Search

The objectives of the present study are to investigate and compare the relative impact of workplace-related factors and personal characteristics on chronic psychosocial stress experience in young physicians. In a prospective study, a cohort of Swiss medical school graduates was followed up, beginning in 2001. In their fourth and eighth year after graduation, 443 physicians assessed their workplace conditions, the experienced effort–reward imbalance, the received professional and emotional support as well as their personal characteristics. The chronic stress experience was measured by the Trier Inventory for the Assessment of Chronic Stress–Screening Subscale of Chronic Stress (TICS–SCSS), 7 years after graduation. The model of influencing factors on chronic stress experience was tested with a hierarchical regression analysis. The mean in chronic stress (TICS–SCSS) in our study sample is significantly higher ( p < 0.001) compared to an age-matched population representative sample. In the prediction of chronic stress, the workplace-related factor effort–reward imbalance as well as the personal characteristic overcommitment turned out to be the most important risk factors. Stress protective are high satisfaction with career support, sense of coherence and occupational self-efficacy. The whole set of variables used in the regression model explains 51% of the variance of chronic stress experience. In the prediction of chronic stress, gender has no significant moderator effect. It is a matter of concern that young physicians report to feel chronically stressed early in their professional career. Actions have to be taken to reduce the stress level mainly in regard to re-establish reciprocity between perceived effort invested and rewards received, in the form of esteem, monetary gain and career opportunities including job security. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Kaolin-based activated clotting time assessed by HEMOCHRON (HkACT) is a clinical standard for heparin monitoring alone and combined with aprotinin during cardiopulmonary bypass (CPB). However, aprotinin is known to prolong not only celite-based but also kaolin-based activated clotting time. Overestimation of activated clotting times implies a potential hazardous risk of subtherapeutic heparin anticoagulation. Recently, a novel ‘aprotinin-insensitive’ activated clotting time test has been developed for the SONOCLOT analyzer (SaiACT). The aim of our study was to evaluate SaiACT in patients undergoing CPB in presence of heparin and aprotinin. Methods: Blood samples were taken from 44 elective cardiac surgery patients at the following measurement time points: baseline (T0); before CPB after heparinization (T1 and T2); on CPB, before administration of aprotinin (T3); 15, 30, and 60min on CPB after administration of aprotinin (T4, T5, and T6); after protamine infusion (T7). On each measurement time point, activated clotting time was assessed with HkACT and SaiACT, both in duplicate. Furthermore, the rate of factor Xa inhibition and antithrombin concentration were measured. Statistical analysis was done using Bland and Altman analysis, Pearson''s correlation, and ANOVA with post hoc Bonferroni–Dunn correction. Results: Monitoring anticoagulation with SaiACT showed reliable readings. Compared to the established HkACT, SaiACT values were lower at all measurement time points. On CPB but before administration of aprotinin (T3), SaiACT values (mean±SD) were 44±118s lower compared to HkACT. However, the difference between the two measurement techniques increased significantly on CPB after aprotinin administration (T4–T6; 89±152s, P = 0.032). Correlation of ACT measurements with anti-Xa activity was unchanged for SaiACT before and after aprotinin administration (r 2 =0.473 and 0.487, respectively; P =0.794), but was lower for HkACT after aprotinin administration (r 2 =0.481 and 0.361, respectively; P =0.041). On CPB after administration of aprotinin, 96% of all ACT values were classified as therapeutic by HkACT, but only 86% of all values were classified therapeutic if ACT was determined by SaiACT. Test variability was comparable for SaiACT and HkACT. Conclusions: The use of SaiACT may result in more consistent heparin management that is less affected by aprotinin and a corresponding increase in heparin administration for patients receiving aprotinin. [Copyright &y& Elsevier]

Rather little is known about how psychosocial evaluations for living kidney donation (LKD) are performed. We aimed to explore whether Swiss transplant centers (STCs) vary regarding the rate of living kidney donors refused for psychosocial reasons, the psychosocial evaluation process, and the characteristics of the donors., Methods: We investigated 310 consecutive candidates for LKD in 4 of 6 existing STC during mandatory psychosocial evaluations. We registered (i) sociodemographic data, (ii) the type of the decision-making process regarding LKD (ie, snap decision, postponed, deliberate, other), (iii) the evaluator's perception of the donor's emotional bonding and his/her conflicts with the recipient, (iv) the donor's prognosis from a psychosocial perspective, (v) time taken for the psychosocial evaluation, and (vi) its result (eligible, eligible with additional requirements, not eligible)., Results: Centers had comparable proportions of noneligible donors (2.9%-6.0%) but differed significantly in the percentage of donors accepted with additional requirements (3.4%-66%, P  < 0.001). Significant differences emerged between centers regarding the time needed for evaluation (75-160 min [interquartile range (IQR) 75-180 min] per single exploration, P  < 0.001), the perception of the donor's emotional bonding (visual analogue scale [VAS] 8-9 [IQR 6-10], P  < 0.001), his/her conflicts with the recipient (VAS 1.5-2 [IQR 0-3], P  = 0.006), the donor's psychosocial prognosis (VAS 8-9 [IQR 7-10], P  < 0.001), and the type of decision concerning LKD (59%-82% with snap decision "yes," P  = 0.008). However, despite differences in the psychosocial evaluation process, the rates of patients accepted for transplantation (eligible and eligible with additional requirements versus noneligible) were comparable across STC ( P  = 0.72)., Conclusions: Our results emphasize that it is more important to establish clear guidelines to identify potential psychosocial risks than to stringently standardize the procedure for psychosocial evaluation of living kidney donors., Competing Interests: IQR, interquartile range; VAS, visual analogue scale (for emotional relationship: 0 = not attached to 10 = closely attached; for conflict: 0 = no conflict to 10 = conflicts; for prognosis: 0 = not good to 10 = very good).The authors of this manuscript declare no conflicts of interest as described by Transplantation DIRECT., (Copyright © 2022 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)

Introduction: Delirium has been recognised as an underdiagnosed and undermanaged syndrome with substantial prevalence rates and potentially deleterious consequences in the medically ill population. Despite its frequent administration in the management of delirium, the effectiveness of pipamperone has not yet been evaluated., Methods: In this retrospective, descriptive cohort study of 192 patients, pipamperone as monotherapy and as an adjunct to haloperidol, haloperidol alone, or atypical antipsychotics were compared with respect to their effectiveness in the management of delirium and its subtypes over the course of 20 days., Results: In this elderly patient population, pipamperone alone and as an adjunct to haloperidol was as effective as haloperidol or atypical antipsychotics in the management of delirium. Management with low-dose pipamperone monotherapy achieved delirium resolution in 70% of patients, over a mean of 6.4 (2-20) days. With pipamperone as an adjunct to haloperidol, delirium resolved in 59% of patients, over a mean of 7.4 (2-20) days. When haloperidol or atypical antipsychotics (risperidone, olanzapine or quetiapine) were used, the delirium resolution rates were 72 and 67%, over a mean of 5.2 (2-11) and 6.4 (2-20) days, respectively. The addition of pipamperone to haloperidol decreased the requirement for lorazepam. Pipamperone proved to be equally effective in all delirium subtypes - hypoactive, hyperactive and mixed. Nonetheless, potential bias could not be excluded in this observational design., Conclusion: From these initial results, low-dose pipamperone was as effective as haloperidol or atypical antipsychotics in the management of delirium and its subtypes, and was benzodiazepine-sparing when used as an adjunct to haloperidol.

