Illness perception and cardiovascular risk factors in patients with type 2 diabetes: cross-sectional questionnaire study.

AIM. To investigate illness perception in patients with type 2 diabetes mellitus and its association with the degree of control over relevant cardiovascular risk factors. METHODS. A cross-sectional questionnaire-based study was performed from June 2007 to March 2008. A stratified random sample of 46 Croatian general practitioners was asked to select, using systematic sampling, the first 6 patients with type 2 diabetes mellitus aged > or =18 years who visited them for consultation during the study period. Data on 250 patients included patient illness perception assessment (Brief Illness Perception Questionnaire, IPQ), cardiovascular risk factors, and socio-demographic data. RESULTS. The patients' mean age was 63.0+/-10.9 years and mean duration of diabetes was 9.3+/-7.8 years. The patients' illness perception assessment on an 11-point (0 to 10) scale showed the highest median scores (interquartile range): 10 (8 to 10) for "timeline" and 8 (7 to 9) for "treatment control," followed by 7 (5 to 8) for "personal control," 7 (5 to 9) for "understanding," 5 (3 to 7) for "consequences," 6 (4 to 7) for "concern," and 5 (2 to 7) for "emotional response." The lowest score was 3 (1 to 5) for "identity." Multivariate logistic regression showed that the Brief IPQ item "concern" (P<0.001) was a significant predictor of body mass index; "personal control" (P<0.001) and "concern" (P=0.048) were significant predictors of fasting blood glucose; "treatment control" (P=0.009) was a significant predictor of total cholesterol; and "understanding" (P=0.010) was a significant predictor of blood pressure. CONCLUSION. As patients' beliefs seem to be associated with the degree of control over cardiovascular risk factors, they should be included in routine clinical assessments.

Burnout in European family doctors: the EGPRN study.

INTRODUCTION: The aim of this study was to determine the prevalence of burnout, and of associated factors, amongst family doctors (FDs) in European countries. Methodology. A cross-sectional survey of FDs was conducted using a custom-designed and validated questionnaire which incorporated the Maslach Burnout Inventory Human Services Survey (MBI-HSS) as well as questions about demographic factors, working experience, health, lifestyle and job satisfaction. MBI-HSS scores were analysed in the three dimensions of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). RESULTS: Almost 3500 questionnaires were distributed in 12 European countries, and 1393 were returned to give a response rate of 41%. In terms of burnout, 43% of respondents scored high for EE burnout, 35% for DP and 32% for PA, with 12% scoring high burnout in all three dimensions. Just over one-third of doctors did not score high for burnout in any dimension. High burnout was found to be strongly associated with several of the variables under study, especially those relative to respondents' country of residence and European region, job satisfaction, intention to change job, sick leave utilization, the (ab)use of alcohol, tobacco and psychotropic medication, younger age and male sex. CONCLUSIONS: Burnout seems to be a common problem in FDs across Europe and is associated with personal and workload indicators, and especially job satisfaction, intention to change job and the (ab)use of alcohol, tobacco and medication. The study questionnaire appears to be a valid tool to measure burnout in FDs. Recommendations for employment conditions of FDs and future research are made, and suggestions for improving the instrument are listed.

[Characteristics of depression in Otocac ten years after the war]. / Obiljezja depresije u Otoccu deset godina nakon zavrsetka domovinskog rata.

BACKGROUND: Depression is an important public health problem today. In the primary care setting, a high percentage of patients with depression present exclusively with physical symptoms; depression can often go undiagnosed in these patients. Another challenge for primary care doctors is the treatment of patients with depression and somatic comorbidity. When faced with demands to treat multiple chronic diseases, physicians may give depression less priority. The consequences of exposure to war stress on mental health have been constantly explored. Posttraumatic stress disorder and depression have been identified as the most common psychopathological consequences of exposure to war stressors. The 1991-1995 war in Croatia left deep psychosocial scars and affected self-perceived health, physical ability and mental health of the entire Croatian population stricken by war. Otocac is one of the areas that were more severely affected by war. OBJECTIVES: The aim of the study was to evaluate the prevalence and characteristics of depression in general practice patients in Otocac, Croatia, ten years after the war in Croatia. METHODS: In March 2005, 300 patients aged 18 and older were systematically selected from the patient list of a general practitioner in Otocac, Croatia. These patients were assessed for depression and classified as having a mild, moderate, severe or severe depressive episode with psychotic elements, according to the criteria of the ICD-10 classification of Mental and Behavioral Disorders, Croatian edition. Data were also collected on psychosomatic complaints, chronic diseases, sociodemographic characteristics, participation in war actions, refugee status, comorbid psychiatric diseases in patients and their family members. Differences in the characteristics of depressive and non-depressive patients were tested by chi2-test and Fisher's test. The level of significance was set at p < 0.05. The collected data were analyzed using the SPSS statistical software package, version 12.0.0. RESULTS: A total of 147 (49.0%) patients (65 male and 82 female) met ICD-10 criteria for depressive episode. Distribution of severity of depression showed the majority of depressive patients to meet the criteria for moderate (38.8%) and severe (39.5%) depressive episode. There was a statistically significant difference in the presence of all psychosomatic complaints between depressive and nondepressive patients. Unemployed patients were more often depressed (p = 0.002), and so were divorced and widowed patients (p < 0.001). There was no statistically significant sex difference in the frequency of depressive symptoms. Depression showed no correlation with the patient refugee status, but there was significant correlation with the presence of psychiatric diseases in a patient family member (p = 0.0001). Correlation between depression and the patient chronic somatic diseases was statistically significant for hypertension, cardiac diseases and malignant diseases. CONCLUSION: The results of our study indicated a high prevalence of depression in the group of general practice patients in Otocac, Croatia, ten years after the war in Croatia. Severe and moderate depressive episodes predominated, without sex difference in the frequency of depressive symptoms. Long-term psychological consequences of exposure to war stress as well as other characteristics of the post-war period in the area affected by war may in part explain these findings.