Patient satisfaction in anesthesiology: a narrative review.

PURPOSE OF REVIEW: Healthcare is increasingly expanding its view in outcome discussions to integrate patient-reported outcomes such as patient satisfaction. Involving patients in the evaluation of services and the development of quality improvement strategies is paramount, especially in the service-oriented discipline of anaesthesiology. RECENT FINDINGS: Currently, while the development of validated patient satisfaction questionnaires is well established, the use of rigorously tested scores in research and clinical practice is not standardized. Furthermore, most questionnaires are validated for specific settings, which limits our ability to draw relevant conclusions from them, especially considering the rapidly expanding scope of anaesthesia as a discipline and the addition of same-day surgery. SUMMARY: For this manuscript, we review recent literature regarding patient satisfaction in the inpatient and ambulatory anaesthesia setting. We discuss ongoing controversies and briefly digress to consider management and leadership science regarding 'customer satisfaction'.

Assessing the psychosocial work environment in the health care setting: translation and psychometric testing of the French and Italian Copenhagen Psychosocial Questionnaires (COPSOQ) in a large sample of health professionals in Switzerland.

BACKGROUND: Measuring work-related stress in a reliable way is important in the development of appropriate prevention and intervention strategies. Especially in multilingual studies the use of comparable and reliable instruments is crucial. Therefore, the aim of this study was to translate selected scales and single items from the German version of the Copenhagen Psychosocial Questionnaire (COPSOQ) into French and Italian and psychometrically test them in a sample of health professionals. METHODS: This study used cross-sectional data from health professionals at 163 randomised selected health organisations in Switzerland. Selected COPSOQ items/scales were backwards- and forwards- translated and cross-culturally adapted from German to French and Italian. Reliability was assessed with Cronbach alpha and intraclass correlation coefficients, construct validity with confirmatory factor analysis (CFA) and structural equation modelling as well as comparative fit index. RESULTS: Responses from 12,754 health professionals were included in the analysis. Of the overall 24 scales, 20 in the German version, 19 in the French version and 17 in the Italian version attained sufficient internal consistency with a threshold of 0.7 for Cronbach's alpha. Predominantly high factor loadings on scale level are reported (> 0.35), as well as good and satisfactory fit values with RMSEA below 0.1, SRMR below 0.08 and CFI above 0.95. For 10 out of 15 scales, the test for factor invariance revealed a significant difference regarding the psychological constructs of the scales across the language versions. CONCLUSIONS: The psychometric properties verify the underlying theoretical model of the COPSOQ questionnaire, which is to some extent comparable across the three language versions. Of the 10 scales with significant factor variance, four showed large differences, implying that revision is needed for better comparability. Potential cultural issues as well as regional differences may have led to the factor variance and the different reliability scores per scale across language versions. One known influencing factor for regional differences is culture, which should be considered in scale development. Moreover, emerging topics such as digitization should be considered in further development of the questionnaire.

Psychosocial burden in nurses working in nursing homes during the Covid-19 pandemic: a cross-sectional study with quantitative and qualitative data.

BACKGROUND: The Covid-19 pandemic led to increased work-related strain and psychosocial burden in nurses worldwide, resulting in high prevalences of mental health problems. Nurses in long-term care facilities seem to be especially affected by the pandemic. Nevertheless, there are few findings indicating possible positive changes for health care workers. Therefore, we investigated which psychosocial burdens and potential positive aspects nurses working in long-term care facilities experience during the Covid-19 pandemic. METHODS: We conducted a mixed-methods study among nurses and nursing assistants working in nursing homes in Germany. The survey contained the third German version of the Copenhagen Psychosocial Questionnaire (COPSOQ III). Using Welch's t-tests, we compared the COPSOQ results of our sample against a pre-pandemic reference group of geriatric nurses from Germany. Additionally, we conducted semi-structured interviews with geriatric nurses with a special focus on psychosocial stress, to reach a deeper understanding of their experiences on work-related changes and burdens during the pandemic. Data were analysed using thematic coding (Braun and Clarke). RESULTS: Our survey sample (n = 177) differed significantly from the pre-pandemic reference group in 14 out of 31 COPSOQ scales. Almost all of these differences indicated negative changes. Our sample scored significantly worse regarding the scales 'quantitative demands', 'hiding emotions', 'work-privacy conflicts', 'role conflicts', 'quality of leadership', 'support at work', 'recognition', 'physical demands', 'intention to leave profession', 'burnout', 'presenteeism' and 'inability to relax'. The interviews (n = 15) revealed six main themes related to nurses' psychosocial stress: 'overall working conditions', 'concern for residents', 'management of relatives', 'inability to provide terminal care', 'tensions between being infected and infecting others' and 'technicisation of care'. 'Enhanced community cohesion' (interviews), 'meaning of work' and 'quantity of social relations' (COPSOQ III) were identified as positive effects of the pandemic. CONCLUSIONS: Results clearly illustrate an aggravation of geriatric nurses' situation and psychosocial burden and only few positive changes due to the Covid-19 pandemic. Pre-existing hardships seem to have further deteriorated and new stressors added to nurses' strain. The perceived erosion of care, due to an overemphasis of the technical in relation to the social and emotional dimensions of care, seems to be especially burdensome to geriatric nurses.

