Confidentiality as a barrier to support seeking among physicians: the influence of psychosocial work factors in four European hospitals (the HOUPE study).

BACKGROUND: Concerns about protecting patient's privacy can interfere with proper stress adaptation which is associated with physician's health. It is important to investigate relevant organizational confounders to this phenomenon to enable interventions that can ameliorate the subjective burden of patient confidentiality. OBJECTIVES: This study investigates factors in the psychosocial work environment that can explain patient confidentiality's prominence in social support seeking among physicians, and if these factors covary differently with support seeking according to country. PARTICIPANTS: University hospital physicians in four European cities (N=2095) in Sweden, Norway, Iceland and Italy participated in a cross-sectional survey. METHODS: Questionnaire comprised items on psychosocial work environment, basic socio-demographics, presence of formal and informal meetings at work, and measurement of confidentiality as a barrier for support. RESULTS: High role conflict, availability of formal or informal meetings, lack of control over decisions, and lack of control over work pace were predictors of confidentiality as a barrier to support. There were differences between countries in how these factors covaried with confidentiality as a barrier to support. High role conflict was the strongest predictor of confidentiality as a barrier to support across all samples. CONCLUSIONS: Psychosocial work factors predicted confidentiality as a barrier to support seeking among physicians. It is important to create routines and an organizational framework that ensures both the patient's right to privacy and physician's ability to cope with emotional demanding situations from work.

Associations between confidentiality requirements, support seeking and burnout among university hospital physicians in Norway, Sweden, Iceland and Italy (the HOUPE study).

Concerns about protecting patient's privacy are experienced as a limitation in the opportunity to obtain and utilize social support by many physicians. As resources of social support can modify the process of burnout, patient confidentiality may increase risk of this syndrome by interfering with proper stress adaptation. This study investigates if experiencing limitations in seeking social support due to confidentiality concerns are associated with burnout. University hospital physicians in four European countries completed measures of burnout, (Index) of Confidentiality as a Barrier for Support (ICBS), and factors of social resources and job demands. Linear regression analysis showed that ICBS was significantly associated with the burnout dimension of Exhaustion and not with Disengagement. These findings were present when controlling for factors known to diminish or increase the likelihood of burnout. These results are the first to demonstrate that patient confidentiality is associated with burnout in the process of stress management among physicians.

Assessing survival in widowers, and controls - a nationwide, six- to nine-year follow-up.

BACKGROUND: The aim of this study was to assess if widowers had an increased mortality rate during the first 6 to 9 years after the death of their wife, compared initially to an age-matched control group and also compared to the general population of Iceland. METHODS: The study base was comprised of all 371 men born in 1924-1969 who were widowed in Iceland in 1999-2001 and 357 controls, married men, who were matched by age and residence.The widowers and controls were followed through the years 2002-2007 using information from Statistics Iceland. Mortality rates were compared between the groups and also with the general population. The mortality rate comparisons were: study group vs. control group, on the one hand, and study group vs. general population on the other. Causes of death were also compared between widowers and their wives. RESULTS: A statistically significant increase in mortality in the widowers' group, compared to controls, was observed.Lifestyle-related factors could not be excluded as contributing to cause of death in these cases. CONCLUSIONS: Being a widower was related to an increased risk of death for at least 9 years after the death of their wife.

Autonomy and well-being among Nordic male and female hospital physicians.

OBJECTIVE: The aim of this study is to analyze the level of autonomy of Nordic hospital physicians, to examine whether there is a noticeable gender difference, and to evaluate the relation between autonomy and the well-being of these professionals. PARTICIPANTS: This quantitative study is based on 1697 questionnaires that were filled out by hospital physicians in Sweden, Norway and Iceland. METHODS: The quantitative data are analysed statistically. Student's independent sample T-test is used to identify significant gender differences between the means of the variables autonomy and well-being. The Chi-Square test of independence is used to obtain information on the relation between autonomy and the well-being of male and female physicians. RESULTS: Nordic male physicians enjoy significantly more autonomy than their female colleagues but the average level of autonomy is not very high for either of the genders. Autonomy turns out to have a significant positive effect on the well-being of both male and female hospital physicians, but the effect is stronger among women. CONCLUSION: Even though the recent economical crisis makes cutbacks in the health care system necessary, it is important to avoid drastic reorganizations which are aimed at improved efficiency, but threaten the autonomy and well-being of hospital physicians.

Confidentiality and physicians' health. A cross-sectional study of University Hospital Physicians in four European cities (the HOUPE-study).

OBJECTIVE: To investigate how the subjective burden of confidentiality can act as a stressor that affects physicians' psychological health and wellbeing. METHOD: Cross-sectional survey data from a sample of university hospital physicians (N=1,956) in four European countries (Sweden, Norway, Iceland and Italy) who participated in the HOUPE (Health and Organization among University hospital Physicians in Europe) study was analysed. RESULTS: About 25% of the participants reported that confidentiality impedes emotional support to a considerable degree. An index of confidentiality as a barrier to seeking support (ICBS) had a negative effect on physicians' health and wellbeing. The effect of ICBS was confirmed and slightly increased when controlled for variables known to buffer the adverse mental and physical effects of stress. Though the physicians in Iceland and in Norway found confidentiality the most challenging, it was the physicians in Italy and Sweden who showed a significant effect of ICBS on their health and wellbeing. CONCLUSIONS: Whether confidentiality is a stressor in its own right or an amplifier of stressful situations in medical practice should be further investigated to gain a better understanding of the effect of confidentiality on physicians' coping, stress and health. In addition, there is a need to investigate how physicians can balance coping with the inevitable emotional demands of medical practice and maintaining the ethics of confidentiality in a way that protects both patients' privacy rights and physicians' health and wellbeing.

[Smoking, obesity and education of Icelandic women by rural-urban residence]. / Reykingar, holdafar og menntun kvenna í borg og bae.

OBJECTIVE: To assess the prevalence of obesity and the association with smoking and education among young Icelandic women residing within and outside the capital area. MATERIALS AND METHODS: A self-administered questionnaire was sent to 28.000 Icelandic women, 18-45 years-old, in the period November 2004 to June 2005. The sample was randomly selected from The National Registry, response rate being 54.6%. The study was part of a large Nordic population-based cross-sectional study. Logistic regression was used for assessing the odds ratio of obesity (BMI > or = 30) in a multivariate analysis according to smoking and education, taking also into account age and alcohol consumption. The chi-square test was used for comparing percentages. RESULTS: Thirteen percent of women residing in the capital area were obese compared with 21% outside the capital. In the multivariate analysis obesity was increased among women living outside the capital (OR = 1.66; 95% CI 1,50-1,83), among smokers (OR=1,13; 95% CI 1.01-1.28), and among women who did not have university education (OR=1.53; 95%CI 1.36-1.71). Daily smokers within the capital area were more likely to be obese (OR=1.27; 95%CI 1.07-1.49) but not smokers outside the capital (OR=1.0). . CONCLUSIONS: Residence outside the capital area, daily smoking and non-university education are associated with an increased risk of obesity among young Icelandic women. The relationship between these factors is complex and differs between women residing within and outside the capital area.