The risk of road traffic crashes for occupational drivers: A responsibility study with comparison to the general population.

BACKGROUND: Road accidents are the leading type of work-related fatalities, but the impact of work-related travel on overall traffic safety has been scarcely studied. OBJECTIVE: The main objective of the present study was to assess drivers' relative road accident risk between work-related and personal journeys. METHODS: A responsible/non-responsible case-control study was performed on a sample of 7,051 road accidents in France from the VOIESUR project. Logistic regression determined odds-ratios according to work-related versus personal travel, and identified risk factors for responsibility, specific to each of the two sub-groups. RESULTS: Drivers traveling on duty or commuting home were significantly less often responsible for accidents than drivers on personal journeys: OR = 0.75 [0.63; 0.89] and 0.65 [0.53; 0.80] respectively. Responsibility was significantly more frequent in commuting to versus from work: OR = 1.38 [1.06; 1.78]. Among on-duty drivers, professional passenger-transport drivers had the lowest risk of responsibility (OR = 0.25 [0.11; 0.58]), while those on temporary or work/study contracts and professional light goods vehicle drivers had the highest risk (OR = 11.64 [2.15; 62.94] and OR = 29.83 [5.19; 171.38] respectively). When driving under the influence of alcohol, risk of responsibility was higher in commuting home than in personal journeys. CONCLUSION: On-duty drivers showed lower risk of responsibility for an accident than other drivers. However, on-duty drivers on temporary or work/study contracts, who are usually not subject to specific regulations, showed higher risk, and should be the subject of particular attention regarding occupational risk prevention.

Relationship Between Work Mode, Time of Admission, and Mortality in St-Segment Elevation Myocardial Infarction: Results From the TURKMI Registry.

Treatment of acute myocardial infarction has evolved steadily. However, limited studies exist regarding the effect of all innovations on mortality. We aimed to investigate the effect of time of admission and work mode on 1-year outcomes in patients presenting with ST-segment elevation myocardial infarction (STEMI). Based on the TURKMI registry, we analyzed 735 STEMI patients recruited consecutively and prospectively from 50 PCI-capable cardiology clinics within a prespecified two-week period. Centers were categorized as "on-call" and "on-duty" according to their work mode. At 1-year follow-up, all-cause mortality and cardiovascular mortality were the primary outcomes. The secondary outcome was a composite of coronary revascularization, re-infarction/stroke, and recurrent angina. One-fifth of the participants (19.5%) were treated in the on-call group. All-cause mortality (7.9 vs 10.5%, aHR: 1.16, P = .650) and cardiovascular mortality rates (6.1 vs 9.1%, aHR: 1.35, P = .413) were similar between centers' modes of work. Likewise, both groups were equally likely to undergo coronary revascularization (P = .278), re-MI/stroke (P = .280), recurrent angina (P = .175), and the composite outcome of these components (P = .482). No significant difference was observed in primary outcomes between weekend and weekday admissions. In conclusion, we observed similar outcomes between the on-call and on-duty groups among STEMI patients.

Are first responders first? The rally to the suspected out-of-hospital cardiac arrest.

BACKGROUND: Time is the crucial factor in the "chain of survival" treatment concept for out-of-hospital cardiac arrest (OHCA). We aimed to measure different response time intervals by comparing emergency medical system (EMS), fire fighters and smartphone aided volunteer responders. METHODS: In two large Swedish regions, volunteer responders were timed from the alert until they arrived at the scene of the suspected OHCA. The first arriving volunteer responders who tried to fetch an automated external defibrillator (AED-responder) and who ran to perform bystander cardiopulmonary resuscitation (CPR-responder) were compared to both the first arriving EMS and fire fighters. Three-time intervals were measured, from call to dispatch, the unit response time (from dispatch to arrival) and the total response time. RESULTS: During 22 months, 2631 suspected OHCAs were included. The median time from call to dispatch was in minutes 1.8 (95% CI = 1.7-1.8) for EMS, 2.9 (95% CI = 2.8-3.0) for fire-fighters and 3.0 (95% CI = 2.9-3.1) for volunteer responders. The median unit response time was 8.3 (95% CI = 8.1-8.5) for EMS, 6.8 (95% CI = 6.7-6.9) for fire fighters and 6.0 (95% CI = 5.7-6.2) for AED-responders and 4.6 (95% CI = 4.5-4.8) for CPR-responders. The total response time was 10.4 (95% CI = 10.1-10.6) for EMS, 10.2 (95% CI = 9.9-10.4) for fire fighters, 9.6 (95% CI = 9.1-9.8) for AED-responders and 8.2 (95% CI = 8.0-8.3) for CPR-responders. CONCLUSION: First arriving volunteer responders had the shortest unit response time when compared to both fire fighters and EMS, however this advantage was reduced by delays introduced at the dispatch center. Earlier automatic dispatch should be considered in further studies.

