A Meta-Analysis of the Effectiveness of Military and Veterans Affairs (VA) Combat-Related PTSD Programs

A meta-analysis was conducted to examine the effectiveness of 55 treatment outcomes reported by military and Veterans Affairs (VA) treatment centers for combat-related posttraumatic stress disorder (PTSD). The analysis includes 46 tested treatment outcomes derived from 21 psychotherapy studies, and nine tested treatment outcomes derived from seven pharmacotherapy studies, which were obtained through PsychINFO and PsychARTICLES database searches, as well as a reference search. Analysis of all treatment outcomes suggested a statistically significant, and meaningful, decrease in PTSD symptoms between baseline and post-treatment time points, t(54) = 9.27, p < .001, d = 0.35. Additionally, analysis of outcomes between psychotherapy and pharmacotherapy treatments resulted in statistically significant differences in PTSD assessment scores at post-test, indicating a greater degree of change for psychotherapy than for pharmacotherapy.

Gender inequalities in occupational health related to the unequal distribution of working and employment conditions: a systematic review

Introduction: Gender inequalities exist in work life, but little is known about their presence in relation to factors examined in occupation health settings. The aim of this study was to identify and summarize the working and employment conditions described as determinants of gender inequalities in occupational health in studies related to occupational health published between 1999 and 2010. Methods: A systematic literature review was undertaken of studies available in MEDLINE, EMBASE, Sociological Abstracts, LILACS, EconLit and CINAHL between 1999 and 2010. Epidemiologic studies were selected by applying a set of inclusion criteria to the title, abstract, and complete text. The quality of the studies was also assessed. Selected studies were qualitatively analysed, resulting in a compilation of all differences between women and men in the prevalence of exposure to working and employment conditions and work-related health problems as outcomes. Results: Most of the 30 studies included were conducted in Europe (n=19) and had a cross-sectional design (n=24). The most common topic analysed was related to the exposure to work-related psychosocial hazards (n=8). Employed women had more job insecurity, lower control, worse contractual working conditions and poorer self-perceived physical and mental health than men did. Conversely, employed men had a higher degree of physically demanding work, lower support, higher levels of effort-reward imbalance, higher job status, were more exposed to noise and worked longer hours than women did. Conclusions: This systematic review has identified a set of working and employment conditions as determinants of gender inequalities in occupational health from the occupational health literature. These results may be useful to policy makers seeking to reduce gender inequalities in occupational health, and to researchers wishing to analyse these determinants in greater depth.

A relevância das medidas individualizadas : ouvimos o paciente mas captamos a história?

Individualized measures are relevant for the assessment of therapeutic results and allow patients to identify the aspects that they value the most in assessing their clinical improvement. PSYCHLOPS, as an individualized measure, invite the patient to create their own items. The items created by the patients were compared with the contents of standardized measures. A sample composed by 107 patients admitted for psychological treatment in Hospital Espírito Santo (Évora), and three institutions for drug misuse fill in the PSYCHLOPS and two standardized measures presented in a random order: CORE-OM and PHQ-9. 279 items were created in PSYCHLOPS and later recoded, by thematic analysis, in 51 subthemes. Work-related problems was the most common subtheme identified by patients as relevant to the clinical improvement assessment. From the 51 subthemes, 17 (33.3%) were not represented in CORE-OM and 43 (84.3%) were not represented in PHQ-9. The majority of our sample indicated at least one subtheme that was not represented in CORE-OM and PHQ-9. These results show us the importance of individualized measures in identifying the patients’ most value concerns, which may have implications in the therapeutic process.

The role of leader-member exchanges in mediating the relationship between locus of control and work reactions

The relationship between locus of control, the quality of exchanges between subordinates and leaders (LMX), and a variety of work-related reactions (intrinsic/extrinsic job satisfaction, work-related well-being, and organizational commitment) are examined. It was predicted that people with an internal locus of control develop better quality relations with their manager and this, in turn, results in more favourable work-related reactions. Results from two different samples (N = 404, and N = 51) supported this prediction, and also showed that LMX either fully, or partially, mediated the relationship between locus of control and all the work-related reactions.