Background and Objectives: Lung transplantation is a complex medical treatment, and for patients with end-stage lung diseases it is often the last therapeutic option available for survival. However, lung transplantation poses not only a physical but also a psychological challenge for patients. The aim of this study was to gain a deeper understanding of patients' individual concerns related to their lung transplantation within the first 6 months post-transplant., Methods: Forty lung transplant patients were interviewed at three different measurement timepoints post-transplant (T1: 2 weeks; T2: 3 months; and T3: 6 months) using semi-structured interviews to address their thoughts, feelings, and attitudes with respect to the transplantation process, their new lungs, and their medication. Interviews were analyzed by means of qualitative content analysis., Results: "Physical complaints", "fear of organ rejection", "side effects of medication", and "restrictions in everyday life" were the most frequently named concerns within the first 6 months post-transplant. Most themes remained unchanged over time, whereas mentions of restrictions in everyday life increased significantly over the three assessments., Conclusions: Although the majority of the patients experienced considerable improvements in physical health after transplantation, they simultaneously reported that they were suffering from physical complaints, fear of organ rejection and infections, medication adverse effects, and restrictions in everyday life. For patients, lung transplantation therefore often means replacing one disease with another. Healthcare providers are challenged to support patients in dealing with this unresolvable dilemma.

Background: Lung transplantation (LTx) aims to reduce physical disability and mental distress, extend survival, and improve health-related quality of life (HRQoL). In this systematic review we aimed to: (1) augment evidence regarding measures to assess HRQoL and psychological outcomes after LTx; and (2) summarize HRQoL and psychological outcomes after LTx., Methods: Validated and standardized instruments with well-known psychometric properties used for assessing HRQoL and psychological outcomes after LTx were identified by means of comprehensive literature searches of PsychINFO and Medline/PubMed, up through March 2014, using the following search terms in various combinations: lung transplantation; physical functioning; symptom experience; mental health; anxiety; depression; distress; social functioning; life satisfaction; and health-related quality of life., Results: The search strategy identified 371 titles and abstracts. Of these, 279 were retrieved for further assessment and 63 articles selected for final review. Thirty-nine studies were found for HRQoL, 15 for physical functioning, 5 for mental health and 4 for social functioning. A total of 50 psychometric instruments were encountered., Conclusions: Considerable heterogeneity exists in methodology, operational concepts and applied outcome measures in the existing literature on HRQoL and psychological outcomes after LTx. Nevertheless, the studies generally point to significant improvements in both mental health and HRQoL post-transplant. Further research is warranted utilizing consistent outcome measures, including LTx-specific measures and longitudinal study designs., (Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Questions Under Study: To (1) assess distinct clusters of psychological distress and health-related quality of life during the first 6 months following lung transplantation; (2) identify patients with poor psychosocial outcomes; and (3) determine potential predictors regarding psychological distress and health-related quality (HRQoL) of life at 6 months post-transplant., Methods: A total of 40 patients were examined for psychological distress (Symptom Checklist short version-9) and quality of life (EuroQOL five-dimension health-related quality of life questionnaire) during their first 6 months post-transplant. Hierarchical cluster analyses were performed to identify specific types of post-transplant outcomes in terms of psychological distress and HRQoL over the first six post-transplant months. Correlational analyses examined medical and psychosocial predictors of the outcome at 6 months post-transplant., Results: Three distinctive clusters were identified, summarizing either groups of patients with (1) optimal (35%), (2) good (42%), and (3) poor outcome-clusters (23%). The latter tended to be older, to suffer from more severe disease, to have more co-morbidities, to have had a prolonged intensive care unit and/or hospital stay, to have more hospital admissions and were more frequently treated with antidepressants post-transplant. Disease severity, length of stay, quality of life two weeks post-transplant, hospital admissions and use of antidepressants were strong predictors of psychological distress and impaired health-related quality of life at six months of follow-up., Conclusion: Almost a quarter of the investigated patients suffered from elevated distress and substantially impaired HRQoL, with no improvements over time. Results underscore the psychosocial needs of patients with poor post-transplant outcomes.

Purpose: The aim of this article is to examine the mutual associations between patients' and partners' depression and quality of life (QOL) in couples facing cancer with respect to potential resources (sense of coherence and relationship quality (RQ)) and stressors (physical complaints)., Patients and Methods: Questionnaires rating depression, QOL, sense of coherence, RQ, and physical complaints were completed by 207 couples facing different cancer types and stages. Multiple regression models were used to assess the mutual associations between patient and partner variables., Results: In female patients, 40.7% of the variance in depression score was explained by male partners' stressors and resources, whereas only 3.5% of the variance in male patients' depression was explained by female partners' stressors and resources. In male and female partners, respectively, the patients' stressors and resources explained 34.9% versus just 15.8% of the variance in depression. Regarding QOL in female patients, 30.1% of the variance was explained by the partners' stressors and resources, versus only 3.7% in male patients. Meanwhile, in male and female partners, respectively, the patients' stressors and resources explained 25.6% and 12.9% of the variance in QOL., Conclusions: These findings support a couples-centered approach to psycho-oncological counseling and treatment. Particularly in depressed couples with low RQ, couples therapy or counseling should be considered because of the mutual adverse association between depression and QOL in these couples., (Copyright © 2014 John Wiley & Sons, Ltd.)

