Cross-national comparison of job satisfaction in doctors during economic recession.

BACKGROUND: Job satisfaction in doctors is related to migration, burnout, turnover and health service quality. However, little is known about their job satisfaction during economic recessions. Iceland and Norway have similar health care systems, but only Iceland was affected severely by the 2008 economic crisis. AIMS: To examine job satisfaction in Icelandic and Norwegian doctors, to compare job satisfaction with Icelandic data obtained before the current recession and to examine job satisfaction in response to cost-containment initiatives. METHODS: A survey of all doctors working in Iceland during 2010, a representative comparison sample of Norwegian doctors from 2010 and a historic sample of doctors who worked at Landspitali University Hospital in Iceland during 2003. The main outcome measure was job satisfaction, which was measured using a validated 10-item scale. RESULTS: Job satisfaction levels in Icelandic doctors (response rate of 61%, n = 622/1024), mean = 47.7 (SD = 10.9), were significantly lower than those of Norwegian doctors (response rate of 67%, n = 1025/1522), mean = 53.2 (SD = 8.5), after controlling for individual and work-related factors. Doctors at Landspitali University Hospital (response rate of 59%, n = 345/581) were less satisfied during the recession. Multiple regression analysis showed that cost-containment significantly affected job satisfaction (P < 0.001). CONCLUSIONS: Job satisfaction in doctors was lower in Iceland than in Norway, which may have been attributable partly to the current economic recession.

Physical function predicts improvement in quality of life in elderly Icelanders after 12 weeks of resistance exercise.

BACKGROUND: Little is known about the effects of resistance training on health related quality of life (HRQL) in the elderly. AIM: The main purpose of the study was to investigate the effects of resistance training on strength, body composition, functional capacity and HRQL in independent living elderly people. We hypothesised that resistance training would improve lean mass, muscle strength, physical function and HRQL. METHODS: Subjects (N = 237, 73.7±5.7 yrs, 58.2% female) participated in a 12-week resistance exercise program (3 times/week; 3 sets, 6-8 repetitions at 75-80% of the 1-repetition maximum) designed to increase strength and muscle mass of major muscle groups. Body composition, quadriceps- and grip strength, timed up and go test (TUG), six minute walk for distance (6MW) and HRQL were measured at baseline and endpoint. RESULTS: Two hundred-and-four participants completed the study. Although the increase in lean mass was small (+0.8 kg, P<0.01), quadriceps strength (+53.5 N), grip strength (+3.0 lb), TUG (-0.6 sec), 6MW (+33.6 m) and HRQL (+1.2 t-score) improved significantly (all P<0.01). Changes in 6MW predicted improvement in HRQL after 12 weeks. CONCLUSIONS: Our study shows that a 12-week resistance exercise program significantly improves lean mass, muscle strength, physical function and HRQL in elderly individuals, and that improvements in physical function predict improvements in HRQL. Our study indicates that resistance training should be promoted for the elderly as it has the potential to improve physical performance, thereby prolonging healthy, independent aging.

[Posttraumatic stress disorder.].

Post traumatic stress disorder (PTSD) and post-traumatic therapeutic intervention are relatively new concepts, and in fact it was only recently that psychiatric disorders connected with disastrous events were accepted as a separate category in the medical nomenclature. An attempt will be made here to shed some light on these concepts, principally in the hope that it may be of use to doctors in rural areas. Both old and recent papers, have been reviewed concerning the immediate as well as the long-term effects on individuals and groups who have been exposed to stressful experiences such as life-threatening situations. In addition to describing the symptoms of PTSD, risk factors are discussed such as individual vulnerability, particular circumstances, and the interaction of factors more conducive to chronic problems than the nature or intensity of the stressor. Then the term post-traumatic therapeutic intervention is evaluated. The view that emotional processing is the essence of treatment of the disorder is widely questioned. More comprehensive ideas about methods, and aid to people suffering from PTSD, are considered.

