Expectations of patients, nurses and physicians in geriatric nursing home emergencies.

OBJECTIVES: To determine contentment with the performance of primary mission emergency care providers. METHODS: A prospective cohort study was conducted using key informant interviews to assess quality of life and self-rated degree of contentment with care in geriatric emergencies. RESULTS: Interviews concerning a total of 152 geriatric emergency cases in nursing homes were conducted with patients in 13 (8.6%) cases, geriatric nurses in 132 (86.8%) cases and emergency physicians in 116 (76.3%) cases within a 3-month period. All responding patients as well as the majority of nurses (96.2%) and physicians (79.4%) were content with the quality of emergency care, but showed less contentment with communication (57.6% of nurses; 22.4% of physicians) and with cooperation on-site (57.6% of nurses; 20.7% of physicians). CONCLUSIONS: Participants perceived a deficit in communication and cooperation on-site. There is a need for intensified education in managing geriatric emergency patients, especially with regard to communication and psychosocial issues.

Preoperative stress and anxiety in day-care patients and inpatients undergoing fast-track surgery.

BACKGROUND: To investigate preoperative levels of stress and anxiety in day-care patients and inpatients undergoing surgical interventions. METHODS: Before induction of anaesthesia, the degree of stress and anxiety was assessed in 135 patients using stress and anxiety questionnaires, bio-feedback, physiological measures, and serum levels for stress variables. Questionnaire responses and physiological measures such as arterial pressure, heart rate, skin conductance, cortisol, and catecholamine levels were compared for day-care patients and inpatients. RESULTS: Significant preoperative anxiety was reported by 34 (45.3%) inpatients and 23 (38.3%) day-care patients. Personal responses in stress and anxiety questionnaires and mean values of arterial pressure and heart rate did not differ significantly in day-care patients when compared with inpatients. Correlation between deviations in plasma cortisol concentrations from normal diurnal distribution and anxiety scores and stress scores was also similar, and the relative increase in preoperative stress variables and measures observed in day-care patients and inpatients was also comparable. Bio-feedback measurements revealed significantly higher preoperative skin conductance (P<0.001) in day-care patients than in inpatients, indicating increased vegetative stress responses. CONCLUSIONS: Preoperative anxiety and stress are common in surgical patients. Questionnaires and bio-feedback measurements may help to assess the degree of patients' burdens. Surgeons should be aware of the personal anxiety of patients and consider patient preferences when deciding who should undergo fast-track surgery in day-care.

Family background and sexual abuse associated with eating disorders.

OBJECTIVE: The authors examined the possible relationship of negative early familial experiences and childhood sexual abuse to the later development of eating disorders. METHODS: Three anonymous questionnaires--a sexual abuse screening checklist, the Biographic Inventory for Diagnosis of Behavioral Disturbances, and the Eating Disorder Inventory--were distributed to 350 female university students. RESULTS: Of the 202 women who completed the questionnaires, 44 (21.8%) were victims of childhood sexual abuse. There were no significant differences in the total or the subscale scores on the Eating Disorder Inventory among women with no, one, or repeated incidents of sexual abuse. However, women who reported an adverse family background displayed significantly higher Eating Disorder Inventory total and subscale scores than did women who assessed family background as a secure base. CONCLUSIONS: The data in this nonclinical female cohort suggest that childhood sexual abuse is neither necessary nor sufficient for the later development of an eating disorder, while an adverse family background may be an important etiological factor.

Changes of serum antibodies to heat-shock protein 65 in coronary heart disease and acute myocardial infarction.

Accumulating evidence indicates the involvement of heat shock proteins (hsp), a family of stress-inducible proteins, in atherosclerosis. For carotid atherosclerosis an association with an increase in hsp65 antibodies has been demonstrated. To investigate whether such antibodies are also associated with coronary heart disease (CHD) and acute myocardial infarction (MI), an age- and sex-matched study with patients suffering from CHD (n = 114) and MI (n = 89) and healthy controls (n = 76) was performed. All study participants (n = 279) were consecutively recruited according to typical diagnostic criteria. Determination of antibody titres to hsp65 was performed by an enzyme-linked immunosorbent assay (ELISA). Hsp65 antibody titres in CHD showed a significant increase compared to the healthy control group (P = 0.029), however, hsp65 antibody titres were found to be significantly lower in acute MI, compared to CHD (P = 0.005). Alteration in hsp65 antibody titres showed no correlation to established cardiovascular risk factors, e.g. serum total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, blood pressure, smoking, alcohol intake and body weight. In conclusion, serum concentrations of hsp65 antibodies were elevated independently in coronary heart diseases and declined in patients with acute myocardial infarction, indicating a possible involvement of the antibodies in the pathogenesis of this disease.