Self-reported cardiovascular health of teachers: results from the 5-year follow-up of the Gutenberg Health Study cohort.

OBJECTIVES: Following an exploratory approach, we examined cardiovascular disease risk factors at baseline and the 5-year incidence proportion of self-reported doctor-diagnosed cardiovascular diseases (CVD) in teachers and other occupational groups of the Gutenberg Health Study. METHODS: Study participants lived in the region of Mainz, Germany. Data from 6510 working participants without prevalent CVD at baseline (2007-2012) were analyzed. Participants were teachers (n = 215), other professionals from the health, social or educational (HSE) fields (n = 1061) or worked outside the HSE fields (n = 5234). For occupational comparisons, we estimated prevalence ratios (PR) for each CVD risk factor at baseline with robust Poisson regression analyses. We calculated crude CVD incidence rates based on the observed 5-year CVD cumulative incidence at follow-up and estimated age-weighted incidence proportions. All analyses were stratified by sex. RESULTS: Male non-HSE workers showed a higher prevalence of smoking and physical inactivity than male teachers (PR 2.26; 95%-CI: 1.06-4.82/PR 1.89; 95%-CI: 1.24-2.87). In contrast, non-HSE workers and other HSE professionals were less likely to have reported an unhealthy alcohol intake than teachers. Differences were attenuated after SES-adjustment. We did not detect occupational group-specific differences in CVD incidence. However, there were only two cases of CVD among the teachers. CONCLUSION: Particularly male teachers showed a healthier lifestyle regarding physical inactivity and smoking. Nevertheless, occupational-medical care practitioners and researchers need to be aware of the relatively heightened prevalence of unhealthy alcohol intake in female and male teachers, and in absolute terms, the high hypertension prevalence in male teachers.

Muscle Activation and Subjectively Perceived Effort in Typical Violin Positions.

Violinists display a high incidence of task-specific musculoskeletal problems. Sources pertaining to violin playing and teaching traditions as well as musicians' medicine research offer only imprecise and contradictory recommendations regarding suitable instrument positions. The aim of this study was to add to a growing scientific base for teaching and medical counseling regarding violin positioning. The study evaluated muscle activation (EMG) and subjectively perceived effort (Borg scale) in four standardized typical violin positions, as well as the violinists' normally used one. The hypothesis, the smaller the angle between the instrument's longitudinal axis (LoAx) and the player's central sagittal plane (CSP) and the angle between its lateral axis (LatAx) and the player's horizontal plane (HP), the more muscle activation and perceived effort in the violinist's left arm, was confirmed: Decreasing the LoAx-CSP angle from 50° to 20° and the LatAx-HP angle from 50° to 20° resulted in a highly significant and independent increase of EMG and Borg scale self-ratings mean values. Results may allow for a first step in decision-making on violin positioning for ergonomic adaptations in teaching as well as prevention and therapy of playing-related health problems at all levels of proficiency.

The Gutenberg health study: associations between occupational and private stress factors and work-privacy conflict.

