N Magnavita

Health determinants and survival in nursing home residents in Europe: Results from the SHELTER study

OBJECTIVE The care processes directed towards institutionalized older people needs to be tailored on goals and priorities that are relevant for this specific population. The aim of the present study was (a) to describe the distribution of selected health determinants in a sample of institutionalized older adults, and (b) to investigate the impact on survival of such measures. DESIGN Multicentre longitudinal cohort-study. SETTING 57 nursing homes (NH) in 7EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non-EU country (Israel). PARTICIPANTS 3036 NH residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) study. MEASUREMENTS We described the distribution of 8 health determinants (smoking habit, alcohol use, body mass index [BMI], physical activity, social participation, family visits, vaccination, and preventive visits) and their impact on 1-year mortality. RESULTS During the one-year follow up, 611 (20%) participants died. Overweight (HR 0.79; 95% C.I. 0.64-0.97) and obesity (HR 0.64; 95% C.I. 0.48-0.87) resulted associated with lower mortality then normal weight. Similarly, physical activity (HR 0.67; 95% C.I. 0.54-0.83), social activities (HR 0.63; 95% C.I. 0.51-0.78), influenza vaccination (HR 0.66; 95% C.I. 0.55-0.80) and pneumococcal vaccination (HR 0.76 95% C.I. 0.63-0.93) were associated with lower mortality. Conversely, underweight (HR 1.28; 95% C.I. 1.03-1.60) and frequent family visits (HR 1.75; 95% C.I. 1.27-2.42) were associated with higher mortality. CONCLUSIONS Health determinants in older NH residents depart from those usually accounted for in younger and fitter populations. Ad hoc studies are warranted in order to describe other relevant aspects of health in frail older adults, with special attention on those institutionalized, with the ultimate goal of improving the quality of care and life.

Health promotion for older people in Portugal

In a country like Portugal where life expectancy is very high, Health Promotion for Older People (HP4OP) is a relevant issue and specific strategies are considered within priority health programmes defined at the national level by the Directorate-General of Health on behalf of the Ministry of Health. The National Health Plan 2016–2020 includes directives to facilitate health promotion and access to health and social services, as well as to reduce the burden of chronic diseases. HP4OP funds and resources derive mainly from the Ministry of Health and also from the Ministry of Labour, Solidarity and Social Security. Moreover, institutions can access European and other funds to develop projects in this field and some municipalities also finance projects and initiatives. Health plans, strategies and programmes outlined at the national level are adopted by Regional Health Administrations and the Groups of Health Centres guide implementation at the local level through dedicated units that work within the primary health care context. The integration of both social and health actions in terms of HP4OP depends on collaboration between the Ministry of Health; the Ministry of Labour, Solidarity and Social Security; municipalities; institutions in the cooperative and social sector and other stakeholders such as families, educational institutions, religious communities and health professionals. As a whole, health promotion policies for the older people in Portugal tackle the social determinants of health too. Nevertheless, a systematic approach and an integrated strategy to tackle HP4OP might constitute an important condition for the full implementation of such policies. Additionally, fragmentation of initiatives at the regional and local levels, together with other barriers to addressing health promotion activities among health professionals, might lead to the non-homogeneous implementation of interventions of HP4OP throughout the country. It is expected that many of these constraints will be overcome with the launch and implementation of the intersectoral National Strategy for the Promotion of Active Ageing from 2017.

Healthy ageing – happy ageing: Health Promotion for Older People in Italy

Health Promotion for Older People (HP4OP) is a relevant issue in Italy, one of the countries where people live the longest. Strategies, programmes and projects are set and planned at the national level, mainly by the Ministry of Health within the National Health Service, but strong competencies, funds and resources derive also from the Government, the Ministry of Labour and Social Policies and the Ministry of Internal Affairs. Moreover, European funds contribute to programmes and projects in this field. After strategic implementation at the regional level, programmes and projects are carried out at the local level under the National Health Service, mainly by the Local Health Authorities in conjunction with municipalities and other relevant stakeholders such as NGOs, the voluntary sector, families and educational and religious entities, etc. Even though Italy has been engaged in HP4OP to improve active life expectancy since 1992, a lack of planning and resources for HP4OP, policy diversification at the regional level and a prevailing interest in care-assistance rather than health promotion and prevention have prevented consistent implementation of HP4OP throughout the country.