Psychosocial consequences of weight loss following gastric banding for morbid obesity.

BACKGROUND: This study was performed to determine what consequences surgery for morbid obesity has on weight loss, problems in eating behavior, quality of life, physical appearance and mental state. METHOD: After a minimum follow-up of > 8 months (median follow-up 21 months, range 8-48 months), a questionnaire concerning extent of, satisfaction with and consequences of weight loss was mailed to 250 morbidly obese patients after laparoscopic Swedish adjustable gastric banding (SAGB). In addition, the partner's opinion regarding the operation was evaluated as well as the consequences of weight loss for partnership and sexual relationship. RESULTS: 160 patients (64%) completed and returned the questionnaire. Most patients (87%) were happy with the extent of weight loss. Weight loss, however, was connected with negative consequences for the body such as flabby skin (53%), abdominal skin overhang (47%) and pendulous breasts (42%). Patients who were satisfied with their postoperative physical appearance showed significantly less weight loss than did patients who were unhappy with their appearance (38 vs 54 kg). Most of the partners (91%) believed that the decision for SAGB was right. An improvement in partnership was reported by more than half of the partners (59%), and an improved sexual relationship by 45%. CONCLUSION: Laparoscopic SAGB is an effective surgical treatment for morbid obesity. However, the consequences of excess and rapid weight loss for physical appearance are negative in many cases. Well-directed information about the consequences of excess weight loss before SAGB and the possibilities and limits of plastic surgery must be given preoperatively to offset high and often unrealistic expectations.

The prognostic significance of coma-rating, duration of anoxia and cardiopulmonary resuscitation in out-of-hospital cardiac arrest.

Early determination of outcome after successful prehospital cardiopulmonary resuscitation (CPR) is a common problem with great ethical, economic, social, and legal consequences. We prospectively investigated 112 adult patients who had been resuscitated after out-of-hospital cardiac arrest (CA). The aim of our study was to determine whether coma rating by the mobile intensive care unit (MICU) is a useful tool for outcome prediction. For neurological assessment the Innsbruck Coma Scale (ICS) was used initially and after return of spontaneous circulation (ROSC) or 20-30 min after the start of CPR, before any sedating drugs were given. The duration of anoxia and CPR were determined with the automatically recorded emergency call protocol of the dispatch centre and the protocol of the MICU. For estimation of cerebral outcome at the time of discharge from hospital we used the Glasgow-Pittsburgh Cerebral Performance Categories (CPC). Restoration of spontaneous circulation was achieved in 42 patients (37%), and 15 (13%) were discharged from hospital. The first coma rating performed immediately at the time of arrival on scene had no significant prognostic value for prediction of neurological outcome (P = 0.204) and survival (P = 0.103). The second coma rating (performed after ROSC or 20-30 min after the start of CPR), however, demonstrated a significant correlation with neurological outcome (P = 0.0000) and survival (P = 0.0000), a correlation which was comparable to both duration of anoxia and duration of CPR. In patients with out-of-hospital cardiac arrest prognostic information could be obtained with the ICS as early as 20-30 min after the start of cardiopulmonary resuscitation.

Stress coping of patients with ankylosing spondylitis.

Seventy-six male patients with ankylosing spondylitis (SA) and sixteen healthy controls were assessed for their stress coping mechanisms. As compared to healthy controls, the coping behaviour of the patients with SA was characterized by a significantly higher degree of playing down the stressful situation through comparison with others and by more substitutive gratification; they also showed less self-accusation and resignation. These coping mechanisms apparently do not change significantly in the course of the illness, as in our study we found that patients with different durations of illness did not differ from each other with regard to the coping strategies they used. When comparing the different strategies of coping the subjective intensity of pain, we found at a low intensity of pain a significant positive correlation with the strategies of 'playing down the stressful situation through comparison with others' and 'positive self-instruction', and a negative correlation with 'self-accusation'.

