Levonorgestrel intrauterine system versus medical therapy for menorrhagia

Background - Menorrhagia is a common problem, yet evidence to inform decisions about therapy is limited. In a pragmatic, multicenter, randomized trial, we compared the levonorgestrel-releasing intrauterine system (levonorgestrel-IUS) with usual medical treatment in women with menorrhagia who presented to their primary care providers. Methods - We randomly assigned 571 women with menorrhagia to treatment with levonorgestrel-IUS or usual medical treatment (tranexamic acid, mefenamic acid, combined estrogen–progestogen, or progesterone alone). The primary outcome was the patient-reported score on the Menorrhagia Multi-Attribute Scale (MMAS) (ranging from 0 to 100, with lower scores indicating greater severity), assessed over a 2-year period. Secondary outcomes included general quality-of-life and sexual-activity scores and surgical intervention. Results - MMAS scores improved from baseline to 6 months in both the levonorgestrel-IUS group and the usual-treatment group (mean increase, 32.7 and 21.4 points, respectively; P<0.001 for both comparisons). The improvements were maintained over a 2-year period but were significantly greater in the levonorgestrel-IUS group than in the usual-treatment group (mean between-group difference, 13.4 points; 95% confidence interval, 9.9 to 16.9; P<0.001). Improvements in all MMAS domains (practical difficulties, social life, family life, work and daily routine, psychological well-being, and physical health) were significantly greater in the levonorgestrel-IUS group than in the usual-treatment group, and this was also true for seven of the eight quality-of-life domains. At 2 years, more of the women were still using the levonorgestrel-IUS than were undergoing the usual medical treatment (64% vs. 38%, P<0.001). There were no significant between-group differences in the rates of surgical intervention or sexual-activity scores. There were no significant differences in serious adverse events between groups. Conclusions - In women with menorrhagia who presented to primary care providers, the levonorgestrel-IUS was more effective than usual medical treatment in reducing the effect of heavy menstrual bleeding on quality of life. (Funded by the National Institute of Health Research Health Technology Assessment Programme; ECLIPSE Controlled-Trials.com number, ISRCTN86566246.)

Advanced manufacturing technology, work design, and performance:a change study

Two alternative work designs are identified for operators of stand-alone advanced manufacturing technology (AMT). In the case of specialist control, operators are limited to running and monitoring the technology, with operating problems handled by specialists, such as engineers. In the case of operator control, operators are given much broader responsibilities and deal directly with the majority of operating problems encountered. The hypothesis that operator control would promote better performance and psychological well-being than would specialist control (which is more prevalent) was tested in a longitudinal field study involving work redesign for operators of computer-controlled assembly machines. Change from specialist to operator control reduced downtime, especially for high-variance systems, and was associated with greater intrinsic job satisfaction and less perceived work pressure. The implications of these findings for both small and large-scale applications of AMT are discussed.

Individual spirit at work and its outcomes:an empirical examination in corporate Thailand

The purpose of the present study was to conduct empirical research in corporate Thailand in order to (1) investigate the relationships between individual spirit at work and three employee work attitudinal variables (organisational identification, job satisfaction and psychological well-being) and three organisational outcomes (in-role performance, organisational citizenship behaviours (OCB), and turnover intentions) (2) further examine causal relations among these organisational behaviour variables with a longitudinal design (3) examine three employee work attitudes as mediator variables between individual spirit at work and three organisational outcomes and (4) explore the potential antecedents of organisational conditions that foster employee experienced individual spirit at work. The 715 completed questionnaires were received from the first wave of data collection during July 2008 and the second wave was conducted again within the same organisations and 501 completed questionnaires were received during April 2009. Data were obtained through 52 organisations which were from three types of organisations within Thailand: public organisations (N=237,185), for-profit organisations (N=244,155), and not-for-profit organisations (N=234,161). Confirmatory factor analysis of all measures used in the study and hypothesized model were tested with structural equation modeling techniques. Results were strongly supportive. In addition, although the model was invariant across rater of performance and OCB, there were differences across self report and supervisor rating. Additionally, the antecedents of organisational conditions that fostered employees experienced individual spirit at work and the implications of these findings for practice and research are discussed.

Weight-based discrimination, body dissatisfaction and emotional eating:the role of perceived social consensus.