BACKGROUND: Work-privacy conflict (WPC) is no longer a rarity but constitutes a societal problem. The objectives of the present study were (1) to investigate the distribution and prevalence of WPC among the employed participants in the Gutenberg Health Study at baseline and (2) to study the dependence of WPC on a broad range of private life and occupational characteristics as well as on psychosocial working conditions. METHODS: This analysis is based on a representative, population-based sample of 3,709 employees participating in the Gutenberg Health Study. Descriptive and bivariable analyses were carried out separately for women and men. Distribution and prevalence of WPC were examined according to socio-demographic and occupational characteristics as well as psychosocial working conditions. Further, stepwise selection of Poisson log-linear regression models were performed to determine which socio-demographic and occupational characteristics were most associated with the outcome variable WPC and to obtain adjusted prevalence ratios from the final model. The multivariable analyses were conducted both separately for women and men and with all subjects together in one analysis. RESULTS: There was a high prevalence of WPC in the present study (27.4 % of the men and 23.0 % of the women reported a high or very high WPC). A variety of factors was associated with WPC, e.g. full-time employment, depression and many of the psychosocial risk factors at work. Also, the multivariable results showed that women were of higher risk for a WPC. CONCLUSIONS: By affecting the individual work life, home life, and the general well-being and health, WPC may lead to detrimental effects in employees, their families, employers, and society as a whole. Therefore, the high prevalence of WPC in our sample should be of concern. Among women, the risk for suffering from WPC was even higher, most likely due to multiple burdens.

Development of a mobbing short scale in the Gutenberg Health Study.

PURPOSE: Despite its highly detrimental potential, most standard questionnaires assessing psychosocial stress at work do not include mobbing as a risk factor. In the German standard version of COPSOQ, mobbing is assessed with a single item. In the Gutenberg Health Study, this version was used together with a newly developed short scale based on the Leymann Inventory of Psychological Terror. The purpose of the present study was to evaluate the psychometric properties of these two measures, to compare them and to test their differential impact on relevant outcome parameters. METHODS: This analysis is based on a population-based sample of 1441 employees participating in the Gutenberg Health Study. Exploratory and confirmatory factor analyses and reliability analyses were used to assess the mobbing scale. To determine their predictive validities, multiple linear regression analyses with six outcome parameters and log-binomial regression models for two of the outcome aspects were run. RESULTS: Factor analyses of the five-item scale confirmed a one-factor solution, reliability was α = 0.65. Both the single-item and the five-item scales were associated with all six outcome scales. Effect sizes were similar for both mobbing measures. CONCLUSION: Mobbing is an important risk factor for health-related outcomes. For the purpose of psychosocial risk assessment in the workplace, both the single-item and the five-item constructs were psychometrically appropriate. Associations with outcomes were about equivalent. However, the single item has the advantage of parsimony, whereas the five-item construct depicts several distinct forms of mobbing.

Night shift work and cardiovascular diseases among employees in Germany: five-year follow-up of the Gutenberg Health Study.

OBJECTIVE: This study aimed to determine if there is an increased risk of incident cardiovascular diseases (CVD) resulting from cumulative night shift work in the German population-based Gutenberg Health Study (GHS). METHODS: We examined working participants of the GHS at baseline and after five years. Cumulative night shift work in the 10 years before baseline was assessed and categorized as low (1-220 nights ≙ up to 1 year), middle (221-660 nights ≙ 1-3 years), and high (>660 nights ≙ more than 3 years) night shift exposure. Hazard ratios (HR) were estimated for incident "quality-assured CVD events" using Cox proportional hazard models. RESULTS: At baseline, 1092 of 8167 working participants performed night shift work. During the follow-up, 202 incident cardiovascular events occurred. The crude incidence rates for CVD per 1000 person-years were 6.88 [95% confidence interval (CI) 4.80-9.55] for night shift workers and 5.19 (95% CI 4.44-6.04) for day workers. Cumulative incidence curves showed a higher cumulative incidence in workers exposed to night shift work compared to day workers after five years. The adjusted HR for incident CVD events were 1.26 (95% CI 0.68-2.33), 1.37 (95% CI 0.74-2.53) and 1.19 (95% CI 0.67-2.12) for employees in the low, middle and high night shift categories compared to employees without night shift work, respectively. CONCLUSIONS: The observed tendencies indicate that night shift work might be negatively associated with cardiovascular health. We expect the continued follow-up will clarify the long-term impact of night shift work.

Burnout, self-rated general health and life satisfaction among teachers and other academic occupational groups.

