***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Purpose To compare tachycardia and cardiac strain between  24-hour shifts ( 24hS ) and 14-hour night shifts ( 14hS ) in emergency physicians ( EPs ) , and to investigate key factors influencing tachycardia and cardiac strain . Methods We monitored  heart rate ( HR ) with Holter-ECG in a shift-r and omized trial comparing a 24hS , a 14hS , and a control day , within a potential for 19 EPs . We also measured  24-h HR the third day ( D3 ) after both shifts . We measured perceived stress by visual analog scale and the number of life- and -death emergencies . Results The 17 EPs completing the whole protocol reached maximal HR ( 180.9 ± 6.9 bpm ) during both shifts . Minutes of tachycardia > 100 bpm were higher in 24hS ( 208.3 ± 63.8 ) than in any other days ( 14hS : 142.3 ± 36.9 ; D3/14hS : 64.8 ± 31.4 ; D3/24hS : 57.6 ± 19.1 ; control day : 39.2 ± 11.6 min , p < .05 ) . Shifts induced a cardiac strain twice higher than in days not involving patients contact . Each life- and -death emergency enhanced 26 min of tachycardia ≥100 bpm ( p < .001 ) , 7 min ≥ 110 bpm ( p < .001 ) , 2 min ≥ 120 bpm ( p < .001 ) and 19 min of cardiac strain ≥30 % ( p = .014 ) . Stress was associated with greater duration of tachycardia ≥100 , 110 and 120 bpm , and of cardiac strain ≥30 % ( p < .001 ) . Conclusion We demonstrated several incidences of maximal HR during shifts combined with a high cardiac strain . Duration of tachycardia were the highest in 24hS and lasted several hours . Such values are comparable to those of workers exposed to high physical dem and ing tasks or heat . Therefore , we suggest that EPs limit their exposure to 24hS. We , furthermore , demonstrated benefits of HR monitoring for identifying stressful events . Clinical Trials.gov identifier : NCT01874704 Background The study investigated the extent to which approaches to work , workplace climate , stress , burnout and satisfaction with medicine as a career in doctors aged about thirty are predicted by measures of learning style and personality measured five to twelve years earlier when the doctors were applicants to medical school or were medical students . Methods Prospect i ve study of a large cohort of doctors . The participants were first studied when they applied to any of five UK medical schools in 1990 .  Postal question naires were sent to all doctors with a traceable address on the current or a previous Medical Register . The current question naire included measures of Approaches to Work , Workplace Climate , stress ( General Health Question naire ) , burnout ( Maslach Burnout Inventory ) , and satisfaction with medicine as a career and personality ( Big Five ) . Previous question naires had included measures of learning style ( Study Process Question naire ) and personality . Results Doctors ' approaches to work were predicted by study habits and learning styles , both at application to medical school and in the final year . How doctors perceive their workplace climate and workload is predicted both by approaches to work and by measures of stress , burnout and satisfaction with medicine . These characteristics are partially predicted by trait measures of personality taken five years earlier . Stress , burnout and satisfaction also correlate with trait measures of personality taken five years earlier . Conclusions Differences in approach to work and perceived workplace climate seem mainly to reflect stable , long-term individual differences in doctors themselves , reflected in measures of personality and learning style BACKGROUND To examine the mortality pattern of Danish doctors for the period 1973 - 1992 . METHODS A historical prospect i ve cohort study based on the membership register of the Danish Medical Association . The study population consisted of 21,943 medical doctors , 6012 of whom were women . The doctors ' cause-specific mortality was compared with that of the general population . RESULTS The study covered about 277,000 person-years . A total of 2387 deaths occurred from 1 January 1973 to 31 December 1992 . The doctors ' mortality was lower than that of the general population . Both sexes showed a st and ardized mortality ratio ( SMR ) below one for cancer , circulatory diseases and other natural causes . Mortality due to lung cancer was particularly low . The SMR for suicide was significantly increased , 1.6 for males ( 95 % CI : 1.4 - 1.9 ) and 1.7 for females ( 95 % CI : 1.1 - 2.5 ) . The suicide rate was increased , in particular because of an increased number of suicides by poisoning . In addition female doctors displayed a relatively high mortality due to accidents and