Konsumerismi, potilaiden ja kuluttajien aktiivinen toiminta sekä erityisesti lääkäreiden kokemukset ja näkemykset potilaista kuluttajina

Consumerism emphasises the patient s position and freedom of choice. Consumerism is being promoted by a range of phenomena occurring in society and health care. Different actors hold different views on the patient as a consumer and on his or her participation. Consumer demand is created outside the patient physician relationship and the commercialisation of services generates new expectations with respect to physician s work. More and more patients may be interested in adopting a more equal position in the care relationship, and trying to negotiate with the physician or to even dictate how he or she should be cared for. In Finland, very little research has been conducted on patients and consumers organising themselves at national system level, patients as choosers, and physicians attitudes to various consumerist phenomena or the choice made by the patient. In the empirical data for this study, the term consumer-patient refers to active consumers and patients making choices related to their clinical care prior to a physician s diagnosis. Consumer-patients are also represented by consumer and patient organisations and movements. The main research question is: How do physicians regard the care choice made by the patient? This question is addressed from a perspective encompassing patients and consumers organised activities and individuals active behaviour in health care as well as physicians experiences and their views on patients as consumers making choices related to their care. The first part (Study I), examines the patient organisation field, information sources used including the websites of such organisations, files from Finland s Slot Machine Association, RAY, a survey conducted by a Finnish television news department and interviews of patient organisations. Based on observation and a physician survey, Study II examines physicians attitudes to the idea that patients could obtain information through consumer movements about physicians care practices before seeking medical care. Studies III−IV use a physician survey to examine physicians attitudes to direct-to-consumer-advertising of prescription drugs (DTCA) and their experiences and views of patient requests related to treatments and examinations. Study V uses comparative surveys to examine the attitudes of health care professionals and the population to the introduction of new technologies in health care, using genetic screenings and tests as an example. The number of patient organisations increased, with a particular escalation as of the 1990s. The characteristics and operating methods of the organisations varied greatly. Physicians organisations adopted a negative or neutral attitude towards the consumer movements idea of distributing information on care practices, whereas individual physicians attitudes were slightly more positive. Physicians regarded direct-to-consumer-advertising of prescription drugs as negative, but took a more permissive attitude towards indirect advertising. More than every third physician considered drug advertisements in general to be harmful or useless in the distribution of drug information to patients or consumers. More than half of physicians conducting patient work reported that they (very) often encountered patients who stated upon arrival for a consultation that they wanted specific treatments or examinations, and that the number of such situations had increased. Such situations were viewed as positive with regard to the care relationship by every fifth physician and as negative by two fifths. Physicians justified a reserved attitude to the patients consumer role by referring to their medical expertise and position as care decision-makers, the patient physician relationship and the public health care system. Reasons for a positive attitude included the patient s participation and co-operation, the patient physician relationship and the patient s knowledge. Professionals were more reserved than lay people about the introduction and extension of genetic technologies in health care. A significant minority of the physicians did not take a clear pro or con attitude to the patients consumer role or to the use of new technologies in health care. The physicians age, gender, place of work and specialisation influenced their attitudes to the patient s consumer role, and private physicians viewed it in a more positive light than those working in public health care. Active consumer-patients challenge the society to hold a discussion of the patient s choice, participation in care decision-making and participation in health care policy in general. Their transformation into customers and consumers implies not only a new division of individuals roles and powers, but also contributes to changing relationships between system level roles: between citizens and the state and between public and private health care. This phenomenon raises various issues related to health care policy. In conclusion, topics are presented for discussion, practical measures and further research. Keywords: health care, consumerism, distribution of technologies, commercialisation, physicians, patients, consumers, patient s choice, patient s role.