Objectives: The aim of the study was to determine if Sonoclot with its sensitive glass bead-activated, viscoelastic test can predict postoperative bleeding in patients undergoing cardiac surgery at predefined time points., Design: A prospective, observational clinical study., Setting: A teaching hospital, single center., Participants: Consecutive patients undergoing cardiac surgery (N = 300)., Interventions: Besides routine laboratory coagulation studies and heparin management with standard (kaolin) activated clotting time, additional native blood samples were analyzed on a Sonoclot using glass bead-activated tests. Glass bead-activated clotting time, clot rate, and platelet function were recorded immediately before anesthesia induction and at the end of surgery after heparin reversal but before chest closure., Measurements and Main Results: Primary outcome was postoperative blood loss (chest tube drainage at 4, 8, and 12 hours postoperatively). Secondary outcome parameters were transfusion requirements, need for surgical re-exploration, time of mechanical ventilation, length of intensive care unit and hospital stay, and hospital morbidity and mortality. Patients were categorized into "bleeders" and "nonbleeders." Patient characteristics, operations, preoperative standard laboratory parameters, and procedural times were comparable between bleeders and nonbleeders except for sex and age. Bleeders had higher rates of transfusions, surgical re-explorations, and complications. Only glass bead measurements by Sonoclot after heparin reversal before chest closure but not preoperatively were predictive for increased postoperative bleeding., Conclusions: Sonoclot with its glass bead-activated tests may predict the risk for postoperative bleeding in patients undergoing cardiac surgery at the end of surgery after heparin reversal but before chest closure., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Trichotillomania (TTM) is characterized by recurrent hair-pulling that results in substantial hair loss. A previous pilot study demonstrated that the online self-help intervention 'decoupling' (DC) might be effective at reducing hair-pulling symptoms, with a stronger effect than progressive muscle relaxation (PMR). We aimed to extend these findings using a more robust randomized clinical trial design, including diagnostic interviews by phone, a 6-month follow-up and e-mail support., Methods: One hundred five adults with TTM were recruited online and randomly allocated to either DC (n = 55) or PMR (n = 50). The intervention lasted 4 weeks, with severity of TTM assessed at 3 time points (before intervention, immediately after intervention and at the 6-month follow-up) using the Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS). Both intention-to-treat and completer analyses were conducted., Results: Intention-to-treat analysis demonstrated highly significant and comparable symptom reductions (MGH-HPS) in both the DC and PMR groups (p < 0.001, partial x03B7;2 = 0.31) that persisted through 6 months of follow-up. Participants' subjective appraisals favoured DC in some areas (e.g. greater satisfaction with DC than PMR). Completer analyses demonstrated the same pattern as the intention-to-treat analyses., Conclusions: Despite subjective appraisals in favour of DC, symptom reduction was comparable in the two groups. While the results suggest that even short Internet-based interventions like DC and PMR potentially help individuals with TTM, a partial effect of unspecific factors, like regression towards the mean, cannot be ruled out. Therefore, longitudinal studies with non-treated controls are warranted., (© 2015 S. Karger AG, Basel.)

Questions Under Study: A transplant represents a decisive event for patients and their caregivers. This article deals with the attitudes patients and their spouses have towards the transplantation., Methods: In a cross-sectional study, 121 patients and their spouses were surveyed by questionnaire after a heart, lung, liver or kidney transplant. Attitudes were assessed by means of semantic differentials. Based on the results, an 'Attitudes towards Transplantation' Scale was developed. Sense of coherence (SOC-13), quality of life (Sf-36), quality of the relationship (RAS), burnout (BM) and the patient's emotional response to the transplant (TxEQ-D) were additional psychosocial variables measured in order to assess the association between the attitudes and psychosocial characteristics of transplant patients and their spouses., Results: The majority of patients and their spouses reported positive attitudes towards the transplant, including the attitudes towards medication, their perceived self and fate of being a transplant patient or spouse. Patients and spouses, however, had a negative attitude towards the transplantation in terms of stress and anxiety. Patients reported greater emotional stress from the transplant and rated their post-transplant perceived fate more negatively than their spouses. Attitudes towards the transplant were significantly associated with the sense of coherence and the quality of relationship., Conclusion: The attitudes of patients and spouses to different aspects of the transplant itself and to being a transplant patient or spouse should be deliberately reconsidered and facilitated in the psychosocial counselling with regard to the comprehensibility, manageability and meaningfulness of the transplant experience as well as to potential conflicts in the partnership.

Objectives: Medication non-adherence is a common problem in organ transplantation patients with severe consequences for the patients' health. This study aimed at examining the determinants of intention formation and adherence behavior based on the Theory of Planned Behavior (TPB). Moreover, to account for the role of patients' partners, provided social support by partners was included. Here, support provided by female partners was hypothesized to be more effective than support provided by male partners., Method: This cross-sectional study comprised 121 heart, liver, lung, and kidney transplant recipients (n=81 men; mean age=54.32, SD=13.32) and their partners (mean age=51.99, SD=13.67). Patients completed a questionnaire with TPB variables and a validated measure of self-reported adherence. Partners reported their provided social support with regard to medication adherence of the patients., Results: For the prediction of intention to adhere to medication, the non-significant main effect of provided social support was qualified by partners' gender: Support provided by women was positively related to patients' intention to adhere, whereas support provided by men was slightly negatively related to the intention to adhere in their female spouses. Intentions in turn emerged together with relationship quality as the most important predictor of adherence behavior., Conclusion: The beneficial effects of support provided by women could be replicated within the framework of the TPB in the context of organ transplantation. Interventions should focus on increasing the effectiveness of support provision of male partners and on promoting relationship quality., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: The objectives of the study were to investigate the gender-related development of life satisfaction in young physicians over an 8-year period of residency, to compare it with a representative sample, and to analyze the relationships between both person- and health-related factors and life satisfaction., Methods: A prospective study was carried out including five measurement points among a cohort of 337 Swiss physicians. Measurements include domain-specific life satisfaction (FLZ(M)), sense of coherence (SOC-13), anxiety and depression (HADS-D), chronic stress (TICS) and socio-demographic variables. Data were analyzed with multivariate procedures., Results: Life satisfaction in physicians of both genders is lower compared to a representative sample. Over the 8-year period of residency, the course of life satisfaction seems to be rather unstable and domain-specific. Female physicians are more satisfied with life than their male counterparts. Depressive symptoms and stress experience are highly negatively associated with life satisfaction in multivariate analysis., Conclusions: To study the development of life satisfaction over time, it is more appropriate to use a domain-specific life satisfaction questionnaire than a total score. Furthermore, it is a matter of concern that--compared to a representative sample--physicians in residency show lower life satisfaction at all measurement points. Depressive symptoms and chronic stress are found to diminish life satisfaction. This could keep some physicians from staying in the medical profession. Senior physicians should be aware of the negative impact of chronic stress on life satisfaction.