Objective: Discrimination can have a negative impact on psychological well-being, attitudes and behaviour. This research evaluates the impact of experiences of weight-based discrimination upon emotional eating and body dissatisfaction, and also explores whether people's beliefs about an ingroup's social consensus concerning how favourably overweight people are regarded can moderate the relationship between experiences of discrimination and negative eating and weight-related cognitions and behaviours. Research methods and procedures: 197 undergraduate students completed measures about their experiences of weight-based discrimination, emotional eating and body dissatisfaction. Participants also reported their beliefs concerning an ingroup's attitude towards overweight people. Results: Recollections of weight-based discrimination significantly contributed to emotional eating and body dissatisfaction. However, the relationships between experiencing discrimination and body dissatisfaction and emotional eating were weakest amongst participants who believed that the ingroup held a positive attitude towards overweight people. Discussion: Beliefs about ingroup social consensus concerning overweight people can influence the relationships between weight-based discrimination and emotional eating and body dissatisfaction. Changing group perceptions to perceive it to be unacceptable to discriminate against overweight people may help to protect victims of discrimination against the negative consequences of weight-based stigma.

Randomised trial of levonorgestrel intrauterine system compared to usual medical treatment for heavy menstrual bleeding:the ECLIPSE Trial

Objective: Heavy menstrual bleeding (menorrhagia) is a common problem, yet evidence is limited to inform therapeutic decisions.We compared the levonorgestrel-releasing intrauterine system(LNG-IUS) to usual medical treatment in a pragmatic randomised trial in primary care. Methods: We randomly assigned 571 women consulting their primary care providers with menorrhagia to LNG-IUS or to usual medical treatment as clinically appropriate (tranexamic acid, mefenamic acid, combined estrogen/progestogen or progestogen only). The primary outcome was a patient-reported measure ofimpact of menorrhagia, the validated Menorrhagia Multi-Attribute Scale (MMAS), assessed over 2 years. Secondary measures included generic quality of life (SF-36), sexual activity and surgical intervention.Results MMAS scores improved from baseline in both the LNG-IUS and usual medical treatment groups by 6 months (mean increases 32.7 points versus 21.4 points, respectively; P < 0.001for both) and were maintained over 2 years, but improvements were significantly greater with LNG-IUS (mean between-group difference 13.4 points, 95%CI, 9.9–16.9; P < 0.001).All domains of MMAS (practical difficulties, social life, family life,work/daily routine, psychological well being and physical health)improved significantly more with LNG-IUS, as were seven of the eight domains of SF-36. More women were still using LNG-IUSthan usual medical treatment at 2 years (64% versus 38%,P < 0.001). There were no significant between-group differences in surgical intervention rates or sexual activity scores. There were no serious adverse events in either group.Conclusions Among women presenting to primary care providers with menorrhagia, LNG-IUS was more effective than usual medical treatment at reducing the impact of this problem on their quality of life. In practice therefore, conventional treatments, such as tranexamic and mefenamic acid, remain helpful choices in women for whom LNG-IUS is considered unsuitable, or due to individual preference. For other women, LNG-IUS can be confidently recommended as an effective initial medical therapy for menorrhagia. Funding: This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number 02/06/02)

Advancing the psychology of entrepreneurship:a review of the psychological literature and an introduction

This article provides a narrative review of psychology of entrepreneurship research published in leading psychology journals, based on which we develop an organising framework for future psychological contributions to this field. Furthermore, we introduce the manuscripts collected in this special issue. Our review identified five research areas, broadly corresponding with basic psychological domains, namely personal differences; careers; health and well-being; cognition and behaviour; and leadership; as well as three cross-cutting themes: gender issues; genetic and biological foundations; and context. With the aim to stimulate integration across different approaches and disciplines, we propose a framework to understand how psychologists can offer innovative contributions to the multi-disciplinary entrepreneurship literature. This includes a focus on the entrepreneur embedded in and in interaction with his or her immediate and wider context; attention to different types of entrepreneurs; and a focus on dynamic within-person processes evolving over time.

Role of organizational identification, on Implicit Leadership Theories ILTs, transformational leadership and work attitudes

This investigation explores the effects of organizational identification on employees’ Implicit Leadership Theories (ILTs) and the perception of leader behaviors. The study involved a cross-sectional survey of 439 employees from seven companies based in South Wales. Respondents completed two questionnaires that measured their organizational identification, ILTs, recognition of ILTs in their manager, manager’s leadership behaviors (transactional and transformational), and psychological reactions (job satisfaction, well-being, and turnover intentions). The level of organizational identification did not affect the prototype of an ideal work-based leader. However, high organizational identification was associated with more positive ratings on the actual manager, the extent to which their manager displayed transactional and transformational behaviors, and with more positive psychological reactions to work. Employees high in organizational identification based their judgments of their leader’s transactional and transformational behaviors on the extent to which they recognized their leader as possessing leadership traits. However, those low on organizational identification allowed their prototype of their ideal leader to bias their judgment of their actual leader’s behavior. Finally, there was partial support for the augmenting hypothesis (that tranformational leadership would predict additional variance in psychological outcomes above that predicted by transactional leadership) for those high in organizational identification but not for those low in organizational identification.

