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Biomedical subjects

Bengt Arnetz

Publications and source records attributed to Bengt Arnetz.

16 recordsLinked to original sources
PubMed2006

Development of abdominal fat and incipient metabolic syndrome in young healthy men exposed to long-term stress.

BACKGROUND AND AIM: The sympathetic nervous system may be involved in the pathophysiology of insulin resistance and metabolic cardiovascular syndrome in young men. The aim was to study the effects of long-term stress on different features of the metabolic syndrome (MES) in formerly non-obese healthy young males during 5 months of defined conditions. METHODS AND RESULTS: Sixteen healthy male sailors (mean age 36.5 (SD)+/-7 years) participating in a sailing race around the world were recruited for the study. Investigations were done before the start and at stop overs after finishing laps 1, 2 and 4 (1, 2(1/2) and 5 months, respectively). Anthropometric and blood pressure data as well as biochemical data associated with MES were substantiated. Food intake and exercise were chartered and largely controlled. A mean weight loss of 4.5+/-2 kg (P<0.005), comprising both fat and lean body mass, was recorded during the first lap. Subsequently after 5 months, a weight gain, mainly consisting of 1.2+/-1.1 kg body fat (P<0.05), took place, concomitantly with a protein mass drop of 0.6+/-1.1 kg (P<0.05). The body fat gain accumulated on the abdominal region. Elevated blood levels of HbA1c, insulin and the triglycerides/high-density lipoprotein ratio were also observed during the race. Likewise heart rate and systolic blood pressure increased slightly but to a statistically significant extent. CONCLUSIONS: Non-obese healthy young men exposed to long-term stress developed abdominal obesity and signs of a metabolic syndrome in embryo, also emphasized by biochemical and blood pressure alterations. It is suggested that long-term and sustained stress activation might be an additional risk factor for the development of MES, even after control of dietary and exercise habits.

Abdominal Fat↗
PubMed2006

Measuring moral distress in pharmacy and clinical practice.

This article presents the development, validation and application of an instrument to measure everyday moral distress in different health care settings. The concept of moral distress has been discussed and developed over 20 years. A few instruments have been developed to measure it, predominantly in nursing. The instrument presented here consists of two factors: level of moral distress, and tolerance/openness towards moral dilemmas. It was tested in four medical departments and three pharmacies, where 259 staff members completed a questionnaire. The two factors were found to be reliable. Differences in levels of moral distress were found between pharmacies and clinical departments, and between the youngest and oldest age groups; departmental staff and the youngest group experienced higher levels of moral distress. Departments reported less tolerance/openness towards moral dilemmas than pharmacies. The instrument needs to be tested further, but its strengths are the focus on everyday ethical dilemmas and its usefulness in different health care settings.

Adaptation, Psychological↗
PubMed2005

"We are white coats whirling round"--moral distress in Swedish pharmacies.

OBJECTIVE: The extended role of pharmacists has made pharmacy practice more complex and increased the moral responsibility of pharmacy staff. Consequently, ethics has become an important part of their daily work. In health care, ethical dilemmas have been shown to cause distress, usually referred to as "moral distress". Moral distress among hospital personnel has been well described and discussed in numerous studies. There are very few similar studies in pharmacy settings. This article reports on the results of an investigation concerning whether and in what situations moral distress is present in pharmacy practice. METHOD: A questionnaire derived from focus group data, covering ethically troubling situations in pharmacy settings, was distributed to all staff of three pharmacies in Sweden. RESULTS: The results show that moral distress is experienced in the day-to-day pharmacy practice, and that it is in many ways connected to care providing. For example, prioritizing between customers was reported as very stressful. Younger personnel reported higher moral distress than their older colleagues did. However, there were no differences between pharmacies. A lack of support structures, such as meetings where ethical issues can be discussed, was reported by all the participating pharmacies. CONCLUSION: It is reasonable to assume that moral distress is even more present in pharmacy practice than in other health care areas as it is, in general, much more sensitive and exposed to the modern, demanding customer. The meeting with the customer is on a more neutral ground than in, for example, a hospital setting. Although there are ethical codes for pharmacists, they are not enough. Moral distress is experienced anyway; general codes and personal coping strategies must be supplemented with support from the management and work organization. There is a need to look more closely at specific factors related to the degree and extension of moral distress, going beyond individual coping strategies.