Background and Objectives: The study is concerned with family physicians in the transition phase from residency to practice. Factors relating to the decision to take up a career in family medicine rather than a different medical career are investigated. Further, incentives and disincentives for starting a family practice as well as factors influencing the decision about practice location and practice model are addressed., Methods: In a prospective cohort study on physicians' career development, 88 family physicians and 437 physicians aspiring to a different medical career participated in a questionnaire survey on the reasons for their choice of specialty and career, their mentoring support, and their work-life balance aspirations. Quantitative and qualitative data were analyzed using hierarchical logistic regression and content analysis, respectively., Conclusions: Family physician tutors should actively approach trainees in medical school and residency, pointing out the advantages of family medicine in terms of continuity of patient contact and the wide range of illnesses and patients, as well as the prospect of a work-life balance tailored to personal needs. Unlike other countries, Switzerland started its structured residency-training programs only recently.

Questions Under Study: To date, there are hardly any studies on the choice of career path in medical school graduates. The present study aimed to investigate what career paths can be identified in the course of postgraduate training of physicians; what factors have an influence on the choice of a career path; and in what way the career paths are correlated with career-related factors as well as with work-life balance aspirations., Methods: The data reported originates from five questionnaire surveys of the prospective SwissMedCareer Study, beginning in 2001 (T1, last year of medical school). The study sample consisted of 358 physicians (197 females, 55%; 161 males, 45%) participating at each assessment from T2 (2003, first year of residency) to T5 (2009, seventh year of residency), answering the question: What career do you aspire to have? Furthermore, personal characteristics, chosen specialty, career motivation, mentoring experience, work-life balance as well as workload, career success and career satisfaction were assessed. Career paths were analysed with cluster analysis, and differences between clusters analysed with multivariate methods., Results: The cluster analysis revealed four career clusters which discriminated distinctly between each other: (1) career in practice, (2) hospital career, (3) academic career, and (4) changing career goal. From T3 (third year of residency) to T5, respondents in Cluster 1-3 were rather stable in terms of their career path aspirations, while those assigned to Cluster 4 showed a high fluctuation in their career plans. Physicians in Cluster 1 showed high values in extraprofessional concerns and often consider part-time work. Cluster 2 and 3 were characterised by high instrumentality, intrinsic and extrinsic career motivation, career orientation and high career success. No cluster differences were seen in career satisfaction. In Cluster 1 and 4, females were overrepresented., Conclusion: Trainees should be supported to stay on the career path that best suits his/her personal and professional profile. Attention should be paid to the subgroup of physicians in Cluster 4 switching from one to another career goal in the course of their postgraduate training.

Question Under Study: The present study aimed to compare the prevalence of work-life conflicts and the health status of physicians, with a representative sample of university graduates as well as with a representative sample of the general Swiss working population. Furthermore, it aimed to analyse whether work-life conflicts correlate with the health of physicians, as it does in the general working population., Methods: The present cross-sectional study analysed data from 2007 originating from the SwissMedCareer Study (a prospective cohort study of physicians who graduated in 2001; n = 543) and the Swiss Household Panel (a representative Swiss survey on living and working conditions; university graduates of the same age range: n = 172, general working population of the same age range: n = 670). Data were analysed with Chi2 tests, correlations and logistic regressions., Results: Physicians reported strong time-based as well as strain-based work-life conflicts more frequently than university graduates and the general working population. Significantly more physicians reported "moderate" to "very poor" health than the other two samples. Surprisingly, on the other side of the scale ("very good" health), physicians outnumbered the other samples too. Strong associations between work-life conflict and self-rated health as well as various health complaints were found for physicians., Conclusion: The high prevalence of work-life conflicts may explain the comparably high prevalence of poor self-rated health in the physicians' sample.

Questions Under Study: In recent years, distress and alexithymia have been recognised as psychosocial factors related to both somatic and psychosomatic diseases. In this study distress and alexithymia and their associations with physical parameters were investigated in lung recipients., Methods: The study, which included 76 patients after a lung transplant, measured psychological distress (Symptom Checklist, SCL-K-9) and alexithymia (Toronto Alexithymia Scale, TAS-20). Physical health was assessed by means of lung function (FEV1), exhaled nitric oxide (eNO), and comorbidity (CCI) at the time of the questionnaire survey. A bronchiolitis obliterans syndrome (BOS) was assessed at the time of the questionnaire survey and one year later., Results: Mean values of distress were found to be significantly higher in lung recipients than in a normal community sample, and mean values of alexithymia were significantly higher in lung patients than in healthy persons. There is a significant positive correlation between distress and BOS at the time of the questionnaire survey (p = .008). Distress is a predictor for new-onset BOS one year after the questionnaire survey (p = .026). No significant correlations were found between alexithymia and physical parameters., Conclusions: Lung transplants go hand-in-hand with increased alexithymia and psychological distress. In addition, psychological distress may contribute to the development of BOS. This association underlines the importance of psychosocial support after lung transplantation.

Objectives: The communication with patients who have undergoned transplantation is greatly influenced by their subjective experience. This paper deals with this subjective transplant-specific experience six months after surgery., Methods: Following their heart, lung, liver, or kidney transplantation, 120 patients were questioned concerning their experiences regarding the transplantation, the organ itself, and changes in their personal life. Their statements were investigated by qualitative content analysis., Results: Generally, the statements concerning the transplantation were positive. Interpersonal contact with the medical staff and or family members was perceived as very helpful. Two-thirds of the patients spoke openly about their organ. For the most part, their statements about changes in their personal life were positive, expressed in the sense of personal growth. Fears and insecurities occurred as negative changes., Conclusions: On the whole, the majority of the patients expressed positive experiences regarding their transplantation. Interpersonal and supportive relationships played a significant role.

Objectives: The study investigates the development of anxiety and depression during residents' postgraduate training as well as the symptom patterns and the prediction of these patterns of impaired affectivity by personality factors. It furthermore regards the differences between these patterns in workplace- and career-related factors as well as in worklife balance., Methods: In a prospective cohort study (2001-2007), 390 junior physicians of various specialties (54.9% females, 45.1% males) were investigated with respect to the percentage of participants with elevated anxiety and depression scores at the beginning of the second, fourth, and sixth year of residency, respectively. Symptom patterns were evaluated by two-step cluster analysis. The prediction of the assignment to the symptom patterns was investigated by logistic regression analysis. The differences in further factors between the two patterns was analyzed by t-tests., Results: In the second year of residency, relevant anxiety symptoms were found in 30% of the physicians, and in the fourth and sixth year in 20%; relevant depression symptoms were found in 15% and 10%, respectively. The cluster analysis revealed two symptom patterns: Type A (n = 135, 34.6%) with continuously elevated anxiety and depression symptoms; and type B (n = 255, 65.4%) with continuously low values. Personality factors such as the sense of coherence, self-esteem, occupational self-efficacy expectation, and overcommitment significantly predicted the assignment to the symptom patterns. Also in terms of workload, mentoring experience, career satisfaction, and worklife balance, persons of type A differ from those of type B., Conclusion: Personality factors play an important role in physicians' ability to cope with job demands. Persons with an elevated vulnerability for anxiety and depression should be continuously supported and counselled by a mentor during residency.