Characterizing firefighter's exposure to over 130 SVOCs using silicone wristbands: A pilot study comparing on-duty and off-duty exposures.

Firefighters are occupationally exposed to an array of hazardous chemicals, and these exposures have been linked to the higher rates of some cancer in firefighters. However, additional research that characterizes firefighters' exposure is needed to fully elucidate the impacts on health risks. In this pilot study, we used silicone wristbands to quantify off-duty and on-duty chemical exposures experienced by 20 firefighters in Durham, North Carolina. By using each firefighter's off-duty wristband to represent individual baseline exposures, we assessed occupation-related exposures (i.e. on-duty exposures). We also investigated the influence of responding to a fire event while on-duty. In total, 134 chemicals were quantified using both GC-MS and LC-MS/MS targeted methods. Seventy-one chemicals were detected in at least 50% of all silicone wristbands, including 7 PFAS, which to our knowledge, have not been reported in wristbands previously. Of these, phthalates were generally measured at the highest concentrations, followed by brominated flame retardants (BFRs) and organophosphate esters (OPEs). PFAS were measured at lower concentrations overall, but firefighter PFOS exposures while on-duty and responding to fires were 2.5 times higher than off-duty exposures. Exposure to polycyclic aromatic hydrocarbons (PAH), BFRs, and some OPEs were occupationally associated, with firefighters experiencing 0.5 to 8.5 times higher exposure while on-duty as compared to off-duty. PAH exposures were also higher for firefighters who respond to a fire than those who did not while on-duty. Additional research with a larger population of firefighters that builds upon this pilot investigation may further pinpoint exposure sources that may contribute to firefighters' risk for cancer, such as those from firefighter gear or directly from fires. This research demonstrates the utility of using silicone wristbands to quantify occupational exposure in firefighters and the ability to disentangle exposures that may be specific to fire events as opposed to other sources that firefighters might experience.

A Study of Leisure Constraints and Job Satisfaction of Middle-Aged and Elderly Health Care Workers in COVID-19 Environment.

The purpose of the study was to examine the leisure constraints and job satisfaction of middle-aged and elderly health care workers. The study employed a mixed research method, utilizing SPSS 22.0 and AMOS 23.0 statistical software to analyze 260 questionnaires using basic statistical tests, t-tests, ANOVA tests, and structural equation models, and then interviewed medical and public health workers and experts in the field, and the results were analyzed using multivariate verification analysis. The results showed that there was a significant low correlation between leisure constraints and job satisfaction among middle-aged and elderly health care workers (p < 0.01); interpersonal constraints and external job satisfaction factors were the main influencing factors; improving promotion opportunities and receiving appreciation increased job satisfaction; poor working environment and facilities, as well as the lack of achievement, were the main factors that reduced satisfaction; health factors, a lack of family support, no exercise partner, and a lack of extra budget are the key to leisure constraints. If the organization can provide nearby sports facilities for middle and high-age medical workers, improve welfare, and increase willingness to participate in leisure activities, physical and mental health can be improved. Finally, interpersonal interaction in leisure obstacles is the main reason for improving job satisfaction.

Who are less likely to return to work after getting injured on duty? A 12-month epidemiological evaluation in an orthopedic and traumatology center in Hong Kong.

OBJECTIVES: Cases of injury on duty (IOD) are common in Hong Kong, but literature on this group of patients is limited. This study aims to describe local IOD cases' epidemiological characteristics and identify factors affecting return to work (RTW) outcomes. METHODS: This is a retrospective epidemiological study of IOD patients in the orthopedic and traumatology center of Yan Chai Hospital in 2016, using the hospital's electronic clinical record analysis and reporting system; 323 out of the 10 730 patients (M:F = 206:117; mean age 46.9 ± 11.3) were included. Data on demographics, the injury episode, administrative procedures, treatment and rehabilitation were collected. Outcomes were measured by "RTW" and "time to RTW from injury." RESULTS: Around 80% of patients had a successful RTW and the mean time to RTW was 10.6 ± 9.0 months. Patients who were female, divorced or widowed and living alone in a public rental flat were less likely to RTW. Psychiatric consultations (OR 13.70, P < .001), legal disputes (OR 8.20, P < .001) and more than 5 months of waiting time for physiotherapy (OR 3.89, P = .002) were the strongest among the numerous risk factors for non-RTW. An increase in one visit to the general outpatient clinic and the presence of legal disputes had lengthened the time to RTW by 4.8 days (P < .001) and 18.0 months (P < .001), respectively. CONCLUSIONS: Several demographic, psychosocial and administrative factors were negatively associated with RTW in the local population. Recommendations were made for healthcare providers and policymakers accordingly.