Antisocial addicts: the importance of additional axis I disorders for the 28-month outcome.

The association between additional co-morbid axis I disorders and the following 28-month course of drinking and mental distress was explored in a nation-wide representative sample (N = 100) of treatment-seeking alcoholics with antisocial personality disorder (ASPD). Diagnoses at admission were assessed with the Diagnostic Interview Schedule and follow-up status was assessed with a questionnaire and from informants. Only 24% had no additional diagnoses, 39% had an affective disorder, 43% panic/agoraphobia, 61% other anxiety disorders, and 47% were polysubstance abusers. Polysubstance abusers had more prior admissions, and were more often involved in fights, while additional anxiety disorder was associated with lower prevalence of drunken driving arrests. Relapse (87%) was best predicted by the number of prior admissions (odds ratio [OR] = 1.3), while affective disorders reduced the risk of relapse (OR = 0.2). Readmissions (55%) were least common among those with affective disorders (44%). Identifying axis I diagnoses, and in particular affective disorders among treatment-seeking ASPD alcoholics, is of substantial importance both in research and clinical practice.

[Health-related quality of life among Icelanders.].

OBJECTIVE: To study health-related quality of life (HRQL) among adults in Iceland with a generic Icelandic instrument, IQL (Icelandic Quality of Life), if it is the same among men and women, and if it changes by increasing age. Furthermore, it was intended to find norms for men and women in different age groups in order to evaluate patients' deviation in HRQL. MATERIAL AND METHODS: IQL was sent to 2800 individuals, a random sample from the national registry, stratified by sex in 10 years age groups from 20-79 years and those above 80 years. For each sub-scale on the instrument and for the combined instrument raw scores were calculated for men and women in the age groups 20-49 years, 50-69 years and 70 years and older which were converted to a T-score. RESULTS: The response rate was 61%, lower among the youngest (20-29 years) as well as among the oldest (80 years and older), but similar for men and women. Internal missing values were few. Reliability of the test was good (Cronbach's alfa=0.91). HRQL among women in general was worse than that of men both in general as well as on most sub-scales. HRQL decreases with advancing age, however, with certain exceptions. A marked difference was found between the youngest and the oldest. The quality of life in the oldest group is worse than among the younger, both in general and on most sub-scales except finance and anxiety. Depression and social function do not change significantly with age. The oldest are especially worse on the scales general health, energy and physical health. Sleep becomes worse with increasing age, especially among women. Five factors explain two thirds of the variance, general health (23.4%), mental wellbeing (20.5%), satisfaction (9.0%), sleep (6.9%) and finance (6.3%). CONCLUSIONS: When evaluating HRQL among patients it is necessary for health-care providers and researchers to take into consideration the difference in HRQL between men and women and the changes occurring with age.

[Validation of an Icelandic version of the Geriatric Depression Scale (GDS).].

OBJECTIVE: The GDS is a widely used tool world wide, both in clinical practice and in research of the elderly. The objective was to translate and validate the Geriatric Depression Scale (GDS) in Iceland. The short version of the GDS was also studied. MATERIAL AND METHODS: GDS was translated from English to Icelandic and backtranslated. Individuals, both hospitalised and healthy, born 1933 or before were included in the study. Those who had MMSE (Mini Mental State Examination) score under 23 were excluded. Seventy-one individuals were examined for depression both with a structured interview, Composite International Diagnostic Interview; 1993 (CIDI-a) and with the GDS. RESULTS: The GDS results were comparable to the results from the interview. The cutoff score for depression was chosen 13/14 according to the most favorable values of sensitivity (0.77), specificity (0.95), positive predictive value (0.77) and kappa (0.72). One cutoff was chosen because in our study there were persons with moderate or severe depression but no one with mild depression was detected. Our cutoff score for depression was identical with the cutoff score in the original american GDS version, but the original american version included a cutoff for mild depression also. CONCLUSIONS: The Icelandic GDS is a reliable method to screen for depression among the elderly. We conclude that GDS is an useful tool in unravelling depressive illness amongst the elderly although not diagnostic per se.

