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.

[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.

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.