Physician burnout, as a prolonged response to chronic emotional and interpersonal stressors on the job, has been associated with suboptimal patient care and deterioration in the patient-provider relationship. Although prior studies have identified a range of factors associated with decreased patient satisfaction, most have been conducted in tertiary care settings, with staff burnout examined at the hospital unit-level. To examine the impact of physician burnout on patient satisfaction from consultation in the primary care setting, a cross-sectional survey was conducted in Western Greece. Using a one-with-many design, 30 physicians and 300 of their patients, randomly selected, responded to the survey. Results showed that patient satisfaction correlated significantly with physician emotional exhaustion (r = -.636, p < .01) and physician depersonalization (r = -.541, p < .01). Mixed-effects multilevel models indicated that 34.4% of total variation in patients' satisfaction occurred at the physician level, after adjustment for patients' characteristics. Moreover, physician emotional exhaustion and depersonalization remained significant factors associated with patient satisfaction with consultation, after controlling for patient and physician characteristics. Patients of physicians with high-exhaustion and high-depersonalization had significantly lower satisfaction scores, compared with patients of physicians with low-exhaustion and low-depersonalization, respectively. Future studies need to explore the mechanisms by which physician burnout affects patient satisfaction.

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Childhood wheeze and asthma have reached a plateau in an urban environment in Greece, while the male:female ratio increased. Asthma diagnosis declined among schoolage but not preschool wheezers during 2003-2008.

After a continuous increase of asthma, hay fever, and eczema during 1991-2003 among schoolchildren in Patras, Greece, the prevalence of current wheeze/asthma (diagnosed wheezing and/or asthma in the past 2 years) has reached a plateau (6.9%) during the period 2004-2008. Using methodology identical to the three previously conducted cross-sectional, parental questionnaire surveys (1991, n = 2417; 1998, n = 3076; 2003, n = 2725) we examined further trends in the prevalence of rhinoconjunctivitis and eczema in the same urban environment among third and fourth grade schoolchildren (8-9 years old) in 2008 (n = 2688). In the four surveys, respective prevalence rates of rhinoconjunctivitis were 2.1, 3.4, 4.6, and 5.1% (absolute prevalence increase: 1998 versus 1991, 61.9%; 2003 versus 1998, 35.5%; 2008 versus 2003, 10.9%) and those of eczema were 4.5, 6.3, 9.5, and 10.8% (absolute prevalence increase: 1998 versus 1991, 40.0%; 2003 versus 1998, 50.8%; 2008 versus 2003, 13.7%; sex-adjusted p for trend, <0.001). Among current wheezer/asthmatic patients there was an increase in lifetime rhinoconjunctivitis (sex-adjusted p for trend, <0.001) and lifetime eczema (sex-adjusted p for tend, <0.001) over the period 1991-2008. The proportion of atopic wheeze/asthma (current asthma with lifetime rhinoconjunctivitis and/or eczema) increased further during 2003-2008 (p < 0.05; p for trend during 1991-2008, <0.001). In conclusion, there is a continuous increase in the prevalence of allergic manifestations-rhinoconjunctivitis and eczema-among preadolescent children in Patras, Greece, during the period 1991-2008. After a steep rise during 1991-2003, the frequency of atopic wheeze/asthma continued to increase at a decelerating rate during 2003-2008, while wheeze/asthma prevalence remained unchanged during the same 5-year period.

The prevalence of allergic rhinitis, hay fever and eczema has risen worldwide during the last four decades but may have reached a plateau in some westernized societies. We examined time trends in the prevalence of childhood chronic or recurrent rhinitis, rhinoconjunctivitis and eczema in urban Greece. Using identical methodology, three population-based cross-sectional parental questionnaire surveys on current (last two years) and lifetime allergic symptoms of the nose, eyes and skin were performed among 8-10-yr-old children in 1991, 1998 and 2003 in Patras, Greece. Exactly 2417, 3006 and 2725 questionnaires were completed in 1991, 1998 and 2003, respectively. Prevalence rates of current (lifetime) symptoms of chronic or recurrent rhinitis were 5.1% (6.0%) for 1991, 6.5% (8.0%) for 1998 and 8.0% (9.8%) for 2003. Respective values for rhinoconjunctivitis were 1.8% (2.1%), 2.7% (3.4%) and 3.6% (4.6%) and for eczema 2.5% (4.5%), 3.4% (6.3%) and 5.0% (9.5%) (p for trend <0.001). Among current asthmatics there was an increase in lifetime rhinitis (p = 0.038), current (p = 0.025) and lifetime rhinoconjunctivitis (p = 0.007) and current (p = 0.001) and lifetime eczema (p < 0.001); male predominance increased throughout the study. The proportion of atopic asthma (current asthma with chronic or recurrent rhinitis and/or rhinoconjunctivitis and/or eczema) increased during the same period (p < 0.001). In conclusion, there is a continuous increase in the prevalence of allergic manifestations among preadolescent children in Patras, Greece during the period 1991-2003. In our population, boys have contributed to this increase more than girls and the increase of atopy is, at least partially, responsible for the increase of asthma.

BACKGROUNDThe aim of the present study was to compare the prevalence of asthma among schoolchildren in 1978, 1991, and 1998 in Patras, Greece.METHODSThe study populations of the three comparable cross sectional surveys comprised third and fourth grade public school children in Patras, Greece. Sample sizes in 1978, 1991, and 1998 were 3735, 2952 and 3397 children and response rates were 80.4%, 81.9%, and 90.6%, respectively. Prevalence of current, non-current, and lifetime asthma or recurrent wheezing was determined by parental questionnaire. Personal communication with the parents of asthmatic children in 1991 and 1998 provided data on lost schooldays.RESULTSPrevalence rates of current asthma or wheezing in 1978, 1991, and 1998 were 1.5%, 4.6%, and 6.0%, respectively (1978–91: p=0.01, 1991–98: p=0.02, 1978–98: p=0.03). Lifetime prevalences of asthma or wheezing in 1991 and 1998 were 8.0% and 9.6%, respectively (p=0.03). Current diagnosed asthma increased proportionally to diagnosed wheezing during 1991–98. The number of schooldays lost in the previous 2 years because of asthma did not change (p>0.1) between 1991 (0.31 per child) and 1998 (0.34 per child).CONCLUSIONSOur results support a true increase in the prevalence of current and lifetime asthma in the last 20 years among pre-adolescent children in Patras, Greece.