Principles: Various non-specific questionnaires were used to measure quality of life and psychological wellbeing of patients after organ transplantation. At present cross-organ studies dealing specifically with the psychological response to a transplanted organ are non-existent in German-speaking countries., Methods: The Transplant Effects Questionnaire TxEQ-D and the SF-36 Quality of Life Questionnaire were used to examine the psychological response and quality of life of 370 patients after heart, lung, liver or kidney transplantation. The organ groups were compared with regard to psychosocial parameters., Results: 72% of patients develop a feeling of responsibility for the received organ and its function. This feeling is even stronger towards the patient's key relationships i.e. family, friends, the treatment team and the donor. 11.6% worry about the transplanted organ. Heart and lung patients report significantly fewer concerns than liver and kidney patients. Overall, only a minority of patients report feelings of guilt towards the donor (2.7%), problems in disclosing their transplant to others (2.4%), or difficulties in complying with medical orders (3.5%). Lung transplant patients show significantly better adherence., Conclusions: A feeling of responsibility towards those one is close to and towards the donor is a common psychological phenomenon after transplantation of an organ. Conscious feelings of guilt and shame are harboured by only a minority of patients. The fact that heart and lung patients worry less about their transplant might have primarily to do with the greater medical and psychosocial support in this group.

Questions Under Study: The present study aimed to investigate the differences between future family physicians, and physicians aspiring to other medical specialities, in terms of sociodemographic factors and variables concerning personality factors, career motivation, career success, importance of life goals and work-life balance; further, the stability in career choice of family physicians from medical school through to residency was evaluated., Methods: Data reported are from four assessments of the Swiss physicians' longitudinal career development study, begun in 2001 (T1). At T4, in 2007, 543 residents (76% of the initial sample at T1) completed a questionnaire concerning their personal and professional goals. The difference between family physicians and specialists was studied by multivariate analyses of covariance adjusted for gender., Results: Of the study sample, 84 (17%) decided on family medicine, 66% of them as early as medical school or at the beginning of residency. Compared to specialists, more family physicians are married and more have children. Their intrinsic and extrinsic career motivation is lower, their extraprofessional concerns are greater and they rate their objective and subjective career success lower. The favoured models of work-family and work-life balance respectively are part-time oriented., Conclusion: Future family physicians, both females and males, are less career-oriented. The results suggest that the waning reputation of family medicine and the uncertain development of this medical discipline in the Swiss healthcare system attract less career-oriented applicants. A well-balanced integration of professional and private life is an essential goal for the new generation of doctors; this applies even more to female doctors and family physicians. Considering this trend, the question arises whether the current number of medical school graduates is sufficient to ensure the population's healthcare provision in the future.

Objectives: The aim of this study was to compare the following approaches to assess left ventricular preload by transesophageal echocardiography (TEE): left ventricular end-diastolic volume index (LVEDVI) determined by using the method of disc summation (LVEDVI(Md)) and left ventricular end-diastolic area index (LVEDAI) were compared with LVEDVI assessed by the modified Simpson formula (LVEDVI(Si)). Global end-diastolic volume index (GEDVI) and stroke volume index (SVI) measured by the PiCCO(plus) system (Pulsion Medical Systems, Munich, Germany) were used as TEE-independent reference variables., Design: Prospective observational study., Setting: Community hospital., Participants: Twenty-two patients undergoing elective cardiac surgery., Interventions: After the induction of anesthesia, hemodynamic assessment by TEE and the PiCCO(plus) system was made 20 (T(1)) and 10 minutes (T(2)) before and 10 (T(3)) and 20 minutes (T(4)) after a fluid trial. At each time point, LVEDVI(Md), LVEDAI, LVEDVI(Si), GEDVI, and SVI were determined., Measurements and Main Results: The fluid trial resulted in a significant increase of all preload variables measured at T(3). At T(4), all preload variables but LVEDVI(Md) showed a significant decrease. The mean bias +/- 2 SD for percent changes (Delta) of LVEDVI(Md) - DeltaLVEDVI(Si) was 1.5% +/- 59.0% and for DeltaLVEDAI - Delta LVEDVI(Si) 0.9% +/- 23.6%. The correlation between LVEDVI(Md) and LVEDVI(Si) was significantly weaker than between LVEDAI and LVEDVI(Si) (p < 0.001). Comparing TEE measurements with GEDVI and SVI, strong correlations were observed for LVEDAI and LVEDVI(Si) only., Conclusion: The method of disc summation cannot be recommended for preload assessment during a fluid challenge in cardiac surgery patients. By contrast, single-plane area measurements provided reliable information when compared with the application of the modified Simpson formula.

Objectives: The study investigates in what way physicians integrate their desire to have children into their career planning., Methods: Within the framework of a prospective cohort study of Swiss medical school graduates on career development of young physicians, beginning in 2001, 534 participants (285 women, 249 men) were assessed in January 2007, in terms of having children, planning to have children, the career aspired to and the work-family balance used or planned., Results: Among the study participants, 19% (54) of the women and 24% (59) of the men have children. Of the others 88% plan to start a family in the future. Female physicians with children are less advanced in their careers than women without children; for male physicians no such difference can be observed. Of the female physicians with children or the desire for children 42% aspire to work in a practice, 28% to a clinical and only 4% to an academic career. Of the male physicians with children or the desire for children one third aspire to work in a practice, one third to a clinical and 14% to an academic career. The preferred model of work repartition of female physicians with children is father full time/mother part time or both parents part time; the preferred model of male physicians is father full time/mother part time or not working., Conclusion: Children are an important factor in the career and life planning of physicians, female physicians paying more attention to an even work-family balance than male physicians., (Copyright 2008 S. Karger AG, Basel.)