Extending a model of shift-work tolerance

The present study contributes to theory and practice through the development of a model of shift-work tolerance with the potential to indicate interventions that reduce nurses' intention toward turnover and increase job satisfaction in hospital-based settings. Survey data from 1257 nurses were used to conduct structural equation modeling that examine the direct and indirect effects of supervisor and colleague support, team identity, team climate, and control over working environment on time-based work/life conflict, psychological well-being, physical symptoms, job satisfaction, and turnover intention. The analysis of the proposed model revealed a good fit The chi-square difference test was non-significant (χ2(26)=338.56), the fit indices were high (CFI=.923, NFI=.918, and NNFI=.868), the distribution of residuals was symmetric and approached zero, the average standardized residual was low (AASR=.04), and the standardized RMR was .072. In terms of the predictor variable, the final model explained 48% of the variance in turnover intention. The data revealed considerable evidence of both direct effects on adjustment and complex indirect links between levels of adjustment and work-related social support, team identity, team climate, and control. Nurses with high supervisor and coworker support experienced more positive team climates, identified more strongly with their team, and increased their perceptions of control over their work environment. This in turn lowered their appraisals of their time-based work/life conflict, which consequently increased their psychological well-being and job satisfaction and reduced their physical health symptoms and turnover intention. The type of shift schedule worked by the nurses influenced levels of turnover intention, control over work environment, time-based work/life conflict, and physical symptoms.

The impact of computer display height and desk design on 3D posture during information technology work by young adults

Computer display height and desk design to allow forearm support are two critical design features of workstations for information technology tasks. However there is currently no 3D description of head and neck posture with different computer display heights and no direct comparison to paper based information technology tasks. There is also inconsistent evidence on the effect of forearm support on posture and no evidence on whether these features interact. This study compared the 3D head, neck and upper limb postures of 18 male and 18 female young adults whilst working with different display and desk design conditions. There was no substantial interaction between display height and desk design. Lower display heights increased head and neck flexion with more spinal asymmetry when working with paper. The curved desk, designed to provide forearm support, increased scapula elevation/protraction and shoulder flexion/abduction.

The effect of non-standard employment on work-family balance

Across the last four decades, the structure of the Australian labour market has changed profoundly as non-standard forms of employment have become more prevalent. According to many researchers, the growth of non-standard work has been driven by employee preferences, particularly among married women, for greater flexibility to balance paid work with domestic responsibilities and other non-work related pursuits. In contrast, other researchers argue that the increasing prevalence of non-standard employment reflects employer demands for greater staffing flexibility. From this perspective, non-standard forms of employment are considered to have a negative effect on work-family balance. This paper explores whether non-standard employment is associated with improved or poorer work-to-family conflict and tests whether experiences vary by gender. It concentrates on three common forms of non-standard employment: part-time employment, casual and fixed-term work contracts and flexible scheduling practices (such as evening work, weekend work and irregular rostering). Analysis is based on 2299 employed parents from the first wave of the Household, Income and Labour Dynamics on Australia (HILDA) project. Results show that few scheduling measures are significant determinants of work-family balance. However, part-time employment is associated with reduced work-to-family strain for both men and women, even after controlling for various other employment and household related characteristics. Casual employment, in contrast, incurs the cost of poorer work-family balance for men. Surprisingly, HILDA data show that overall men experience greater work-to-family strain than women.

How innovation can alleviate negative consequences of demanding work contexts:The influence of climate for innovation on organizational outcomes

This study examines climate for innovation as a method by which negative organizational consequences of demanding work may be lessened. It was expected that a climate for innovation would enable employees to develop coping mechanisms or improved work-related processes which counteract negative consequences of work demands. Extending the job demands-resource model (Karasek, 1979), we predicted and found that among the sample of 22,696 respondents from 131 healthcare organizations, organizational climate for innovation alleviated the negative effects of work demands on organizational performance. Thus, this study informs climate theories and guides practitioners' efforts to support the employees. © 2007 The British Psychological Society.