Working under a black cloud:how to sustain organizational identification after a merger

This article argues against the merger folklore that maintains that a merger negatively affects well-being and work attitudes primarily through the threat of job insecurity. We hold that the workplace is not only a resource for fulfilling a person's financial needs, but that it is an important component of the self-concept in terms of identification with the organization, as explained by social identity theory. We unravel the key concepts of the social identity approach relevant to the analysis of mergers and review evidence from previous studies. Then, we present a study conducted during a merger to substantiate our ideas about the effects of post-merger organizational identification above and beyond the effects of perceived job insecurity. We recommend that managers should account for these psychological effects through the provision of continuity and specific types of communication. © 2006 British Academy of Management.

Managing people and performance:An evidence based framework applied to health service organizations

People and their performance are key to an organization's effectiveness. This review describes an evidence-based framework of the links between some key organizational influences and staff performance, health and well-being. This preliminary framework integrates management and psychological approaches, with the aim of assisting future explanation, prediction and organizational change. Health care is taken as the focus of this review, as there are concerns internationally about health care effectiveness. The framework considers empirical evidence for links between the following organizational levels: 1. Context (organizational culture and inter-group relations; resources, including staffing; physical environment) 2. People management (HRM practices and strategies; job design, workload and teamwork; employee involvement and control over work; leadership and support) 3. Psychological consequences for employees (health and stress; satisfaction and commitment; knowledge, skills and motivation) 4. Employee behaviour (absenteeism and turnover; task and contextual performance; errors and near misses) 5. Organizational performance; patient care. This review contributes to an evidence base for policies and practices of people management and performance management. Its usefulness will depend on future empirical research, using appropriate research designs, sufficient study power and measures that are reliable and valid.

The effects of prior moves on job relocation stress

This study examines the relationship between the number of prior moves, time living in an area and psychological reactions of employees undergoing job relocation. Relocating employees from a single organization completed questionnaires on average six weeks before and 10 weeks after their move. Results show that the greater the number of prior moves the lower was the reported stress following the move. However, the relationship between number of prior moves and well-being also followed a quadratic trend such that those with few and those with many prior moves reported the greatest stress. Furthermore, the longer the relocator had lived in the area prior to moving, the greater was the general stress and the job-related anxiety and depression following the move.

A randomised controlled trial of the clinical effectiveness and cost-effectiveness of the levonorgestrel-releasing intrauterine system in primary care against standard treatment for menorrhagia:the ECLIPSE trial

