here help to develop a more comprehensive understanding of the actual impact of COVID-19.
| S-EPMC7941676 | biostudies-literature
Project description:Physicians are considered to be the most informed consumers in the use of medical services since they have more information about diseases or medical technology. However, although plenty of researchers have suggested that different medical seeking behavior exists among physicians, very few empirical studies have been conducted to investigate differences in medical utilization between physicians and the general population.We explored differences in the utilization of healthcare services between physicians and the general population using a population-based dataset.A cross-sectional study.Data for this study were sourced from the Taiwan Longitudinal Health Insurance Database 2000. We included 1426 physicians and 1426 sex- and age-matched comparison subjects.We used Wilcoxon-Mann-Whitney tests to explore differences in variables of healthcare resource utilization between physicians and comparison subjects. We further used Kruskal-Wallis tests to examine differences in variables of healthcare resource utilization between physician practice location and comparison subjects.We found that physicians had significantly fewer outpatient visits (13.2 vs. 15.7, p<0.001) and significantly lower outpatient costs (US$477 vs. US$680, p<0.001) than comparison subjects. Furthermore, physicians had lower total health service costs than comparison subjects (US$643 vs. US$1066, p<0.001). This indicates that the mean total health service costs in the year 2010 was 1.66-fold greater for comparison subjects than for physicians. We also found that there were significant differences in the mean number of outpatient services (p<0.001), outpatient costs (p = 0.001), inpatients costs (p = 0.018), and total costs (p = 0.001) among office-based physicians, hospital-based physicians, and comparison subjects. Specifically, Scheffe contrast tests showed that office-based physicians had significantly more outpatient visits (19.3 vs.10.7, p<0.001) and significantly higher outpatient costs (US$656 vs. US$402, p<0.001) than hospital-based physicians.Physicians had less healthcare utilization than comparison subjects. Furthermore, hospital-based physicians had higher inpatient costs and less outpatient services and costs than office-based physicians.
| S-EPMC4709064 | biostudies-other
Project description:The polypill has been advocated for cardiovascular disease (CVD) management. The fraction of the population who could benefit from the polypill in Switzerland is unknown. Assess (1) the prevalence of subjects (a) eligible for the polypill and (b) already taking a polypill equivalent; and (2) the determinants of polypill intake in the first (2009-2012) and second follow-ups (2014-2017) of a population-based prospective study conducted in Lausanne, Switzerland. The first and the second follow-ups included 5038 and 4596 participants aged 40-80 years, respectively. Polypill eligibility was defined as having a high CVD risk as assessed by an absolute CVD risk ≥ 5% with the SCORE equation for Switzerland and/or presenting with CVD. Four polypill equivalents were defined: statin + any antihypertensive with (A) or without (B) aspirin; statin + calcium channel blocker (CCB) (C); and statin + CCB + angiotensin-converting enzyme inhibitor (D). The prevalence of polypill eligibility was 20.6% (95% CI 19.5-21.8) and 27.7% (26.5-29.1) in the first and second follow-up, respectively. However, only around one-third of the eligible 29.5% (95% CI 26.7-32.3) and 30.4% (27.9-33.0) respectively, already took the polypill equivalents. All polypill equivalents were more prevalent among men, elderly and in presence of CVD. After multivariable adjustment, in both periods, male gender was associated with taking polypill equivalent A (OR: 1.93; 95% CI 1.45-2.55 and OR: 1.67; 95% CI 1.27-2.19, respectively) and polypill equivalent B (OR: 1.52; 95% CI 1.17-1.96 and OR: 1.41; 95% CI 1.07-1.85, respectively). Similarly, in both periods, age over 70 years, compared to middle-age, was associated with taking polypill equivalent A (OR: 11.71; CI 6.74-20.33 and OR: 9.56; CI 4.13-22.13, respectively) and equivalent B (OR: 13.22; CI 7.27-24.07 and OR: 20.63; CI 6.51-56.36, respectively). Former or current smoking was also associated with a higher likelihood of taking polypill equivalent A in both periods. A large fraction of the population is eligible for the polypill, but only one-third of them actually benefits from an equivalent, and this proportion did not change over time.
| S-EPMC7994372 | biostudies-literature
Project description:ObjectivesEarly retirement occurs when one's job satisfaction suffers due to employment mismatch resulting from factors such as inadequate compensation. Medical doctors report high levels of job stress and burnout relative to other professionals. These levels are highest among emergency physicians (EPs), and despite general improvements in their working conditions, early retirement continues to become more common in this population. The purpose of this study was to identify the factors influencing EPs intention to retire early and to develop a probability equation for its prediction.MethodsA secondary analysis of data from the 2015 Korean Society of Emergency Physicians Survey was performed. The variables potentially influencing early retirement were organized into personal characteristics, extrinsic factors, and intrinsic factors. Logistic regression analysis was performed to identify risk factors and to develop a probability equation; these findings were then arranged in a nomogram.ResultsOf the 377 survey respondents included in the analysis, 48.0% intended to retire early. Risk factors for early retirement included level of satisfaction with the specialty and its outlook, slanderous reviews, emergency room safety, health status, workload intensity, age, and hospital type. Intrinsic factors (i.e., slanderous reviews and satisfaction with the specialty and its outlook) had a stronger influence on early retirement than did extrinsic factors.ConclusionsTo promote career longevity among EPs, it is vital to improve emergency room safety and workload intensity, to enhance medical professionalism through a stronger vision of emergency medicine, and to strengthen the patient-doctor relationship.