The role of leader-member exchanges in mediating the relationship between locus of control and work reactions

The relationship between locus of control, the quality of exchanges between subordinates and leaders (LMX), and a variety of work-related reactions (intrinsic/extrinsic job satisfaction, work-related well-being, and organizational commitment) are examined. It was predicted that people with an internal locus of control develop better quality relations with their manager and this, in turn, results in more favourable work-related reactions. Results from two different samples (N=404, and N=51) supported this prediction, and also showed that LMX either fully, or partially, mediated the relationship between locus of control and all the work-related reactions.

Exploring calling work orientation: Construct clarity and organizational implications

Employees maintain a personal view toward their work, which can be referred to as their work orientation. Some employees view their work as their life's purpose (i.e., calling work orientation) and they tend to be 1) prosocially motivated, 2) derive meaning from work, and 3) feel that their purpose is from beyond the self. The purpose of the current dissertation was to differentiate calling work orientation from other similar workplace constructs, to investigate the most common covariates of calling work orientation, and to empirically test two possible moderators of the relationship between calling work orientation and work-related outcomes of job satisfaction, job performance, and work engagement. Two independent samples were collected for the purpose of testing hypotheses: data were collected from 520 working students and from 520 non-student employees. Participants from the student sample were recruited at Florida International University, and participants from the employee sample were recruited via the Amazon Mechanical Turk website. Participants from the student sample answered demographic questions and responded to self-report measures of job satisfaction, job performance, work engagement, spirituality, meaningful work, prosocial motivation, and work orientation. The procedure was similar for the employee sample, but their survey also included measures of counterproductive work behaviors, organizational citizenship behaviors, conscientiousness, and numerical ability. Additionally, employees were asked whether they would be willing to have a direct supervisor, peer, co-worker, client, or subordinate rate their job performance. Hierarchical regression findings suggest calling work orientation was predictive of overall job performance above and beyond two common predictors of performance, conscientiousness and numerical ability. The results for the covariate analyses provided evidence that prosocial motivation, meaningful work, and spirituality do play a significant role in the development of an employees' work orientation. Perceived career opportunities moderated the relationship between calling work orientation and job performance for the employee sample. Core self-evaluations moderated the relationship between calling work orientation and job performance, and core self-evaluations moderated the relationship between calling work orientation and work engagement. Collectively, findings from the current study highlight the benefits of examining work orientation in the prediction of workplace outcomes.

Has your work worked you too hard? Physically demanding work and disability in a sample of the older Irish population

There is a heightened need for the practitioner to be alert to the determinants of functional limitations and disabilities owing to the ageing workforce. This study investigated the association between work type and disability in older age in both the paid and the previously unexplored, unpaid worker (household labour).Data on demographic factors, physical measurements, work history and functional status were collected on three hundred and fifty seven 57-80-year-olds. Past or present work was identified as either physically demanding or not. Functional limitations and activities of daily living (ADL) disabilities were assessed using validated scales. Logistic regression was used to examine the relationship between the dependent variables and work type (physically demanding work or not physically demanding work).Over half of the sample reported doing physically demanding work. 20 % had complete function (n = 67), 65 % (n = 223) functional limitations and 15 % (n = 53) ADL disability. Physically demanding work was associated with functional limitations [OR 2.52 (1.41, 4.51), p = 0.01] and ADL disability [OR 2.10 (1.06, 4.17), p = 0.03] after adjustment for a measure of obesity and gender. When gender stratified, looking only at females, physically demanding work was associated with ADL disability [OR 2.79 (1.10, 7.07), p = 0.03] adjusted for a measure of obesity and household labour. Physically demanding work was related to functional limitations and ADL disability in older age. This is valuable information to inform practitioners in the treatment of older people with functional limitations and disabilities and in guiding interventions in the prevention of work related disability.

