Responding to Young People's Health Risks in Primary Care: A Cluster Randomised Trial of Training Clinicians in Screening and Motivational Interviewing.

OBJECTIVE: To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors, on clinicians' detection of health risks and patients' risk taking behaviour, compared to a didactic seminar on young people's health. DESIGN: Pragmatic cluster randomised trial where volunteer general practices were stratified by postcode advantage or disadvantage score and billing type (private, free national health, community health centre), then randomised into either intervention or comparison arms using a computer generated random sequence. Three months post-intervention, patients were recruited from all practices post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later. Researchers recruiting, consenting and interviewing patients and patients themselves were masked to allocation status; clinicians were not. SETTING: General practices in metropolitan and rural Victoria, Australia. PARTICIPANTS: General practices with at least one interested clinician (general practitioner or nurse) and their 14-24 year old patients. INTERVENTION: This complex intervention was designed using evidence based practice in learning and change in clinician behaviour and general practice systems, and included best practice approaches to motivating change in adolescent risk taking behaviours. The intervention involved training clinicians (nine hours) in health risk screening, use of a screening tool and motivational interviewing; training all practice staff (receptionists and clinicians) in engaging youth; provision of feedback to clinicians of patients' risk data; and two practice visits to support new screening and referral resources. Comparison clinicians received one didactic educational seminar (three hours) on engaging youth and health risk screening. OUTCOME MEASURES: Primary outcomes were patient report of (1) clinician detection of at least one of six health risk behaviours (tobacco, alcohol and illicit drug use, risks for sexually transmitted infection, STI, unplanned pregnancy, and road risks); and (2) change in one or more of the six health risk behaviours, at three months or at 12 months. Secondary outcomes were likelihood of future visits, trust in the clinician after exit interview, clinician detection of emotional distress and fear and abuse in relationships, and emotional distress at three and 12 months. Patient acceptability of the screening tool was also described for the intervention arm. Analyses were adjusted for practice location and billing type, patients' sex, age, and recruitment method, and past health risks, where appropriate. An intention to treat analysis approach was used, which included multilevel multiple imputation for missing outcome data. RESULTS: 42 practices were randomly allocated to intervention or comparison arms. Two intervention practices withdrew post allocation, prior to training, leaving 19 intervention (53 clinicians, 377 patients) and 21 comparison (79 clinicians, 524 patients) practices. 69% of patients in both intervention (260) and comparison (360) arms completed the 12 month follow-up. Intervention clinicians discussed more health risks per patient (59.7%) than comparison clinicians (52.7%) and thus were more likely to detect a higher proportion of young people with at least one of the six health risk behaviours (38.4% vs 26.7%, risk difference [RD] 11.6%, Confidence Interval [CI] 2.93% to 20.3%; adjusted odds ratio [OR] 1.7, CI 1.1 to 2.5). Patients reported less illicit drug use (RD -6.0, CI -11 to -1.2; OR 0·52, CI 0·28 to 0·96), and less risk for STI (RD -5.4, CI -11 to 0.2; OR 0·66, CI 0·46 to 0·96) at three months in the intervention relative to the comparison arm, and for unplanned pregnancy at 12 months (RD -4.4; CI -8.7 to -0.1; OR 0·40, CI 0·20 to 0·80). No differences were detected between arms on other health risks. There were no differences on secondary outcomes, apart from a greater detection of abuse (OR 13.8, CI 1.71 to 111). There were no reports of harmful events and intervention arm youth had high acceptance of the screening tool. CONCLUSIONS: A complex intervention, compared to a simple educational seminar for practices, improved detection of health risk behaviours in young people. Impact on health outcomes was inconclusive. Technology enabling more efficient, systematic health-risk screening may allow providers to target counselling toward higher risk individuals. Further trials require more power to confirm health benefits. TRIAL REGISTRATION: ISRCTN.com ISRCTN16059206.