| S-EPMC5996188 | biostudies-literature
Project description:Inadequate sodium and potassium dietary intakes are associated with major, yet preventable, health consequences. Local public health interventions can be facilitated and informed by fine-scale geospatial analyses. In this study, we assess the existence of spatial clustering (i.e., an unusual concentration of individuals with a specific outcome in space) of estimated sodium (Na), potassium (K) intakes, and Na:K ratio in the Bus Santé 1992-2018 annual population-based surveys, including 22,495 participants aged 20-74 years, residing in the canton of Geneva, using the local Moran's I spatial statistics. We also investigate whether socio-demographic and food environment characteristics are associated with identified spatial clustering, using both global ordinary least squares (OLS) and local geographically weighted regression (GWR) modeling. We identified clear spatial clustering of Na:K ratio, Na, and K intakes. The GWR outperformed the OLS models and revealed spatial variations in the associations between explanatory and outcome variables. Older age, being a woman, higher education, and having a lower access to supermarkets were associated with higher Na:K ratio, while the opposite was seen for having the Swiss nationality. Socio-demographic characteristics explained a major part of the identified clusters. Socio-demographic and food environment characteristics significantly differed between individuals in spatial clusters of high and low Na:K ratio, Na, and K intakes. These findings could guide prioritized place-based interventions tailored to the characteristics of the identified populations.
| S-EPMC8229307 | biostudies-literature
Project description:BackgroundMedical uncertainty is a pervasive and important problem, but the strategies physicians use to manage it have not been systematically described.ObjectivesTo explore the uncertainty management strategies employed by physicians practicing in acute-care hospital settings and to organize these strategies within a conceptual taxonomy that can guide further efforts to understand and improve physicians' tolerance of medical uncertainty.DesignQualitative study using individual in-depth interviews.ParticipantsConvenience sample of 22 physicians and trainees (11 attending physicians, 7 residents [postgraduate years 1-3), 4 fourth-year medical students), working within 3 medical specialties (emergency medicine, internal medicine, internal medicine-pediatrics), at a single large US teaching hospital.MeasurementsSemistructured interviews explored participants' strategies for managing medical uncertainty and temporal changes in their uncertainty tolerance. Inductive qualitative analysis of audio-recorded interview transcripts was conducted to identify and categorize key themes and to develop a coherent conceptual taxonomy of uncertainty management strategies.ResultsParticipants identified various uncertainty management strategies that differed in their primary focus: 1) ignorance-focused, 2) uncertainty-focused, 3) response-focused, and 4) relationship-focused. Ignorance- and uncertainty-focused strategies were primarily curative (aimed at reducing uncertainty), while response- and relationship-focused strategies were primarily palliative (aimed at ameliorating aversive effects of uncertainty). Several participants described a temporal evolution in their tolerance of uncertainty, which coincided with the development of greater epistemic maturity, humility, flexibility, and openness.ConclusionsPhysicians and physician-trainees employ a variety of uncertainty management strategies focused on different goals, and their tolerance of uncertainty evolves with the development of several key capacities. More work is needed to understand and improve the management of medical uncertainty by physicians, and a conceptual taxonomy can provide a useful organizing framework for this work.
| S-EPMC7985858 | biostudies-literature
Project description:OBJECTIVE: to assess the levels and determinants of interleukin (IL)-1?, IL-6, tumour necrosis factor (TNF)-? and C-reactive protein (CRP) in a healthy Caucasian population. METHODS: population sample of 2884 men and 3201 women aged 35 to 75. IL-1?, IL-6 and TNF-? were assessed by a multiplexed particle-based flow cytometric assay and CRP by an immunometric assay. RESULTS: Spearman rank correlations between duplicate cytokine measurements (N = 80) ranged between 0.89 and 0.96; intra-class correlation coefficients ranged between 0.94 and 0.97, indicating good reproducibility. Among the 6085 participants, 2289 (37.6%), 451 (7.4%) and 43 (0.7%) had IL-1?, IL-6 and TNF-? levels below detection limits, respectively. Median (interquartile range) for participants with detectable values were 1.17 (0.48-3.90) pg/ml for IL-1?; 1.47 (0.71-3.53) pg/ml for IL-6; 2.89 (1.82-4.53) pg/ml for TNF-? and 1.3 (0.6-2.7) ng/ml for CRP. On multivariate analysis, greater age was the only factor inversely associated with IL-1? levels. Male sex, increased BMI and smoking were associated with greater IL-6 levels, while no relationship was found for age and leisure-time PA. Male sex, greater age, increased BMI and current smoking were associated with greater TNF-? levels, while no relationship was found with leisure-time PA. CRP levels were positively related to age, BMI and smoking, and inversely to male sex and physical activity. CONCLUSION: Population-based levels of several cytokines were established. Increased age and BMI, and to a lesser degree sex and smoking, significantly and differentially impact cytokine levels, while leisure-time physical activity has little effect.
