High prevalence of burnout syndrome in Czech general practitioners: A cross-sectional survey.

Objective: A wide range in prevalence rates of burnout among general practitioners (GPs) has been reported in various regions, with an increasing trend. This nationwide cross-sectional study aimed to estimate the prevalence and associated determinants of burnout in Czech GPs. Methods: 1000 randomly selected physicians from the Czech Society of General Practitioners (through a pseudorandom number generator) were emailed an online survey based on the Maslach Burnout Inventory - Human Services Survey. Data collection was performed between January and February 2023. Results: 331 questionnaires were obtained (227 females and 104 males, mean age - 49.9 years, the mean number of registered patients - 1951). 21.8 % of GPs scored a high level of burnout in all three of its dimensions and 23.9 % in no dimension at all. The most prevalent dimension was reduced personal accomplishment (PA, 56.2 %) followed by emotional exhaustion (EE, 50.2 %) and depersonalization (DP, 40.5 %). Reaching burnout in all three dimensions was significantly more frequent in males and in GPs registering a number of patients above the median. Increasing age and years of practice were protective factors for DP but risk factors for reduced PA. Employed GPs had lower EE scores than GP practice owners. The respondents' basic characteristics reflected their presence among Czech GPs, which testifies against selection bias. Conclusions: The high rate of burnout (∼22 %) should be addressed by promoting personal resources along with the perception of the importance of GPs in society. A sufficiently dense network of GPs should allow them to register a lower number of patients.

Evaluation of potential aging biomarkers in healthy individuals: telomerase, AGEs, GDF11/15, sirtuin 1, NAD+, NLRP3, DNA/RNA damage, and klotho.

Aging is a natural process of gradual decrease in physical and mental capacity. Biological age (accumulation of changes and damage) and chronological age (years lived) may differ. Biological age reflects the risk of various types of disease and death from any cause. We selected potential biomarkers of aging - telomerase, AGEs, GDF11 and 15 (growth differentiation factor 11/15), sirtuin 1, NAD+ (nicotinamide adenine dinucleotide), inflammasome NLRP3, DNA/RNA damage, and klotho to investigate changes in their levels depending on age and sex. We included 169 healthy volunteers and divided them into groups according to age (under 35; 35-50; over 50) and sex (male, female; male and female under 35; 35-50, over 50). Markers were analyzed using commercial ELISA kits. We found differences in values depending on age and gender. GDF15 increased with age (under 30 and 35-50 p < 0.002; 35-50 and over 50; p < 0.001; under 35 and over 50; p < 0.001) as well as GDF11 (35-50 and over 50; p < 0.03; under 35 and over 50; p < 0.02), AGEs (under 30 and 35-50; p < 0.005), NLRP3 (under 35 over 50; p < 0.03), sirtuin 1 (35-50 and over 50; p < 0.0001; under 35 and over 50; p < 0.004). AGEs and GDF11 differed between males and females. Correlations were identified between individual markers, markers and age, and markers and sex. Markers that reflect the progression of biological aging vary with age (GDF15, GDF11, AGEs, NLRP3, sirtuin) and sex (AGEs, GDF11). Their levels could be used in clinical practice, determining biological age, risk of age-related diseases and death of all-causes, and initiating or contraindicating a therapy in the elderly based on the patient's health status.

How General Practitioners and Their Patients Adhere to Osteoporosis Management: A Follow-Up Survey among Czech General Practitioners.

Introduction: General practitioners (GPs) are key participants in osteoporosis (OP) management. The aim was to evaluate their adherence to lege artis management of the disease, potential barriers, and to discuss differences observed in comparison with the baseline survey carried out in 2007; the focus was on secondary prevention. Methods: On behalf of two professional associations, 2-round postal survey among randomly selected GPs (>1/4 of all Czech GPs) was performed in 2014. The questionnaire covered areas concerning GP's role in the fight against OP, knowledge about OP, management of OP-related fractures, barriers to the management of OP, system- and patient-related in particular, and availability and use of information sources. Results: The overall questionnaire return rate was 37% (551 respondents); mean age of the respondents was 53 year (37% men). The GP's role in the treatment of OP was rated as essential in 28 and 37% of men and women, respectively (P = 0.012). The guideline for diagnosis and treatment of OP for GPs was considered accessible by 92% of respondents. As much as 60% of the respondents were adherent to the guideline, i.e., used it repeatedly. The knowledge of several risk factors was very good, however, recommended daily intake of calcium was stated correctly by only 41% of respondents, and daily intake of vitamin D by only 40%. Three quarters reported active steps after a fracture: referral to a specialist, life-style recommendations, prescription of calcium/vitamin D supplements. Half of the respondents focus on fall prevention. System-related barriers, such as lack of possibility to prescribe selected drugs (61%) and financial limits set by health insurance company (44%) were most frequently reported. Patient-related barriers were also common, patient's non-adherence (reported by 29%) and patient's reluctance to go to a specialist (18%). Conclusion: GPs adhered to OP management more than in 2007. Knowledge of risk factors and involvement in post-fracture care was relatively high. Compared to baseline survey, patient-related barriers, patient non-adherence in particular, were more common. Prescribing conditions are still an important issue. Among GPs, education should be focused on calcium and vitamin D intake, doses, sources, and supplements.

