Survey of perceived stress and work demands of consultant doctors.

OBJECTIVES: The objectives of this study were to assess the work demands as potential stressors of health service consultants, and to describe the development of tools for measuring stress experiences of consultants. METHODS: A stratified random sample of 500 NHS consultants in Scotland was targeted by a postal questionnaire and 375 (75%) returned a valid response. They completed questionnaires, including information on demographic factors, work demands, occupational stressors, and burnout. RESULTS: Principal components analysis showed that professional work demands of consultants fell into three categories: clinical, academic, and administrative. Their perceived stressors separated into four main factors: clinical responsibility, demands on time, organisational constraints, and personal confidence. These were assessed by 25 questions in the specialist doctors' stress inventory. Specific questions about perceived stressors which resulted in a high positive response included questions about demands on time, and organisational change in the NHS. CONCLUSION: These self reported data characterise and measure the consultants' work demands and their role as potential stressors. These measurements could form the basis for strategies to reduce occupational stress in these workers.

Models of job-related stress and personal achievement among consultant doctors.

The antecedents and outcomes of feelings of job-related stress and personal achievement were studied in a large sample of consultant doctors working in Scotland. In a sample of 333 doctors it was found that a tendency to use emotion-oriented coping strategies and negative appraisals of organizational changes in the practice of medicine mediated the effect of the personality dimension of Neuroticism on reported job stress. Job stress levels predicted the degree of 'burnout' experienced by doctors, i.e. their tendencies to be emotionally exhausted by their work and to dehumanize patients. Higher clinical workloads were related to higher levels of stress but also to higher feelings of personal achievement. A substantial proportion of the variance in many of the variables in the stress model was accounted for by a general tendency to experience negative emotions, closely related to Neuroticism; this general factor appeared to be similar to the recently formulated concepts of 'negative affectivity' and 'somatopsychic distress'. The personality factors of Extraversion and Conscientiousness both contributed to positive feelings of personal achievement (N = 344); the effect of Extraversion was direct, whereas the effect of Conscientiousness was mediated by a tendency to use task-oriented coping strategies. Models of the processes of stress and personal achievement were tested for acceptability using the EQS Structural Equations Program. The implications of the models for transactional theories of stress are discussed.

Down's syndrome in the Lothian region of Scotland--1978 to 1989.

A study of Down's syndrome in Lothian for the years 1978-1989 revealed a significantly higher than expected incidence of cases in 1987. The increased incidence was particularly significant among women aged 35 years or more. The increase could not be attributed to demographic changes on birth rates or to the age distribution of the women concerned. A temporal association between the cluster of cases and the events at Chernobyl in April 1986 was demonstrated. However, according to current understanding, there is no biologically plausible explanation to link the 2 events, given the reported levels of radioactive fallout in the Lothian region, resulting from the Chernobyl disaster. An explanation for the increased incidence of Down's syndrome in 1987 remains outstanding.

A comparison of the reactivity and immunogenicity of RA 27/3 strain rubella vaccine prepared in WI-38 or MRC5 human diploid cells.

The immunogenicity and clinical reactivity of rubella vaccine derived from WI-38 or MRC5 human diploid cells was compared in 125 seronegative adolescent females. Seroconversion rates, assessed by single radial haemolysis testing of paired pre- and post-vaccination samples exceeded 98% (56/57 and 68/68 vaccinees, respectively) for both vaccines. Quantitative assessment of rubella-specific antibodies in 53 post-vaccination sera by an ELISA technique also failed to reveal any difference in immunogenicity between the vaccines. Assessable calendar records documenting the occurrence of local and systemic signs and symptoms in the four weeks following vaccination were returned by 106 subjects. No important statistically significant difference in parameters of clinical reactivity between the vaccine groups was observed although the incidence of pain at the injection site was found to be significantly higher for vaccinees receiving WI-38 derived vaccine.

The impact of a rubella prevention policy on the outcome of rubella in pregnancy.

Surveillance of rubella vaccination in schoolgirls has continued intensively in Edinburgh since 1970. Screening for rubella antibody of all women attending antenatal clinics has been available since 1974. The analysis of cases of rubella occurring in pregnancy during an outbreak in 1979 confirmed the efficacy of schoolgirl vaccination in the city but indicated poor implementation of postnatal vaccination. Eighteen (67%) of 27 proven cases occurred in women who were screened in previous pregnancies and not immunized. Of the total of 13 liveborn infants the only two with congenital rubella defects were born to mothers in this group. Rubella immunization of schoolgirls and women of childbearing age must receive continued intensive effort if the problems of rubella in pregnancy are to be eradicated.

Non-accidental injury to children: a survey of professional attitudes.

A small sample of general practitioners was questioned about non-accidental injury to children. Differences emerged between those qualifying before and after 1960. Differences were also found in management between the general practitioners and other workers in this field, health visitors, social workers and the police. The need to include this subject in the continuing education of general practitioners is stressed.

A survey of cancer morbidity and mortality in vaccinees seven to 12 years after the administration of live vaccine propagated in human diploid cells.

Using record linkage, cancer morbidity and mortality were examined in 2973 recipients of RA 27/3 strain rubella vaccine propagated in WI 38 cells. During the follow-up reported (mean duration 9.8 years; range seven to 12 years) the rate of cancer notifications and of deaths from cancer were similar to those observed in the equivalent age range of the general population.

Rubella screening and immunisation of schoolgirls: results six to seven years after vaccination.

A long term follow-up study was carried out of girls given RA27/3 or Cendehill rubella vaccine in their 13th-14th year compared with a group of girls who had been found to be naturally immune at the age. A high proportion of the girls in all groups had persistent rubella antibody six to seven years after inclusion in the study, although some of these would have been considered to be susceptible to rubella by methods currently in use for screening for rubella antibody. Great care should be taken in interpreting the efficiency of the schoolgirl immunisation policy in the United Kingdom; women in their childbearing years who may have received vaccine but are found by a screening test to be seronegative should be retested by a more sensitive procedure before a final report is made.

Pilot study of factors associated with exacerbations in chronic bronchitis.

The factors associated with exacerbations of chronic bronchitis were investigated in a pilot study of 23 male patients over a period of 29 months. There were 63 exacerbations-56 were fully investigated and in seven only serological studies were possible. Evidence of the presence of an infective agent was sought in the early stages of the exacerbations and during relative quiescence. Significantly more potential pathogens, both bacterial (pneumococci and Haemophilus influenzae) and viral and mycoplasmal, were found during exacerbations than in quiescent periods. It was not possible to demonstrate that atmospheric pollution or low temperature influenced exacerbations, but the data are insufficient to exclude a small effect.It is emphasized that the value of future work on these lines would be increased if agreement could be reached on the definition of an exacerbation.