Nurses' and physicians' perceptions of the impact of eHealth and information systems on the roles of health care professionals: A qualitative descriptive study.

The increased use of eHealth and information systems impacts health care work broadly, including cultural and social aspects of work such as the roles of health care professionals. This qualitative descriptive study examined the perceptions of health care professionals in terms of how eHealth and information systems have changed their roles. The data was collected via 15 semi-structured thematic interviews and analysed using content analysis with an inductive approach. The analysis indicated mainly unconscious changes in the roles of professional groups. The professionals perceived that the role of digitally competent professionals in the working community was important. Moreover, high digital competency was seen to have led to an increase or change in work tasks. Professionals' own working environments and job opportunities were seen to have affected to their roles when using information systems. eHealth was perceived to have created inequalities in work tasks, increased skills gaps and complicated work. However, eHealth made cooperation between professionals easier than before. Organisations should pay more attention to equal opportunities to increase professional's digital competency, even out workloads between professionals, and provide equal access to eHealth and information systems.

Professionals Evaluating Clients' Suitability for Digital Health and Social Care: Scoping Review of Assessment Instruments.

BACKGROUND: Increased digital health and social care services are generally considered to improve people's access to services. However, not everyone can equally access and use these resources. Health and social care professionals should assess clients' suitability for digital solutions, but to succeed, they need information about what to evaluate and how. OBJECTIVE: This scoping review aimed to identify evaluation tools that professionals can use when assessing clients' suitability for digital health and social care. We summarized the dimensions and the practical usefulness of the instruments. METHODS: The MEDLINE (Ovid), CINAHL, Web of Science, and ASSIA databases were searched in February 2023 following the Joanna Briggs Institute's Manual for Evidence Synthesis. Studies were included if they focused on health and social care clients and professionals, examined clients' suitability for using digital health or social care, and applied related assessment methods in the direct client work of professionals. Studies focusing primarily on instruments intended for research use without clear applicability to professionals' practical contexts were excluded. Details of the eligible studies were extracted, and qualitative content analysis according to the research objectives was performed. RESULTS: A total of 19 articles introducing 12 different assessment instruments intended for the health care context were included in the review. No instruments were found for evaluating the suitability for digital social care. The instruments contained 60 dimensions of the client's suitability for digital health, which reflected four perspectives: (1) skill-based suitability, (2) suitability based on general ability to maintain health, (3) suitability based on attitude and experience, and (4) suitability based on practical matters. The described practical usefulness of the instruments included professionals' possibility to (1) identify clients most in need of education and support, (2) direct and recommend the right clients for the right digital services, (3) ensure that clients can use digital health, (4) improve effectiveness and maximize the provision of digital health, (5) develop and redesign services, and (6) empower clients. CONCLUSIONS: Based on the diverse assessment instruments available and the dimensions they measure, there seems to be no comprehensive evaluation tool for assessing clients' prerequisites to use digital solutions. It is important to further develop comprehensive screening tools applicable to professionals' busy work (both in health and social care) with defined threshold values for suitability.

Predicting Internet Use and Digital Competence Among Older Adults Using Performance Tests of Visual, Physical, and Cognitive Functioning: Longitudinal Population-Based Study.

BACKGROUND: The rapidly increasing role of the internet in obtaining basic services poses challenges, especially for older adults' capabilities of getting the services they need. Research on the predictors of older adults' internet use and digital competence is especially relevant given that people are living longer than before, and the age profile of many societies is changing rapidly. OBJECTIVE: We aimed to examine the associations of objective measures of physical and cognitive impairment with the nonuse of the internet for services and low digital competence among older adults. METHODS: A longitudinal population-based design was used that combined data from performance tests and self-rated questionnaires. Data were gathered in 2017 and 2020 among 1426 older adults aged between 70 and 100 years in Finland. Logistic regression analyses were used to examine the associations. RESULTS: Those who had poor near (odds ratio [OR] 1.90, 95% CI 1.36-2.66) or distant vision (OR 1.81, 95% CI 1.21-2.71), restricted or failed abduction of upper arms (OR 1.81, 95% CI 1.28-2.85), and poor results from the word list memory (OR 3.77, 95% CI 2.65-5.36) or word list delayed recall (OR 2.12, 95% CI 1.48-3.02) tests had greater odds for nonuse of the internet for services than their counterparts. Moreover, those who had poor near (OR 2.18, 95% CI 1.57-3.02) or distant vision (OR 2.14, 95% CI 1.43-3.19), poor results from the chair stand test (OR 1.57, 95% CI 1.06-2.31), restricted or failed abduction of upper arms (OR 1.74, 95% CI 1.10-2.76), and poor results from the word list memory (OR 3.41, 95% CI 2.32-5.03) or word list delayed recall (OR 2.05, 95% CI 1.39-3.04) tests had greater odds of low digital competence than their counterparts. CONCLUSIONS: According to our results, older adults' impaired physical and cognitive functioning may hamper their possibilities of accessing internet services such as digital health care services. Our results should be considered when planning digital health care services intended to be used by older adults; that is, digital solutions should also be suitable for older adults with impairments. Furthermore, face-to-face services should be provided for those who cannot use digital services, even if they are assisted properly.