Introduction: Teachers work in a job with specific demands that can strain individual coping capabilities and can pose a risk for the development of psychological problems. Prior studies showed that teachers - in comparison with other occupational groups - had high risks of job-related psychological exhaustion. In our study we compared teachers and other occupational groups on burnout, general life satisfaction and self-rated general health. In addition, we analyzed if sociodemographic and job-related factors were relevant predictors of these outcomes. Methods: We analyzed data from a total of 1,500 subjects arising from the Gutenberg Health Study. Binary logistic regression models and descriptive statistics were calculated to determine potential differences between the occupational group membership and the predictive values of sociodemographic and job-related variables. Results: The occupational groups did not differ significantly in terms of burnout, self-rated general health and satisfaction with life. Logistic regression models showed which sociodemographic and job-related variables were associated with the outcomes. Female sex, part-time employment as well as work-privacy conflicts showed particular predictive relevance. Discussion: Job-related interventions for teachers should aim at specific strains, e.g., arising out of work-privacy conflicts where interventions should focus on support of female teachers.

Patient satisfaction with divided anesthesia care.

BACKGROUND: Up to now, no prospective cohort study using a validated questionnaire has assessed patients' expectation and perception of divided anesthesia care and its influence on patient satisfaction. OBJECTIVE: We assessed patient satisfaction with divided anesthesia care in a district general hospital in Switzerland. We hypothesized that patient expectations, combined with their perceptions of the (un)importance of continuous anesthesia care would influence patient satisfaction. MATERIAL AND METHODS: A total of 484 eligible in-patients receiving anesthesia from October 2019 to February 2020 were included and received preoperative information about divided care via a brochure and face-to-face. The primary outcome was the assessment of patient satisfaction with divided anesthesia care using a validated questionnaire. In group 1 continuity of care was considered important but not performed. In group 2 continuity was ensured. In group 3 continuity was regarded as not important and was not performed. In group 4 patients could not remember or did not answer. A psychometrically developed validated questionnaire was sent to patients at home after discharge. RESULTS: A total of 484 completed questionnaires (response rate 81%) were analyzed. In group 1 (n = 110) the mean total dissatisfaction score was 25% (95% confidence interval [CI] 21.8-28.1), in group 2 (n = 61) 6.8% (95% CI 4.8-8.7), in group 3 (n = 223) 12.1% (95% CI 10.7-13.4), and in group 4 (n = 90) 15% (95% CI 11-18); ANOVA: p < 0.001, η = 0.43. Of the patients 286 (59%) considered continuity of care by the same anesthetist relatively unimportant (34%) or not important at all (25%). The other 40% considered it important (22%) or very important (18%). CONCLUSION: Despite receiving comprehensive preoperative information about divided anesthesia care, 40% of patients still considered continuity of care by the same anesthetist important. We recommend further research evaluating whether and how patient expectations can be modified towards the common practice of divided care and patient satisfaction can be increased.

Psychosocial workload and stress in the workers' representative.

BACKGROUND: Using a data set of works councils of trade union IG Metal, this paper investigates psychosocial stress and strain on this specific group in comparison to employees working in administration in general (leadership and non-leadership-role) and a national reference value. METHODS: For assessing psychosocial work factors on works councils within the sector represented by the trade union IG Metal in Germany, a research by using the German standard version of COPSOQ (Copenhagen Psychosocial Questionnaire) was performed. The instrument includes 87 single items forming 25 aspects of strain and stress. Results from the study group of works councils were compared to those from employees working in administration and to the general population mean (COPSOQ database). Statistical analysis included t-tests, analysis of variance and multiple comparisons of means. To be significant in terms of statistics, p<0.05 (two-tailed) and a minimum deviation of 5 or more points between groups' mean values identify the relevant values. RESULTS: All in all, 309 works councils from a national survey of the German chemical and metalworking industries took part in the study. 113 were full-time works council members (exempted from the duty to perform their regular work), 196 were voluntary members (acting as employee representatives on an honorary basis alongside their normal duties). Comparison between works councils and employees working in administration (leadership roles (N=1810) and non-leadership roles (N=2970)) and for employees in general (N=35.000) showed unfavourable values for works councils for most scales. Significantly higher values indicating higher strain and stress were found for the scales: emotional demands, work-privacy conflict, role conflicts, mobbing, cognitive stress symptoms and burnout. Unfavourable results were obtained for the aspects: quality of leadership, social support, sense of community and general health. Favourable findings were found on the scales: influence at work, quantity of social relations and the partly positive values for quantitative demands and commitment to the workplace. CONCLUSION: Compared to the reference groups, works council members perceive the psychosocial demands of working life as more exhausting for the majority of aspects. This allows several conclusions. One reason may be the extended tasks employee representatives face, an other may be that the education of most works council members does not seem appropriate to the high demands of their managerial and executive tasks.