The Uncounted Casualties of a Hidden COVID-19 Epidemic in China: Cross-sectional Study on Deaths Related to Overwork.

BACKGROUND: During the COVID-19 response, nonclinical essential workers usually worked overtime and experienced significant work stress, which subsequently increased their risk of mortality due to cardiovascular diseases, stroke, and pre-existing conditions. Deaths on duty, including deaths due to overwork, during the COVID-19 response were usually reported on web-based platforms for public recognition and solidarity. Although no official statistics are available for these casualties, a list of on-duty deaths has been made publicly available on the web by crowdsourcing. OBJECTIVE: This study aims to understand the trends and characteristics of deaths related to overwork among the frontline nonclinical essential workers participating in nonpharmaceutical interventions during the first wave of COVID-19 in China. METHODS: Based on a web-based crowdsourced list of deaths on duty during the first wave of the COVID-19 response in China, we manually verified all overwork-related death records against the full-text web reports from credible sources. After excluding deaths caused by COVID-19 infection and accidents, a total of 340 deaths related to overwork among nonclinical essential workers were attributed to combatting the COVID-19 crisis. We coded the key characteristics of the deceased workers, including sex, age at death, location, causes of death, date of incidence, date of death, containment duties, working area, and occupation. The temporal and spatial correlations between deaths from overwork and COVID-19 cases in China were also examined using Pearson correlation coefficient. RESULTS: From January 20 to April 26, 2020, at least 340 nonclinical frontline workers in China were reported to have died as a result of overwork while combatting COVID-19. The weekly overwork mortality was positively correlated with weekly COVID-19 cases (r=0.79, P<.001). Two-thirds of deceased workers (230/340, 67.6%) were under 55 years old, and two major causes of deaths related to overwork were cardiovascular diseases (138/340, 40.6%) and cerebrovascular diseases (73/340, 21.5%). Outside of Hubei province, there were almost 2.5 times as many deaths caused by COVID-19-related overwork (308/340, 90.6%) than by COVID-19 itself (n=120). CONCLUSIONS: The high number of deaths related to overwork among nonclinical essential workers at the frontline of the COVID-19 epidemic is alarming. Policies for occupational health protection against work hazards should therefore be prioritized and enforced.

Prognostic impact of the presence of on-duty cardiologist on patients with acute myocardial infarction admitted during off-hours.

BACKGROUND: Owing to reduced staffing, patients hospitalized for acute myocardial infarction (AMI) during off-hours (nights, weekends, and holidays) have poorer outcomes than those admitted during regular hours. Whether the presence of an on-duty cardiologist in a hospital during off-hours is related to better outcomes for patients with AMI remains unclear. The Miyazaki Prefectural Nobeoka Hospital had a unique medical care system in that cardiologists were on call for half of the week and on duty for the other half during off-hours, thus providing an opportunity to assess the relationship between the presence of an on-duty cardiologist and patient outcomes. We examined clinical outcomes of patients admitted for AMI during off-hours according to the presence of an on-duty cardiologist. METHODS: We recruited 225 consecutive patients with AMI hospitalized during off-hours, who underwent stent implantation at Miyazaki Prefecture Nobeoka Hospital from 2013 to 2017. The endpoints were in-hospital death or long-term major adverse cardiac events (MACE) including cardiovascular death, non-fatal MI, non-fatal stroke, stent thrombosis, ischemia-driven target-lesion revascularization, admission owing to unstable angina, or admission owing to heart failure. RESULTS: Based on the presence of an on-call cardiologist at admission, we divided patients into the cardiologist on-call group (n = 112) or cardiologist on-duty group (n = 113). The presence of an on-duty cardiologist did not affect door-to-reperfusion time (p = 0.776), level of peak creatine kinase (p = 0.971), or in-hospital death (p = 0.776). The Kaplan-Meier curve analysis showed similar prognosis for the cardiologist on-duty and cardiologist on-call groups (p = 0.843), and multivariable Cox regression analysis showed that the presence of an on-duty cardiologist was not associated with MACE. CONCLUSIONS: The presence of an on-duty cardiologist is not a prognostic factor for patients hospitalized for AMI during off-hours in our medical system. Further prospective multicenter studies should confirm our results.