Primary healthcare managers' perceptions of management competencies at different management levels in digital health services: secondary analysis.

PURPOSE: The purpose of this study is to describe primary health-care managers' perceptions of management competencies at different management levels in digital health services using the management competency assessment program as a framework. DESIGN/METHODOLOGY/APPROACH: A secondary analysis study involving 21 semi-structured individual interviews was conducted among Finnish primary health-care managers at different management levels (frontline, middle and senior). The deductive framework method was used to analyze the data. FINDINGS: Similarities and differences were found in management competencies between different levels of management. Competencies related to the use of digitalization were highlighted by managers at all management levels. Managers at all management levels were involved in developing digital solutions and supporting employees in using digital solutions in their work. Frontline and middle managers emphasized more issues related to day-to-day management and communication with employees, whereas senior managers highlighted the management of large entities. RESEARCH LIMITATIONS/IMPLICATIONS: In the secondary analysis, data were used for purposes other than originally intended. Therefore, the data are subject to limitations of the methodology applied and should be transferred to other contexts with caution. PRACTICAL IMPLICATIONS: Identifying the management competencies needed to manage digital health services is important to target managers' training according to needs in the future. SOCIAL IMPLICATIONS: The results could be used to develop the management of digital health services, as well as improve digital health services and their deployment. ORIGINALITY/VALUE: Previous literature mostly examined managers' informatics competencies and paid little attention to other management competencies. This study discusses more broadly the management competencies that digital health services require from managers at different levels of management.

The Factors Associated With Nonuse of and Dissatisfaction With the National Patient Portal in Finland in the Era of COVID-19: Population-Based Cross-sectional Survey.

BACKGROUND: In the abnormal circumstances caused by the COVID-19 pandemic, patient portals have supported patient empowerment and engagement by providing patients with access to their health care documents and medical information. However, the potential benefits of patient portals cannot be utilized unless the patients accept and use the services. Disparities in the use of patient portals may exacerbate the already existing inequalities in health care access and health outcomes, possibly increasing the digital inequality in societies. OBJECTIVE: The aim of this study is to examine the factors associated with nonuse of and dissatisfaction with the Finnish nationwide patient portal My Kanta Pages among the users of health care services during the COVID-19 outbreak. Several factors related to sociodemographic characteristics, health, and the use of health care services; experiences of guidance concerning electronic services; and digital skills and attitudes were evaluated. METHODS: A national population survey was sent using stratified sampling to 13,200 Finnish residents who had reached the age of 20 years. Data were collected from September 2020 to February 2021 during the COVID-19 pandemic. Respondents who had used health care services and the internet for transactions or for searching for information in the past 12 months were included in the analyses. Bivariate logistic regression analyses were used to examine the adjusted associations of respondent characteristics with the nonuse of My Kanta Pages and dissatisfaction with the service. The inverse probability weighting (IPW) method was applied in all statistical analyses to correct for bias. RESULTS: In total, 3919 (64.9%) of 6034 respondents were included in the study. Most respondents (3330/3919, 85.0%) used My Kanta Pages, and 2841 (85.3%) of them were satisfied. Nonusers (589/3919, 15%) were a minority among all respondents, and only 489 (14.7%) of the 3330 users were dissatisfied with the service. Especially patients without a long-term illness (odds ratio [OR] 2.14, 95% CI 1.48-3.10), those who were not referred to electronic health care services by a professional (OR 2.51, 95% CI 1.70-3.71), and those in need of guidance using online social and health care services (OR 2.26, 95% CI 1.41-3.65) were more likely nonusers of the patient portal. Perceptions of poor health (OR 2.10, 95% CI 1.51-2.93) and security concerns (OR 1.87, 95% CI 1.33-2.62) were associated with dissatisfaction with the service. CONCLUSIONS: Patients without long-term illnesses, those not referred to electronic health care services, and those in need of guidance on the use of online social and health care services seemed to be more likely nonusers of the Finnish nationwide patient portal. Moreover, poor health and security concerns appeared to be associated with dissatisfaction with the service. Interventions to promote referral to electronic health care services by professionals are needed. Attention should be targeted to information security of the service and promotion of the public's confidence in the protection of their confidential data.