Sexual dysfunctions: relationship to childhood sexual abuse and early family experiences in a nonclinical sample.

Studies investigating a possible relationship between childhood sexual abuse and adult sexual dysfunction have reported highly discrepant results. The purpose of the present study was to examine 202 female university students for early familial experience and childhood sexual abuse in relation to adult sexual disorders. Each student was asked to complete three questionnaires on victimization, sexual dysfunction, early familial experiences. Results indicated that: (a) victims of multiple CSA more frequently reported sexual desire disorders and orgasm disorders than did single-incident victims and nonvictims; (b) single-incident victims and nonvictims reported no significantly different rates for any kind of sexual dysfunction; (c) negative early familial experiences were significantly related to any kind of sexual disorder; and (d) women who reported orgasm disorders more often reported an inadequate sex education than did women with another or no sexual dysfunction. The data suggest that both family dysfunction and sexual victimization contribute to sexual disorders in adulthood, and that later sexual disorders are to a large extent the result of sexual abuse-related factors in particular and family dysfunction in general.

Sexual dysfunction in males: significance of adverse childhood experiences.

This paper examines the impact of childhood sexual victimization, physical abuse, and dysfunctional family background on sexual dysfunctions in adulthood in a nonclinical male student sample. The current analysis is based on data from a survey by questionnaire from 301 males. Our findings show that (a) occasional sexual dysfunctions, especially premature ejaculation and sexual desire disorder, are frequent in young male adults; and (b) long-lasting adverse familial relationship to attachment figures are more influential to later sexual dysfunction than are childhood sexual abuse experiences.

The professional image anticipated by anaesthesiologists.

The perspective of anaesthesiologists regarding their professional image in the eyes of colleagues and the public was assessed. A self-reporting questionnaire (Instrument for Stress-related Job Analysis) was completed by 125 anaesthesiologists. Respondents' self-image and presumed image in the eyes of colleagues do not give a bright picture of the anaesthesiologist's role. The anticipated image showed significantly more anaesthesiologists who presumed low professional recognition by their colleagues from other specialties (P = 0.002) and the lay public (P = 0.015) than those who assumed high marks. Presumed colleague opinion correlated significantly with characteristics of job satisfaction including the possibility to co-determine sequence of operations (P = 0.006), recognition of suggestions and ideas (P = 0.007) and fellow support (P = 0.001). Regarding working conditions the possibility to actively control operational procedures also significantly correlated with colleague opinion (P = 0.003). The authors conclude that the possibility to actively influence quality and pace of work on a par with surgical colleagues could help boost self-esteem and self-confidence in anaesthesiologists. Furthermore, positive image promotion in cooperating medical professions and the public could help focus more attention on the important contribution of anaesthesiology to modern medicine.

Fully developed burnout and burnout risk in intensive care personnel at a university hospital.

We assessed the prevalence of fully developed burnout, burnout risk and the influence of work and employment related factors in five intensive care units at a university hospital. A cross-sectional study was conducted using self-reporting questionnaires for the evaluation of the frequency and intensity of burnout syndrome (Maslach Burnout Inventory) and work and employment related factors. From a total of 320 eligible intensive care personnel, 33 physicians and 150 nurses participated in the study (59% response rate). Applying the process model for burnout, 63 participants (34.4%) were at risk for burnout and another 11 respondents (6.0%) revealed evidence of fully developed burnout (emotional exhaustion > or =4.0 and lack of personal accomplishment < or =4.0). No statistically significant difference in prevalence of fully developed burnout or burnout risk was detected in sub-groups according to age, gender level of training, years of employment and family status. The desire to choose the same profession again was significantly less in respondents with fully developed burnout (P=0.006). The opportunity to regularly attend facilitation was significantly lower for participants with fully developed burnout (P=0.002) compared to participants with no burnout. Fully developed burnout and burnout risk are common in intensive care personnel. Support from facilitators appeared to be an important preventive factor

[Burnout and stress disorders in intensive care doctors]. / Burnout und Belastungsstörungen bei Intensivmedizinern.