Objectives: The present study investigates a) whether the German version of the Transplant Effects Questionnaire (TxEQ-D), which measures the emotional response to an organ transplantation, has the same factorial structure as the English original version and b) whether the psychometric properties as well as the correlations with the scales of the SF-36 are comparable., Methods: The questionnaire TxEQ was translated into German and filled out by 370 heart, lunge, liver and kidney transplant patients. Subsequently, factor and item analyses were conducted. The SF-36 was used to test validity., Results: The TxEQ-D has the same factorial structure as the English version as well as comparable psychometric properties. The TxEQ-D factor "worry about transplant" shows the highest correlations with the 10 scales of the SF-36, the lowest correlations with the 10 scales of the SF-36 scales are found for the factor "adherence"., Conclusions: The TxEQ-D is a useful screening instrument in psychosomatic research and in the psychotherapy practice to detect patients with problematic emotional responses to an organ transplantation.

Objective: Psychosocial aspects have been investigated in transplant medicine mainly by the means of various structured questionnaires. To date only few interview data are available on patients thoughts about their self, the transplanted lung or the medication, and the relationship between these thoughts and compliance or gender., Methods: Twenty patients were interviewed after transplantation about their perceptions on self, body, transplanted lung, medication and social network. Their compliance was rated by the attending physicians. The overall interrater-reliability for the category groups was Kappa=.8. The article presents quantitative results of the content analysis., Results: Statements were made most frequently about the patients' social network and their self, and significantly less frequently about their body, lung and medication. "Closeness", "distance" and "depression" where main issues that these patients were dealing with. "Closeness" and "distance" played major roles in interpersonal relationships as well as in the relationship to the new lung. Depression mainly had to do with health burdens and the psychosocial consequences of the transplantation (e.g. financial worries). Women made significantly more statements about their social network than men; furthermore they formulate more accented emotional evaluations. Patients with low compliance were more frequently preoccupied with their self, their body as well as the experience of "dependence" and "achievement" than patients with high compliance; also low compliant patients made more critical statements., Conclusions: For lung transplant recipients social relationships are the prime topic of their daily experience. With respect to compliance behaviour, special attention should be paid to the patients' self and body perception as well as to their experience of dependence. These results should be confirmed in studies with larger sample sizes.

Background and Objectives: Only few comparative prospective studies have been published on psychosocial issues of organ transplant. This study investigated patient groups with various organ transplants with respect to their quality of life and psychosocial situation before and after surgery., Methods: 76 patients receiving an organ transplant (lung n = 22, liver n = 26, allogeneic bone marrow n = 28) were investigated with regard to quality of life (SF-36), life satisfaction (FLZ), social support (F-SozU), and psychological symptoms (HADS-D) before (T0) as well as six (T1) and twelve (T2) months after transplant., Results: In the pre-transplant period the values of the psychosocial variables were partly lower than those of the community normal sample. After transplant lung and bone marrow patients reported less anxiety and depression and a higher life satisfaction, and liver patients reported less depression, compared to the norms. Quality of life, life satisfaction and psychological symptoms of all patients improved significantly post-transplant, whereas the perceived social support decreased. Contrary to the other groups, the psychological well-being of liver transplant recipients was deteriorating between T1 and T2., Conclusions: An organ transplant improved the patients' quality of life and psychosocial situation to a great extent. This effect was better in lung and bone marrow than in liver transplant patients.

Background and Objective: Sleep disturbances are prevalent but often overlooked or underestimated. We suspected that sleep disorders might be particularly common among pharmacy customers, and that they could benefit from counselling. Therefore, we described the prevalence and severity of symptoms associated with sleep and wakefulness disorders among Swiss pharmacy customers, and estimated the need for counselling and treatment., Methods: In 804 Swiss pharmacies (49% of all community pharmacies) clients were invited to complete the Stanford Sleep Disorders Questionnaire (SDQ), and the Epworth Sleepiness Scale (EPW). The SDQ was designed to classify symptoms of sleep and wakefulness into the four most prevalent disorders: sleep apnoea syndrome (SAS), insomnia in psychiatric disorders (PSY), periodic leg movement disorders/restless legs (RLS) and narcolepsy (NAR). Data were entered into an internet-linked database for analysis by an expert system as a basis for immediate counselling by the pharmacist., Results: Of 4901 participants, 3238 (66.1%) were female, and 1663 (33.9%) were male. The mean age (SD) of females and males was 52.4 (18.05), and 55.1 (17.10) years, respectively. The percentages of female and male individuals above cut-off of SDQ subscales were 11.4% and 19.8% for sleep apnoea, 40.9% and 38.7% for psychiatric sleep disorders, 59.3% and 46.8% for restless legs, and 10.4% and 9.4% for narcolepsy respectively. The prevalence of an Epworth Sleepiness Scale score >11 was 16.5% in females, and 23.9% in males. Reliability assessed by Cronbach's alpha was 0.65 to 0.78 for SDQ subscales, and for the Epworth score., Conclusions: Symptoms of sleep and wakefulness disorders among Swiss pharmacy customers were highly prevalent. The SDQ and the Epworth Sleepiness Scale score had a satisfactory reliability to be useful for identification of pharmacy customers who might benefit from information and counselling while visiting pharmacies. The internet-based system proved to be a helpful tool for the pharmacist when counselling his customers in terms of diagnostic classification and severity of symptoms associated with the sleeping and waking state.

Background: After an organ transplant, immunosuppressants must be taken on a regular basis to prevent rejection of the transplanted organ. To our knowledge, there have been no studies to date on how transplant recipients experience the effects and side effects of immunosuppressants. The present study tested a newly developed screening instrument that records the subjective experiences and cognitive attitudes of patients vis-à-vis their immunosuppressive medication., Method: 98 patients were questioned before a heart, lung, liver or kidney transplant and 12 months after the transplant by means of various psychosocial measuring instruments (Sense of Coherence, SOC; Hospital Anxiety and Depression Scale, HADS-D; Quality of Life, SF-36; Satisfaction with Life, FLZ; Social Support, F-SOZU). 12 months after the transplants were performed, seven further items intended to measure the subjective experiences and cognitive attitudes of the patients vis-à-vis their immunosuppressive medication were used. The treating doctors assessed patients' overall compliance 12 months after the transplant operation., Results: Die "Medication Experience Scale for Immunosuppressants" (MESI) showed an internal consistency (Cronbach's alpha) of 0.78. Its values correlated significantly negatively with the sense of coherence recorded before the transplant. There were also significantly negative correlations with physical functioning, mental health, satisfaction with life and social support, as well as significantly positive ones with anxiety and depression 12 months post-transplant. In a comparison of organ groups, lung-transplant patients exhibited the highest MESI values. Patients whose compliance was assessed as "very good" experienced the effects of the immunosuppressants less intensely than patients with "good" to "moderate" compliance. Sensitivity of the MESI scale with regard to compliance was 0.81, with a specificity of 0.71, a positive predictive value of 0.68, and a negative predictive value of 0.83. The cut-off value between "very good" and "limited" compliance was a scale score of 15 points., Conclusion: The MESI is a short, easy-to-use screening instrument for recording the subjective experiences and attitudes of patients after an organ transplant. Of clinical significance is the correlation with compliance. Patients with a scale score of > 15 in particular should be spoken to by their treating doctor with regard to their attitudes to and experiences of the immunosuppressants, as well as with regard to their compliance behaviour.

