Surveillance in hereditary nonpolyposis colorectal cancer syndrome

Hereditary nonpolyposis colorectal cancer (HNPCC) is an inherited cancer predisposition syn-drome characterized by early onset colorectal cancer (CRC) and several other extra-colonic cancers, most commonly endometrial cancer (EC) and gastric cancer. Our aim was to evaluate the efficiency and results of the ongoing CRC and EC surveillance programs and to investigate the grounds for future gastric cancer screening by comparing the gastric biopsies of mutation positive and negative siblings in search for premalignant lesions. We also compared a new surveillance method, computerized tomographic colonoscopy (CTC) with optic colonoscopy. The patient material consisted of 579 family members from 111 Finnish HNPCC families al-most all harboring a known mismatch repair gene mutation. The efficacy of CRC and EC surveillance programs on HNPCC patients was evaluated by comparing the stage and survival of cancer cases detected with surveillance versus without. The performance of a new technique, CTC, was explored using a same-day colonoscopy as a reference standard. The use of intrauterine aspiration biopsies for EC surveillance was intro-duced for the first time in a HNPCC setting. Upper GI endoscopies were performed and biop-sies taken from mutation carriers and their mutation-negative siblings. The present surveillance program for CRC proved to be efficient. The CRC cases detected by surveillance were at a significantly more favorable stage than those in the non-surveilled group. This advantage was reflected in a significantly higher CRC-specific survival in the sur-veilled group. The performance of a new technique, CTC was found insufficient for polyp detection in this population in which every polyp, no matter the size, should be detected and removed. Colono-scopy was confirmed as a better surveillance modality than CTC. We could not observe any of the assumed differences in the gastric mucosa from mutation carriers and their mutation-negative siblings and no cases of gastric cancer were detected. The results gave no support for gastric surveillance. The EC surveillance program (transvaginal ultrasound and intra-uterine biopsy every 2-3 years) seemed to be efficient. It yielded several asymptomatic cancer cases and premalignant lesions. The stage distribution of the endometrial cancers in the group under surveillance tended to be more favorable than that of the mutation-positive, symptomatic EC patients who had no surveillance. None of the surveilled EC patients died of EC compared to six in the non-surveilled patients during the follow up. The improvement was, however, not statistically sig-nificant, thus far. Another observation was the good performance of endometrial aspiration biopsies used in this setting for the first time.

Surveillance of Surgical Site Infections following Major Hip and Knee Surgery in Finland

Background and aims. Since 1999, hospitals in the Finnish Hospital Infection Program (SIRO) have reported data on surgical site infections (SSI) following major hip and knee surgery. The purpose of this study was to obtain detailed information to support prevention efforts by analyzing SIRO data on SSIs, to evaluate possible factors affecting the surveillance results, and to assess the disease burden of postoperative prosthetic joint infections in Finland. Methods. Procedures under surveillance included total hip (THA) and total knee arthroplasties (TKA), and the open reduction and internal fixation (ORIF) of femur fractures. Hospitals prospectively collected data using common definitions and written protocol, and also performed postdischarge surveillance. In the validation study, a blinded retrospective chart review was performed and infection control nurses were interviewed. Patient charts of deep incisional and organ/space SSIs were reviewed, and data from three sources (SIRO, the Finnish Arthroplasty Register, and the Finnish Patient Insurance Centre) were linked for capture-recapture analyses. Results. During 1999-2002, the overall SSI rate was 3.3% after 11,812 orthopedic procedures (median length of stay, eight days). Of all SSIs, 56% were detected after discharge. The majority of deep incisional and organ/space SSIs (65/108, 60%) were detected on readmission. Positive and negative predictive values, sensitivity, and specificity for SIRO surveillance were 94% (95% CI, 89-99%), 99% (99-100%), 75% (56-93%), and 100% (97-100%), respectively. Of the 9,831 total joint replacements performed during 2001-2004, 7.2% (THA 5.2% and TKA 9.9%) of the implants were inserted in a simultaneous bilateral operation. Patients who underwent bilateral operations were younger, healthier, and more often males than those who underwent unilateral procedures. The rates of deep SSIs or mortality did not differ between bi- and uni-lateral THAs or TKAs. Four deep SSIs were reported following bilateral operations (antimicrobial prophylaxis administered 48-218 minutes before incision). In the three registers, altogether 129 prosthetic joint infections were identified after 13,482 THA and TKA during 1999-2004. After correction with the positive predictive value of SIRO (91%), a log-linear model provided an estimated overall prosthetic joint infection rate of 1.6% after THA and 1.3% after TKA. The sensitivity of the SIRO surveillance ranged from 36% to 57%. According to the estimation, nearly 200 prosthetic joint infections could occur in Finland each year (the average from 1999 to 2004) after THA and TKA. Conclusions. Postdischarge surveillance had a major impact on SSI rates after major hip and knee surgery. A minority of deep incisional and organ/space SSIs would be missed, however, if postdischarge surveillance by questionnaire was not performed. According to the validation study, most SSIs reported to SIRO were true infections. Some SSIs were missed, revealing some weakness in case finding. Variation in diagnostic practices may also affect SSI rates. No differences were found in deep SSI rates or mortality between bi- and unilateral THA and TKA. However, patient materials between these two groups differed. Bilateral operations require specific attention paid to their antimicrobial prophylaxis as well as to data management in the surveillance database. The true disease burden of prosthetic joint infections may be heavier than the rates from national nosocomial surveillance systems usually suggest.