Hire me: Computational inference of hirability in employment interviews based on nonverbal behavior

Understanding the basis on which recruiters form hirability impressions for a job applicant is a key issue in organizational psychology and can be addressed as a social computing problem. We approach the problem from a face-to-face, nonverbal perspective where behavioral feature extraction and inference are automated. This paper presents a computational framework for the automatic prediction of hirability. To this end, we collected an audio-visual dataset of real job interviews where candidates were applying for a marketing job. We automatically extracted audio and visual behavioral cues related to both the applicant and the interviewer. We then evaluated several regression methods for the prediction of hirability scores and showed the feasibility of conducting such a task, with ridge regression explaining 36.2% of the variance. Feature groups were analyzed, and two main groups of behavioral cues were predictive of hirability: applicant audio features and interviewer visual cues, showing the predictive validity of cues related not only to the applicant, but also to the interviewer. As a last step, we analyzed the predictive validity of psychometric questionnaires often used in the personnel selection process, and found that these questionnaires were unable to predict hirability, suggesting that hirability impressions were formed based on the interaction during the interview rather than on questionnaire data.

Diverse Routes from School, via Higher Education, to Employment. A Comparison of Nine European Countries

The central theme for this study is graduate employment and employability in European-wide discussion. In this study, the complex relationships between higher education and the world of work are explored from the vantage point of how individuals make use of the higher education system in their transition from education to employment. The variation among individual transition processes in nine European countries is analysed with the help of a comparable graduate survey. Countries in this study are Italy, Spain, France, Austria, Germany, the Netherlands, the United Kingdom, Finland, and Norway. The data used for the study is commonly known as the “CHEERS” or “Careers after Higher Education, A European Research Survey.” The data was collected in 1999. The study discusses the possibilities and limitations the higher education system has in supporting the initial education-to-work transitions of youth. The study also addresses problems with comparing national higher education systems in terms of enrolment and graduate employability. A central purpose for this study is to reflect on concerns about the prolongation of individual transitions with a framework that simultaneously considers both the graduate employability and the duration of the education-to-work transition process. The key concept for this study is the standard student/graduate; synonym concepts are the traditional and the conventional student/graduate. Standard graduates are relatively young individuals who are performing their initial transition from education to working-life and who complete the degree-earning process within the stipulated time frame. In all nine countries, standard graduates make up a considerable share of the student flow, passing from higher education to the labour markets. The share of standard graduates is by far the largest in France, where they comprise the overwhelming mass. The proportion of the standard graduates is the lowest in Italy, Finland, and Austria where approximately one in four graduates completed the process of higher education within the stipulated time frame. Of the nine countries compared, employability of the whole graduate population is the greatest in Norway, the UK, Finland, and the Netherlands. Compared with employability of the whole graduate population, variation among the countries is considerably reduced when reviewing the employability of only the standard graduates. Thereby, even though the ranking among countries remains largely unchanged, the variations among them are smaller when the duration of degree earning process is standardized. The study also discusses other ideal types of student careers (or transition processes) besides the standard student/graduate. Results of regression analyses indicate that that at the pan-European level analysis, the graduate labour markets are not heavily segmented in terms of the type of the individual transition process. When considering within-country differences between the graduates, the field of studies is clearly a more powerful explanatory variable than the type of the transition process. There are, nevertheless, clear indications that, irrespective of the country, chances of finding a high status job are, on the average, highest amongst those who graduate within the stipulated duration of the degree program and who thereby have experienced the standard student career, whereas, participating in working life while studying protects against unemployment after finishing one’s degree.

Institutional legacies, employment and professional integration of non EU/EEA doctors in France

Internationally, policies for attracting highly-skilled migrants have become the guidelines mainly used by the Organisation for Economic Co-operation and Development (OECD) countries. Governments are implementing specific procedures to capture and facilitate their mobility. However, all professions are not equal when it comes to welcoming highly-skilled migrants. The medical profession, as a protective market, is one of these. Taking the case of non-EU/EEA doctors in France, this paper shows that the medical profession defined as the closed labour market, remains the most controversial in terms of professional integration of migrants, protectionist barriers to migrant competition and challenge of medical shortage. Based on the path-dependency approach, this paper argues that non-EU/EEA doctors' issues in France derive from a complex historical process of interaction between standards settled in the past, particularly the historical power of medical corporatism, the unexpected long-term effects of French hospital reforms of 1958, and budgetary pressures. Theoretically, this paper shows two significant findings. Firstly, the French medical system has undergone a series of transformations unthinkable in the strict sense of a path-dependence approach: an opening of the medical profession to foreign physicians in the context of the Europeanisation of public policy, acceptance of non-EU/EEA doctors in a context of medical shortage and budgetary pressures. Secondly, there is no change of the overall paradigm: significantly, the recruitment policies of non-EU/EEA doctors continue to highlight the imprint of the past and reveal a significant persistence of prejudices. Non-EU/EEA doctors are not considered legitimate doctors even if they have the qualifications of physicians which are legitimate in their country and which can be recognised in other receiving countries.