Attitude of Health Personnel↗
PubMed2005

Why do nurses at a university hospital want to quit their jobs?

The aim of the study was to investigate to what extent the registered nurses at a university hospital intend to quit their present jobs and the reasons for this. A total of 833 nurses at a university hospital responded to two mailed, work-environment questionnaires (Quality Work Competence and Huddinge University Hospital Model Questionnaire). About 54% (n = 449) intended to quit and 35% (n = 155) had already taken steps to do so. Main reasons were dissatisfaction with the salary (65%), psychologically strenuous and stressful work (32%), a wish to 'try something new' (28%) and limited opportunities to make a professional career (19%). Nurses who intended to quit ('quitters') rated a higher work tempo (P < 0.001), experienced an increased work-related exhaustion (P < 0.001) and a lower quality of patient care (P < 0.01). They also perceived to a lower degree that their competence was made good use of (P < 0.001) and that they had fewer opportunities of developing their own competence (P < 0.001) and making a professional career. They were less satisfied with the support from their superiors for participating in nursing research and developing projects (P < 0.001). Finally, the 'quitters' knew to a significantly lesser extent (P < 0.001) why they had the actual salary they had, what the salary was based on and what to do to improve it. However, it was found that the hospital still had a 'core group' of highly motivated and dedicated nurses with an unusually high amount of mental energy left. All findings regarding the 'quitters' are factors amenable to interventions.

Adult↗
PubMed2004

Individual and organizational well-being of female physicians--an assessment of three different management programs.

Abstract Management programs have become a popular method to develop future leaders. There is, however, a lack of controlled studies assessing the long-term effects of such programs on participants' career development, organizational influence, and mental and physical well-being. The aim of this prospective, controlled study was to assess the possible impact from 3 different structured management development programs on the individual and organizational well-being of female physicians. One year after the end of the 1-year intervention program, the intervention group reported statistically significant improvements in ratings of organizational influence, management feed back, perception of the organizational leadership, contact with one's immediate supervisor, and personal skills development as compared with the reference group. There were no statistically significant differences, however, between the groups with regard to individual health and well-being or career development. These results give rise to many questions, both concerning the effects of these 3 management programs and the career possibilities for female physicians.

Absenteeism↗
PubMed2004

The relative importance of leadership and payment system. Effects on quality of care and work environment.

The key question addressed in this study is whether the introduction of stronger financial incentives in health care give rise to such a restrictive context that leadership has only a minor influence? Or is good leadership, on the contrary, important to the achievement of both financial and other goals, regardless of contextual factors? Physicians in one Swedish County Council with performance-based reimbursement and in 10 councils without such a system were studied in a cross-sectional questionnaire study. The result of this study indicates that although contextual factors were of substantial importance there is scope for leaders to act, and their actions make a considerable difference, both for the experience of the work process and for the outcome in terms of work environment and quality of care. A good leadership may be able to shield the health care organisation from unwanted side effects of increased financial pressure.

Adult↗
PubMed2004

Living with conflicts-ethical dilemmas and moral distress in the health care system.

During the last decade, the Swedish health care system has undergone fundamental changes. The changes have made health care more complex and ethics has increasingly become a required component of clinical practice. Considering this, it is not surprising that many health care professionals suffer from stress-related disorders. Stress due to ethical dilemmas is usually referred to as "moral distress". The present article derives from Andrew Jameton's development of the concept of moral distress and presents the results of a study that, using focus group method, identifies situations of ethical dilemmas and moral distress among health care providers of different categories. The study includes both hospital clinics and pharmacies. The results show that all categories of staff interviewed express experiences of moral distress; prior research has mostly focused on moral distress experienced by nurses. Second, it was made clear that moral distress does not occur only as a consequence of institutional constraints preventing the health care giver from acting on his/her moral considerations, which is the traditional definition of moral distress. There are situations when the staff members do follow their moral decisions, but in doing so they clash with, e.g. legal regulations. In these cases too, moral distress occurs. Hitherto research on moral distress has focused on the individual health care provider and her subjective moral convictions. Our results show that the study of moral distress must focus more on the context of the ethical dilemmas. Finally, the conclusion of the study is that the work organization must provide better support resources and structures to decrease moral distress. The results point to the need for further education in ethics and a forum for discussing ethically troubling situations experienced in the daily care practice for both hospital and pharmacy staff.