Background and Objectives: The study investigated first-year residents' career entry experiences according to gender, clinical field and type of training hospital. In addition to quantitatively assessed workplace experiences, this paper reports qualitative data on institutional conditions as well as interpersonal and individual experiences encountered by junior physicians during their first year of residency., Methods: The present study is part of the longitudinal Swiss physicians' career development study. After their first year of residency, participants were interviewed for the second time. The qualitative data of this second assessment are reported in this paper. A total of 1861 terms were given by 342 junior physicians working in the two main clinical fields (internal medicine and surgical fields) with regard to positive and negative experiences in the career entry period. The answers were assigned to 12 categories (according to Mayring's content analysis). These categories were then allocated to three superordinate subject areas: Institutional conditions, Interpersonal experiences, and Individual experiences., Results: Institutional conditions accounted for 17% of all entries, with negative experiences in particular, high workload - predominating. Within Interpersonal workplace experiences (41% of all responses), relationship experiences accounted for the largest proportion of all statements (25.7%), which were mainly positive. Individual experiences (42%) were assessed both positively (professional competence, learning, responsibility, and pleasure) and negatively (working under pressure and curtailment of one's private life). Female and male residents reported similar workplace experiences. Residents in surgical fields more often complained of a lack of professional support than those in internal medicine. Physicians working in university or big county hospitals had more negative experiences with regard to teaching than residents at smaller hospitals., Conclusion: The junior physicians' career-entry experiences indicated that a genuine concept of education and training would greatly improve their workplace experiences. Furthermore, senior physicians should bear in mind that they are important role models for the junior staff.

Objectives: Transplant patients are exposed to many different types of mental and social stress. The study investigates these patients' need for psychosocial counselling., Methods: At 6 months and again at 12 months following either a lung, liver or bone-marrow transplantation, 76 patients were questioned about their need for psychosocial counselling. The measuring instruments employed were: SF-36 (quality of life), FLZ (life satisfaction), HADS-D (anxiety/depression), and F-SoZu K-14 (social support)., Results: The need for psychosocial counselling in all three patient groups was at its greatest before transplantation. It amounted to 42.9 % (lung transplantation patients), 50.0 % (liver transplantation patients) and 26.7 % (bone marrow transplantation patients). Six months after transplantation, the need for counselling in all patient groups had quite clearly decreased. Among liver transplant patients, however, it increased again between the sixth and twelfth months. The need for counselling in all patient groups correlated significantly with anxiety. Moreover, at one-year follow-up, significantly negative correlations with mental health, life satisfaction and social support were observed., Discussion: Especially during the evaluation phase prior to organ transplantation, transplantation patients demonstrate a considerable need for counselling. Psychosocial counselling should be an obligatory part of therapy before and after organ transplantation.

Objective: After lung transplantation little attention has been devoted to patient's personality and illness perceptions, although the importance of illness perceptions (e.g. to the psychosocial status of health) as well as the relationship between personality and illness perceptions is well-known from other areas of medicine., Methods: Fifty patients more than one year after lung transplantation were surveyed by the NEO Five-Factor Inventory (NEO-FFI) as well as the "control" and "consequences" scales of the Illness Perception Questionnaire (IPQ). Medical data included the diagnoses of the underlying lung diseases and the pulmonary graft function as measured by the forced expiratory volume in one second (FEV(1))., Results: In our patients, mean values of the personality factors "extraversion" (p=.003), "openness to experiences" (p<.001), "agreeableness" (p=.035), and "conscientiousness" (p<.001) were significantly higher compared to the normal population. "Openness to experiences" correlated positively and "neuroticism" negatively with the illness perception "control". There was no correlation between illness perceptions and lung function., Conclusion: In lung transplant recipients, personality traits are more relevant to illness perceptions ("control") than current graft function.

Background and Objectives: To date, there have been several prospective cohort studies investigating the workplace experiences of junior physicians, but with limited focus on gender issues. The objective of the present study is to explore the workplace experiences of first-year residents according to gender, type of training hospital, and clinical field., Methods: Data reported are from the second assessment of the longitudinal Swiss physicians' career development study, begun in 2001. In 2003, 497 residents (54.7% females, 45.3% males) assessed their workplace conditions, social support at work, and effort-reward imbalance., Results: There are few, but relevant, gender related differences in workplace experiences, with female physicians experiencing less mentoring and higher over-commitment, yet more positive social relationships at work. In a multivariate model, significant differences in some workplace variables with regard to type of training hospital and/or clinical field are found: workplace conditions are rated worse in type "A" hospitals (university and cantonal hospitals) than in type "B"/"C"/"D" hospitals (regional hospitals and highly specialised units), and in surgical fields than in internal medicine. In "A" hospitals mentoring is assessed as better, but positive social relationships as worse. Both scales are rated worse in surgical fields than in internal medicine. The effort-reward imbalance (ERI) is rated significantly higher (unfavourable) in "A" hospitals than in "B"/"C"/"D" hospitals, regardless of gender and clinical field. Significantly more subjects with an ERI quotient above 1 (which is unfavourable) work in "A" hospitals, and in surgical fields regardless of hospital type. Of the total sample, 81 subjects (16.3%), 41 males and 40 females, show an ERI quotient above 1. The greater the workload, the worse the rating of workplace conditions, effort-reward imbalance, and over-commitment., Conclusion: Institutional determinants are crucial factors for the workplace experiences and first career steps of junior physicians. Medical educators, especially those in "A" hospitals, should become more involved in structured residency programs and be aware of potential gender inequalities in the career support of female physicians.

