Factors Identified with Higher Levels of Career Satisfaction of Physicians in Andalusia, Spain.

The satisfaction of physicians is a worldwide issue linked with the quality of health services; their satisfaction needs to be studied from a multi-dimensional perspective, considering lower- and higher-order needs. The objectives of this study were to: i) measure the career satisfaction of physicians; ii) identify differences in the dimensions of career satisfaction; and iii) test factors that affect higher- and lower-order needs of satisfaction among physicians working in Andalusian hospitals (Spain). Forty-one percent of 299 eligible physicians participated in a study conducted in six selected hospitals. Physicians reported higher professional, inherent, and performance satisfaction than personal satisfaction. Foreign physicians reported higher levels of personal and performance satisfaction than local physicians, and those who received non-monetary incentives had higher professional and performance satisfaction. In conclusion, physicians in the selected Andalusian hospitals reported low levels of personal satisfaction. Non-monetary incentives were more relevant to influence their career satisfaction. Further investigations are recommended to study differences in the career satisfaction between foreign and local physicians.

Fracture risk prediction in outpatients from Krakow Region using FRAX tool versus fracture risk in 11-year follow-up.

INTRODUCTION: FRAX is a an algorithm accepted by WHO for evaluating fragility fracture risk of women aged 40 years or more. The aim of this study was to use the FRAX tool to verify the risk of fractures in a population of women from the Cracow region in an 11-year follow-up. MATERIALS AND METHODS: The study was a retrospective cohort survey evaluating the incidence of fragility fractures over 11 years of follow-up. 5,092 women aged 50 years and more were randomly chosen from a group of 100,000 female patients of the Cracow Medical Centre who came to the Centre for densitometric examination between 1997 and 2001. Finally, 1024 patients were randomized into the study. After an average of 11 years a follow-up telephone survey was conducted among a randomly selected group of patients using a questionnaire corresponding to the one applied in the first survey. 10-year fracture risk was calculated for each patient using FRAX based on the BMI (Body Mass Index) and for 886 women using FRAX based on BMD (Bone Mineral Density) at the femoral neck. The Polish version of FRAX was validated by comparing the predicted risk with the actual incidence of fractures during the 11-year follow-up. RESULTS: The 10-year probability of a major osteoporotic fracture calculated using FRAX based on BMI for the entire group was 5.3% (median, 1st/3rd quartile: 3.5-8.5%) and the probability of a proximal femur (hip) fracture was 1.3% (median, 1st-3rd quartile: 0.7% -2.4%). In 886 women whose BMD T-score at the femoral neck was available, the mean probability of a major osteoporotic fracture was 4.9% (3.3-7.9%) and of a hip fracture 0.9% (0.3-2.3%). The actual absolute fracture risk calculated on the basis of the number of patients who had experienced a fracture during the follow-up was surprisingly much higher than the predicted figure. The risk of a major fracture in the study group was 17.7% and of a proximal femur fracture, 3%. CONCLUSION: In our opinion, FRAX is a very good screening tool, but not a precise diagnostic tool.

Cytotoxicity of Aspergillus fungi isolated from hospital environment.

The majority of mycotoxins produced by Aspergillus fungi are immunosuppressive agents, and their cytotoxicity may impair defense mechanisms in humans. The objective of the study was evaluation of the cytotoxicity of fungi isolated from an environment where inpatients with impaired immunity were present. The materials comprised 57 fungal strains: Aspergillus fumigatus, Aspergillus niger: Aspergillus ochraceus, Aspergillus flavus, Aspergillus versicolor and Aspergillus ustus isolated from hospital rooms in Cracow. The cytotoxicity of all the strains was evaluated using the MTT test (3-(4,5-dimethylthiazol-2-yl) 2,5 diphenyltetrazolium bromide). To emphasize the differences in cytotoxicity among the particular strains, variance analysis (ANOVA) and Tukey's difference test were used. Out of 57 Aspergillus strains tested, 48 (84%) turned out to be cytotoxic. The cytyotoxicity was high (+++) in 21 strains, mainly in A. fumigatus. The least cytotoxic were A. niger fungi, this being statistically significant (p<0,05). To protect a patient from the adverse effects of mycotoxins, not only his or her immunity status should be evaluated but also the presence of fungi in hospital environment and their cytotoxicity should be monitored (possible exposure).

Perception of palliative care and euthanasia among recently graduated and experienced nurses.

