Female executives are particularly prone to the sleep-disturbing effect of isolated high-strain jobs: a cross-sectional study in German-speaking executives.

This study assessed the main, curvilinear, interactive and gender-dependent effects of job demands, job control and social support in the prediction of sleep quality. Participants were 348 male and 76 female executives and managers from Germany, Austria and Switzerland. A multiple regression controlling for age, occupational hierarchy and various health behaviors was computed. On the level of the main effects of the Job-Demand-Control-Support (JDCS) model, the results indicate a sleep-promoting effect of social support. A significant three-way interaction of job demands, job control and social support was observed. This interaction confirms the buffering effect of high job control and high social support on high job demands. Further, this three-way interaction of the JDCS dimensions is moderated by gender as indicated by a significant four-way interaction. The directions of the significant interactions suggest that female executives are especially prone to react with impaired sleep quality when exposed to isolated high-strain jobs. The study seems to imply that the JDCS model is a suitable framework for the prediction of sleep quality among executives and managers. The results suggest that the JDCS model might contribute to a better understanding of the higher prevalence of poor sleep amongst female executives. Further, the results imply that high job control and high social support might help executives to maintain good sleep quality despite experiencing high job demands.

Risk assessment in diabetes management: how do general practitioners estimate risks due to diabetes?

OBJECTIVES: To evaluate the ability of general practitioners (GPs) in Germany to estimate the risk of patients with diabetes developing complications. METHODS: An interview study using a structured questionnaire to estimate risks of four case vignettes having diabetes-specific complications within the next 10 years, risk reduction and life expectancy potential. A representative random sample of 584 GPs has been drawn, of which 150 could be interviewed. We compared GPs' estimates among each other (intraclass correlation coefficient (ICC) and Cohen's (multirater-) kappa) and with risks for long-term complications generated by the multifactor disease model "Mellibase", which is a knowledge-based support system for medical decision management. RESULTS: The risk estimates by GPs varied widely (ICC 0.21 95% CI (0.13 to 0.36)). The average level of potential risk reduction was between 47% and 70%. Compared with Mellibase values, on average, the GPs overestimated the risk threefold. Mean estimates of potential prolongation of life expectancy were close to 10 years for each patient, whereas the Mellibase calculations ranged from 3 to 10 years. CONCLUSIONS: Overestimation could lead to unnecessary care and waste of resources.

[Metaphor and narrative as instruments for identity development among general practitioners? A qualitative study of a 240-hour course]. / Metapher und Narrativ als Instrumente allgemeinmedizinischer Identitätsbildung? Eine qualitative Studie aus dem 240-Stunden-Kurs.

Focusing on case presentation in GPs' training programmes did not confirm the high expectations of "narrative based medicine" concerning the linguistic categories of 'metaphor' and 'narrative' as central instruments for the promotion of the professional identity of young general practitioners. Quantitative evaluation control showed that traditional Balint-group work was highly estimated throughout the whole course programme against all other items followed by case presentations. These results indicate that integration of the narrative-based approach into Balint group work might be possible, but moreover they suggest the possibility of a narrative-based qualitative evaluation of the training group's interactions and processes, which until now has been used far too seldom.