Stroke and coronary heart disease in relation to hyperglycemia gender and age

This study was carried out to compare the fasting plasma glucose (FPG) and 2-h plasma glucose (2-h PG) criteria for diabetes with regard to their relation to stroke mortality and the incidence of ischemic and hemorrhagic stroke. In addition, the age-and gender difference in the incidence of coronary heart disease (CHD) and stroke and their relation with known cardiovascular disease risk factors and diabetes mellitus was examined. The study was a sub-data analysis of the Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe (DECODE) study including 25 181 individuals, 11 844 (47%) men and 13 345 (53%) women aged 25 to 90 years, from 14 European cohorts. In individuals without a history of diabetes elevated 2-h post-challenge glucose was a better predictor of stroke mortality than elevated fasting glucose in men, whereas the latter was better than the former in women. Elevated FPG and 2-h PG levels were associated with an increased risk of ischemic stroke incidence. 2-h PG contributed to the risk more strongly than FPG. No relationship between hyperglycemia and the risk of hemorrhagic stroke was found. The risk of CHD and ischemic stroke incidence increased with age in both genders, but was higher in all age groups in men than in women. The gender difference was, however, more marked for CHD than for ischemic stroke. Age, smoking and diabetes contributed to the development of both CHD and ischemic stroke. Elevated cholesterol levels predicted CHD only, whereas elevated blood pressure was a risk predictor for the incidence of ischemic stroke. The CHD and ischemic stroke risk was higher in men than in women with and without diabetes, however, the gender difference diminished for CHD but enlarged for ischemic stroke in diabetic individuals. The known risk factors including diabetes contributed differently to the risk of CHD and ischemic stroke in women and in men. Hyperglycemia defined by FPG or 2-h PG increases the risk of ischemic stroke in individuals without diabetes. FPG better predicts stroke mortality in women and 2-h PG in men. The risk of acute CHD and ischemic stroke is higher in men than in women in all ages, but such gender difference is more marked for CHD than for ischemic stroke. CHD risk is higher in men than in women, but the difference is reduced in diabetic population. Diabetes, however, increases stroke risk more in men than in women in all ages.

Using Trichogramma Westwood (Hymenoptera: Trichogrammatidae) for insect pest biological control in cotton crops: an Australian perspective.

Trichogramma Westwood egg parasitoids alone generally fail to suppress heliothine pests when released in established cotton-growing regions. Factors hindering their success include indiscriminate use of detrimental insecticides, compensation for minimal pest larval hatch due to their activity via reduced larval cannibalism or mortality in general, singly laid heliothine eggs avoiding detection and asynchronous development benefiting host over parasitoid. Yet, despite these limitations, relatively large Trichogramma pretiosum Riley populations pervade and effectively suppress Helicoverpa (Hardwick) pests in Australian Bt (Bacillus thuringiensis Berliner)-transgenic cotton, Gossypium hirsutum L., crops, especially in the Ord River Irrigation Area (ORIA) of tropical northern Australia, where their impact on the potentially resistant pest species, Helicoverpa armigera (Hubner), is considered integral to the local insecticide resistance management (IRM) strategy for continued, sustainable Bt-transgenic cotton production. When devoid of conventional insecticides, relatively warm and stable conditions of the early dry season in winter grown ORIA Bt-transgenic cotton crops are conducive to Trichogramma proliferation and biological control appears effective. Further, there is considerable scope to improve Trichogramma's biological control potential, in both the ORIA and established cotton-growing regions, via habitat manipulation. It is proposed that Trichogramma may prove equally effective in developing agricultural regions of monsoonal northern Australia, and that environmental constraints on Trichogramma survival, and those of other natural enemies, require due consideration prior to their successful application in biological control programs.

I/O Device Virtualization in the multi-core era, a QoS perspective

In this paper, we propose an extension to the I/O device architecture, as recommended in the PCI-SIG IOV specification, for virtualizing network I/O devices. The aim is to enable fine-grained controls to a virtual machine on the I/O path of a shared device. The architecture allows native access of I/O devices to virtual machines and provides device level QoS hooks for controlling VM specific device usage. For evaluating the architecture we use layered queuing network (LQN) models. We implement the architecture and evaluate it using simulation techniques, on the LQN model, to demonstrate the benefits. With the architecture, the benefit for network I/O is 60% more than what can be expected on the existing architecture. Also, the proposed architecture improves scalability in terms of the number of virtual machines intending to share the I/O device.

