Systematic review of interventions to improve the psychological well-being of general practitioners

BACKGROUND: The health of doctors who work in primary care is threatened by workforce and workload issues. There is a need to find and appraise ways in which to protect their mental health, including how to achieve the broader, positive outcome of well-being. Our primary outcome was to evaluate systematically the research evidence regarding the effectiveness of interventions designed to improve General Practitioner (GP) well-being across two continua; psychopathology (mental ill-health focus) and 'languishing to flourishing' (positive mental health focus). In addition we explored the extent to which developments in well-being research may be integrated within existing approaches to design an intervention that will promote mental health and prevent mental illness among these doctors.

METHODS: Medline, Embase, Cinahl, PsychINFO, Cochrane Register of Trials and Web of Science were searched from inception to January 2015 for studies where General Practitioners and synonyms were the primary participants. Eligible interventions included mental ill-health prevention strategies (e.g. promotion of early help-seeking) and mental health promotion programmes (e.g. targeting the development of protective factors at individual and organizational levels). A control group was the minimum design requirement for study inclusion and primary outcomes had to be assessed by validated measures of well-being or mental ill-health. Titles and abstracts were assessed independently by two reviewers with 99 % agreement and full papers were appraised critically using validated tools.

RESULTS: Only four studies (with a total of 997 GPs) from 5392 titles met inclusion criteria. The studies reported statistically significant improvement in self-reported mental ill-health. Two interventions used cognitive-behavioural techniques, one was mindfulness-based and one fed-back GHQ scores and self-help information.

CONCLUSION: There is an urgent need for high quality, controlled studies in GP well-being. Research on improving GP well-being is limited by focusing mainly on stressors and not giving systematic attention to the development of positive mental health.

Patterns and predictors of help-seeking contacts with health services and general practitioner detection of suicidality prior to suicide: a cohort analysis of suicides occurring over a two-year period

Background: Contact with primary care and psychiatric services prior to suicide may be considerable, presenting
opportunities for intervention. However, there is scant knowledge on the frequency, nature and determinants of
contact.
Method: Retrospective cohort study-an analysis of deaths recorded as suicide by the Northern Ireland Coroner’s
Office linked with data from General Practice patient records over a 2 year period
Results: Eighty-seven per cent of suicides were in contact with General Practice services in the 12 months before
suicide. The frequency of contact with services was considerable, particularly among patients with a common
mental disorder or substance misuse problems. A diagnosis of psychiatric problems was absent in 40 % of suicides.
Excluding suicide attempts, the main predictors of a noted general practitioner concern for patient suicidality are
male gender, frequency of consultations, diagnosis of mental illness and substance misuse.
Conclusions: Despite widespread and frequent contact, a substantial proportion of suicidal people were
undiagnosed and untreated for mental health problems. General Practitioner alertness to suicidality may be too
narrowly focused.

Effects of a green tax reform in Portugal: a general equilibrium analysis

Do ponto de vista da política económica, existe a possibilidade de utilizar a receita dos impostos ambientais para baixar os impostos sobre o trabalho, promovendo assim o emprego. Esta oportunidade surge na literatura como forma dos países industrializados responderem a um duplo desafio: um crescente nível de poluição e um decrescente nível de emprego. Alguns países tomaram já decisões no sentido de alcançar o “duplo dividendo”: melhorias ambientais e diminuição do desemprego. Os resultados teóricos, na sua maioria cépticos em relação à verificação do segundo dividendo, são substancialmente contrariados por uma série de estudos que utilizam modelos de equilíbrio geral. Pretendese com este trabalho fazer uma simulação para a economia portuguesa de uma reforma fiscal ambiental com as características referidas e a verificação da existência do “duplo dividendo”, através de um modelo computacional de equilíbrio geral. Para além disso, é feita uma análise dos impactos do Mercado Europeu de Licenças de Emissão, ao nível sectorial e regional, em Portugal, utilizando dados microeconómicos, com o objectivo de estudar as consequências ao nível das trasacções entre sectores e efeitos distributivos entre regiões.

Strategie des General-Management : Ausweg aus der Krise

In dem Buch werden verschiedene Managementtypen vorgestellt.

South Carolina/general sessions court circuits meeting benchmark : 80% of pending docket 365 days or less as of February 28, 2015

This document provides statistics on criminal and general sessions courts meeting the benchmark of 80% of pending dockets broken down by circuits and counties.