Stress e Emergência Médica: níveis e factores de stress em profissionais de emergência pré–hospitalar

O stress é a doença da actualidade, devido à exigência e à pressão emocional que o meio pode exercer sobre todas as pessoas, quer no seu ambiente pessoal quer no ambiente profissional. O termo stress serve cada vez mais como justificação ou forma de expressão de irritações, mal-estar físico e mental, cansaço, ansiedade e depressões. Todavia torna-se pertinente percebermos a evolução do stress enquanto conceito e enquanto doença. Neste trabalho contextualizamos o stress no âmbito da Emergência Pré – Hospitalar, explorando-o, avaliando-o e analisando-o, de modo a podermos perceber os níveis de stress e de que forma os Profissionais de Emergência a ele estão sujeitos. Considerando a base teórica deste estudo definimos, como objectivo geral do trabalho, a avaliação de níveis e factores de stress percepcionados pelos profissionais de emergência médica e como objectivos específicos do estudo a descrever e caracterizar, a nível da região centro, os indivíduos que desempenham funções na emergência préhospitalar, verificar a percepção dos mesmos no que respeita ao stress na sua vida profissional, conhecer como percepcionam os níveis de stress em situações profissionais de emergência e identificar a sua percepção no que concerne aos níveis de stress diário no seu quotidiano. Com estes objectivos, utilizamos uma amostra de 184 profissionais de Emergência Médica divididos por quatro profissões [Médicos, Enfermeiros, Técnicos de Ambulância de Emergência (TAE) e Operadores de Central de Emergência Médica(OPCEM)], com idades compreendidas entre os 20 e os 56 anos. Realizámos ainda um estudo descritivo explorando os questionários de stress no INEM (Instituto Nacional de Emergência Médica) e o Questionário de Vulnerabilidade do Stress com variáveis do estudo demográfico. Podemos concluir que o stress está presente nas actividades de emergência. A sua presença relaciona-se, por um lado, com uma maior ou menor discriminação dos factores stressantes e, por outro, numa maior ou menor centração no sujeito, nomeadamente, um maior perfeccionismo e intolerância à frustração que se apresentam como distressantes para a actividade profissional de emergência. Os aspectos estudados permitem-nos clarificar o sentido e a utilidade do conceito, a sua operacionalidade e a sua importância nos profissionais de emergência. / Stress is the disease of our time, due to the requirement and emotional pressure that the media can have on all people, both in their personal environment and in the professional environment. The word stress increasingly serves as a justification or form of expression of irritation, physical discomfort and mental fatigue, anxiety and depression. However it is pertinent to realize the evolution of stress as a concept and as a disease. In this work, we contextualize under the stress of the Pre - Hospital Emergency, exploring it, assessing it and analyzing it, so you can see the stress levels and how the Emergency Professionals are subject to it. Whereas the theoretical basis of this study as a strategic objective of the work, the assessment of levels and stress factors perceived by medical emergency professionals and specific objectives of the study description and characterization, the level of the center, individuals who perform functions in pre-hospital emergency, check their perception with regard to the stress in your life, know how they experience the stress levels of professionals in emergency situations and identify the perceptions of individuals regarding the levels of daily stress in their daily lives. For this we used a sample of 184 professionals of Medical Emergency divided by four professions [(Doctors, Nurses, Technicians Ambulance Emergency (TAE), Operators of Emergency Medical Center (OPCEM)], aged 20 to 56 years. We conducted a descriptive study also exploring the questionnaires of stress in INEM(National Institute of Medical Emergency) and Vulnerability Questionnaire Stress with variables of the study population. We can conclude that stress is present in emergency activities. Its presence is related to, first, with more or less stressful factors of discrimination and, secondly, a greater or lesser concentration on the subject, in particular, greater perfectionism and intolerance to frustration that stand as unstressed for the activity of emergency professionals. The areas studied will clarify the meaning and usefulness of the concept, its operation and its importance in day-to-day occupation of emergency.