The skill paradox: Explaining and reducing employment discrimination against skilled immigrants

Using a social identity theory approach, we theorized that recruiters might be particularly biased against skilled immigrant applicants. We refer to this phenomenon as a skill paradox, according to which immigrants are more likely to be targets of employment discrimination the more skilled they are. Furthermore, building on the common ingroup identity model, we proposed that this paradox can be resolved through human resource management (HRM) strategies that promote inclusive hiring practices (e.g., by emphasizing fit with a diverse clientele). The results from a laboratory experiment were consistent with our predictions: Local recruiters preferred skilled local applicants over skilled immigrant applicants, but only when these applicants were qualified for a specific job. This bias against qualified and skilled immigrant applicants was attenuated when fit with a diverse clientele was emphasized, but not when fit with a homogeneous clientele was emphasized or when the hiring strategy was not explained. We discuss the implications of our findings for research on employment discrimination against skilled immigrants, including the role of inclusiveness for reducing discriminatory biases.

The Spatial effects of transportation on industrial employment

This paper examines the direct and indirect impacts of transport infrastructure on industrial employment. We estimate regressions with spatial econometric methods using data from the Spanish regions for the period 1995-2008. We find that the density of motorways and the amount of port traffic (particularly general non-containerized and container traffic) are significant determinants of industrial employment in the region, while the effects of railway density and the amount of airport traffic are unclear. Our empirical analysis shows the existence of significant negative spatial spillovers for the density of motorways and levels of container port traffic while the impact of general non-containerized port traffic seems to be mainly local.

Is Self-employment a Way to Escape from Skill Mismatches?

During the last two decades, skill mismatches have become one of the most important issues of policy concern in the EU (European Commission, 2008). Hence, the literature has stressed the necessity to reduce skill mismatches. We contribute to this literature by analyzing the impact of the transition from salaried employment to self-employment on self-reported skill mismatches. To do so, we resort to the European Community Household Panel (ECHP) covering the period 1994–2001. Using panel data, we track individuals over time and measure their self-reported skill mismatch before and after the transition. Our empirical findings indicate not only that the average self-employee is less likely to declare being skill-mismatched but also that those individuals who transit from salaried employment to self-employment reduce their probability of skill mismatches after the transition. Keywords: Self-employment, skill mismatches, salaried employment. JEL Classification: L26, J24, B23 __________________________

Henkilöstöresurssien organisointi suuren alusöljyvahingon torjunnassa

Tässä pro gradu -tutkielmassa tarkastellaan henkilöstöresurssien organisointia suuren alusöljyvahingon torjuntatilanteessa. Tavoitteena on suunnitella Suomenlahden rannikon öljyntorjunnasta vastaavien viranomaisten käyttöön optimaalinen rekrytointistrategia pahimman todennäköisen alusöljyvahingon varalle. Tutkimuksessa selvitetään myös millainen työsopimus öljyntorjuntatyöntekijöiden kanssa voidaan sopia. Näiden lisäksi etsitään vastausta siihen,kuinka työvoima saadaan pidettyä. Tämän laadullisen tutkimuksen teoreettinen osuus toteutettiin kirjallisuuskatsauksena. Tutkimuksen empiirinen aineisto kerättiin haastattelemalla yhdeksää asiantuntijaa syksyn 2009 aikana. Haastattelut olivat muodoltaan puolistrukturoituja teemahaastatteluja. Tutkimustulosten mukaan merkittävin lisätyövoiman tarve ilmenee käsin tehtävässä rantapuhdistustyössä. Etenkin puhdistustyön pitkittyessä pelastusviranomaiset tarvitsevat avukseen ulkopuolista työvoimaa. Rekrytointi suoritetaan muutamien viikkojen kuluessa öljyvahingon aiheutumisen jälkeen. Alueellinen pelastuslaitos suorittaa rekrytoinnin käyttäen tehokkaita, laajan kohderyhmän tavoittavia rekrytointiviestinnän välineitä (esim. sanomalehdet, TV ja Internet). Työntekijöiden kanssa sovitaan määräaikainen, Kunnallista virkaja työehtosopimusta noudattava työsopimus. Tärkeimpinä puhdistustyöntekijöitä motivoivina tekijöinä nähdään työn merkitys yhteiskunnalle, selkeästi määritelty, saavutettavissa oleva tavoite sekä palaute tehdystä työstä.