Towards digital health equity - a qualitative study of the challenges experienced by vulnerable groups in using digital health services in the COVID-19 era.

BACKGROUND: The COVID-19 pandemic has given an unprecedented boost to already increased digital health services, which can place many vulnerable groups at risk of digital exclusion. To improve the likelihood of achieving digital health equity, it is necessary to identify and address the elements that may prevent vulnerable groups from benefiting from digital health services. This study examined the challenges experienced by vulnerable groups in using digital health services during the COVID-19 pandemic. METHODS: Qualitative descriptive design was utilized. Semi-structured interviews were conducted between October 2020 and May 2021. The participants (N = 74) were older adults, migrants, mental health service users, high users of health services, and the unemployed. Qualitative content analysis with both inductive and deductive approach was used to analyze the data. Challenges related to the use of digital health services were interpreted through digital determinants of health from the Digital Health Equity Framework. RESULTS: For most of the participants the access to digital health services was hampered by insufficient digital, and / or local language skills. The lack of support and training, poor health, as well as the lack of strong e-identification or suitable devices also prevented the access. Digital services were not perceived to be applicable for all situations or capable of replacing face-to-face services due to the poor communication in the digital environment. Fears and the lack of trust regarding digital platforms were expressed as well as concerns related to the security of the services. Contact with a health care professional was also considered less personal and more prone to misunderstandings in the digital environment than in face-to-face services. Finally, digital alternatives were not always available as desired by participants, or participants were unaware of existing digital services and their value. CONCLUSION: Several development needs in the implementation of digital health services were identified that could improve equal access to and benefits gained from digital services in the future. While digital health services are increasing, traditional face-to-face services will still need to be offered alongside the digital ones to ensure equal access to services.

Digital Divide in Perceived Benefits of Online Health Care and Social Welfare Services: National Cross-Sectional Survey Study.

BACKGROUND: The number of online services in health care is increasing rapidly in developed countries. Users are expected to take a more skilled and active role in taking care of their health and prevention of ill health. This induces risks that users (especially those who need the services the most) will drop out of digital services, resulting in a digital divide or exclusion. To ensure wide and equal use of online services, all users must experience them as beneficial. OBJECTIVE: This study aimed to examine associations of (1) demographics (age, gender, and degree of urbanization), (2) self-rated health, (3) socioeconomic position (education, experienced financial hardship, labor market position, and living alone), (4) social participation (voting, satisfaction with relationships, and keeping in touch with friends and family members), and (5) access, skills, and extent of use of information and communication technologies (ICT) with perceived benefits of online health care and social welfare services. Associations were examined separately for perceived health, economic, and collaboration benefits. METHODS: We used a large random sample representative of the Finnish population including 4495 (56.77% women) respondents aged between 20 and 97 years. Analyses of covariance were used to examine the associations of independent variables with perceived benefits. RESULTS: Access to online services, ICT skills, and extent of use were associated with all examined benefits of online services. ICT skills seemed to be the most important factor. Poor self-rated health was also consistently associated with lower levels of perceived benefits. Similarly, those who were keeping in touch with their friends and relatives at least once a week perceived online services more often beneficial in all the examined dimensions. Those who had experienced financial hardship perceived fewer health and economic benefits than others. Those who were satisfied with their relationships reported higher levels of health and collaboration benefits compared with their counterparts. Also age, education, and degree of urbanization had some statistically significant associations with benefits but they seemed to be at least partly explained by differences in access, skills, and extent of use of online services. CONCLUSIONS: According to our results, providing health care services online has the potential to reinforce existing social and health inequalities. Our findings suggest that access to online services, skills to use them, and extent of use play crucial roles in perceiving them as beneficial. Moreover, there is a risk of digital exclusion among those who are socioeconomically disadvantaged, in poor health, or socially isolated. In times when health and social services are increasingly offered online, this digital divide may predispose people with high needs for services to exclusion from them.