Information and communication technology demands at work : the association with job strain, effort-reward imbalance and self-rated health in different socio-economic strata

PURPOSE: The use of information and communication technology (ICT) is common in modern working life. ICT demands may give rise to experience of work-related stress. Knowledge about ICT demands in relation to other types of work-related stress and to self-rated health is limited. Consequently, the aim of this study was to examine the association between ICT demands and two types of work-related stress [job strain and effort-reward imbalance (ERI)] and to evaluate the association between these work-related stress measures and self-rated health, in general and in different SES strata. METHODS: This study is based on cross-sectional data from the Swedish Longitudinal Occupational Survey of Health collected in 2014, from 14,873 gainfully employed people. ICT demands, job strain, ERI and self-rated health were analysed as the main measures. Sex, age, SES, lifestyle factors and BMI were used as covariates. RESULTS: ICT demands correlated significantly with the dimensions of the job strain and ERI models, especially with the demands (r = 0.42; p < 0.01) and effort (r = 0.51; p < 0.01) dimensions. ICT demands were associated with suboptimal self-rated health, also after adjustment for age, sex, SES, lifestyle and BMI (OR 1.49 [95 % CI 1.36-1.63]), but job strain (OR 1.93 [95 % CI 1.74-2.14) and ERI (OR 2.15 [95 % CI 1.95-2.35]) showed somewhat stronger associations with suboptimal self-rated health. CONCLUSION: ICT demands are common among people with intermediate and high SES and associated with job strain, ERI and suboptimal self-rated health. ICT demands should thus be acknowledged as a potential stressor of work-related stress in modern working life.

Referenciação de crianças com problemas de comunicação e linguagem a partir dos cuidados de saúde primários

Os problemas de comunicação e linguagem (PCL) podem limitar a atividade e participação de um indivíduo ao longo da sua vida. Todavia, a intervenção precoce tem-se provado bastante eficaz nestes casos. Os médicos de família (MF) encontram-se numa posição privilegiada para deteção e referenciação destes problemas em idades precoces. Porém, há evidências de que a sua participação neste processo tem sido reduzida, nomeadamente no que respeita à referenciação para serviços de Intervenção Precoce. Assim, esta investigação pretende compreender qual o papel que os MF consideram ter relativamente a este processo e quais os fatores que podem influenciar a referenciação de crianças com suspeita de PCL. Este estudo teve como base um desenho de investigação descritivo, transversal e observacional. Recorreu-se a um método de amostragem por redes para a distribuição de um questionário On-line. O instrumento foi construído pela autora e é de caráter maioritariamente quantitativo, embora integre uma questão qualitativa de resposta semiaberta. Dos questionários enviados foram devolvidos 55. A resposta semiaberta foi preenchida por 16 dos 55 MF. Os resultados demonstram que a maioria dos MF valoriza bastante ou muito a sua participação na deteção de PCL e considera importante detetar precocemente estes problemas. Para além disso, valorizam bastante ou muito a colaboração em equipa e do terapeuta da fala. A grande parte sente-se influenciada pela preocupação dos pais, pela satisfação com os serviços e com os resultados da Escala de Avaliação de Desenvolvimento de Mary Sheridan Modificada para a referenciação de crianças com PCL. Para além disso, identificam barreiras relacionadas com recursos humanos, serviços, conhecimentos relacionados com o processo de referenciação, burocracia, lentidão do processo e com a atitude dos pais. Considera-se que este estudo pode constituir um ponto de partida para futuras investigações, para a adequação de estratégias institucionais e implementação de práticas que aproximem profissionais e serviços, de forma a melhorar o processo de referenciação de crianças com PCL a partir dos cuidados de saúde primários.

An exploratory study of the relationship between psychosocial hazard and ambulatory physiological response in higher education employees.

Purpose: as exposure to psychosocial hazard at work represents a substantial risk factor for employee health in many modern occupations, being able to accurately assess how employees cope with their working environment is crucial. As the workplace is generally accepted as being a dynamic environment consideration should be given to the interaction between employees and the acute environmental characteristics of their workplace. The aim of this study was to investigate the effects of both acute demand and chronic work-related psychosocial hazard upon employees through ambulatory assessment of heart rate variability and blood pressure. Design: a within-subjects repeated measures design was used to investigate the relationship between exposure to work-related psychosocial hazard and ambulatory heart rate variability and blood pressure in a cohort of higher education employees. Additionally the effect of acute variation in perceived work-related demand was investigated. Results: two dimensions of the Management Standards were found to demonstrate an association with heart rate variability; more hazardous levels of “demand” and “relationships” were associated with decreased SDNN. Significant changes in blood pressure and indices of heart rate variability were observed with increased acute demand.