Mental health and patterns of work-related coping behaviour in a German sample of student teachers: a cross-sectional study.

PURPOSE: The aim of this cross-sectional study was to evaluate the mental health of student teachers, to analyse the extent to which they feel prepared for their profession by the university curriculum and to investigate patterns of coping with occupational stress. METHODS: A sample of 481 German student teachers was investigated using two standardised instruments: GHQ-12 (General Health Questionnaire) and AVEM (Arbeitsbezogenes Verhaltens- und Erlebensmuster), an occupational stress and coping questionnaire describing four patterns of work-related coping behaviour. In addition, we asked how well the student teachers felt that the curriculum prepared them for their profession. RESULTS: Forty-four per cent of the student teachers report impaired mental health in the second teacher training period, indicated by a GHQ value equal to or over the cut-off of four. The AVEM responses revealed more than 40% showing risk patterns (A or B) compared to only 26.3% displaying a healthy coping style (G), while 32.8% demonstrate an unambitious style (S). These GHQ values are inversely correlated with the extent to which student teachers feel prepared for their work by the university curriculum. CONCLUSIONS: Our data indicate a problematic stress level for student teachers in the second training phase (high exposure to health risks and unfavourable coping styles). Since teaching is clearly an extremely demanding job, it is vital that teacher training systems contribute towards protecting the health of teachers by focusing on fostering healthy personal attitudes and equipping young teachers with coping styles and skills that will better prepare them for the challenges facing them in their daily work. Self-care health management should also be part of the teacher training curriculum.

Increment of fatigue, depression, and stage fright during the first year of high-level education in music students.

BACKGROUND: Public opinion associates music performance with pleasure, relaxation, and entertainment. Nevertheless, several studies have shown that professional musicians and music students are often affected by work-related burdens. These are closely related to stress and anxiety. OBJECTIVE: Scrutinizing specific health strains and work attitudes of music students during their freshman year of high-level education. METHODS: One hundred five students in three Swiss music universities were part of a longitudinal study using standardized assessment questionnaires. Before and after their first study year, some custom-made questionnaires designed to fit the particular work environment of musicians were used together with the already validated inquiry instruments. RESULTS: Fatigue, depression, and stage fright increased significantly. CONCLUSIONS: Our results indicate more study is needed and attempts should be made to minimize the stress level, improve the students' ability to cope with stress, and otherwise reduce their risk for injury. This appears particularly important considering the long-term negative effects of stressors on individuals' health as revealed by modern research.

Determining factors for compensatory movements of the left arm and shoulder in violin playing.

Introduction: Despite a large number of available ergonomic aids and recommendations regarding instrument positioning, violin players at any proficiency level still display a worrying incidence of task-specific complaints of incompletely understood etiology. Compensatory movement patterns of the left upper extremity form an integral part of violin playing. They are highly variable between players but remain understudied despite their relevance for task-specific health problems. Methods: This study investigated individual position effects of the instrument and pre-existing biomechanical factors likely determining the degree of typical compensatory movements in the left upper extremity: (1) left elbow/upper arm adduction ("Reference Angle α", deviation from the vertical axis), (2) shoulder elevation ("Coord x", in mm), and (3) shoulder protraction ("Coord y", in mm). In a group of healthy music students (N = 30, 15 m, 15 f, mean age = 22.5, SD = 2.6), "Reference Angle α" was measured by 3D motion capture analysis. "Coord x" and "Coord y" were assessed and ranked by a synchronized 2D HD video monitoring while performing a pre-defined 16-s tune under laboratory conditions. These three primary outcome variables were compared between four typical, standardized violin positions varying by their sideward orientation ("LatAx-CSP") and/or inclination ("LoAx-HP") by 30°, as well as the players' usual playing position. Selected biomechanical hand parameter data were analyzed as co-factors according to Wagner's Biomechanical Hand Measurement (BHM). Results: Mean "Reference Angle α" decreased significantly from 24.84 ± 2.67 to 18.61 ± 3.12° (p < 0.001), "Coord x" from 22.54 ± 7.417 to 4.75 ± 3.488 mm (p < 0.001), and "Coord y" from 5.66 ± 3.287 to 1.94 ± 1.901) mm (p < 0.001) when increasing LatAx-CSP and LoAx-HP by 30°. Concerning the biomechanical co-factors, "Reference Angle α", "Coord y", but not "Coord x", were found to be significantly increased overall, with decreasing passive supination range (r = -0.307, p = <0.001 for "Passive Supination 250 g/16Ncm", and r = -0.194, p = <0.001 for "Coord y"). Compensatory movements were larger during tune sections requiring high positioning of the left hand and when using the small finger. Discussion: Results may enable to adapt individually suitable instrument positions to minimize strenuous and potentially unhealthy compensation movements of the left upper extremity.

