Liberal fluid fasting: impact on gastric pH and residual volume in healthy children undergoing general anaesthesia for elective surgery.

BACKGROUND: The paediatric preoperative fasting time of 2 h for clear fluids, as suggested by guidelines, is often exceeded. Shorter preoperative fasting has been proposed to avoid potential outcomes such as dehydration, ketoacidosis, reduced arterial blood pressure, and patient discomfort. The aim of this study was to investigate whether liberal clear fluid intake until premedication significantly reduces actual fasting time and impacts gastric pH and residual volume. METHODS: Children (1-16 yr old, ASA I or II) undergoing elective procedures with general anaesthesia requiring tracheal intubation were randomised for clear fluid intake until premedication with midazolam (liberal) or 2 h fluid fasting (standard). Actual fasting times were recorded. Gastric content was sampled after tracheal intubation with an orogastric tube to determine gastric pH and residual volume. Data are presented as median [interquartile range]. RESULTS: We included 162 children aged 1.1-16 yr; gastric pH was determined in 138 patients. Patients' characteristics were similar in the two groups. The liberal fasting group had significantly shorter fasting times (48 [18.5-77.5] vs 234 [223.5-458.5] min; P<0.001). No significant difference was observed regarding gastric pH (1.6 [1.5-1.8] vs 1.6 [1.4-1.7]; P=0.237) or residual volume (0.38 [0.1-1.1] vs 0.43 [0.13-0.73] ml kg-1; P=0.535). Twelve patients (15%) in the liberal group (median fluid fasting 32 min) vs one patient (1%) had gastric residual volumes >2 ml kg-1 (P=0.001). CONCLUSION: Fluid intake until premedication allows for significantly shorter fasting times. Elevated gastric residual volumes may occur more often in patients with fasting times of 30 min or shorter. CLINICAL TRIAL REGISTRATION: NCT02603094.

Gastric pH and residual volume after 1 and 2 h fasting time for clear fluids in children†.

INTRODUCTION: Current guidelines suggest a fasting time of 2 h for clear fluids, which is often exceeded in clinical practice, leading to discomfort, dehydration and stressful anaesthesia induction to patients, especially in the paediatric population. Shorter fluid fasting might be a strategy to improve patient comfort but has not been investigated yet. This prospective clinical trial compares gastric pH and residual volume after 1 vs 2 h of preoperative clear fluid fasting. METHODS: Children (1-16 yr, ASA I or II) undergoing elective procedures in general anaesthesia requiring tracheal intubation were randomized into group A with 60 min or B with 120 min preoperative clear fluid fasting. To determine gastric pH and residual volume, the gastric content was sampled in supine, left and right lateral patient position using an oro-gastric tube after intubation. Data are median (interquartile range) for group A or B (P<0.05). RESULTS: In total, 131 children aged 1.01-16.23 yr were included; gastric pH was determined in 120 cases. Patient characteristic data were similar between the two groups, except for gender (46/33 males in group A/B; P=0.02). Despite significantly shorter fasting times for clear fluids in group A compared with group B (76/136 min; P<0.001), no significant difference was observed regarding gastric pH [1.43 (1.30-1.56)/1.44 (1.29-1.68), P=0.66] or residual volume [0.43 (0.21-0.84)/0.46 (0.19-0.78) ml kg(-1), P=0.47]. CONCLUSION: One hour clear fluid fasting does not alter gastric pH or residual volume significantly compared with 2 h fasting. CLINICAL TRIAL REGISTRATION: The study was approved by the local ethics committee (KEK-ZH-Nr. 2011-0034) and registered with ClinicalTrials.gov (NCT01516775).

[Negative behavioral changes in children and adolescents after anesthesia : Development of a German language version of the Post Hospitalization Behavior Questionnaire]. / Verhaltensauffälligkeiten von Kindern und Jugendlichen nach Narkose : Entwicklung einer deutschsprachigen Version des Post Hospitalization Behavior Questionnaire.