Workplace Violence Is Associated With Impaired Work Functioning in Nurses: An Italian Cross-Sectional Study.

OBJECTIVE: Workplace violence against nurses is a widespread phenomenon that has been associated with many unfavorable individual and organizational outcomes. The aim of this study was to analyze the relationship between violence and work functioning in a sample of Italian nurses. DESIGN: Cross-sectional, with retrospective analysis of exposure. METHODS: All nurses from a local hospital were invited to complete a questionnaire assessing violent experiences that occurred in the previous 12 months. The questionnaire also measured job strain (with the Demand-Control-Support questionnaire), organizational justice (with Colquitt's Questionnaire), and work impairment (with the Nurses Work Functioning Questionnaire). The associations were examined with logistic regression analyses. FINDINGS: Of the 302 nurses who were invited, 275 (91.1%) agreed to participate. The total work impairment score was significantly higher among the nurses exposed to violence compared with the nonexposed nurses (42.2 ± 27.8 vs. 31.9 ± 31.6, respectively; p < .001). Exposed nurses also reported significantly higher levels of job strain (0.96 ± 0.25 vs. 0.8 ± 0.21; p = .003) and lower levels of perceived organizational justice (56.6 ± 12.6 vs. 62.5 ± 14.8; p = .001) than nonexposed nurses. Nurses who had experienced violence had a significantly higher risk for impairment of work functioning than their colleagues (crude odds ratio [OR] = 2.33; 95% confidence interval [CI 95%] = 1.42-3.83). The association between violence and impairment remained significant after adjusting for demographic variables, occupational stress, and perceived organizational justice (OR = 1.83; 95% CI 95% = 1.06-3.17). CONCLUSIONS: Workplace violence is associated with impaired work function in nurses. Job strain and perceived organizational injustice are associated with impairment. CLINICAL RELEVANCE: Violence prevention programs in healthcare activities should include training for violent behavior identification and de-escalation techniques, structural and administrative measures for violence control (such as alarms, surveillance, staff increase), and measures to reduce occupational stress, which can include wellness courses, spirituality, organizational improvements, and staffing methodologies.

Psychosocial Risk Prevention in a Global Occupational Health Perspective. A Descriptive Analysis.

This study aimed to find out which countries around the world require psychosocial hazards and workplace violence to be assessed by employers through a mandatory occupational risk assessment process and to compare the type of legislation between countries. We systematically searched the International Labour Office (ILO) "LEGOSH" database for documents published during the period between December 2017 and February 2018. The search included 132 countries, of which 23 were considered as developed and 109 as developing according to the United Nations. Our review showed that most countries (85, i.e., 64%) have not included mandatory psychosocial risk assessment and prevention in their national occupational safety and health legislation. Moreover, we found differences between developed and developing countries, showing that developed countries more frequently have legislative measures. Within developed countries, we also found differences between countries following the Scandinavian model of workplace health and safety culture and other countries. Moreover, in many countries, workplace violence was prohibited only if it involves an offence to moral or religious customs. In conclusion, the marked difference in psychosocial hazards and workplace violence regulations among countries leads to unequal levels of workers' protection, with adverse effects on global health.

The association between cross-cultural competence and well-being among registered native and foreign-born nurses in Finland.