Basic Human Values in the Workplace

Työntekijöiden henkilökohtaisia arvoja ja niiden yhteyksiä asenteisiin ei ole juuri tutkittu. Tämän tutkimuksen tavoitteena oli selvittää, onko suomalaisessa metalliteollisuuden yrityksen henkilöstön (N=1314) arvojen rakenne S. H. Schwartzin arvoteorian mukainen. Lisäksi tutkittiin arvojen yhteyksiä organisaatiomuutosta koskeviin asenteisiin ja tiedon jakamiseen työyhteisössä. Arvomittarina käytettiin uutta 40-osioista Portrait Value Questionnairea (PVQ). Mittarin validiteetti osoitettiin ver-taamalla nyt kerätyn aineiston arvorakennetta aikaisemmalla mittarilla kerättyihin arvoteorian mukaisiin yliopisto-opiskelijoiden vastauksiin. Organisaatiomuutosta koskevien asenteiden ja tiedonjakamisen mittarit luotiin laadullisissa esitutkimuksissa. Tilastolliset analyysit osoittivat, että toimihenkilöiden ja työntekijöiden arvojen rakenteet noudattivat pääosin Schwartzin teoriaa, mutta turvallisuusarvot sijaitsivat molemmissa ryhmissä universalismin ja hyväntahtoisuuden joukossa. Universalismi ja hyväntahtoisuus ennustivat myönteistä asennetta organisaatiomuutoksia kohtaan, mutta perinteiden ja mielihyvän arvostaminen liittyivät kielteisiin muutosasenteisiin. Sosiaalisia normeja kunnioittavien eli yhdenmukaisuutta arvostavien henkilöiden muut arvot vaikuttivat muutosasenteisiin vähemmän kuin niillä, joille yhdenmukaisuus ei ollut tärkeää. Lisäksi suoriutumisarvon yhteys muutosasenteisiin oli yhdenmukaisuutta arvostavilla henkilöillä positiivinen, mutta niillä, jotka eivät arvostaneet yhdenmukaisuutta, yhteys oli negatiivinen. Itseohjautuvuutta arvostavat henkilöt pitivät työyhteisönsä tiedon jakamista heikompana, kun taas hyväntahtoisuutta ja yhdenmukaisuutta arvostavat pitivät sitä muihin nähden parempana. Suoriutumisarvo oli yhteydessä tiedonjakamiseen vain silloin, kun yhdenmukaisuus oli tärkeää. Työpaikkojen (N=19) keskiarvoja vertailtaessa havaittiin, että ne työpaikat, joissa arvostettiin paljon universalismia, hyväntahtoisuutta ja yhdenmukaisuutta sekä vähän valtaa ja suoriutumista saivat henkilöstöltään parhaat arvioinnit tiedon jakamisesta. Tutkimukseen osallistuneet henkilöt jaettiin työtehtäviensä perusteella kolmeen ammatilliseen ympäristöön: konven-tionaaliseen (mm. taloushallinto), realistiseen (mm. tuotanto) ja yrittäjämäiseen (mm. myynti). Yrittäjämäisessä ammatillisessa ympäristössä toimivat arvostivat enemmän kuin konventionaalisessa ympäristössä toimivat valtaa, itseohjautuvuutta ja suoriutumista. Realistisessa ympäristössä arvostettiin enemmän perinteitä ja mielihyvää kuin yrittäjämäisessä ympäristössä. Ryhmien väliset erot arvoissa johtuivat koulutuksesta, iästä ja sukupuolijakaumasta.