| S-EPMC3111463 | biostudies-other
Project description:There is limited data on the general health of primary care physicians (PCPs). We aimed to assess the physical and psychological health of Swiss PCPs. We selected a random sample of 1000 PCPs in Western Switzerland. They were asked about their self-rated health status, all medical conditions experienced in the past five years, and the number of days they were hospitalized and off work in 2019. They were also asked whether they had their own general practitioner (GP) and seen a psychiatrist/psychologist in the past 12 months. A total of 503 PCPs were included in the study (women = 51%, GPs = 67%, pediatricians = 19%, gynecologists = 14%). Ninety-four percent considered themselves in good or very good health. In the past five years, PCPs suffered mostly from depression/anxiety (21%), burnout (21%), dyslipidemia (19%) and hypertension (17%). Male and older PCPs had more often cardiovascular disorders, younger PCPs and GPs had more often psychiatric disorders. They were 9% to have been hospitalized (15% for PCPs over 60) and 20% to have been off work (32% for PCPs under 45). Only 47% had their own GP (37% for GPs). They were 16% (mostly female and younger PCPs) to have consulted a psychiatrist/psychologist. In conclusion, although PCPs considered themselves to be in good health, a substantial proportion suffered from a medical condition, mainly psychiatric (depression or burnout) and/or cardiovascular disorders, or were recently hospitalized or off work. Only half had a GP for themselves. These results may be useful for implementing specific health strategies targeting PCPs.
| S-EPMC8648724 | biostudies-literature
Project description:BackgroundDuring transition to retirement there is often a rearrangement of daily life which might provide a key opportunity for interventions to promote a non-sedentary and active lifestyle. To be able to design effective interventions, it is essential to know which sedentary and physical behaviour domains (eg, at home or during leisure time) have potential to facilitate healthy ageing during the retirement transition.ObjectiveTo determine whether unfavourable sedentary and physical activity behaviour before retirement predict unfavourable sedentary and physical activity behaviour after retirement.DesignPopulation-based cohort.Setting and participantsAdults (n=3272) employed in 2010 but retired in 2014.MethodsSelf-reported preretirement job activity, sedentary leisure time, physical activity at home, and walking-cycling and exercise were assessed as predictors for unfavourable sedentary and physical activity behaviours after retirement using logistic regression. Unfavourable behaviours were defined based on the respective median of the cohort distribution. Furthermore, the OR for having multiple unfavourable behaviours after retirement was determined, based on the amount of unfavourable behaviours before retirement. All models were adjusted for gender and education.ResultsUnfavourable preretirement physical activity and sedentary behaviour at home or during leisure time were the strongest predictors of the same behaviours after retirement. Unfavourable job activity did not predict physical activity but did predict unfavourable sedentary behaviour after retirement (OR=1.66, 95% CI 1.41 to 1.96). Unfavourable exercise behaviour before retirement predicted unfavourable sedentary and physical activity after retirement in all domains. With all behaviours being unfavourable before retirement, the OR of having at least three unfavourable behaviours after retirement was 36.7 (95% CI 16.8 to 80.5).ConclusionsAdults with a higher number of unfavourable preretirement physical activity and sedentary behaviours are likely to carry these unfavourable behaviours into retirement age. Interventions should target those with more unfavourable preretirement physical activity and sedentary behaviours before retirement, and those interventions focusing on exercise might have greatest potential.
| S-EPMC7389486 | biostudies-literature
Project description:BackgroundHealth status is a principal determinant of labour market participation. In this study, we examined whether excess weight is associated with withdrawal from the labour market owing to premature retirement.MethodsThe analyses were based on nationally representative data from Finland over the period 2001-15 (N ∼ 2500). The longitudinal data included objective measures of body weight (i.e. body mass index and waist circumference) linked to register-based information on actual retirement age. The association between the body weight measures and premature retirement was modelled using cubic b-splines via logistic regression. The models accounted for other possible risk factors and potential confounders, such as smoking and education.ResultsExcess weight was associated with an increased risk of premature retirement for both men and women. A closer examination revealed that the probability of retirement varied across the weight distribution and the results differed between sexes and weight measures.ConclusionBody weight outside a recommended range elevates the risk of premature retirement.
| S-EPMC8514174 | biostudies-literature