BACKGROUND: Negative behavioral changes after anesthesia in children are common. The Post Hospitalization Behavior Questionnaire (PHBQ) was particularly developed and has been widely used in English-speaking countries to investigate such behavioral changes. The PHBQ consists of 27 questions related to behavioral features observed by parents after anesthesia or hospitalization, each involving comparison with their baseline status. AIM: A comparable diagnostic tool in German should be established. MATERIAL AND METHODS: The PHBQ was translated into German using a well defined back-translation method. A 3-point Likert scale was used to categorize behavioral features as less than, equal to or more than baseline. Overall 600 questionnaires were given out at children's hospital discharge, following surgical or medical procedures or examinations with or without concurrent anesthesia or deep sedation. After questionnaires were returned, factor and item analysis was conducted. Cronbach's alpha was calculated to determine internal consistency as a measure of reliability. RESULTS: In total, 155 returned and completed questionnaires were assessed, with patients' age ranging from 1.1 to 15.9 (median 5.7) years and length of hospitalization between 1 to 15 (median 2.5) days. The German translation of the PHBQ has a factorial structure that is similar to the English version, and its psychometric properties are also similar. After analysis of the main components and consideration of the Scree plot, either 6 or 7 factors were indicated. Analogously to the original version, we chose 6 factors, which explain 58% of variance. Items were not identically assigned to factors as with the original version, and terms used to describe the factors were slightly adapted. Reliability was adequate, with Cronbach's alpha for the 6 factors being between 0.6 and 0.82 (for total scale: Cronbach's alpha = 0.89, compared to 0.82 for the original version). Children younger than 5 years showed more negative behavioral changes than older children. There were no gender differences. CONCLUSION: With the German translation of the PHBQ presented here an instrument is available to detect negative behavioral changes after anesthesia in children among German speaking populations. The translation is comparable to the English version with minor differences concerning its factorial structure, which may be due to the predominant role of anxiety in all items. Like the original, this questionnaire does not per se discriminate between anesthesia and hospitalization induced behavioral changes. However, the German translation of the PHBQ is a questionnaire that is feasible for clinical routine and scientific settings and can be easily and quickly completed by caregivers.

Effect of different quantities of a sugared clear fluid on gastric emptying and residual volume in children: a crossover study using magnetic resonance imaging.

BACKGROUND: Gastric emptying in the first 2 h after 7 ml kg(-1) of sugared clear fluid has recently been investigated in healthy children using magnetic resonance imaging (MRI). This study aims to compare gastric volume and emptying half-life during 1 h after 3 or 7 ml kg(-1) sugared clear fluid intake. METHODS: Fourteen healthy volunteer children aged 11.1 (8.2-12.5) yr were investigated prospectively after administration of 3 and 7 ml kg(-1) diluted raspberry syrup in a randomized order, after overnight fasting (baseline). Gastric content volume (GCV(w)) was assessed with a 1.5 Tesla MRI scanner in a blinded fashion. Data are presented as median (range) and compared using the Wilcoxon test. RESULTS: Baseline GCV(w) was 0.39 (0.04-1.00) and 0.34 (0.07-0.75) before intake of 3 and 7 ml kg(-1) syrup, respectively (P=0.93). GCV(w) was 0.45 (0.04-1.55)/1.33 (0.30-2.60) ml kg(-1) 60 min after ingestion of 3/7 ml kg(-1) syrup (P=0.002). Thus GCV(w) had declined to baseline after 3 ml kg(-1) (P=0.39) but not after 7 ml kg(-1) (P=0.001) within 60 min. T(1/2) was 20 (10-62)/27 (13-43) min (P=0.73) after 3/7 ml kg(-1). CONCLUSION: In healthy volunteer children, residual GCV(w) 1 h after intake of 3 ml kg(-1) syrup is significantly smaller than that after 7 ml kg(-1) and within the range of baseline.

Residual gastric contents volume does not differ following 4 or 6 h fasting after a light breakfast - a magnetic resonance imaging investigation in healthy non-anaesthetised school-age children.