A risk perspective on human resource management: A review and directions for future research

Arguing the value of effective HRM practice has long been a focus in the HRM literature. However, there is also a case for identifying the risks presented by inappropriate or absent HRM practices. Although risk management has been established in the broader management literature for over two decades, human resource related risks have not featured as prominently as other types of risks. HRM as a discipline has a role to play in addressing this situation and raising awareness of human resource issues as risks for the organization. A review of papers published since the year 2000 in a broad range of high quality management journals, identifies that limited research has thus far taken a risk management perspective on human resources. Although the HRM and risk management disciplines stand to benefit from drawing the two areas together, this review concludes that further research and development of the phenomenon of human resource risk management is needed.

Engagement with superannuation: Is there really a gender gap?

A recent report produced by Suncorp Bank and The association of Superannuation Funds of Australia (ASFA) found women were less engaged with their superannuation than men (2012). Given that women have lower superannuation balances than men, a lack of engagement could leader to a further reduction in their ability to provide for themselves in retirement (Basu and Drew, 2009). Using a variety of measures of engagement, we find women are mostly as engaged as men. The main determinants of engagement continue to be financial literacy, age and value of superannuation.

Pushing the boundaries' versus identifying the boundaries: An institutional perspective of NPM Principles

This paper considers the boundaries of new public management (NPM) principles in the context of the mandate for a commercial approach within in a New Zealand state-owned enterprise (SOE). Investigating a commercial approach to NPM through an institutional theory lens, the case study highlights complexities and potential conflict between structured NPM principles and the more complex reality. Analysis reveals blurred lines and boundaries have implications for public sector organisations such as SOEs, government and other stakeholders, where managers push the boundaries beyond the point where stakeholders are comfortable. Thus, a key challenge involves developing clearer institutional boundaries to balance freedoms with stakeholder acceptability.

Older job seekers' job search intensity: The interplay of proactive personality, age and occupational future time perspective

Long-term unemployment of older people can have severe consequences for individuals, communities and ultimately economies, and is therefore a serious concern in countries with an ageing population. However, the interplay of chronological age and other individual difference characteristics in predicting older job seekers' job search is so far not well understood. This study investigated relationships among age, proactive personality, occupational future time perspective (FTP) and job search intensity of 182 job seekers between 43 and 77 years in Australia. Results were mostly consistent with expectations based on a combination of socio-emotional selectivity theory and the notion of compensatory psychological resources. Proactive personality was positively related to job search intensity and age was negatively related to job search intensity. Age moderated the relationship between proactive personality and job search intensity, such that the relationship was stronger at higher compared to lower ages. One dimension of occupational FTP (perceived remaining time left in the occupational context) mediated this moderating effect, but not the overall relationship between age and job search intensity. Implications for future research, including the interplay of occupational FTP and proactive personality, and some tentative practical implications are discussed.

A lifespan perspective on emotion regulation, stress, and well-being in the workplace

Researchers in the field of occupational stress and well-being are increasingly interested in the role of emotion regulation in the work context. Emotion regulation has also been widely investigated in the area of lifespan developmental psychology, with findings indicating that the ability to modify one's emotions represents a domain in which age-related growth is possible. In this chapter, we integrate the literatures on aging, emotion regulation, and occupational stress and well-being. To this end, we review key theories and empirical findings in each of these areas, summarize existing research on age, emotion regulation, and stress and well-being at work, and develop a conceptual model on how aging affects emotion regulation and the stress process in work settings to guide future research. According to the model, age will affect: (1) what kinds of affective work events are encountered and how often; (2) the appraisal of and initial emotional response to affective work events (emotion generation), and; (3) the management of emotions and coping with affective work events (emotion regulation). The model has implications for researchers and practitioners who want to understand and facilitate successful emotion regulation and stress reduction in the workplace among different age groups.