[Validation of an Icelandic version of the Geriatric Depression Scale (GDS).].

OBJECTIVE: Health-related quality of life (HRQL) is increasingly used to estimate needs for medical treatment, to evaluate its outcome and quality of care. The aim of this study was to compare the HRQL of several diagnostic groups before and after treatment with the HL-test (HL = IQL, Icelandic Quality of Life test) and to study its validity for measuring changes in quality of life. MATERIAL AND METHODS: Patients on waiting lists for coronary catheterization, orthopedic or urologic operations, patients in psychiatric out-patient treatment and patients entering treatment for alcohol dependence were asked to fill in the HL-test, a total of 1195 patients. Three months after treatment they were retested. The results of tests were standarized with population norms available to make them directly comparable with those of the general population. RESULTS: The response rate was 75% in each round. The HRQL of all patients was reduced in all aspects compared to that of the general population, that of the heart and urology patients less so than that of the orthopedic and psychiatric patients. Each group had a specific profile, especially marked for the orthopedic and psychiatric patients. Following treatment the HRQL or some aspects of it improved in all groups, especially for those which it had been most impaired. CONCLUSIONS: Studies of HRQL provide information useful for planning and delivery of health services. The HL-test is an instrument with good validity and reliability which is easy to use for such studies.

[Climateric symptoms and hormone replacement treatment among 50 years old Icelandic women.].

OBJECTIVE: The objective of the research was to estimate the prevalence and treatment of climacteric symptoms among 50 years old women, including which doctors are prescribing the hormone replacement treatment (HRT) and what information is given about the risk and benefit of HRT. MATERIAL AND METHODS: All (n=956) 50 years old women living in Reykjavík and neighbouring towns were included. A detailed questionnaire was posted to the women with two follow-up reminders. A non-response survey was conducted by phone among those not responding. RESULTS: The response rate was 72.2% (n=690). Sleep disturbances were the most common climacteric complaint occurring every day, mainly difficulty in maintaining sleep (14.8%). Hot flushes occuring every day (3.6%) and every night (2.2%) were more common than palpitations occuring every day (0.5%) and every night (0.2%). One fourth of the women had been to a doctor because of anxiety and 17% because of depression. Women who had been oophorectomised, were suffering from insomnia, hypertension, had high body mass index (BMI) or were not on HRT were more likely to suffer from hot flushes and palpitations. More than every other woman was on HRT (54%). Combination of oestrogen and progesterone were most commonly used. Hot flushes were less common in women on HRT and one third reported better sleep after starting HRT. Women on HRT more frequently visited doctors, were more often suffering from anxiety, chronic tiredness, fibromyalgia and pain. They more often were heavy smokers and had chronic bronchitis. Most often the HRT was started by gynaecologists (67%) but continued by family doctors (56%). About one fifth claimed that they had not received information about the risk and benefit of HRT. CONCLUSIONS: More than every other 50 years old woman is on HRT. These women differ in various ways from women not receiving HRT, which underlines the importance of accurate diagnosis and treatment of climacteric symptoms. Better patient information is needed.

The effects of fluoxetine combined with nicotine inhalers in smoking cessation--a randomized trial.