other types of violent death . CONCLUSIONS Compared with the general population the doctors ' mortality was low , but the mortality from external causes was increased , mainly due to an excess number of suicides Abstract OBJECTIVE : To assess the association between  HMO practice  , time pressure , and physician job satisfaction . DESIGN : National r and om stratified sample of 5,704 primary care and specialty physicians in the United States . Surveys contained 150 items reflecting 10 facets ( components ) of satisfaction in addition to global satisfaction with current job , one ’s career and one ’s specialty . Linear regression-modeled satisfaction ( on 1–5 scale ) as a function of specialty , practice setting ( solo , small group , large group , academic , or HMO ) , gender , ethnicity , full-time versus part-time status , and time pressure during office visits . “ HMO physicians ” ( 9 % of total ) were those in group or staff model HMOs with > 50 % of patients capitated or in managed care . RESULTS : Of the 2,326 respondents , 735 ( 32 % ) were female , 607 ( 26 % ) were minority ( adjusted response rate 52 % ) . HMO physicians reported significantly higher satisfaction with autonomy and administrative issues when compared with other practice types ( moderate to large effect sizes ) . However , physicians in many other practice setting s averaged higher satisfaction than HMO physicians with re sources and relationships with staff and community ( small to moderate effect sizes ) . Small and large group practice and academic physicians had higher global job satisfaction scores than HMO physicians ( P<.05 ) , and private practice physicians had quarter to half the odds of HMO physicians of intending to leave their current practice within 2 years ( P<.05 ) . Time pressure detracted from satisfaction in 7 of 10 satisfaction facets ( P<.05 ) and from job , career , and specialty satisfaction ( P<.01 ) . Time allotted for new patients in HMOs ( 31 min ) was less than that allotted in solo ( 39 min ) and academic practice s ( 44 min ) , while 83 % of family physicians in HMOs felt they needed more time than allotted for new patients versus 54 % of family physicians in small group practice s ( P<.05 after Bonferroni ’s correction ) . CONCLUSIONS : HMO physicians are generally less satisfied with their jobs and more likely to intend to leave their practice s than physicians in many other practice setting s. Our data suggest that HMO physicians ’ satisfaction with staff , community , re sources , and the duration of new patients visits should be assessed and optimized . Whether providing more time for patient encounters would improve job satisfaction in HMOs or other practice setting s remains to be determined Background Emergency physicians are exposed to greater stress during a 24-hour shift ( 24 hS ) than a 14-hour night shift ( 14 hS ) , with an impact lasting several days . Interleukin-8 ( IL-8 ) is postulated to be a chronic stress biomarker . However , no studies have tracked IL-8 over several shifts or used it for monitoring short-term residual stress . The IL-8 response to the shifts may also increase with age . Conveniently , IL-8 can be measured non-intrusively from urine . Methods We conducted a shifts-r and omized trial comparing 17 emergency physicians ’ urinary IL-8 levels during a 24 hS , a 14 hS , and a control day ( clerical work on return from leave )  . Mean levels of IL-8 were compared using a Wilcoxon matched-pairs test . Independent associations of key factors including shifts , stress , and age with IL-8 levels were further assessed in a multivariable generalized estimating equations model . Results Mean urinary IL-8 levels almost doubled during and after a 24 hS compared with a 14 hS or a control day . Furthermore , IL-8 levels failed to return to control values at the end of the third day after the shift despite a rest day following the 24 hS. In the multivariable model , engaging in a 24 hS , self-reported stress , and age were independently associated with higher IL-8 levels . A 24 hS significantly increased IL-8 levels by 1.9 ng ( p = .007 ) . Similarly , for every unit increase in self-reported stress , there was a 0.11 ng increase in IL-8 levels ( p = .003 ) ; and for every one year advance in age of physicians , IL-8 levels also increased by 0.11 ng ( p = .018 ) . Conclusion The 24 hS generated a prolonged response of the immune system . Urinary IL-8 was a strong biomarker of stress under intensive and prolonged dem and s , both acutely and over time . Because elevated IL-8 levels are associated with cardiovascular disease and negative psychological consequences , we suggest