BACKGROUND AND OBJECTIVE: The various acute and chronic demands and burdens put ICU staff at greater risk for developing psychological and stress disorders. It was the aim of this study to assess the prevalence rates of burnout-syndrome in anesthetists, and to evaluate the contribution of working conditions to the development of burnout. METHODS: Self-reporting questionnaires were used to assess emotional well-being and physical health, burnout-syndrome (Maslach Burnout Inventory), and working conditions (Instrument for Stress-Oriented Task Analysis) in 89 anaesthetists (56 males, 33 females). RESULTS: One quarter of the anaesthetists show high values on the subscales "emotional exhaustion" or "depersonalization", and one fifth low values on the subscale "lack of personal accomplishment". About one quarter of the probands may be seen as "at risk for burnout". Feelings of ill-health are relatively frequent in both sexes. Long working hours and night duties, the cooperation with members of different occupational groups, and small working place resources are seen as particular stresses. CONCLUSION: Burnout-syndrome and psychosomatic symptoms are frequent in intensive care doctors. But preventive measures such as adequate resources at the work place and supervision can influence personal behavior and working conditions, and thus reduce the risk of burnout.

Post-duty psychomotor performance in young and senior anaesthetists.

BACKGROUND AND OBJECTIVE: The level of performance in junior and senior anaesthetists was investigated after 24-h shift working and on-call duties. METHODS: Pre- and post-duty psychomotor function, influence on response time, cognitive function and well-being in 23 individuals (13 junior and 12 senior anaesthetists) was assessed before and after 24-h in-house on-call duty. Subjective perception of tiredness and concentration abilities was estimated by applying a visual analogue scale. RESULTS: The self-assessed tiredness prior to duty was high in both age groups and significantly increased in senior anaesthetists after night duty (P = 0.01). Post-duty impairment of concentration abilities was reported in both groups. Comparing results from pre- and post-duty psychometric testing showed a comparable decline in junior and senior anaesthetists as well. Assessment of burnout showed a significant lack of personal accomplishment in junior anaesthetists as compared to their older colleagues (P = 0.038). Senior anaesthetists judged their contribution to patient well-being significantly higher than did their younger colleagues (P = 0.035). CONCLUSIONS: Although tiredness and subjective impairment of concentration abilities was high in senior anaesthetists after 24-h in-house on-call duty, performance assessed by psychometric testing does not support the hypothesis that senior colleague's performance cannot keep up with routine hospital shift work.

Significance of working conditions on burnout in anesthetists.

BACKGROUND: The influence of working conditions on the development of burnout syndrome was assessed in anesthetists working at a university hospital. METHODS: Self-reporting questionnaires were used to assess physical health and emotional well-being (Health and Stress Profile), burnout syndrome (Maslach Burnout Inventory) and working conditions (Instrument for Stress-Oriented Task Analysis) in anesthetists. RESULTS: Twenty-three anesthetists (25.8%) appeared to be at risk for burnout, and three anesthetists (3.4%) had already developed full-blown burnout syndrome. Anesthetists at risk for burnout more frequently suffered from limited complexity of work (P=0.001), lacking individual time control (P=0.004), lack of participation possibilities (P=0.012), and had more physical complaints (P=0.017) and greater job dissatisfaction (P=0.002) than did their colleagues with no burnout symptoms. CONCLUSION: Job conditions providing little opportunity to influence work pace and participation contribute to the development of burnout syndrome. Communication and contact with colleagues appear to be an important preventive regulative.

Influence of working conditions on job satisfaction in anaesthetists.

BACKGROUND: We studied job satisfaction, physical health, emotional well-being and working conditions in 125 Austrian and Swiss anaesthetists. METHODS: Responses to self-reporting questionnaires were evaluated. Dependent variables included job satisfaction, emotional well-being and physical health. Independent variables included age, sex, marital status, position and working conditions as assessed by the Instrument for Stress-related Job Analysis. RESULTS: Control over work shows a strong effect on job satisfaction in anaesthetists, for example influence on handling tasks (P=0.001), time control (P=0.002) and participation (P=0.001), whereas task demands and task-related problems did not have any effect. Anaesthetists in leading positions and specialists reported lower job satisfaction (P=0.012) than did anaesthetists in non-leading positions. Job satisfaction was associated with better physical health (P=0.001) and better emotional well-being (P=0.005). CONCLUSIONS: Our results suggest that a high level of job satisfaction in anaesthetists correlates with interesting work demands and the opportunity to contribute skills and ideas. To improve job satisfaction, more attention should be paid to improving working conditions, including control over decision-making, and allowing anaesthetists to have more influence on their own work pace and work schedule.