AIMS: Nicotine replacement therapy (NRT) is an established aid in stopping smoking, while the role of antidepressants remains uncertain. Antidepressants added to NRT might improve abstinence rates. Our aim was to determine the efficacy of nicotine inhaler and fluoxetine vs. nicotine inhaler and placebo in attempts to quit smoking. DESIGN: A randomized, double-blind, placebo-controlled trial. SETTING: A smoker's cessation clinic. PARTICIPANTS: One hundred volunteers smoking 10 cigarettes/day or more. INTERVENTIONS: Subjects were instructed to start taking a daily dose of 10 mg of fluoxetine or placebo 16 days before stopping smoking, then 20 mg 10 days before quitting, continuing for up to at least 3 months. Subjects were instructed to use 6-12 units per day of nicotine inhalers after stopping smoking for up to 6 months. MEASUREMENTS: Continuous abstinence rates recorded at various time points up to 12 months from the quit date. FINDINGS: The sustained abstinence rate for the inhaler-fluoxetine group was 54%, 40%, 29% and 21% after 1.5, 3, 6 and 12 months, respectively, compared to 48%, 40%, 32% and 23% for the inhaler-placebo group. The differences were not significant at any time point. Abstinence up to 3 months was more likely in older smokers, those with a lower Beck Depression Inventory Score (BDI), lower Fagerström Test of Nicotine Dependence (FTND) score and no history of alcoholism. Fluoxetine appeared to increase abstinence rates among high BDI smokers compared to high BDI smokers assigned placebo. Serum levels of nicotine during treatment in the inhaler-fluoxetine group were lower than in the inhaler-placebo group so that fluoxetine may have reduced inhaler use through a common site of action. CONCLUSIONS: We found no evidence that fluoxetine treatment when used as an adjunct to NRT in unselected smokers is effective, but there may be an advantage to using it in depressed smokers.

[Results of alcoholism treatment 28 months after admission.].

OBJECTIVE: Alcoholism and other substance use dis-orders are prevalent chronic disorders. It is therefore important to study the outcome of treatment provided to assess current state as a reference for future comparison. MATERIAL AND METHODS: From December 1991 to September 1992 a total of 351 patients admitted to the three main treatment options for alcohol and other substance disorders in Iceland were selected as a representative sample of those seeking treatment. They were evaluated with a structured psychiatric interview and asked about their alcohol and social history. At 16 and 28 months the patients were followed-up to study the outcome. RESULTS: About 16% of the patients remained abstinent throughout the 28 months follow-up period. The best outcome was found among younger, married, fully employed patients without other psychiatric diagnoses, 23-28% being abstinent for 28 months. The poorest outcome was seen among the divorced and among patients with more than four prior treat-ments where less than 10% were abstinent for 28 months. Similar proportions of patients seeking each of the three units were readmitted, between 42% and 54%. CONCLUSIONS: Outcome of treatment of alcoholism and other substance use disorders depends to a substantial degree on the patients' comorbidity, and prior further new and better treatment methods for these disorders, but more important, preventive efforts against substance use disorders must be increased.

The role of psychiatric comorbidity in the prediction of readmission for detoxification.

In a prospective study over a 28-month period in Iceland using a representative sample (N = 351), the association among patients seeking detoxification between comorbid psychopathology and (1) number of lifetime admissions, (2) readmissions for detoxification, and (3) a "revolving-door" career (i.e., at least four admissions within 30 months) was studied. Psychiatric diagnoses were assigned using the Diagnostic Interview Schedule (DIS), and the patients were asked about prior admissions for detoxification and then evaluated for 28 months for readmissions. Patients with no comorbid diagnoses had the fewest lifetime admissions. Agoraphobia/panic disorder predicted readmission (odds ratio [OR], 5.8) for those with less than two prior admissions. For those with more than three prior admissions, readmissions were primarily related to polysubstance abuse. The development of a revolving-door career was rare (6%) among those with less than four prior admissions. Among others (27%), it was primarily predicted by polysubstance abuse. Thus, early recognition and treatment of anxiety disorders among substance abusers might prevent further readmissions.

Social consequences of substance abuse: the impact of comorbid psychiatric disorders. A prospective study of a nation-wide sample of treatment-seeking patients.