COPSOQ III in Germany: validation of a standard instrument to measure psychosocial factors at work.

BACKGROUND: Over the last almost 20 years COPSOQ (Copenhagen Psychosocial Questionnaire) has become a well-established instrument to measure psychosocial stress at work. In Germany, a first validated version of COPSOQ was introduced in 2005. After the COPSOQ international network took over responsibility for the development of COPSOQ, a new version was published in 2019 (COPSOQ III). The German version of this questionnaire is now to be validated. METHODS: Measurement qualities of German COPSOQ III are explored in adherence to the to the usual requirements of a validation study as defined by DIN EN ISO 10075-3. A sample of observations from more than 250,000 participants surveyed with the COPSOQ in Germany is used for univariate and multivariate statistical analysis. RESULTS: With its 84 items the German COPSOQ III includes all psychosocial work factors that are internationally obligatory and is still compatible with almost 70% of the content in the 2005 German version. Typical psychometric properties of the questionnaire (e. g., validity and reliability) are either good or very good for most of the 84 items and 31 scales. Beyond basic results, congruences with widely used theoretical approaches like the Demand-Control(-Support) model or the Job Demands-Resources model are generally satisfactory. CONCLUSIONS: With the launch of COPSOQ III in Germany, new workplace psychosocial aspects could be explored. Like the preceding version, the questionnaire is a highly useful instrument for research as well as for risk assessment in enterprises. COSPQO III covers a multitude of theoretical approaches and gives comprehensive information on psychosocial working conditions to deduce actions for their improvement.

Correction: Work-life conflict and cardiovascular health: 5-year follow-up of the Gutenberg Health Study.

[This corrects the article DOI: 10.1371/journal.pone.0251260.].

Work-life conflict and cardiovascular health: 5-year follow-up of the Gutenberg Health Study.

INTRODUCTION: Work-life conflicts (WLC) may impact health, but few studies prospectively consider the impact of WLC on objective outcomes such as cardiovascular disease. Using data from the Gutenberg Health Study (GHS), we examined if WLC at baseline was associated with an increased five-year incidence of cardiovascular events (myocardial infarct, stroke, atrial fibrillation, peripheral artery disease, coronary artery disease, chronic heart failure, sudden cardiac death). We also considered if WLC was associated with incident hypertension and arterial stiffness and if the effects of WLC on cardiovascular health differ for men and women. METHODS: A working subsample of the 15,010 GHS cohort participants completed the Copenhagen Psychosocial Questionnaire, which included five "work-privacy conflict" questions at baseline and at the five-year follow-up. Relative risks for incident hypertension due to increased WLC at baseline (WLC scores exceeding 60 out of 100) were estimated with Poisson regression in the subgroup of participants without hypertension at baseline (n = 2426). Categories of WLC at baseline and follow-up were also used to examine the risk of hypertension due to chronic/recurrent WLC. In this subgroup, we also examined the association between WLC as a continuous score ranging from 0 to 100 with change to arterial stiffness after five years using linear regression. Hazard ratios were estimated for incident cardiovascular events in a larger subsample of participants without prevalent cardiovascular disease at baseline (n = 3698) using Cox regression. We used various multivariable regression models to adjust for sex, age, socioeconomic status, occupational, household, and cardiovascular risk factors. RESULTS: We found no association between WLC and incident hypertension or increased arterial stiffness. The fully-adjusted relative risk for WLC >60 at baseline and hypertension was 0.93 (95% 0.74-1.17). The risk of hypertension due to chronic/recurrent WLC >60 was increased but not statistically significant (RR = 1.13, 95% CI 0.83-1.54). Overall, hazard ratios for incident cardiovascular events were also not increased. However, stratifying the results by sex resulted in a hazard ratio of 1.47 (95% CI 0.54-3.98) for incident cardiovascular disease among women in the fully adjusted model. CONCLUSIONS: Although our results were not statistically significant, they indicate that WLC is negatively impacting the cardiovascular health of women. While these results need to be confirmed with additional research and a longer follow-up, interventions to prevent WLC will promote health and could be especially beneficial for women.