BACKGROUND: While American Society of Anesthesiologists and European Society of Anaesthesiology guidelines recommend 6 h pre-anaesthetic fasting for food and non-clear fluids in children, some institutions allow shorter fasting times of 4 h. Aim of this pilot study was to compare weight-indexed residual gastric contents volumes (GCV(w)) after 4 vs. 6 h after a light breakfast, using magnetic resonance imaging (MRI) in healthy volunteer children not scheduled for anaesthesia. METHODS: Four vs. 6 h (F(4) /F(6)) of food fasting were simulated in a crossover study. After overnight fasting (baseline), each child ingested a light breakfast (cereal flakes, milk products) on two separate days. Additional clear fluid (7 ml/kg raspberry syrup) was given either after 2 (F(4) ) or 4 h (F(6) ), followed by half-hourly MRI acquisition for 2 h. MRI was obtained on a 1.5 Tesla scanner as 5 mm axial images (FIESTA) and volumes were traced manually by one blinded observer. Data are given as median (range) or mean ± standard deviation. RESULTS: Eighteen healthy volunteers aged 9.0 (6.8-12.2) years participated. GCV(w) for F(4) and F(6) at baseline was 0.50 ± 0.27 and 0.76 ± 0.48 ml/kg (P = 0.07), respectively, GCV(w) after 4 and 6 h was 0.72 ± 0.85 and 0.47 ± 0.25 ml/kg (P = 0.88). T(1/2) after syrup intake was 30.8 ± 12.2 and 28.3 ± 5.7 min (P = 0.47) for F(4) and F(6) , respectively. CONCLUSION: Residual gastric contents volumes at a hypothetical anaesthesia start were similar for 4 and 6 h food fasting in healthy volunteer school-age children.

Workplace experience of radiographers: impact of structural and interpersonal interventions.

PURPOSE: Within the framework of organisational development, an assessment of the workplace experience of radiographers (RGs) was conducted. The aims of this study were to develop structural and interpersonal interventions and to prove their effectiveness and feasibility. METHODS: A questionnaire consisting of work-related factors, e.g. time management and communication, and two validated instruments (Workplace Analysis Questionnaire, Effort-Reward Imbalance Scale) was distributed to all RGs (n = 33) at baseline (T1). Interventions were implemented and a follow-up survey (T2) was performed 18 months after the initial assessment. RESULTS: At T1, areas with highest dissatisfaction were communication and time management for ambulant patients (bad/very bad, 57% each). The interventions addressed adaptation of work plans, coaching in developing interpersonal and team leadership skills, and regular team meetings. The follow-up survey (T2) showed significantly improved communication and cooperation within the team and improved qualification opportunities, whereas no significant changes could be identified in time management and in the workplace-related scales 'effort' expended at work and 'reward' received in return for the effort. CONCLUSION: Motivating workplace experience is important for high-level service quality and for attracting well-qualified radiographers to work at a place and to stay in the team for a longer period.

[Attitudes toward older people at the beginning and end of medical students' education]. / Einstellungen zu alten Menschen zu Beginn und am Ende des Medizinstudiums.

In the present study, 188 first year and 120 sixth year students of the University of Zurich were questioned about their attitudes towards older people, their knowledge concerning aging specific developments, their experiences with older people and their own expectations concerning old age. Structured and standardized questionnaires were used. The data were analyzed using univariate and multivariate statistical methods. The results show a positive image of old age independent of gender and point in time of education. Their positive experiences with older people and their positive expectations concern their own aging refer, above all, to their own mental health. For the transfer of gerontological and geriatric knowledge in the education of medical students, these mainly positive attitudes towards older people should be taken into account. Risk factors as well as protective factors concerning the development and treatment of diseases which are characteristic for old age should be pointed out.

[Young physicians' view on factors that increase the attractiveness of general practice]. / Möglichkeiten zur Attraktivitätssteigerung der Hausarztmedizin aus der Sicht junger Arztinnen und Arzte.