Conflict, Psychological↗
PubMed2004

The impact of management programs on physicians' work environment and health. A prospective, controlled study comparing different interventions.

Female physicians have less influence over their daily work conditions and exhibit slower career advancement as compared to their male colleagues. The aim of this study is to assess the impact on individual and organizational well being from different kinds of management programs. Female physicians participating in management intervention programs were compared with a reference group of matched physicians and sickness absenteeism was significantly lower in the intervention group. No significant differences were found between the groups with regard to career advancement, individual, organizational and professional well being. Health care organizations spend a substantial amount of resources on management programs in order to improve leadership, autonomy and the work-environment of physicians in times of increasing discontent among this key group of health care employees. Our study indicates some beneficial health effects from structured management programs but there is a need to develop and assess the efficacy of these programs further.

Adult↗
PubMed2003

Endocrine measures of stress and self-rated health: a longitudinal study.

OBJECTIVE: Simple global self-ratings of health have been found to hold considerable predictive validity in relation to morbidity and mortality. Inverse associations between chronic stress and self-rated health (SRH) have been found and suggested to explain part of the predictive validity of SRH. Studies including biological data are, however, few. The purpose of this paper is to study the relationship between endocrine measures of stress and SRH. METHODS: A longitudinal study of 102 healthy middle-aged men. Written questionnaires and blood samples were collected at baseline and at follow-up 1 year later. RESULTS: A decrease in SRH below the level of good was associated with significantly increased s-prolactin and decreased s-testosterone. Poorer SRH and increased levels of s-prolactin were significantly associated with increased vital exhaustion at follow-up. CONCLUSION: Our study identifies a possible biological pathway, which might be of relevance in understanding the well-established association between SRH and health.

Adult↗
PubMed2003

Downsizing within a hospital: cutting care or just costs?

Downsizing of staff is becoming increasingly common in hospitals as a way to meet the demands of shrinking budgets. This study, based in Sweden, used a longitudinal design to study staff views of their work environment, their individual health and the quality of the care they were delivering during a period of hospital downsizing. Although there were no significant changes in perceptions of quality of care, perceptions of workload substantially increased whilst perceptions of mental energy substantially decreased. These two changes could point to future problems with quality of care after a period of hospital downsizing.

Adult↗
PubMed2003

Multiple chemical sensitivity in male painters; a controlled provocation study.

The purpose of the present study was to examine whether male painters reporting multiple chemical sensitivity (MCS) differ from their matched controls (male painters without such sensitivity) during controlled chamber challenges to singular and mixtures of odorous chemicals with respect to: (1) Subjective rating of symptoms (i.e., symptoms related to central nervous system (CNS) and symptoms related to irritation) and sensations of smell elicited by low-level chemical exposures. (2) Changes in serum prolactin and cortisol levels, changes in nasal cavity and eye redness as a result of the various exposures. Moreover, background assessments were made regarding mental well-being, sense of coherence (SOC) as well as state of anxiety and depression in both groups. The MCS and control group consisted of 14 and 15 male painters respectively. Regarding background assessments of mental well-being, anxiety, depression and SOC, statistically significant differences were obtained between painters with MCS and their controls. During the controlled chamber challenges, neither difference regarding sensations of smell nor development of CNS related symptoms were seen between MCS and control group. In contrast, subjective rating of symptoms related to irritation (i.e., eyes, nose, throat, skin, and breathing difficulties) was significant higher in subjects with MCS. No differences between the groups as a result of the different exposures were seen concerning nasal cavity, eye redness and serum cortisol levels. However, a trend (P = 0.056) between the groups was measured regarding a decline of serum prolactin levels in the MCS group. This is a relatively small study with a limited number of volunteers; and no definitive conclusions can be drawn concerning the above findings. But it is the first controlled challenge study that incorporates similarly exposed groups (painters) recruited from a community rather than from a clinical population.