Multi-Sensor Data Fusion in A Real-Time Support System for On-Duty Firefighters.

While working on fire ground, firefighters risk their well-being in a state where any incident might cause not only injuries, but also fatality. They may be incapacitated by unpredicted falls due to floor cracks, holes, structure failure, gas explosion, exposure to toxic gases, or being stuck in narrow path, etc. Having acknowledged this need, in this study, we focus on developing an efficient portable system to detect firefighter's falls, loss of physical performance, and alert high CO level by using a microcontroller carried by a firefighter with data fusion from a 3-DOF (degrees of freedom) accelerometer, 3-DOF gyroscope, 3-DOF magnetometer, barometer, and a MQ7 sensor using our proposed fall detection, loss of physical performance detection, and CO monitoring algorithms. By the combination of five sensors and highly efficient data fusion algorithms to observe the fall event, loss of physical performance, and detect high CO level, we can distinguish among falling, loss of physical performance, and the other on-duty activities (ODAs) such as standing, walking, running, jogging, crawling, climbing up/down stairs, and moving up/down in elevators. Signals from these sensors are sent to the microcontroller to detect fall, loss of physical performance, and alert high CO level. The proposed algorithms can achieve 100% of accuracy, specificity, and sensitivity in our experimental datasets and 97.96%, 100%, and 95.89% in public datasets in distinguishing between falls and ODAs activities, respectively. Furthermore, the proposed algorithm perfectly distinguishes between loss of physical performance and up/down movement in the elevator based on barometric data fusion. If a firefighter is unconscious following the fall or loss of physical performance, an alert message will be sent to their incident commander (IC) via the nRF224L01 module.

Higher sense of coherence is associated with better mental and physical health in emergency medical services: results from investigations on the revised sense of coherence scale (SOC-R) in rescue workers.

As rescue workers are regularly confronted with potentially traumatising on-duty events, they have an increased risk to develop trauma-related mental and physical health impairments, including post-traumatic, depressive, and somatic symptoms. For this high-risk group, it could be of particular importance to experience their occupational burden as manageable, meaningful, and coherent. This mindset - called sense of coherence - may be a potential resilience factor against the development of mental and physical health problems. In a cross-sectional cohort of 102 rescue workers (Mdn(QD)age = 26.0 (8.5), age range: 18-61), including 36 women, we investigated whether higher values on the Revised Sense of Coherence Scale (SOC-R) predicted lower post-traumatic, depressive, and somatic symptoms. In addition, we evaluated the factor structure of the SOC-R using confirmatory factor analyses. Linear regressions indicated that higher SOC-R, but particularly manageability scores were associated with less post-traumatic (ß = -.31, p = .009), depressive (ß = -.44, p < .001), and somatic symptoms (ß = -.36, p = .002). Furthermore, we found that all symptom scores significantly increased with occupational and private-life trauma exposure. The SOC-R's factor structure was replicated, comprising the three subscales manageability, reflection, and balance. However, the SOC-R's convergent factor validity was rather low in the present sample. Taken together, a high sense of coherence, and in particular a high manageability conviction, was observed as resilience factors for high-risk groups that are frequently exposed to potentially traumatic events. Future studies might investigate whether strengthening the sense of coherence could be one building block in an effective prevention program for maintaining long-term health in risk groups.

Debido a que los trabajadores de rescate se enfrentan regularmente con eventos laborales potencialmente traumatizantes, presentan un mayor riesgo de desarrollar trastornos mentales y físicos relacionados con el trauma, incluyendo síntomas postraumáticos, depresivos y somáticos. Para este grupo de alto riesgo sería importante el experimentar su trabajo como manejable, significativo y coherente. Esta perspectiva ­llamada sentido de coherencia­ podría ser un factor potencial de resiliencia en contra del desarrollo de problemas mentales y físicos. En una cohorte transversal con 102 trabajadores de rescate (Mdn(QD)edad = 26.0 (8.5), rango de edad: 18-61), de los cuáles 36 eran mujeres, investigamos si los valores más altos en la Escala del Sentido de Coherencia Revisada (SOC-R) predijeron menos síntomas postraumáticos, depresivos y somáticos. Además, evaluamos la estructura factorial del SOC-R mediante análisis factoriales confirmatorios. Las regresiones lineales indicaron que las puntuaciones más altas del SOC-R, pero particularmente la capacidad de menejabilidad, se asociaron con menos síntomas postraumáticos (ß = −.31, p = .009), depresivos (ß = −.44, p <.001) y somáticos (ß = −.36, p = .002). Además, encontramos que a mayor la exposición con traumas laborales y privados los puntajes de estos síntomas aumentaron significativamente. La estructura factorial del SOC-R se replicó con sus tres subescalas manejabilidad, reflexión y equilibrio. Sin embargo, la validez del factor convergente del SOC-R era menor en la presente muestra. En general, se observó que un alto sentido de coherencia y, en particular una alta manejabilidad, funcionan como factores de resiliencia en grupos de alto riesgo que con frecuencia están expuestos a eventos potencialmente traumáticos. Estudios futuros deberían investigar si el fortalecimiento del sentido de coherencia podría ser un componente básico en un programa de prevención eficaz para mantener la salud a largo plazo en grupos de riesgo.