PURPOSE: The objectives of this study are to investigate young physicians' career plans at the end of their residency, and to assess what factors contribute in their view to improve the image of family medicine/general practice and make it an attractive career goal. METHODS: As part of a prospective study on career determinants in young physicians, begun in 2001, 534 residents were asked in 2007 about their aspired to professional career, their planned model of private practice, arguments against or for family medicine/general practice, respectively, and factors to improve the attractiveness of the latter. RESULTS: Of the study sample, 84 participants (42% men, 58% women) decided on family medicine (60% specialise in primary care, 40% in general internal medicine), 450 specialise in other medical specialties. Of the 534 study participants, 208 plan to work in a private practice, mostly in a group practice (88%). Of the future family physicians, 49% want to open their practice in an urban area, of the future specialists the respective number is 77%. Main reasons not to decide on family medicine are the uncertain development in health policy and the low income. The diversity of work, the broad spectrum of patients and the continuity in the doctor-patient relationship are named as factors in favour of family medicine. The possibility to run interdisciplinary group practices and better financial conditions are crucial factors to make family medicine an attractive career goal for young physicians. CONCLUSIONS: Family medicine is still assessed as an interesting field, however, the conditions of work as a family physician/general practitioner have a deterrent effect on young physicians.

[How to determine outcomes for clinical studies]. / Was soil ich messen? Bestimmen einer Zielgrösse für klinische Studien.

Outcomes represent an essential part of clinical studies because they direct interpretation. Investigators should agree on outcomes that reflect their research question best. If the focus is on clinical aspects investigators should include patient-important outcomes. On the other hand, if mechanisms in the development or progression of diseases are of interest physiological parameters might be the better choice. Selection of outcomes may impact substantially on the study design and analysis because confounding factors could differ across different outcomes. Finally, existing literature should also be considered in order to select outcomes that were used in previous studies. Thereby, appreciation and summary of the overall evidence is facilitated.

[How to measure patient-important outcomes in clinical studies]. / Wie soil ich messen? Operationalisierung von patienten-orientierten Zielgrössen in klinischen Studien.

Investigators often want to assess patient-important outcomes in clinical studies. They are confronted with the challenging selection of the most appropriate instrument. Instruments should offer an unambiguous and reliable measurement. In addition, there should be evidence from validation studies that they really measure what they intend to measure. Fully standardised questionnaires often fulfil these requirements best and they are amenable to statistical analyses. However it should be ensured that these measurement properties have been verified for the language, in which the questionnaire will be used. There are databases that inform investigators about instruments that have been validated in the respective language.

Waiting for a liver transplant: psychosocial well-being, spirituality, and need for counselling.

UNLABELLED: The number of patients in need of a liver transplant vastly exceeds the number of available organs; the demand worldwide for organs leads to increased waiting times and mortality of patients on the waiting list. The aim of our study was to assess the psychosocial well-being of transplant candidates and their need for psychosocial counselling. METHODS: Sixty-nine liver transplant candidates were asked about their psychosocial well-being, quality of life, spirituality, and need for counselling assessed by interview and questionnaire (HADS-D, FLZ, LOT, SOC, SF-36, SBI-15R) during the initial evaluation procedure for organ transplantation as well as 3 and 6 months after listing. RESULTS: Candidates for a liver transplant exhibited a significant limitation in the levels of their quality of life and psychological well-being, compared with the community normal samples. They showed significantly higher levels of anxiety, but lower levels of spirituality. Almost half of the candidates (47%) expressed a need for counselling during the evaluation procedure. Patients with advanced diseases reported a lower need. Age and the personality-related "Sense of Coherence" correlated negatively with need for counselling. On the waiting list, psychosocial parameters and functions remained largely stable; the need for counselling decreased significantly. CONCLUSIONS: There is a relevant need for psychosocial counselling during the process of liver transplant evaluation. Need for counselling is associated with personality and age, as well as with somatic parameters.

Influence of body core temperature on blood loss and transfusion requirements during off-pump coronary artery bypass grafting: a comparison of 3 warming systems.