Organisational Responses to Workplace Harassment: An Exploratory Study

Purpose – The aim of this paper is to explore what kind of measures personnel managers have taken to intervene in workplace harassment and to explore how organisational characteristics and the characteristics of the personnel manager affect the choice of response strategies. Design/methodology/approach – The study was exploratory and used a survey design. A web-based questionnaire was sent to the personnel managers of all Finnish municipalities and data on organisational responses and organisational characteristics were collected. Findings – The study showed that the organisations surveyed relied heavily on reconciliatory measures for responding to workplace harassment and that punitive measures were seldom used. Findings indicated that personnel manager gender, size of municipality, use of “sophisticated” human resource management practices and having provided information and training to increase awareness about harassment all influence the organisational responses chosen. Research limitations/implications – Only the effects of organisational and personnel manager characteristics on organisational responses were analysed. Future studies need to include perpetrator characteristics and harassment severity. Practical implications – The study informs both practitioners and policy makers about the measures that have been taken and that can be taken in order to stop harassment. It also questions the effectiveness of written anti-harassment policies for influencing organisational responses to harassment and draws attention to the role of gendered perceptions of harassment for choice of response strategy. Originality/value – This paper fills a gap in harassment research by reporting on the use of different response strategies and by providing initial insights into factors affecting choice of responses.

The prevention of workplace bullying as a question of human resource management: measures adopted and underlying organizational factors

The aim of this study has been to analyze measures adopted to counteract workplace bullying from the perspective of human resource management. First, the kind of measures that are adopted to prevent bullying were examined. Second, factors affecting the extent of such measures were explored. The introduction of written anti-bullying policies and the provision of information were found to be the most common measures adopted. The policies strongly emphasized the role of supervisors and the immediate superior. Measures to counteract bullying were positively related to the adoption of ‘sophisticated’ human resource practices, previous negative publicity concerning bullying and the presence of a young human resource manager. The results, however, also indicated that imitation seemed to provide an important impetus behind anti-bullying efforts.

The Significance of Gender in the Prevalence, Forms and Perceptions of Workplace Bullying

Workplace bullying has been shown to have severe negative consequences for both the victims and organisations concerned. Thus, the aim of this paper is to further understanding of workplace bullying by in particular exploring the significance of gender in this phenomenon. The focus is on the prevalence, forms and perceptions of bullying, and the extent to which these interactions and perceptions can be understood as gendered. The aim of the paper is twofold: firstly, to describe gender differences in bullying in the male-dominated business world, and, secondly, to explain these differences by discussing how gender is linked to bullying and victimisation. It is argued that the higher prevalence rates reported by women can be seen as the result of an interaction between higher actual exposure rates to negative behaviours, lower perceived possibilities to defend themselves, and less reluctance to classify negative experiences as bullying, which all are mediated by perceptions of power.

Ways of Explaining Workplace Bullying: A Review of Enabling, Motivating, and Precipitating Structures and Processes in the Work Environment

This paper summarizes literature explaining workplace bullying and focuses on organisational antecedents of bullying. In order to better understand the logic behind bullying, a model discussing different types of explanations is put forward. Thus, explanations for and factors associated with bullying are classified into three groups, i.e. enabling structures or necessary antecedents (e.g. perceived power imbalances, low perceived costs, and dissatisfaction and frustration), motivating structures or incentives (e.g. internal competition, reward systems, and expected benefits), and precipitating processes or triggering circumstances (e.g. downsizing and restructuring, organisational changes, changes in the composition of the workgroup). The paper concludes that bullying is often an interaction between structures and processes from all three groupings.

Workplace Bullying among Business Professionals - Prevalence, Organisational Antecedents and Gender Differences (summary section only)

Workplace bullying can be defined as repeated and persistent negative acts that involve a power imbalance and create a hostile work environment. Partly because of the many negative consequences associated with the phenomenon, bullying has recently become the focus of many studies by contemporary organisational researchers. Drawing on a survey, this thesis provides information on the prevalence and forms of bullying among business professionals, a group of employees neglected in previous bullying research. The thesis follows a tradition among Nordic researchers that emphasises the role of the psychosocial work environment in bullying. In particular, it illustrates how high internal competition and a high degree of organisational politics in business life may lead employees to use bullying as a tactic to gain benefits over their colleagues. Furthermore, it explores the significance of gender in bullying in male-dominated work environments, with women tending to be subjected to more negative acts, tending to feel less capable to defend themselves in these situations, and tending to feel less reluctant to classify these experiences as bullying. In addition to the introductory essay, this thesis consists of a book chapter and four articles. These five papers address particular aspects of workplace bullying: the prevalence and forms of bullying, the significance of gender in bullying, and organisational antecedents of bullying.

Organizational Measures Taken against Workplace Bullying: The Case of Finnish Municipalities

Although workplace bullying and other inappropriate treatment in the workplace have received growing attention, especially in Northern Europe, in the past few decades, little research has so far been conducted about the prevention of and intervention in such phenomena. This paper provides a review of different organizational measures typically recommended for preventing and intervening in workplace bullying and other forms of inappropriate treatment in the workplace. These measures include anti-bullying policies, training and information, appropriate job designs, active monitoring, and early intervention. As for intervention, both informal and formal strategies are discussed. Furthermore, the paper reports findings from a study among Finnish municipalities on the extent to which these measures are actually used in Finland, a country that has fairly recently introduced anti-bullying legislation.