Objectives: The present study investigated the workplace experiences of junior physicians in their first year of residency, and the impact of these experiences on their physical and psychological well-being., Methods: In a prospective longitudinal study 518 junior physicians (54.4% women, 45.6% men) were investigated twice within two years with regard to individual and institutional determinants of career development. Gender-relevant workplace experiences, i. e. effort-reward imbalance, and their relation to physical and psychological well-being, i. e. anxiety and depression, as well as life satisfaction were evaluated., Results: The workplace experiences revealed three significant gender-specific results: Women residents received less mentoring, had more positive social relationships at work, and showed a higher over-commitment than their male colleagues. Both men and women residents reported significantly worse physical and psychological well-being as well as life satisfaction after their first year of residency (T2) compared to the time directly before their graduation from medical school (T1). The junior physicians' life satisfaction scores are significantly lower than those of the normal population. 7-10% of the respondents showed anxiety scores above cut-off, and 1-4% depression scores above cut-off. Personality traits such as a high sense of coherence and low expressiveness are protective factors for well-being and life satisfaction. Insufficient leadership of senior residents and unclear hierarchical structures as well as stress at work and over-commitment are risk factors for the development of symptoms of anxiety and/or depression., Conclusion: The reported results are consistent with the psychosocial stress model by Karasek and Theorell as well as with the model of effort-reward imbalance of Siegrist.

Background and Objectives: Since the 1990s, as many women as men have been entering and graduating from medical schools in Western countries. Up to date, prospective studies of physicians' career paths are lacking. This paper presents the data of the first assessment of a longitudinal survey of a cohort of Swiss medical school graduates, evaluated with regard to how gender and personality traits contribute to their academic achievement and further career planning., Methods: In 2001, 719 graduate students (52.9% females, 47.1% males) returned a postal questionnaire comprising sections on personality traits, career motivation, and career planning., Results: Female graduates scored higher on traits such as helpfulness, relationship consciousness, empathy, family responsibility, and job security. Male students scored higher on traits such as independence, decisiveness, self-confidence, activity, income, and prestige. Women were further advanced in the writing of their thesis (p = 0.04), chose different topics (p <0.001), and had more often decided in which field they wished to specialise (p =.02). Women preferred fields with intensive patient contact (p <0.01), men tended to specialise more in instrumentally oriented and high-technology medicine (p <.001). The regression model revealed that, apart from gender (being female), instrumentality and extrinsic career motivation predict advanced academic achievement, whereas self-esteem and intrinsic career motivation influence the choice of speciality., Conclusions: The results indicate that women plan their career more purposefully than men, and that not only gender but also personality traits and career motivation play an important role in academic achievement and career planning.

The present paper describes a German version of the University of Rhode Island Change Assessment Scale (URICA) called Fragebogen zu Erfassung der Veränderungsbereitschaft (FEVER). The URICA is a questionnaire designed to measure the stages of change. This instrument is well suited for complex problem behavior, because it yields scores for each stage of change for each individual instead of classifying individuals into a single stage. It is based on Prochaska's transtheoretical model of change. This model recognizes that most psychological disorders are characterized by repetitive problem behaviors that are resistant to modification, and that people do not make a simple black or white decision to change their behavior, rather it holds that people change their behavior gradually across different stages. The model has been successfully applied in different areas of health care to help preventive and treatment interventions adjust to clients' readiness for change. The FEVER was used and tested in a cross-sectional study of 129 patients with an eating disorder. It turned out to be an instrument that was easily understood by patients and that yielded the factor structure of the original version. The internal consistency of the scales was good or very good. Means and standard deviations of the scales were comparable to those found using the original instrument. In addition, there was evidence for the predictive and concordant validity of the instrument. We conclude that the FEVER is a valid instrument to assess the motivational dimension of therapeutic change of complex problem behavior.

Objectives: Women are still underrepresented in the senior ranks of medical school faculties. Thus far information has been lacking on gendersensitive career paths for professorial and nonprofessorial staff of Swiss medical schools. The aim of this study was to survey faculty members of all Swiss medical schools on sociodemographic aspects, career paths and current career position., Methods: 342 senior and junior faculty members (SFMs/JFMs) participated in a postal questionnaire survey. They represent 61.9% of female SFMs, 41.8% of male SFMs, 35.2% of female JFMs and 40.3% of male JFMs., Results: There was no age difference between the men and women in the two groups (SFMs/JFMs). There were, however, significant gender-typical differences in terms of living arrangements, whether or not they had children of their own, who the children's primary caregiver was, and whether or not the spouse was a researcher as well. Females were significantly lesslikely to be married or have children, and relied on childminders or nurseries for childcare. Their spouses were more often involved in research. The career paths of physicians in academic medicine showed that fewer female JFMs advanced to tenure; they obtained fewer academic awards and had a lower scientific publication rate., Conclusions: The data show that Swiss medical faculties reflect the same underrepresentation of women in the higher echelons of medicine as most other Western countries. Gender-sensitive mentoring is needed in medical faculties to support women, especially in advancing to tenure and increasing their publication activities.

Background: Alleviation of suffering is widely acknowledged as one of the main goals of medicine. However, no measure to assess this crucial aspect of illness has been developed to date., Aims: To validate PRISM (Pictorial Representation of Illness and Self-Measure) as a simple quantitative method of assessing the perceived burden of suffering due to illness., Methods: Validity and reliability studies to date have involved over 700 patients with a variety of chronic physical illnesses., Results: Reliability of PRISM is good (test-retest reliability r = 0.95; p < or = 0.001, interrater reliability r = 0.79; p < or = 0.001). Qualitative data indicate that the interpretation of the PRISM task is not only consistent among patients, but also consistent with that expected from existing literature on suffering. As expected, PRISM shows strong correlations with psychological variables (notably depression and coping resilience) and also correlates with SF-36 subscale scores. Prospective longitudinal data demonstrate that PRISM is sensitive to therapeutic change. It is very acceptable to patients and takes less than 5 min to administer., Conclusion: In the absence of a 'gold standard' measure of suffering, our validation data must be interpreted with caution. However, the performance of PRISM is entirely consistent with what would be expected of a measure of suffering, based on current published work., (Copyright 2002 S. Karger AG, Basel)

In a prospective study the development of body experience in adolescence and associations with psychosocial characteristics as well as development of symptoms were investigated. Body experience, physical and psychological well-being as well as sense of coherence were assessed three times over the course of 18 months in 325 male and female adolescents aged 16-19 years. During the course of the study the participants reported an improvement of their body experience. Female adolescents reported at all assessment times lower levels of attractiveness/self-confidence and higher levels of insecurity/worry than males. Body experience, physical and psychological well-being as well as sense of coherence were closely associated with each other. The results indicate that body experience generally consolidates during the course of adolescence. However, the development on individual levels can vary considerably. The body experience reflects the physical and psychosexual development as well as the adolescents' well-being. Thus, more consideration should be given to body experience in therapies with adolescents who suffer from psychosomatic illness.