BACKGROUND: The aim of this prospective randomized trial was to evaluate the efficacy of 3 intraoperative warming systems (Warm-Touch, Thermamed SmartCare OP system, and Allon 2001) on maintenance of normothermia and to investigate their effects on perioperative bleeding and transfusion requirements in patients undergoing off-pump coronary artery bypass grafting. METHODS: With institutional approval/patient informed consent, 90 patients presenting for elective multiple off-pump coronary artery bypass grafting were randomly assigned to 1 of the 3 warming systems. Active warming was started after the induction of anesthesia. Perioperative transfusion was based on international guidelines. Body core temperature was recorded every 30 minutes during operation. Perioperative blood loss, autotransfusion, and allogenic transfusions were recorded. Analysis of variance was performed with post hoc Scheffé tests and chi 2 tests. RESULTS: Normothermia could be sufficiently maintained during operation by the Allon 2001 only. Final body core temperature was 34.7 degrees C +/- 0.9 degrees C (Warm-Touch), 35.6 degrees C +/- 0.8 degrees C (Thermamed SmartCare OP), and 36.5 degrees C +/- 0.4 degrees C (Allon 2001; P < .001, Warm-Touch vs Thermamed SmartCare OP, Warm-Touch vs Allon 2001, and Thermamed SmartCare OP vs Allon 2001). Perioperative blood loss was 2683 +/- 1049 mL (Warm-Touch), 2300 +/- 788 mL (Thermamed SmartCare OP), and 1497 +/- 497 mL (Allon 2001; P = .195, Warm-Touch vs Thermamed SmartCare OP; P < .001, Warm-Touch vs Allon 2001; P = .001, Thermamed SmartCare OP vs Allon 2001). Transfusion requirements were 1097 +/- 874 mL (Warm-Touch), 986 +/- 744 mL (Thermamed SmartCare OP), and 431 +/- 387 mL (Allon 2001; P = .838, Warm-Touch vs Thermamed SmartCare OP; P = .003, Warm-Touch vs Allon 2001; P = .013, Thermamed SmartCare OP vs Allon 2001). Free of allogenic transfusion were 15 (51.7%; Warm-Touch), 18 (60%; Thermamed SmartCare OP), and 24 (82.8%; Allon 2001) patients ( P = .037). CONCLUSIONS: The goal of normothermia during off-pump coronary artery bypass grafting was best achieved by the Allon system. With this concept, overall blood loss and transfusion requirements were reduced, hence indicating improved quality of perioperative care.

Incidence and prediction of posttraumatic stress disorder symptoms in severely injured accident victims.

OBJECTIVE: This study was designed to assess the incidence of posttraumatic stress disorder (PTSD) in severely injured accident victims and to predict the presence of PTSD symptoms at a 12-month follow-up. METHOD: A longitudinal, 1-year follow-up study was carried out with 106 consecutive patients with severe accidental injuries who were admitted to the trauma surgeons' intensive care unit at a university hospital. Patients were interviewed within 1 month and 12 months after the accident. Assessments included an extensive clinical interview, the Impact of Event Scale, the Clinician-Administered PTSD Scale, the Sense of Coherence questionnaire, and the Freiburg Questionnaire of Coping With Illness. RESULTS: A total of 13.4 days (SD=6.6) after the accident, five patients (4.7%) met all criteria for PTSD with the exception of the time criterion. A total of 22 other patients (20.8%) had subsyndromal PTSD. At the 1-year follow-up, two patients (1.9%) had PTSD, and 13 (12.3%) had subsyndromal PTSD. Multiple regression analysis explained 34% of the variance of PTSD symptoms 12 months after the accident. Biographical risk factors, the sense of a death threat, symptoms of intrusion, and problem-oriented coping each contributed significantly to the predictive model. CONCLUSIONS: In severely injured accident victims who were healthy before experiencing trauma, the incidence of PTSD was low. One-third of the variance of PTSD symptoms at 1-year follow-up could be predicted by mainly psychosocial variables.

Sense of coherence in adolescents.