La soddisfazione professionale per i radiologi

PurposeThis study sought to evaluate professional satisfaction among Italian radiologists and identify what personal characteristics of radiologists and features of their work and work setting affect job satisfaction.Materials and methodsSatisfaction was assessed by using Warr et al.’s 17-item Job Satisfaction Scale (JSS) in 206 radiologists, 108 radiotherapists and 34 specialists in infectious diseases used as controls.ResultsForty-nine per cent of diagnostic radiologists reported being satisfied with their jobs. The frequency is significantly lower than that found among radiotherapists (64%) and controls (62%). Middle-aged radiologists on lower rungs of the career ladder were more dissatisfied than were their older colleagues in top positions. Female radiologists were less satisfied than their male counterparts with regard to recognition for good work, amount of job variety and distribution of workloads. Stepwise logistic regression analysis showed that job satisfaction was especially affected by physical working conditions, freedom to choose one’s own work method, relationship with one’s immediate boss, attention paid to one’s suggestions and the amount of job variety.ConclusionsThis pilot study identified the sources of professional satisfaction and dissatisfaction among radiologists. A future survey of a stratified random sample of Italian radiologists appears to be feasible.RiassuntoObiettivoScopo di questo studio è stato valutare la soddisfazione professionale dei radiologi e accertare quali caratteristiche dei radiologi, della loro attività e dell’ambiente di lavoro influiscono sulla soddisfazione.Materiali e metodiLa soddisfazione è stata valutata mediante il questionario Job Satisfaction Scale (JSS) di Warr et al., sottoponendolo a 206 radiologi, 108 radioterapisti e 34 infettivologi, questi ultimi usati come controlli.RisultatiIl 49% dei radiodiagnosti è soddisfatto del proprio lavoro. Tale frequenza è significativamente più bassa di quella dei radioterapisti (64%) e dei controlli. I radiologi di mezza età e quelli in posizione gerarchica inferiore sono meno soddisfatti di quelli più anziani e apicali. Le donne radiologo sono meno soddisfatte degli uomini per quanto riguarda i riconoscimenti per il lavoro ben fatto, la varietà del lavoro, la distribuzione dei carichi di lavoro. Mediante analisi logistica stepwise si è osservato che la soddisfazione complessiva è associata principalmente con le caratteristiche fisiche dell’ambiente di lavoro, la libertà di scegliere da sé il proprio metodo di lavoro, le relazioni con il superiore, l’attenzione prestata ai propri suggerimenti, la varietà del lavoro.ConclusioniQuesto studio-pilota identifica le cause di soddisfazione ed insoddisfazione dei radiologi. Appare realizzabile una indagine trasversale a campione multistratificato.

II fenomeno dello stress da malpractice nei radiologi e radioterapisti. Percezione del problema e conseguenze

PurposeRadiology is among the specialties with an increasing risk of litigation. Regardless of the outcome of legal proceedings, physicians who are sued usually perceive the claim as an assault on their integrity and may suffer psychological or physical effects known as “malpractice stress syndrome”.Materials and methodsTwo hundred and six radiologists and 108 radiotherapists responded to a questionnaire containing specific items concerning their perception of malpractice stress and their opinions about the causes of clinical errors, as well as an assessment of work satisfaction and general health.ResultsOne third of physicians had been sued for malpractice. Age was significantly related to the occurrence of malpractice litigation. Radiological errors were purportedly related to occupational discomfort, and the latter variable was significantly associated with work dissatisfaction and a low level of psychological and physical well-being.ConclusionsRadiologists are well acquainted with medical malpractice and its causes; however, they have limited familiarity with clinical risk management practices and often ignore procedures of informed consent. A targeted educational effort is required to overcome these shortcomings.RiassuntoObiettivoLe denunce contro i radiologi per responsabilità civile e penale sono in continuo aumento. Indipendentemente dall’esito del processo, il medico coinvolto può andare incontro ad una serie di disturbi psicofisici che vanno sotto il nome di “stress da malpractice”. Abbiamo inteso indagare le opinioni dei radiologi sul fenomeno della malpractice medica e le esperienze di coloro che sono stati denunciati per malpractice.Materiali e metodiUn questionario relativo alle cause dell’errore e della malpractice ed alle sue conseguenze è stato sottoposto a 206 radiologi e 108 radioterapisti, nel corso di due congressi delle rispettive specialità.RisultatiMentre l’occorrenza di denunce per presunta malpractice si correla con l’età dello specialista, la frequenza degli errori sarebbe associata ad un insieme di fattori di disagio lavorativo, che a loro volta si correlano con una scarsa soddisfazione dal lavoro e un ridotto benessere psicofisico.ConclusioniI radiologi hanno una buona conoscenza del fenomeno della cosiddetta malpractice medica e della cause che contribuiscono ad enfatizzarlo, così come delle condizioni lavorative che causano stress da lavoro, insoddisfazione e aumento degli errori; mostrano però una insufficiente padronanza delle tecniche di clinical risk management e della dottrina del consenso informato. Per colmare tale tipo di carenza è necessario uno sforzo educativo particolare.