Investigation of the compatibility of work and family life for physicians in the Munich metropolitan area. Survey of a representative sample of 1,800 physicians using a questionnaire. Men were less satisfied (7% very satisfied vs. 21%) with compatibility between work and family life than women. The group least satisfied overall was hospital-based physicians (p=0.000, chi-square=122.75). Women rather than men cut back their career due to children, perceived their professional advancement as impaired, desisted from establishing private practice or quit hospital employment altogether. Respondents strove for flexible childcare and makeshift solution if the established service failed. Most did not have that at their disposal. Hospital-based physicians wished for predictable working hours, and would like to have a say in the structure of their schedule. For the majority this was not the case. While for 80% it would be important to participate in the definition of their working hours, this was only possible in 17%. 86% found the opportunity to work part-time important, but many doctors (more than 30%) did not have that option. The biggest help for office-based physicians would be an expedited procedure by the Bavarian Association of Statutory Health Insurance Physicians (KVB) when applying for a proxy. The second most important would be the ability to hand over on-call duties. 36% of respondents felt that compatibility of work and family life was best achieved outside of patient care, during residency 42% believed this to be the case. Only 6% of physicians felt the best compatibility to be achieved in a hospital. Among the physician owners of practices, 34% considered their model to be the best way to reconcile both aspects of life. More flexible options for childcare and more influence on the definition of working hours are necessary in order to better reconcile work and family life. For office-based physicians it must be made easier to find a substitute. Currently, especially women consider children as hindering their careers. Hospitals are perceived as extremely unfavorable workplaces for achieving compatibility between work and family life.
The splanchnic perfusion is reduced early in the course of any shock. The mucosa of the gut suffers most as it experiences a high oxygen demand even in the steady state. The specific arrangement of the micro vessels within the villus of the mucosa exposes the tip of the villus at the highest risk for ischemia, particularly in low flow states. As a consequence the integrity of the mucosal layer is compromised and dysfunction of the mucosal barrier may allow bacteria and toxins to translocate from the gut lumen. Activation of leukocytes and stimulation of cytokine synthesis may comprise a sustained inflammatory response syndrome. So far there is a good body of evidence that the splanchnic region may play an important role in the pathophysiological sequence from shock to organ dysfunction.
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