Joukkoirtisanomisen jälkeen - työllistymisen haasteet ja tukitoimien toimivuus irtisanottujen näkökulmasta

Tämän tutkimuksen tavoitteena on kuvata joukkoirtisanottujen näkökulmasta työllistymisen haasteita, tukitoimien toimivuutta ja miten tukitoimia kehittämällä pystyttäisiin vastaamaan paremmin irtisanottujen kokemiin haasteisiin. Tutkimusmenetelmä on laadullinen haastattelututkimus. Tutkimuksen aineisto kerättiin haastattelemalla yhtätoista Voikkaan tehtaalta vuonna 2006 irtisanottua työntekijää. Tutkimuksen perusteella keskeisimpinä työllistymisen haasteina nähdään ikä, yksipuolinen työkokemus, vaikeasti toiselle alalle siirrettävä ammattitaito sekä haluttomuus muuttaa toiselle paikkakunnalle. Pääsääntöisesti tukitoimiin oltiin melko tyytyväisiä, joskin mielipiteet tukitoimien onnistumisesta vaihtelivat paljon. Muutosturvan tärkeimpänä hyötynä nähtiin mahdollisuus opiskella taloudellisen tuen turvin. Tukitoimia koskevaa tiedotusta kritisoitiin mm. puutteellisista ja vääristä tiedoista.

Myyjien organisaatioon sitoutuminen ja esimiehen vaikutus sitoutumiseen. Case: Alko Oy

Tämän tutkielman tavoitteena on kuvata ja ymmärtää myyjien organisaatioon sitoutumista Alko Oy:ssä, sitä kuinka myyjät ovat sitoutuneita organisaatioon ja sitoutumiseen vaikuttavia tekijöitä. Tarkoituksena on selvittää ja ymmärtää esimiehen vaikutusta sitoutumiseen sekä sitä kuinka esimies voi edistää myyjien sitoutumista. Lisäksi tavoitteena on kartoittaa ja ymmärtää sitoutumisen seurauksia. Tutkimuksen teoreettinen viitekehys muodostuu organisaatioon sitoutumisen tutkimuksesta ja johtajuuden tutkimuksesta, erityisesti transformationaalisesta johtajuudesta ja sen vaikutuksesta sitoutumiseen. Tutkimus on luonteeltaan laadullinen ja pääasiallisena tutkimusmetodina on käytetty teemahaastattelua. Tutkimusaineisto kerättiin haastattelemalla 22 myyjää ja seitsemää esimiestä. Haastattelut nauhoitettiin ja litteroitiin. Haastattelujen lisäksi myyjille tehtiin kysely. Aineistoa analysoitiin teemoittain ja empiirisen aineiston analyysin tulkinta perustuu tutkimuksen teoreettiseen viitekehykseen. Tutkimustulosten mukaan myyjien sitoutuminen kohdeorganisaatiossa on hyvällä tai vähintään kohtuullisella tasolla ja se pohjautuu voimakkaimmin affektiiviseen ulottuvuuteen. Lisäksi sitoutuminen perustuu osittain jatkuvuuteen perustuvaan komponenttiin sekä pieneltä osin myös normatiiviseen. Affektiiviseen sitoutumiseen vaikuttavat merkittävimmin työn monipuolisuus, haastavuus ja mielekkyys, onnistumisen ja merkityksellisyyden tunteet sekä ilmapiiri. Jatkuvuuteen perustuvaan sitoutumiseen vaikuttavat eniten palkitseminen ja siihen liittyen osa-aikaisuus, joka jakoi myyjiä kahtia. Lisäksi työn monipuolisuudella, varmuudella sekä työllistymisvaihtoehdoilla ja perhesyillä on vaikutusta jatkuvuusperusteiseen sitoutumiseen. Normatiiviseen sitoutumiseen vaikuttavat voimakkaimmin positiivinen vapaaehtoinen vastavuoroisuus organisaatiota kohtaan sen toimintaan ja tekemiin investointeihin liittyen. Lisäksi normatiiviseen sitoutumiseen vaikuttavat sosialisaatio kasvatuksen myötä ja psykologinen sopimus odotuksineen. Esimiehen vaikutus sitoutumiseen korostuu tuloksissa ja esimiehen toiminnalla on merkittävin vaikutus affektiiviseen sitoutumiseen. Keskeisimpiä esimiehen vaikutuskeinoja myyjien sitoutumiseen ovat vastuun antaminen ja osallistaminen, palaute, avoin vuorovaikutus ja tiedonkulku sekä tasapuolisuus ja oikeudenmukaisuus toiminnassa. Myös esimiehen kannustavuus ja myyjien yksilöllinen huomiointi, osaamisen kehittämisen tukeminen sekä esimerkillinen toiminta ovat keskeisiä. Sitoutumisen seurauksista merkittävimpiä ovat vähäinen vaihtuvuus sekä työsuorituksen ja asiakaspalvelun laatu. Lisäksi organisaatiokansalaisuuskäyttäytymiseen liittyvät seikat, kuten parhaansa tekeminen, joustavuus ja itseohjautuvuus ovat keskeisiä sitoutumisen seurauksia.