that emergency physicians limit their exposure to 24 hS , especially with advancing age Objectives Appropriate reporting is central to the application of findings from research to clinical practice . The Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) recommendations consist of a checklist of 22 items that provide guidance on the reporting of cohort , case – control and cross-sectional studies , in order to facilitate critical appraisal and interpretation of results . STROBE was published in October 2007 in several journals including The Lancet , BMJ , Annals of Internal Medicine and PLoS Medicine . Within the framework of the revision of the STROBE recommendations , the authors examined the context and circumstances in which the STROBE statement was used in the past . Design The authors search ed the Web of Science data base in August 2010 for articles which cited STROBE and examined a r and om sample of 100 articles using a st and ardised , piloted data extraction form . The use of STROBE in observational studies and systematic review s ( including meta-analyses ) was classified as appropriate or inappropriate . The use of STROBE to guide the reporting of observational studies was considered appropriate . Inappropriate uses included the use of STROBE as a tool to assess the method ological quality of studies or as a guideline on how to design and conduct studies . Results The authors identified 640 articles that cited STROBE . In the r and om sample of 100 articles , about half were observational studies ( 32 % ) or systematic review s ( 19 % ) . Comments , editorials and letters accounted for 15 % , method ological articles for 8 % , and recommendations and narrative review s for 26 % of articles . Of the 32 observational studies , 26 ( 81 % ) made appropriate use of STROBE , and three uses ( 10 % ) were considered inappropriate . Among 19 systematic review s , 10 ( 53 % ) used STROBE inappropriately as a tool to assess study quality . Conclusions The STROBE reporting recommendations are frequently used inappropriately in systematic review s and meta-analyses as an instrument to assess the method ological quality of observational studies OBJECTIVE Physician job satisfaction has been the subject of much research . However , no studies have been conducted comparing academic and private practice physician satisfaction in obstetrics and gynecology . This study was undertaken to measure satisfaction levels for academic and private practice obstetrician-gynecologists and compare different aspects of their practice that contributed to their satisfaction . STUDY DESIGN A survey was mailed to r and omly selected obstetrician-gynecologists in Memphis , TN ; Birmingham , AL ; Little Rock , AR ; and Jackson , MS . Physicians were asked to respond to questions concerning demographics and career satisfaction . They were also asked to assess the contribution of 13 different aspects of their practice in contributing to their job selection and satisfaction using a Likert scale . A score of 1 meant the physician completely disagreed with a statement regarding a factor 's contribution or was completely dissatisfied ; a score of 5 meant the physician completely agreed with a factor 's contribution or was completely satisfied . Simple descriptive statistics , as well as the 2- sample t test , were used . Likert scale values were assumed to be interval measurements . RESULTS Of the 297 question naires mailed , 129 ( 43 % ) physicians responded . Ninety-five ( 74 % ) respondents rated their overall satisfaction as 4 or 5 . No significant difference was found between academic and private physicians when comparing overall job satisfaction ( P = .25 ) . When compared to private practice physicians , the aspects most likely contributing to overall job satisfaction for academic physicians were the ability to teach , conduct research , and practice variety ( P = .0001 , P = .0001 , and P = .007 , respectively ) . When compared with academic physicians , the aspects most likely contributing to job satisfaction for private practice physicians were autonomy , physician-patient relationship , and insurance reimbursement ( P = .0058 , P = .0001 , and P = .0098 , respectively ) . When choosing a practice setting , academic physicians found variety , teaching , and research to be more important ( P = .0027 , P = .0001 , and 
    Output:
    
Some specialties might be at higher risk such as anesthesiologists , psychiatrists , general practitioners and general surgeons .
Physicians are an at-risk profession of suicide , with women particularly at risk .
The rate of suicide in physicians decreased over time , especially in Europe .