Palliative care and euthanasia have become the subject of ethical and political debate in Poland. However, the voice of nurses is rarely heard. The aim of this study is to explore the perception of palliative care and euthanasia among recent university bachelor degree graduates and experienced nurses in Poland. Specific objectives include: self-assessment of the understanding of these terms, recognition of clinical cases, potential acceptability of euthanasia, and an evaluation of attitudes towards palliative care and euthanasia. This is an exploratory study. A convenience sample of 206 recent graduates and 252 experienced nurse practitioners were interviewed. A structured questionnaire was used for collecting and interpreting data. Subjective perception of the terms ;palliative care' and ;euthanasia' was high and consistent with the recognition of clinical cases. The majority of the nurses excluded euthanasia from palliative care. They recognized personal philosophy of life as the most influential factor affecting attitudes towards euthanasia. The importance of the law was valued more highly by the experienced nurses.

Body mass, depressive symptoms and menopausal status: an examination of the "Jolly Fat" hypothesis.

PURPOSE: Estrogens are linked with depression due to their ability to alter the function of the serotonin neural systems. We hypothesize that postmenopausal women should have a higher degree of depressive symptoms than premenopausal women. Further, because estrogen levels in postmenopausal women positively correlate with body fat, we hypothesize that there is an inverse relationship between body fat and depressive symptoms among postmenopausal women. METHODS: We enrolled 1156 Polish urban women aged 45 to 64 in a cross-sectional study. Depressive symptoms were assessed by the Center for Epidemiologic Studies-Depression Scale (CES-D) scale. Menopausal status and education level was assessed by a standardized questionnaire. MAIN FINDINGS: Postmenopausal women had higher mean CES-D scores of depressive symptoms than premenopausal women (14.4 versus 13.2 respectively, p = .018). Both among pre- and postmenopausal women, those with higher education had lower scores of depressive symptoms. In addition, in postmenopausal women with lower education an inverse relationship was observed between body mass index (BMI) and depressive symptoms: a higher BMI was associated with a lower score of depressive symptoms (p = .009). Such a relationship was not present among premenopausal women or women who were postmenopausal but better educated. CONCLUSIONS: This study indicates that menopausal status is related to differences in the degree of occurrence of depressive symptoms. Our results support the "Jolly Fat" hypothesis for postmenopausal women with lower education, namely, a higher BMI is associated with lower score of depressive symptoms.

[Influence of health education on the occurrence of risk factors for coronary heart disease]. / Wplyw edukacji zdrowotnej na wystepowanie czynników ryzyka choroby niedokrwiennej serca.

Despite many prophylactic activities, coronary heart disease (CHD) remains the main health problem in Poland and the most common cause of death among men. Risk factors related to life style are the target for the modification of prophylaxis. The main task of health education is to develop the skills and knowledge affecting the future behavior and habits of healthy lifestyle. The aim of this project was to assess the influence of health education on the occurrence of CHD risk factors among healthy young men. Sixty four men (31 submitted to education and physical training group and 33 to the control group) up to 50 years of age, without recognized cardiovascular diseases were selected for the study. At the beginning the presence of risk factors was recorded in each participant. The education (6 weeks) and training program (25 weeks) was conducted and it was finally evaluated after six months by comparing experimental versus control groups. The background data showed that 95% of men had at least one risk factor, the mean number of risk factors in average participant was 8.8, minimum 2 and maximum 17, there was no difference between the experimental and control groups. The educational program limited amount of risk factors in the experimental group (p<0.0001). Positive changes concerned physical activities (p=2E-09), knowledge (p=0.01) and stress management (p<0.05).

[Psychometric value of CES-D scale for the assessment of depression in Polish population]. / Wartosc pomiarowa skali CES-D do oceny depresji w populacji polskiej.

AIM: The assessment of usefulness of the CES-D scale in the Polish population was studied. METHOD: 50 patients with depression and 150 healthy men and women selected from the general population were examined. In a group of depressed patients the results of the CES-D scale were compared with the Beck scale. The best CES-D cut-off score was defined. Sensitivity and specificity of the CES-D scale in the relation to clinical diagnosis of depression for healthy men and women and depression patients were calculated. Further factor analysis was done and the results were compared with results previously published for North American populations. RESULTS: High reliability of the CES-D scale (Cronbach's alpha coefficient = 0.92), significant correlation (r = 0.79) and moderate agreement (Kappa Cohen coefficient = 0.44) with the Beck scale was reported. It seems that CES-D cut-off score of 16 is adequate for diagnosis of depression. Sensitivity and specificity of the CES-D scale in the relation to clinical diagnosis of depression were respectively 86% and 77%. CONCLUSIONS: Therefore it is well suitable for detecting depression in the Polish population and its results are similar to those obtained for North American populations.