Prescription of evidence-based medicine drugs by general practitioners to patients after myocardial infarction: outcomes from the Czech Republic.

Ischemic heart disease is the most frequent cause of both serious morbidity and mortality of adult population in developed countries. The main aim of the study was to carry out the analysis of general practitioners (GP) prescription of evidence-based therapy in patients after myocardial infarction (MI). Data were retrospectively collected in 2011, by a single application with the help of software that GPs use in their surgeries. All patients of a particular GP who had MI in their history and who were at the time of data collection treated only by GPs (not by the specialists of internal medicine or cardiology) were always included. Four hundred ninety one patients were included in the study. The average age was 70.7 (+/- 11.6) and 69.2% of the involved patients were men. Seventy nine percent of patients used beta-blockers, 80% antiplatelet drugs, 77% statins and 79% used angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs). Forty four percent of patients used drugs from all four groups. The significant prescription decrease was proved in all four groups in dependence on patients' age (p < 0.05). Although the evidence-based medicine usage in patients after MI in the Czech Republic is comparable to other countries, it is not optimal. More intensive involvement of pharmacists in the care of patients after MI would further improve the situation.

Osteoporosis risk assessment and management in primary care: focus on quantity and quality.

INTRODUCTION AND HYPOTHESIS: Early identification of high-risk patients by general practitioners (GPs) plays the key role in the management of osteoporosis (OP). METHODS: We conducted a postal questionnaire survey among 1500 Czech GPs to examine their behaviour related to OP. RESULTS: The overall questionnaire return rate was 38%. The respondents (mean age 52 years; 61.5% women) did not differ from non-respondents. OP knowledge correlated negatively with age (P<0.001). The most common reason for both suspicion of OP and referral for suspected OP is the patient's complaints. When the initial skeletal examination for suspected OP is conducted on the GP's initiative, it is most often X-ray (76%) followed by osteodensitometry (61%). The respondents address five patients (median) per month about this issue. The number of referrals to a specialist for suspected OP during the last quarter was 5 (median). The most commonly reported barriers to OP management were financial limits set by the health insurance agency (71%) and lack of authorization to prescribe selected drugs (71%). CONCLUSIONS: The GPs should pay greater attention to risk factors and be more active in the detection of at-risk patients. It is necessary to motivate the GPs and to overcome the barriers to effective clinical practice.

Perspectives of family medicine in Central and Eastern Europe.

INTRODUCTION: In the last decade of the 20th century, the countries of Central and Eastern Europe (CEE) have experienced rapid changes in health policies. This process was largely supported by international grants. After this support has ended, it is important to keep up with the development, developing its own strategies and priorities. Aims and methods. The aim of the paper is to make a proposal for the future development of the discipline in CEE countries. The proposal is based on reports on an invitational conference that was organized for the key representatives of family medicine from CEE countries. For the purpose of this paper, additional information about the situation was gathered from literature reviews, country visits and personal interviews. RESULTS: Information shows that although family medicine has been formally recognized and introduced in university curricula, there is a very big difference in its academic position. Postgraduate training has been established in all CEE countries, according to the European Directive. Quality measures such as the development and implementation of guidelines and the re-certification procedure have also been formally introduced, but its quality varies. The key areas of concern are atomization of practices, unsatisfactory payment systems, lack of academic infrastructure and unsatisfactory continuous professional development. On the other hand, examples of good practice exist and need to be promoted. CONCLUSION: There is a need for continuous exchange of expertise within the countries. The paper will serve as a discussion paper for the next meeting of experts from CEE countries.