The relative importance of work-related psychosocial factors in physician burnout.

BACKGROUND: Identifying the most significant risk factors for physician burnout can help to define the priority areas for burnout prevention. However, not much is known about the relative importance of these risk factors. AIMS: This study was aimed to examine the relative importance of multiple work-related psychosocial factors in predicting burnout dimensions among physicians. METHODS: In a cross-sectional sample of 2423 Finnish physicians, dominance analysis was used to estimate the proportionate contribution of psychosocial factors to emotional exhaustion, depersonalization and reduced personal accomplishment. The psychosocial factors included job demands (time pressure, patient-related stress, lack of support, stress related to information systems, work-family conflict) and job resources (job control, team climate, organizational justice). RESULTS: Together, psychosocial factors explained 50% of the variance in emotional exhaustion, 24% in depersonalization and 11% in reduced professional efficacy. Time pressure was the most important predictor of emotional exhaustion (change in total variance explained ΔR2 = 45%), and patient-related stress was the most important predictor of both depersonalization (ΔR2 = 52%) and reduced professional accomplishment (ΔR2 = 23%). Stress related to information systems was the least important predictor of the burnout dimensions (ΔR2 = 1-2%). CONCLUSIONS: Psychosocial factors in physicians' work are differently associated with the dimensions of burnout. Among the factors, the most significant correlates of burnout are job demands in the form of time pressure and patient-related stress.

E6/E7 oncogenes increase and tumor suppressors decrease the proportion of self-renewing neural progenitor cells.

Many if not most tissues need a controlled number of stem cells to maintain normal function. Cancer can be seen as a process of disturbed tissue homeostasis, in which too many cells have or acquire too primitive identity. Here we measured how oncogenes and tumour suppressors affect the differentiation capacity, proportion and characteristics of progenitor cells in a model tissue. Neural progenitor cells (NPCs) were exposed to human papilloma virus E6, E7 or E6/E7 oncogenes, which degrade tumour suppressors p53 and pRb family members, respectively. E6/E7-expressing or p53-/- NPCs were able to differentiate, but simultaneously retained high capacity for self-renewal, proliferation, ability to remain multipotent in conditions promoting differentiation and showed delayed cell cycle exit. These functions were mediated through p53 and pRb family, and involved MEK-ERK signalling. Decreased amount of p53 increased self-renewal and proliferation, whereas pRb affected only proliferation. Our results suggest that the oncogenes increase whereas p53 and pRb family tumour suppressors decrease the number and proportion of progenitor cells. These findings provide one explanation how oncogenes and tumour suppressors control tissue homeostasis and highlight their importance in stem cell self- renewal, linked both to cancer and life-long tissue turnover.

Evaluation strategy for Finland's suicide prevention project.

Finland's suicide prevention project (1987-1996) has proceeded to its final phase, evaluation. In this article the general structure of the evaluation and the strategy for evaluating the implementation phase (1992-1996) are presented. The evaluation aims to look at the success of the project in its target areas and the critical factors involved. It deals with the intervention strategies evolved, as well as indicators of progress in suicide prevention activities. A process evaluation approach is used to evaluate the national strategy and the project. The first follow-up (1993) and preliminary results from the ongoing evaluation (1996) show that the project is being largely successful in meeting the operative challenges formulated in the national strategy.