Adult↗
PubMed2002

[Physicians' well-being is deteriorating. Results from a prospective intervention study. The mental energy decreases as workload increases].

The impact of the current transformation of health care on the well-being and working conditions of physicians has been analyzed in a 6-year prospective intervention study at the Orebro University Hospital (USO). Physicians' ratings of their work, organization and health have been compared with those of other health care professionals at USO, as well as with ratings by physicians in other hospitals. Feedback on survey results has been periodically provided to employees in all hospital departments as well as to hospital senior management. The results have formed the basis for a range of improvement initiatives. The study identified a number of positive changes, such as increased ratings on scales measuring social climate, skills development and participatory management. However, workload has increased and mental energy decreased during the same period.

Burnout, Professional↗
PubMed2002

Performance-based reimbursement in health care. Consequences for physicians' cost awareness and work environment.

BACKGROUND: The funding and structure of health care is currently undergoing major changes. The impact of such changes on professional behaviour and working conditions have not been widely studied in Europe. The two aims of this study were to prospectively assess the impact of performance-based reimbursement on physicians' attitudes and self-assessed professional behaviour, related to cost awareness, as well as their working conditions. METHOD: Physicians in Stockholm County Council (with a performance-based reimbursement system) and physicians in eleven Swedish councils without performance-based reimbursement were examined simultaneously in 1994. This was a cross-sectional questionnaire study. RESULT: The results show a heightened cost awareness among physicians in Stockholm but also greater discontent with working condition factors such as decision latitude, job satisfaction and personal well-being. CONCLUSION: These results suggest that in order to counteract physicians discontent as a result of altered structure and increased focus on performance-based reimbursement, the autonomy and influence of physicians over the work processes need to be considered.

Adult↗
PubMed2002

Work site change and psychosocial well-being among health care personnel in geriatric wards--effects of an intervention program.

The study evaluated the effect of a change of work site and organization on work environment and psychosocial parameters: the change involved health care personnel at a geriatric hospital. Another aim of this study was to evaluate the effects of a structured psychoeducational intervention program. The study found few changes in the indices of interest on the experimental and control wards. There were, however, significant improvements in social climate, goal quality, and independence of work on the control ward. The investigators postulated that too much external support hampers a group's ability to actively cope with change and might actually lower a group's ability and self-esteem. In order to achieve successful organizational change, psychosocial intervention programs for personnel must be performed by a well-informed, well-chosen, and experienced counsellor who is well tailored to the local organization.

Adaptation, Psychological↗
PubMedDate not supplied

A randomized clinical trial of the treatment effects of massage compared to relaxation tape recordings on diffuse long-term pain.

BACKGROUND: Long-term musculoskeletal pain is a common problem in primary health care settings that is difficult to treat. Two common treatments are mental relaxation and massage. Scientific studies show contradictory results. Furthermore, many studies lack long-term follow-up even though it is a chronic disorder. The purpose of this randomized clinical trial was to assess possible effects of massage as compared to listening to relaxation tapes in conditions of 'diffuse' and long-term musculoskeletal pain. METHODS: 129 patients from primary health care suffering from long-term musculoskeletal pain were randomized to either a massage or mental relaxation group, and assessed before, during and after treatment. RESULTS: During treatment there was a significant improvement in the three main outcome measures: self-rated health, mental energy, and muscle pain only in the massage group as compared to the relaxation group. However, at the 3-month post-treatment follow-up, there was a significant worsening in the outcome measures (time x group effect p < 0.05) back to initial rating levels in the massage group as compared to no changes in the relaxation group. CONCLUSION: Massage, but not mental relaxation, is beneficial in attenuating diffuse musculoskeletal symptoms. Beneficial effects were registered only during treatment. This lack of long-term benefits could be due to the short treatment period or treatments such as these do not address the underlying causes of pain. Future studies of long-term pain should include longer treatment periods and post-treatment follow-up. It might also be worthwhile assessing the long-term benefits from booster treatment after the initial intense treatment period.

Adolescent↗