The effects of absenteeism on nurses remaining on duty at a tertiary hospital of Limpopo province.

BACKGROUND:  Absenteeism is a global problem in the working force and this is no exception in the nursing profession. Much attention has been drawn to factors that contribute to absenteeism; however, little attention has been placed on the effects of absenteeism on nurses remaining on duty by their colleagues. Nurses absent themselves leaving behind their colleagues to execute their part of work. OBJECTIVES:  To investigate the effects of absenteeism on nurses who remained on duty at a tertiary hospital in Limpopo province. METHOD:  A quantitative descriptive research approach was chosen to enable the researchers to achieve the research aim. Data collected using structured questionnaires were analysed by descriptive statistics. RESULTS:  The findings indicated that absenteeism has an effect on both the nurses' psychological and professional well-being, as well as the quality of patient care provided as a result of psychological stress, low morale of nurses and increased workload. The study further revealed the provision of substandard care to patients by those nurses who are remaining on duty, resulting in risk of medical errors that could jeopardise their professional credibility. Therefore, absenteeism creates an unhealthy working environment for nurses remaining on duty. CONCLUSION:  Nurse managers should provide platforms to address psychological and professional problems experienced by nurses remaining on duty. The study further recommends the introduction of policies that would address absenteeism in the workplace and how nurses who remain on duty could be assisted with the workload of colleagues who continuously absent themselves.

[Self-evaulation of personal physical health, accidents while performing duty and preventive treatment of stress in Prison Service]. / Samoocena stanu zdrowia, wypadki w trakcie sluzby i profilaktyka stresu zawodowego w Sluzbie Wieziennej.

BACKGROUND: The purpose of the work was to assess the level of health, estimate the number of accidents during service and to identify the use and perceived effectiveness of the prevention of occupational stress in Prison Service (PS). MATERIAL AND METHODS: The questionnaire survey was carried out in 2015 at the Central Prison Service Training Center in Kalisz and in selected prisons and detention centers for the group of 250 officers. The questionnaire, which had been constructed for the purpose of the cooperation with the Occupational Safety Body of the Central Board of the Prison Service, was used. There were questions about the frequency of headaches, hypertension, sleep disorders, taking painkillers, accidents during service and prevention of occupational stress. RESULTS: For frequent headaches, sleep disorders and hypertension complain 9-14% of officers. Every 8th officer in the period of 5 years preceding the survey had an accident during his service. Participation rate in the stress prevention and interpersonal training workshops accounted for 70%, and most officers consider them to be effective. The lack of the possibility to make holidays in accordance with the schedule represents the percentage share of 10% of the sample tested, and every 20th of the PS must stop it due to the situation in the service. It was revealed that preferences in the area of applied coping strategies turned out to be slightly differentiating between officers undertaking and not undertaking activity in the field of occupational stress prevention. CONCLUSIONS: Officers serving in the multi-shift system and with a longer service period should be covered by greater prevention from the PS work medicine. Conducting training in the prevention of occupational stress should take place at the beginning of the service. Med Pr 2018;69(4):425-438.