This is both a retrospective and a 16 and 28 months prospective study of the association between psychiatric comorbidity and social consequences (accidents, fights, broken relationships, drunken driving arrest, and reduced employment) related to alcohol in a nation-wide sample (n = 351) of substance abusers seeking inpatient treatment. Psychiatric comorbidity was evaluated with the Diagnostic Interview Schedule, while drinking history and social consequences were assessed with a structured questionnaire. The social consequences had a high rate of re-occurrence. Controlled for alcohol consumption, polysubstance abuse predicted accidents (OR = 2.9) and fights (OR = 3.9) among men, while among pure alcoholics of both sexes phobia (OR = 4.3) and antisocial personality disorder (OR = 3.0) predicted fights. Only level of abuse predicted broken relationships. Antisocials had most drunken driving arrests. Attempts to reduce these social consequences should aim at treating polysubstance abuse, phobia, and antisocial personality disorder. However, the overriding aim should be the promotion of abstinence.

Psychiatric co-morbidity and aftercare among alcoholics: a prospective study of a nationwide representative sample.

AIMS: To study prospectively the type and extent of aftercare sought by patients following their admission for alcohol and other substance abuse treatment as a function of psychiatric co-morbidity. DESIGN: Prospective cohort study with follow-up after 16 months. SETTING AND PARTICIPANTS: A nationwide sample of alcoholics discharged from inpatient treatment (N = 351) in Iceland. MEASUREMENTS: The Diagnostic Interview Schedule was used to assign psychiatric diagnoses at the time of index admission. A questionnaire on the type and number of aftercare attendances was mailed to all participants to obtain information about aftercare. FINDINGS: A combination of attendance at Alcoholics Anonymous (AA) and professional care was the most common aftercare (49%); while only 8% received no aftercare whatsoever. The mean number of AA attendances was over 24 while it was less than 3 for the various professional appointments. Patients with a diagnosis of schizophrenia had a lower rate of attendance at AA. Other types of co-morbidity did not affect AA attendance but did increase rates of professional help-seeking. CONCLUSIONS: Better professional treatment attendance might be gained by integrating AA concepts while AA might benefit from professional input to address the prevalent co-morbid psychiatric disorders.

Medical risk factors amongst drivers in single-car accidents.

OBJECTIVES: To estimate medical risk factors amongst drivers in single-car accidents with special reference to sleepiness and alcohol abuse. DESIGN: An epidemiological survey by means of multiple-choice questionnaires that were mailed to drivers and a random control group. SETTING: Iceland. SUBJECTS: All drivers in single-car accidents (n = 471) during 1989-91 and a control group from the general population (n = 1000). MAIN OUTCOME MEASURE: Medical health profile and answers to questions concerning sleep disorders and alcohol abuse. RESULTS: Compared to the controls the drivers were younger and there were three times more males. The drivers abused alcohol more often. Chronic disorders such as epilepsy, diabetes mellitus, and cardiac disorders were not over-represented. Altogether, 15.4% claimed that sleepiness had caused their traffic accident, logistic regression analyses revealed that these 'sleepy' drivers more often had alcohol abuse and a history of 'almost falling a sleep whilst driving'. CONCLUSIONS: Compared to controls, drivers in single-car accidents are more likely to be young, male, have a history of sleepiness whilst driving, and also have a history suggestive of alcoholism. Chronic disorders like epilepsy and diabetes mellitus were not over-represented amongst the single-car accidents drivers. These results raise the question of how drivers with a high probability of causing an accident (sleepiness and alcoholism) can be identified in time and proper measures taken to prevent 'accidents waiting to happen'.

The 2-year course following detoxification treatment of substance abuse: the possible influence of psychiatric comorbidity.

The influence of psychiatric comorbidity on the course and outcome in a nationwide representative sample (n = 351) of treatment-seeking substance users over a 28-month period was studied prospectively. The patients were administered the Diagnostic Interview Schedule and a questionnaire on drinking history. At 16 and 28 months after admission the patients returned a questionnaire on drinking history and mental health. In cases of those lacking information on either follow-up (45%), details on drinking status was obtained from informants. Completely abstinent were 16%. Generalized anxiety disorder and/or social phobia at the index admission predicted abstinence during the follow-up [odds ratio (OR) = 0.25], whereas onset of alcoholism among these patients after age 25 years predicted a worse prognosis (OR = 13.5). Also increasing number of social consequences related to abuse (OR = 1.3) and drinking more than the median (OR = 2.1) predicted a poor outcome. The abstinent group had significantly better mental health at follow-up. The patients with comorbid psychiatric disorders at admission were worse at follow-up. Although substance use disorders and comorbid psychiatric disorders have to a certain degree separate courses, there is nevertheless significant interaction between them. Early treatment and recognition of comorbid psychiatric disorders among substance abusers is necessary.