BACKGROUND: A growing body of research indicates that cross-cultural competence in nurses can improve migrant patients' health-related outcomes, but little is known about the potential benefits of cross-cultural competence on the nurses' own well-being. OBJECTIVE: To examine whether cross-cultural competence (empathy, skills, positive attitudes, and motivation) is associated with perceived time pressure at work, psychological distress, and sleep problems among registered nurses in Finland, and whether there are differences in these potential associations between native and foreign-born nurses. METHODS: The present cross-sectional study was based on a sample of 212 foreign-born nurses licensed to practice in Finland and a random sample of 744 native Finnish nurses. Data were collected with a questionnaire and analyzed using multiple linear regression and structural equation modeling (SEM). RESULTS: Of all four dimensions of cross-cultural competence, only empathy was associated with perceived time pressure (ß = -0.13, p = .018), distress (ß = -0.23, p < .001), and sleep problems (ß = -0.14, p = .004) after the adjustment for gender, age, employment sector, and frequency of interacting with patients and colleagues from different cultures. There were no differences between native and foreign-born nurses in these observed associations (all ps > .05). CONCLUSIONS: Cross-cultural empathy may protect against perceived time pressure, distress, and sleep problems in both native and foreign-born nurses. Thus, the promotion of this component of cross-cultural competence among nursing personnel should be encouraged.

Foreign-born physicians' perceptions of discrimination and stress in Finland: a cross-sectional questionnaire study.

BACKGROUND: Foreign-born physicians fill in the shortage of physicians in many developed countries. Labour market theory and previous studies suggest that foreign-born physicians may be a disadvantaged group with a higher likelihood of discrimination and less prestigious jobs. The present study examines foreign-born physicians' experiences of discrimination (coming from management, colleagues and patients separately) and patient-related stress and integration-related stress, and it examines how gender, age, employment sector, country of birth, years from getting a practicing license in Finland, language problems, cross-cultural training, cross-cultural empathy, team climate and skill discretion were associated with these factors. METHODS: The present study was a cross-sectional questionnaire study among 371 foreign-born physicians in Finland, aged between 26 and 65 (65% women). Analyses of covariance and logistic regression analyses were conducted to examine the associations. RESULTS: A good team climate and high cross-cultural empathy were associated with lower likelihoods of discrimination from all sources, patient-related stress and integration-related stress. Skill discretion was associated with lower levels of integration-related stress and discrimination from management and colleagues. Language problems were associated with higher levels of integration-related stress. The biggest sources of discrimination were patients and their relatives. CONCLUSIONS: The present study showed the importance of a good team climate, cross-cultural empathy and patience, skill discretion and language skills in regard to the proper integration of foreign-born health care employees into the workplace. Good job resources, such as a good team climate and the possibility to use one's skills, may help foreign-born employees, for instance by giving them support when needed and offering flexibility. Health care organizations should invest in continuous language training for foreign-born employees and also offer support when there are language problems. Moreover, it seems that training increasing cross-cultural empathy and patience might be beneficial.

Does Organizational Justice Modify the Association Between Job Involvement and Retirement Intentions of Nurses in Finland?

Given the growing aging population in Finland, retaining health staff to care for them is important. In an exploration of predictors of quitting before the typical retirement age, which ranges from 63 to 68 years in Finland, we examined whether organizational justice moderated the association between job involvement and retirement intentions among nurses 50 years and over. The sample was 446 nurses (70% practical nurses) working in 134 assisted living facilities providing 24-hour care for older residents in Finland. Job involvement was measured with the Job Involvement Questionnaire, and organizational justice with a scale that tapped its three dimensions: distributive justice, procedural justice, and interactional justice. In covariance analyses, low organizational justice and low job involvement were associated with a higher likelihood of retirement intention. Both interactional justice and procedural justice moderated the association of job involvement with retirement intentions. Among nurses with low job involvement, those who experienced unjust treatment, that is, low interactional justice, and evaluated organizational procedures as unjust had significantly stronger retirement intentions than nurses with high levels of interactional and procedural justice. Distributive justice was associated with retirement intentions in both high and low job-involved respondents. Organizational justice may act as a buffer against retirement intention as one consequence of nurses' low job involvement. © 2016 Wiley Periodicals, Inc.

Does organizational justice predict empowerment? Nurses assess their work environment.