OBJECTIVES: The course of sense of coherence (SOC) in adolescents over an 18-month-period and the correlation between individual variability in the SOC scale scores and physical and psychological symptoms were examined. METHODS: A sample of 341 students from two Swiss senior high schools were investigated by means of questionnaires three times over a period of 18 months. The questionnaire comprised the SOC scale (SOC-13) and measures of physical and psychological impairment. RESULTS: Male adolescents had a significantly higher SOC mean score than females. Significant negative correlations between the SOC and the symptom scales were found in both genders. Higher symptom scores correlated with a greater variability of the SOC scores. Independent of their sex, individuals with a high SOC score at t1 showed less variability in the SOC values over time than individuals with low SOC scores. In adolescents who revealed low symptom scores the SOC scale scores almost reached levels seen in adults and remained relatively stable over time. CONCLUSIONS: The results suggest a certain degree of stability of SOC in middle to late adolescence.

[Curriculum module for health promotion. Results of a controlled intervention study in 2 high schools]. / Unterrichtsmodule zur Gesundheitsförderung. Ergebnisse einer kontrollierten Interventionsstudie an zwei Gymnasien.

The effects of health-promotion lessons carried out in two senior high schools in the canton of Zurich were investigated in a controlled intervention study. The lessons were developed by teachers and students and integrated into regular school lessons. Of particular interest were effects on school climate, school stress experienced by students and their physical and psychological well-being. Students in the intervention and control schools were assessed with a comprehensive questionnaire three times over a period of 18 months. Health-promotion lessons took place in the intervention school between t1 and t2 (12 month interval). Results showed that participation in a structured research project with repeated assessments led to a critical evaluation of school climate and school stress. At the same time that students were more critically judging the school environment, their physical and psychological problems lessened. Results were the same in both schools, that is, there was no specific intervention effect. Presumably, participation in a prospective study with repeated assessments acted as a sensitisation and mobilisation of resources in adolescents. The study showed the possibilities for health promotion, however it also indicated conflicts between the duty of teaching and psychosomatic prevention strategies.

[Communication competence in ultrasound examination in pregnancy]. / Kommunikative Kompetenz bei der Ultraschalluntersuchung in der Schwangerschaft.

INTRODUCTION: 293 physicians in the German-speaking part of Switzerland were questioned about their practices of providing information during prenatal ultrasound examinations. Physicians were asked both how they provide information about the examination procedure itself as well as how they inform the pregnant woman if a fetal anomaly is detected. METHOD: In January 2000, a questionnaire was mailed to a sample of 500 physicians with a specialized qualification in pregnancy ultrasound examinations. The response rate was 59.2%. RESULTS: 90.1% of the physicians reported that they offer information consultations for routine ultrasound examinations. 50.2% mentioned in their answers to an open question that the screening for fetal anomalies is a component of their consultation. Female physicians mentioned this aspect significantly more often than male physicians. Regarding difficulties in the communication of a diagnosis of fetal malformation, the physicians reported most frequently the excessive strain on the pregnant woman, but also their own feelings of helplessness. The subjective emotional stress was considered as high; female physicians with experience of motherhood reported the highest levels of stress. CONCLUSIONS: Screening for fetal anomalies is a difficult and often neglected subject when providing information on prenatal ultrasound examinations. The communication of the diagnosis of a fetal anomaly is not only emotionally stressful for the parents, but also for the physicians and requires high levels of communication competence. These communication aspects should be considered in the training for ultrasound examinations during pregnancy.

[Sexual medicine cases of treatment--developments 1980 - 1990 - 2004]. / Sexualmedizinische Behandlungsfälle - Entwicklungen 1980 - 1990 - 2004.

Sexual dysfunctions can adversely affect men's and women's satisfaction with life over a prolonged period. Besides sexual medicine services in primary medical care, in Switzerland there exist specialized consultation services at University Hospitals. The assessment of the case histories of three years (1980, 1990, and 2004) of the Sexual Medicine Consultation Service at Zurich University Hospital provided the following results: the most common disorders are lack/loss of libido in women and erectile dysfunction in men. Treatment options for sexual disorders have become more differentiated in recent years. The collaboration between the doctors making the referral and the sexual medicine specialists improved markedly between 1980 and 2004. After a diagnostic assessment and a primary treatment in the specialized consultation service, many patients are referred back to the referring doctors for further treatment. Basic and further training in sexual medicine ought to be intensified and improved.