BACKGROUND: Heavy menstrual bleeding (HMB) is a common problem, yet evidence to inform decisions about initial medical treatment is limited. OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) (Mirena(®), Bayer) compared with usual medical treatment, with exploration of women's perspectives on treatment. DESIGN: A pragmatic, multicentre randomised trial with an economic evaluation and a longitudinal qualitative study. SETTING: Women who presented in primary care. PARTICIPANTS: A total of 571 women with HMB. A purposeful sample of 27 women who were randomised or ineligible owing to treatment preference participated in semistructured face-to-face interviews around 2 and 12 months after commencing treatment. INTERVENTIONS: LNG-IUS or usual medical treatment (tranexamic acid, mefenamic acid, combined oestrogen-progestogen or progesterone alone). Women could subsequently swap or cease their allocated treatment. OUTCOME MEASURES: The primary outcome was the patient-reported score on the Menorrhagia Multi-Attribute Scale (MMAS) assessed over a 2-year period and then again at 5 years. Secondary outcomes included general quality of life (QoL), sexual activity, surgical intervention and safety. Data were analysed using iterative constant comparison. A state transition model-based cost-utility analysis was undertaken alongside the randomised trial. Quality-adjusted life-years (QALYs) were derived from the European Quality of Life-5 Dimensions (EQ-5D) and the Short Form questionnaire-6 Dimensions (SF-6D). The intention-to-treat analyses were reported as cost per QALY gained. Uncertainty was explored by conducting both deterministic and probabilistic sensitivity analyses. RESULTS: The MMAS total scores improved significantly in both groups at all time points, but were significantly greater for the LNG-IUS than for usual treatment [mean difference over 2 years was 13.4 points, 95% confidence interval (CI) 9.9 to 16.9 points; p < 0.001]. However, this difference between groups was reduced and no longer significant by 5 years (mean difference in scores 3.9 points, 95% CI -0.6 to 8.3 points; p = 0.09). By 5 years, only 47% of women had a LNG-IUS in place and 15% were still taking usual medical treatment. Five-year surgery rates were low, at 20%, and were similar, irrespective of initial treatments. There were no significant differences in serious adverse events between groups. Using the EQ-5D, at 2 years, the relative cost-effectiveness of the LNG-IUS compared with usual medical treatment was £1600 per QALY, which by 5 years was reduced to £114 per QALY. Using the SF-6D, usual medical treatment dominates the LNG-IUS. The qualitative findings show that women's experiences and expectations of medical treatments for HMB vary considerably and change over time. Women had high expectations of a prompt effect from medical treatments. CONCLUSIONS: The LNG-IUS, compared with usual medical therapies, resulted in greater improvement over 2 years in women's assessments of the effect of HMB on their daily routine, including work, social and family life, and psychological and physical well-being. At 5 years, the differences were no longer significant. A similar low proportion of women required surgical intervention in both groups. The LNG-IUS is cost-effective in both the short and medium term, using the method generally recommended by the National Institute for Health and Care Excellence. Using the alternative measures to value QoL will have a considerable impact on cost-effectiveness decisions. It will be important to explore the clinical and health-care trajectories of the ECLIPSE (clinical effectiveness and cost-effectiveness of levonorgestrel-releasing intrauterine system in primary care against standard treatment for menorrhagia) trial participants to 10 years, by which time half of the cohort will have reached menopause. TRIAL REGISTRATION: Current Controlled Trials ISRCTN86566246. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 88. See the NIHR Journals Library website for further project information.

Living well to the end:a phenomenological analysis of life in extra care housing

OBJECTIVES: To understand older adults' experiences of moving into extra care housing which offers enrichment activities alongside social and healthcare support. DESIGN: A longitudinal study was conducted which adopted a phenomenological approach to data generation and analysis. METHODS: Semi-structured interviews were conducted in the first 18 months of living in extra care housing. Interpretative phenomenological analysis was used because its commitment to idiography enabled an in-depth analysis of the subjective lived experience of moving into extra care housing. Themes generated inductively were examined against an existential-phenomenological theory of well-being. RESULTS: Learning to live in an extra care community showed negotiating new relationships was not straightforward; maintaining friendships outside the community became more difficult as capacity declined. In springboard for opportunity/confinement, living in extra care provided new opportunities for social engagement and a restored sense of self. Over time horizons began to shrink as incapacities grew. Seeking care illustrated reticence to seek care, due to embarrassment and a sense of duty to one's partner. Becoming aged presented an ontological challenge. Nevertheless, some showed a readiness for death, a sense of homecoming. CONCLUSIONS: An authentic later life was possible but residents required emotional and social support to live through the transition and challenges of becoming aged. Enhancement activities boosted residents' quality of life but the range of activities could be extended to cater better for quieter, smaller scale events within the community; volunteer activity facilitators could be used here. Peer mentoring may help build new relationships and opportunities for interactive stimulation. Acknowledging the importance of feeling-empathic imagination-in caregiving may help staff and residents relate better to each other, thus helping individuals to become ontologically secure and live well to the end.

The meaning, antecedents and outcomes of employee engagement:a narrative synthesis

The claim that high levels of engagement can enhance organizational performance and individual well-being has not previously been tested through a systematic review of the evidence. To bring coherence to the diffuse body of literature on engagement, the authors conducted a systematic synthesis of narrative evidence involving 214 studies focused on the meaning, antecedents and outcomes of engagement. The authors identified six distinct conceptualizations of engagement, with the field dominated by the Utrecht Group's ‘work engagement’ construct and measure, and by the theorization of engagement within the ‘job demands–resources’ framework. Five groups of factors served as antecedents to engagement: psychological states; job design; leadership; organizational and team factors; and organizational interventions. Engagement was found to be positively associated with individual morale, task performance, extra-role performance and organizational performance, and the evidence was most robust in relation to task performance. However, there was an over-reliance on quantitative, cross-sectional and self-report studies within the field, which limited claims of causality. To address controversies over the commonly used measures and concepts in the field and gaps in the evidence-base, the authors set out an agenda for future research that integrates emerging critical sociological perspectives on engagement with the psychological perspectives that currently dominate the field.