PURPOSE: The purpose of the study was to explore how nurses assess their empowerment and clarify organizational justice compared to other work-related factors. In addition, we examined the major variables pertinent to empowerment. DESIGN: Cross-sectional survey data were used. METHODS: A total of 2,152 nurses returned the completed questionnaire. The instruments consisted of nurse empowerment, organizational justice, job control, and possibilities for developing work. The data analysis was based on descriptive statistics and further statistical tests. FINDINGS: Organizational justice and empowerment had a clear correlation. Job control, possibilities for developing work and organizational justice were statistically significant predictors of nurse empowerment. CONCLUSIONS: Organizational justice and the possibility to use one's individual skills at work are significant factors in staff activity and its development in nursing. They increase the level of empowerment and commitment as well as motivation to work. CLINICAL RELEVANCE: The results of this study confirm that nurses regard organizational justice as highly important. We can facilitate both work-related empowerment and organizational justice by creating and maintaining a culture of fairness and justice. Employees should be heard and involved more in the planning and decision making of work.

General practitioners' psychosocial resources, distress, and sickness absence: a study comparing the UK and Finland.

BACKGROUND: Many countries, including the UK and Finland, face difficulties in recruiting GPs and one reason for these difficulties may be due to negative psychosocial work environments. OBJECTIVE: To compare psychosocial resources (job control and participative safety), distress and sickness absences between GPs from the UK and those from Finland. We also examined differences in how psychosocial resources are associated with distress and sickness absence and how distress is associated with sickness absence for both countries. METHODS: Two independent cross-sectional surveys conducted in general practice in the UK and Finland. Analyses of covariance were used for continuous outcome variables and logistic regression for dichotomized variable (sickness absence) adjusted for gender, qualification year and response format. RESULTS: UK GPs reported more opportunities to control their work and had higher levels of participative safety but were more distressed than Finnish GPs. Finnish GPs were 2.3 (95% confidence interval = 1.8-3.1) times more likely to report sickness absence spells than UK GPs. Among Finnish GPs, job control opportunities and high participative safety were associated with lower levels of distress, but not among UK GPs. Among UK GPs, higher distress was associated with 2.1 (95% confidence interval = 1.3-3.6) times higher likelihood of sickness absence spells, but among Finnish GPs there were no such association. CONCLUSION: In Finland, primary health care organizations should try to improve participative safety and increase control opportunities of physicians to decrease GP distress, whereas in the UK, other work or private life factors may be more important.

Do nurses who work in a fair organization sleep and perform better and why? Testing potential psychosocial mediators of organizational justice.

We examined whether organizational justice is associated with sleep quality and performance in a population-based sample of 1,729 Finnish registered nurses working full time. In addition, we tested psychological mechanisms mediating the potential association. The results of multivariate linear regression analyses showed higher organizational justice to be associated with fewer sleeping problems (ß values range from -.20 to -.11) and higher self-reported performance (ß values range from .05 to .35). Furthermore, psychological distress (related to the psychological stress model) and job involvement (related to the psychosocial resource model) mediated the association between organizational justice and sleep. Sleeping problems partly mediated the association between organizational justice and performance. Psychological distress explained 51% to 83% and job involvement explained 10% to 15% of the total effects of justice variables on sleeping problems. The findings provide support for the psychological stress model and offer practical implications for reducing nurses' sleeping problems.

Can organizational justice help the retention of general practitioners?

In many countries, public sector has major difficulties in recruiting and retaining physicians to work as general practitioners (GPs). We examined the effects of taking up a public sector GP position and leaving public sector GP work on the changes of job satisfaction, job involvement and turnover intentions. In addition, we examined whether organizational justice in the new position would moderate these associations. This was a four-year prospective questionnaire study including two measurements among 1581 (948 women, 60%) Finnish physicians. A change to work as a public GP was associated with a substantial decrease in job satisfaction and job involvement when new GPs experienced that their primary care organization was unfair. However, high organizational justice was able to buffer against these negative effects. Those who changed to work as public GPs had 2.8 times and those who stayed as public GPs had 1.6 times higher likelihood of having turnover intentions compared to those who worked in other positions. Organizational justice was not able to buffer against this effect. Primary care organizations should pay more attention to their GPs - especially to newcomers - and to the fairness how management behaves towards employees, how processes are determined, and how rewards are distributed.

Is the public healthcare sector a more strenuous working environment than the private sector for a physician?