[Work stress, health and satisfaction of life in young doctors. Results of a longitudinal study in Switzerland]. / Arbeitsstress, Gesundheit und Lebenszufriedenheit junger Arztinnen und Arzte. Ergebnisse einer Schweizer Longitudinalstudie.

BACKGROUND AND OBJECTIVES: Based on the Effort-Reward-Imbalance Model by Siegrist a study was undertaken to find out (a) in what way young doctors assess effort and reward during their specialist training; (b) whether there are certain job stress patterns over time; and (c) what the correlations are, if any, between perceived job stress, health and satisfaction with life. METHODS: Within the framework of a prospective study (2001 - 2007) 370 doctors who had just qualified and were residents in the German-speaking part of Switzerland were assessed four times by means of anonymized questionnaires. Job stress, measured by the Effort-Reward-Imbalance scale, as well as health and satisfaction with life were assessed in these doctors' 2nd (T2), 4th (T3), and 6th (T4) year of specialist training ("residents"). Stress patterns of the participants were evaluated, based on the effort and reward scale values at T2, T3, and T4, by two-step cluster analysis. Gender differences between the clusters were calculated by the 2 test and differences in the continuous variables by analysis of variance with repeated measurements. RESULTS: During residency the percentage of doctors who experienced an Effort-Reward-Imbalance (ratio between effort and reward ERI > 1) increased from 18% at T2 to 20 % at T3 to 25 % at T4. The cluster analysis revealed two clusters: Type 1 (67%) with effort values below average and reward values above average (ER balance) across the three measurement points, and type 2 (33 %) with effort values above average and reward values below average (ER imbalance). Subjects in cluster 2 showed unfavorable values, when compared with those in cluster 1, in overcommitment, in workload and in the health variables (anxiety, depression, physical and psychological well-being), as well as in their assessed satisfaction with life at all three measurement points. CONCLUSIONS: One third of the doctors experienced stress at work, caused by an effort-reward imbalance. This had a negative impact on their health and satisfaction with life. Regular supervision and goal-oriented career counselling provided by senior physicians could contribute to young doctors not feeling so much stressed at work, feeling well and being more content with their work.

[Sexual medicine in primary care--development in the years 1980-1990-2004]. / Sexualmedizin in der ärztlichen Grundversorgung: Entwicklungen 1980-1990-2004.

Sexual disorders are common in community samples. Even so these problems are not often addressed by primary care physicians. In 1980, 1990, and 2004 three cohorts of primary care physicians in the German speaking part of Switzerland were asked to answer a questionnaire on the prevalence of sexual problems and disorders in their patients and their knowledge in sexual medicine. The prevalence of sexual disorders in primary care is underestimated by primary care physicians. Female doctors and female patients address sexual problems more often than male doctors and patients. Lack of sexual interest and erectile dysfunction are the most frequent sexual disorders in primary care. In 2004 the participating doctors assess their knowledge in sexual medicine at a higher level compared to 1980. The training of primary care physicians in primary care should further be improved.

How does psychological processing relate to compliance behaviour after lung transplantation? A content analytical study.

Non-compliance is one of the crucial problems impairing outcome after transplantation. Fourteen lung transplant recipients were interviewed about their thoughts regarding transplant-related topics. Compliance was assessed by doctors. The psychological processing was investigated by content analysis. Highly compliant patients perceived more advantages by transplantation. In contrast, low-compliant patients reported either an emotional distance to the lung or a closer relationship to the donor. Furthermore, they showed a contradictory relationship to the medical staff. There are some indications that perception of advantages by transplantation is crucial to compliance. This experience takes place in the context of a good staff-patient relationship. Emotional distance to the lung or nearness to the donor are further contributing factors of non-compliance.