Family background and sexual abuse associated with somatization.

To help clarify the complex association between negative childhood experiences and somatization, the authors examined the possible relationship between self-reported childhood sexual abuse, dysfunctional family background and several types of somatization in a nonclinical sample. Three anonymous questionnaires were completed by 202 female university students (average age 22 years). The findings confirm that severe or repeated childhood sexual victimization and a familial deficiency syndrome in childhood may be important in the pathogenesis of somatization.

[Eating disorders in women: a representative study]. / Essstörungen bei Frauen: Eine Repräsentativerhebung.

The authors examined the prevalence rates of binge-eating behavior, binge-eating disorder (BED), and bulimia nervosa in a female representative random sample in Tyrol. The data were collected ba telephone. Of the 1,000 women, 3 (0.3%) met the DSM-IV diagnostic criteria for anorexia nervosa, 15 (1.5%) for bulimia nervosa, and 33 (3.3%) for binge-eating disorder. While bulimics were young and found in all weight groups, women with BED were mostly overweight or obese and found in all age groups. The findings show that restrained eating, dieting, and/or excessive exercise are risk factors for developing eating disorders.

[Sexual dysfunctions in men and women: significance of a dysfunctional family climate and sexual abuse]. / Sexuelle Funktionsstörungen bei Männern und Frauen: Bedeutung eines dysfunktionalen Familienklimas und sexuellen Missbrauchs.

The authors examined by questionnaire the prevalence and the possible relationship of childhood sexual abuse and dysfunctional family background to the later sexual dysfunctions in a nonclinical male and female student sample. Of the 202 females, 44 (21.8%) reported a narrowly defined childhood sexual abuse, of the 301 men who completed the questionnaires 29 (9.6%) reported any kind of a sexually abusive experience, and 17 (5.6%) were victims of a marked childhood sexual victimization. 66 (32.6%) females and 79 (26%) males reported an adverse family background. Long-lasting adverse familial relationship to attachment figures were significant to later sexual dysfunctions in both sexes. Women, who reported repeated childhood sexual abuse, reported significantly more frequently sexual desire disorder and orgasm disorder. However, males who experienced-in most cases single-childhood sexual abuse, showed not more frequently sexual dysfunctions than nonvictims.

Statistical modelling in analysis of outcome after trauma Glasgow-Coma-Scale and Innsbruck-Coma-Scale.

AIM OF THE STUDY: The current study investigated the Glasgow-Coma-Scale (GCS) and the Innsbruck-Coma-Scale (ICS) for accuracy and reliability of prehospital prediction of non-survival. METHODS: 254 patients were scored immediately after trauma. RESULTS: Both scales equally predicted non-survival with low scores (p < 0.001). The ICS was slightly better in overall prediction of patient outcome (ICS: 84.98%; GCS: 82.68%), but more importantly, statistical analysis (logistic regression model) showed a greater distance between the median scores of survivors and non-survivors, when scored with the ICS (survival: 12; non-survival: 3) than when scored with the GCS (survival: 7; non-survival: 4). CONCLUSION: The results of the present study not only suggest that it is possible to predict mortality prior to therapy for any individual GCS and ICS coma score, but also indicated the ICS to be safer to use than the GCS because of the greater distance of the median scores for survivors and non survivors.

[Eating disorders in males: a representative survey]. / Essstörungen bei Männern: Eine Repräsentativerhebung.

The present study examined the prevalence of eating disorders in a male representative random sample in Tyrol. The data were collected by telephone. Of the 1000 men, 8 (0.8%) met the DSM-IV diagnostic criteria for binge eating disorder. An additional 42 subjects (4.2%) exhibited a partial binge eating syndrome. These two otherwise widely identical groups of binge eaters were separated only by the DSM-IV frequency criterion. Five subjects (0.5%) met the DSM-IV criteria for the diagnosis of bulimia nervosa, and 94 men (9.4%) reported recurrent overeating. Men with any eating disorder were mostly overweight or obese. The findings show that there is a significant difference in eating disorders between men and women, but certain eating disorders are frequent not only in women but also in men.