[Health-related quality of life.].

INTRODUCTION: With increasing technology in medicine and possibilities to extend life, interest for studying health-related quality of life, i.e. the subjective well-being of patients against the background of their diseases, accidents or treatment, has increased. The purpose of this paper is to introduce a self administered test for health-related quality of life, the IQL (Icelandic Quality of Life), and to show how it differentiates between groups of patients and to encourage the use of such tests in clinical work and research. The reliability and validity of the IQL has been shown to be acceptable. METHOD AND MATERIAL: The IQL had 30 questions and visual analogue items which measure 11 aspects of health-related quality of life. Raw scores for each subscale and for the total test are transformed into T-scores in order to make results easily comparable. The test was administered to a total of 219 persons in four groups of patients and disabled. RESULTS: The test differentiates the more severely ill and disabled persons from the less severely ill. Each subscale except pain differentiates the groups from each other, showing a specific profile for each group. There is a high correlation between health and social aspects of the test as well as between health and satisfaction with life and well-being. The health-related quality of life of alcoholics was lowest in this study. DISCUSSION: The test can be used, both in research and clinical work, in spite of the fact that the current version of it has not been tried out in a representa nottive sample of the population. The test is included in an appendix. CONCLUSION: Health is of major importance for the quality of life. Health-related quality of life needs to be studied in order to evaluate the patients fully and their need for health service as well as its effects.

Psychopathology and alcohol consumption among treatment-seeking alcoholics: a prospective study.

The association between psychopathology and alcohol consumption was studied in a nation-wide representative sample of inpatient alcoholics (n = 245) who were examined at intake and 15 months later. As regards baseline observations men and women with antisocial personality disorder or cognitive impairment had consumed more alcohol in the month prior to admission than those not so affected. In contrast, men with panic disorder drank less compared with those not so affected. The prognosis for men consuming more than the median amount of alcohol was worse than that of women. However, after controlling for psychiatric distress and alcohol consumption at baseline, the prognosis of women was worse. Women but not men who had stopped drinking had a higher degree of psychiatric distress at follow-up compared with those still drinking at a low level. Regarding the prognostic significance of psychiatric disorders at baseline, among men panic disorder predicted continued drinking. Psychiatric distress and alcohol consumption at baseline interacted in the prediction of alcohol consumption at follow-up. The study highlights the importance of a thorough assessment of psychopathology and course of drinking when evaluating the outcome of alcoholism treatment.

Oral contraceptives and risk of breast cancer. A historical prospective case-control study.

BACKGROUND: The goal of this study is to quantify the risk of breast cancer related to use of oral contraceptives while adjusting for known risk factors, e.g. age at first delivery, number of children, and family history, as well as minimising memory bias. METHODS: A historical prospective study design was used. Data collected over a period of 25 years in the screening program of a cancer detection clinic for women aged 25-69 years were utilised. Information on breast cancer among those attending the screening program was searched for in the national cancer registry. Women with breast cancer were matched on date of birth with on average 5.3 control women who were still alive when the diagnosis was made. Mothers and sisters of cases and controls were identified through a national genealogy registry. RESULTS: The odds ratio of developing breast cancer among women with a first degree relative with breast cancer was about 2, but for those ever using oral contraceptives it was 0.92 and even lower (0.50-0.75) if the cancer was diagnosed before the age of 45 years. CONCLUSIONS: Use of oral contraceptives (OC) does not seem to increase the risk of developing breast cancer among women in Iceland.