Korkeasti koulutettujen selviytyminen työn menetyksestä ja pitkittyneestä työttömyydestä

Tämän pro gradu -tutkielman tavoitteena oli ymmärtää ja kuvata korkeasti koulutettujen henkilöiden selviytymistä työn menetyksestä ja pitkittyneestä työttömyydestä. Tutkimuksessa tarkasteltiin pakotettua uramuutosta ja työttömyyttä sekä siitä selviytymistä yksilön kokemuksen näkökulmasta. Lisäksi tutkittiin työttömyyden tukipalveluiden hyödyllisyyttä. Tutkimus toteutettiin kvalitatiivisena kuvailevana tapaustutkimuksena. Tutkimuksen empiirinen aineisto kerättiin haastattelemalla 13 korkeasti koulutettua uusimaalaista työtöntä henkilöä. Haastattelut toteutettiin puolistrukturoitua teemahaastattelumenetelmää käyttäen. Tutkimuksen tulosten perusteella voidaan havaita, että työn menetyksellä koettiin olevan sekä negatiivisia että positiivisia vaikutuksia. Työn menetys koettiin osittain helpotuksena ja hengähdystaukona. Henkilöt selviytyivät itse työn menetyksen tilanteesta jokseenkin hyvin, etenkin jos muutokseen oli voinut varautua ja irtisanomisperusteet olivat selkeät. Korkeasti koulutetut henkilöt käyttivät monipuolisesti sekä tunne- että ongelmakeskeisiä selviytymisstrategioita selviytyäkseen työttömyydestä. Näistä aktiivinen työnhaku sekä opiskelu korostuivat selviytymiskeinoina. Työttömyyden pitkittyminen heikensi selvästi yksilön hyvinvointia ja vertaistuen merkitys korostui työttömyyden pitkittyessä. Tutkimuksesta ilmeni, että julkiset työvoimapalvelut eivät tue riittävästi korkeasti koulutettuja työttömiä. Tukipalveluja tulisi kehittää vastaamaan paremmin muuttuneiden työmarkkinoiden vaateita, sillä työmarkkinoiden muutokset haastavat urien uudenlaiseen tarkasteluun.

The geographic dynamics of industry employment in Brazilian metropolitan areas: lessons for São Paulo

ABSTRACTWe discuss historic trends in large metropolitan areas in Brazil showing that manufacturing has decreased its share in the country but the movement was, in general, more intense in large metropolitan areas and particularly in the São Paulo Metropolitan Area (SPMA). This movement was more intense in the 1980s and in the first half of the 1990s. From mid 1990s up to the end of the 2000s, the manufacturing share trend became flat. We speculate that the first period reflects the exhaustion of the process of import substitution that took place in the previous three decades (1950 to 1980). The second period, from 1993 to 2009, is representative of a new model of growth and the evidence that manufacturing share became flat is reinforcing the idea of a new period in terms of manufacturing employment. While concentration has risen from 1996 to 2005, it decreased again in the second half of the first decade of the 2000s. The SPMA reinvented itself very quickly from late 1970s to mid-2000s.