Seguimiento de egresados de la especialidad en Medicina Familiar y el grado de satisfacción de sus empleadores / Follow-Up of Family Medicine Graduates and Degree of Satisfaction of Their Employers

Introducción: el proceso de globalización de la atención a la salud, la educación, la tecnología y las nuevas formas de organización del trabajo, exigen a los países generar mecanismos de evaluación a sus sistemas educativos. Objetivo: conocer el nivel de satisfacción de los empleadores de unidades médicas con relación al desempeño profesional de los médicos egresados Programa de especialización en medicina familiar para médicos generales del Instituto Mexicano del Seguro Social, de la Facultad de Medicina de la Universidad Nacional Autónoma de México. Métodos: estudio observacional, descriptivo y transversal. Se aplicó un cuestionario por profesores de la Subdivisión de Medicina Familiar, de la Facultad de Medicina de la Universidad Nacional Autónoma de México, que constó de 10 preguntas dirigidas a los directivos de las unidades médicas donde trabajaban (antes y después de la especialización), los egresados del Programa de Especialización en Medicina Familiar para Médicos Generales, relacionadas con el grado de satisfacción de las autoridades con el trabajo desempeñado por los médicos egresados de la especialización bajo la modalidad de capacitación en servicio. Resultados: los resultados generales muestran alta satisfacción de los directivos en cuanto al desempeño profesional de los médicos egresados. Conclusiones: para los empleadores, de Especialización en Medicina Familiar para Médicos Generales, produce una alta satisfacción el desempeño profesional de los egresados(AU)

Objective: Know the level of satisfaction of medical units' employers with respect to professional performance of family medicine graduates from the specialization programs for general practitioner of the Mexican social-security, Medical Faculty Institute of the Autonomous National University from Mexico. Methods: An observational, descriptive study was conducted at the Faculty of Medicine of the National Autonomous University of Mexico. A questionnaire of 10 questions was applied to managers of medical units, related to the satisfaction of the authorities with the work performed by doctors specializing graduates in the form of in-service training where graduates worked, before and after specialization, within the specialization program in Family Medicine for General Practitioners. Results: The general results evidence high satisfaction of the executives as to the professional performance of the graduate doctors. Conclusions: High satisfaction is produced by the professional performance of Family Medicine graduates, to the employers(AU)

[Current state of compensation of on-duty and on-call urologists in France: a study from AFUF]. / État des lieux des rémunérations des gardes et astreintes d'urologie en France: une étude de l'AFUF.

INTRODUCTION: The French Association of Urologists-in-training (AFUF) aimed to assess the current state of remunerations of on-call and on-duty residents, assistants and lecturers in urology in France. MATERIAL AND METHODS: Data were collected from February to May 2013 through a questionnaire sent to all members of the AFUF (327 members). Remunerations were given in gross values. RESULTS: Forty-three residents took part in the study, 16 assistants and 16 lecturers, representing 62 % of the whole centers (54 hospitals out of the 92 centers practicing urology in France). Most of responders were on security or operational on-call. Twenty hospitals were practicing multi-organ removal. Median remunerations of residents were about 59.51€ per on-call when moving at hospital for work and about 119.02€ per onsite duty. Assistants and lecturers were paid a flat fee rate for 37.5 % of them (140€ for assistants [with variability from 40 to 195€] and 130€ for lecturers [42.5-180]) or an hourly rate depending on the hours spent at hospital for the others (62.5 %): first, second move or move<3h were paid 100€ for assistants and 65€ for lecturers, 233.5€ and 236€ respectively for the third one or above 3h, 365€ and 473€ respectively above 8h. Multi-organ removals were paid a flat fee rate (60 %) or an hourly rate (40 %) as well. Beyond a threshold of 2-3hours, the hourly rate was more interesting than the flat fee rate. CONCLUSION: There were disparities in remuneration of on-call and on-duty urologists. Greater variability affected on-call flat fee rate remuneration beyond a certain threshold of hours and remuneration of multi-organ removal. These disparities should be considered in order to get a national harmonization.

Defining the physician's duty to warn: consensus statement of Ontario's Medical Expert Panel on Duty to Inform.

Ontario's Medical Expert Panel on Duty to Inform was formed to consider the duty of Ontario physicians in circumstances where a patient threatens to kill or cause serious bodily harm to a third party. The panel was concerned about the implications of any duty to inform on the integrity of the physician-patient relationship, particularly with respect to confidentiality. The panel agreed that regulations safeguarding the confidentiality of patient information ought to be changed only if there is a critical reason for doing so, but, after deliberation, the panel members concluded that the need to protect the public from serious risk of harm is a paramount concern that should supersede the duty of confidentiality. The recommendations reported here were endorsed in principle by the panelists and the groups they represented (the Royal College of Physicians and Surgeons of Canada, the Canadian Medical Protective Association, the College of Physicians and Surgeons of Ontario, the Ontario College of Family Physicians and the Ontario Medical Association) and are being implemented by the College of Physicians and Surgeons of Ontario.