AIMS: The present study examined the differences between physicians working in public and private health care in strenuous working environments (presence of occupational hazards, physical violence, and presenteeism) and health behaviours (alcohol consumption, body mass index, and physical activity). In addition, we examined whether gender or age moderated these potential differences. METHODS: Cross-sectional survey data were compiled on 1422 female and 948 male randomly selected physicians aged 25-65 years from The Finnish Health Care Professionals Study. Logistic regression and linear regression analyses were used with adjustment for gender, age, specialisation status, working time, managerial position, and on-call duty. RESULTS: Occupational hazards, physical violence, and presenteeism were more commonly reported by physicians working in the public sector than by their counterparts in the private sector. Among physicians aged 50 years or younger, those who worked in the public sector consumed more alcohol than those who worked in the private sector, whereas in those aged 50 or more the reverse was true. In addition, working in the private sector was most strongly associated with lower levels of physical violence in those who were older than 50 years, and with lower levels of presenteeism among those aged 40-50 years. CONCLUSIONS: The present study found evidence for the public sector being a more strenuous work environment for physicians than the private sector. Our results suggest that public healthcare organisations should pay more attention to the working conditions of their employees.

Social support and the likelihood of maintaining and improving levels of physical activity: the Whitehall II Study.

BACKGROUND: Evidence on the association between social support and leisure time physical activity (LTPA) is scarce and mostly based on cross-sectional data with different types of social support collapsed into a single index. The aim of this study was to investigate whether social support from the closest person was associated with LTPA. METHODS: Prospective cohort study of 5395 adults (mean age 55.7 years, 3864 men) participating in the British Whitehall II study. Confiding/emotional support and practical support were assessed at baseline in 1997-99 using the Close Persons Questionnaire. LTPA was assessed at baseline and follow-up in (2002-04). Baseline covariates included socio-demographics, self-rated health, long-standing illnesses, physical functioning and common mental disorders. RESULTS: Among participants who reported recommended levels of LTPA at baseline, those who experienced high confiding/emotional support were more likely to report recommended levels of LTPA at follow-up [odds ratio (OR): 1.39, 95% confidence interval (CI): 1.12-1.70 in a model adjusted for baseline covariates]. Among those participants who did not meet the recommended target of LTPA at baseline, high confiding/emotional support was not associated with improvement in activity levels. High practical support was associated with both maintaining (OR: 1.34, 95% CI: 1.10-1.63) and improving (OR: 1.25, 95% CI: 1.02-1.53) LTPA levels. CONCLUSION: These findings suggest that emotional and practical support from the closest person may help the individual to maintain the recommended level of LTPA. Practical support also predicted a change towards a more active lifestyle.

Differences in well-being between GPs, medical specialists, and private physicians: the role of psychosocial factors.

OBJECTIVE: To examine the well-being differences among physicians working in different health care sectors and to test whether psychosocial stressors account for these differences. The well-being indicators used were psychological distress, self-rated health, and work ability. DATA SOURCES/STUDY SETTING: A total of 2,841 randomly selected Finnish physicians (response rate 57 percent) returned the postal questionnaire, of which 2,047 (1,241 women) fulfilled all the participant criteria. STUDY DESIGN: This is a cross-sectional questionnaire study. PRINCIPAL FINDINGS: General practitioners and medical specialists experienced lower well-being than private physicians and this difference was partly explained by differences in psychosocial stressors. CONCLUSIONS: General practitioners and medical specialists report more problems in well-being than private physicians. It is of particular importance to be aware of the sector-specific difficulties in work environments.

Social participation and maintaining recommended waist circumference: prospective evidence from the English Longitudinal Study of Aging.

OBJECTIVE: To investigate whether older adults participating in social activities are more likely to maintain or achieve recommended waist circumference (WC) levels. METHOD: A total of 4,280 older adults who participated in Wave 2 (baseline) and Wave 4 (follow-up) of the English Longitudinal Study of Ageing. WC was measured by a nurse in both study waves. RESULTS: Participation in education, arts, music groups, evening classes, and in charitable associations was associated with maintaining recommended WC only in those men whose WC was in the recommended range at baseline. Participation in social activities was not associated with achieving recommended WC in women or men with initially large waist. DISCUSSION: Participation in cultural and charitable activities may help in maintaining a recommended level of WC in older men with WC originally in the recommended range.