Psychosocial work load and stress in the geriatric care.

BACKGROUND: Due to the decrease in informal care by family members and the demographic development, the importance of professional geriatric care will rise considerably. Aim of this study was to investigate the psychosocial workplace situation for employees in this profession. METHODS: The German version of the COPSOQ (Copenhagen Psychosocial Questionnaire) was used for the assessment of psychosocial factors at work. The instrument includes 22 scales and 3 single items concerning demands, control, stress, support, and strain.Results between two study groups of geriatric care were compared to each other as well as to employees in general hospital care and a general population mean (COPSOQ database).Statistical analysis included t-tests, ANOVA and multiple comparisons of means. Statistical significance (p < 0.01, two-tailed) and a difference of at least 5 points in mean values were defined as the relevant threshold. RESULTS: In total 889 respondents from 36 institutions took part in the study. 412 worked in Home Care (HC), 313 in Geriatric Nursing Homes (GNH), 164 in other professions (e.g. administration).Comparison between HC and GNH showed more favourable values for the first group for the most scales, e.g. lower quantitative and emotional demands and less work-privacy conflict, better possibilities for development etc. Compared to external values from the German COPSOQ database for general hospital care (N = 1.195) and the total mean across all professions, COPSOQ-total (N = 11.168), the results are again positive for HC workers on most of the scales concerning demands and social support. The only negative finding is the very low amount of social relations at work due to the obligation to work alone most of the time. Employees in GNH rate predictability, quality of leadership and feedback higher when compared to general hospital care and show some further favourable mean values compared to the COPSOQ mean value for all professions. A disadvantage for GNH is the high rating for job insecurity.A supplementary subgroup analysis showed that the degree of negative evaluation of psychosocial factors concerning demands was related to the amount of working hours per week and the number of on-call duties. CONCLUSIONS: Compared to employees in general hospital care and the COPSOQ overall mean value across all professions, geriatric care employees and especially home care workers evaluate their psychosocial working situation more positive for most aspects. However, this seems partly due to the very high proportion of part-time workers. Critical results for the two study groups are the relatively high job insecurity in nursing homes and the lack of social relations for the HCrs.

Swiss Cancer League communication skills training programme for oncology nurses: an evaluation.

AIM: This paper is a report of an evaluation of the effectiveness of a communication skills training programme for oncology nurses. BACKGROUND: Clinical care for patients with cancer is increasingly being divided between nurses and physicians, with nurses being responsible for the continuity of patient care, and oncologists choosing and explaining the basics of anti-cancer therapy. Therefore, oncology nurses will profit from evidence-based communication skills training to allow them to perform in a professional way. METHODS: Between 2003 and 2006 pre- and post-intervention videos of interviews with simulated patients were compared using the Roter Interaction Analysis System. Patient centeredness was assessed by counting segments of appropriate mutual responding to cues and by calculating length of uninterrupted patient speech. FINDINGS: Appropriate empathic (1.6% vs. 3.2%), reassuring statements (2.3% vs. 3.4%), questions concerning psychosocial information (2.8% vs. 4.0%) increased statistically significantly; utterances containing medical information decreased on the part of nurses (17.8% vs. 13.3%) and patients (8.1% vs. 6.7%); and patients provided more psychosocial information (3.3% vs. 5.7%). The level of congruence and empathic responses to patients' emotional cues increased statistically significantly, as did the length of uninterrupted speech (3.7-4.3 utterances; all P < 0.05). CONCLUSION: The communication skills training of the Swiss Cancer League could be used as a model to achieve substantial improvements in patient-centred communication. Sequence analysis of utterances from patient-provider interaction should be used to assess the amount of patient-centred talk.