A lifespan perspective on psychological contracts and their relations with organizational commitment

The current study investigated the influence of age-related constructs on the psychological contract and its relationships with continuance and normative commitment. It was proposed that as people age, their future time perspective (FTP) decreases. Consequently, it was expected that contract fulfilment would be positively related to continuance commitment for workers with short FTP, while it would be positively related to normative commitment for workers with long FTP. Conversely, it was argued that, with age, workers’ perceived work-related expertise increases, resulting in stronger reactions to obligation fulfilment on normative commitment. A study among 334 employees showed that FTP and work-related expertise indeed moderated the relationships between contract fulfilment and organizational commitment. The results showed that the influence of age on the relations between contract fulfilment with outcomes is dependent upon FTP and occupational expertise. The study shows the value of a lifespan perspective on psychological contracts and their relations with organizational commitment.

An intraindividual perspective on pro-environmental behaviors at work

Ones and Dilchert (2012) highlight the importance of examining workplace environmental sustainability at the interindividual (or between-person) and organizational levels. In this commentary, we aim to extend these authors’ framework by focusing on pro-environmental behaviors and their potential predictors at the intraindividual, or within-person, level. To this end, we will first describe the intraindividual perspective, its benefits, and the diary study methodology often used to operationalize this perspective. Secondly, we will share how the intraindividual perspective was useful in an empirical study we conducted on multilevel relationships among employees’ pro-environmental attitude, daily affect, and daily proenvironmental behaviors. Finally, we will discuss a number of possible limitations of the diary study methodology, ways to Correspondence concerning this article should be addressed to Megan J. Bissing-Olson. E-mail: m.bissing-olson@uq.edu.au Address: School of Psychology, The University of Queensland, Brisbane, Queensland 4072, Australia overcome them, and directions for future research.

Relations between chronic regulatory focus and future time perspective: Results of a cross-lagged structural equation model

Future time perspective - the way individuals perceive their remaining time in life - importantly influences socio-emotional goals and motivational outcomes. Recently, researchers have called for studies that investigate relationships between personality and future time perspective. Using a cross-lagged panel design, this study investigated effects of chronic regulatory focus dimensions (promotion and prevention orientation) on future time perspective dimensions (focus on opportunities and limitations). Survey data were collected two times, separated by a 3. month time lag, from 85 participants. Results of structural equation modeling showed that promotion orientation had a positive lagged effect on focus on opportunities, and prevention orientation had a positive lagged effect on focus on limitations.

Remaining time and opportunities at work: Relationships between age, work characteristics, and occupational future time perspective

The authors adapted the concept of future time perspective (FTP) to the work context and examined its relationships with age and work characteristics (job complexity and control). Structural equation modeling of data from 176 employees of various occupations showed that age is negatively related to 2 distinct dimensions of occupational FTP: remaining time and remaining opportunities. Work characteristics (job complexity and control) were positively related to remaining opportunities and moderated the relationship between age and remaining opportunities, such that the relationship became weaker with increasing levels of job complexity and control.

A lifespan perspective on leadership

In this chapter, we present a lifespan model of leadership that outlines how leader and follower age as well as age-related changes in leader traits and characteristics, leader behaviors, and follower attribution and identification processes may influence leadership effectiveness. First, we describe how leader traits and characteristics change with age and how these developmental changes may impact on leader behaviors and, subsequently, leadership effectiveness. Specifically, we discuss age-related changes in leaders’ task competence, interpersonal attributes, and motivation to lead. We particularly focus on how generativity – a set of interconnected motives pertaining to establishing and guiding future generations – may emerge as an important concern among older leaders. Second, we review theoretical approaches that help explain how and why leader age and age-related traits and characteristics, follower age, as well as leader-follower age differences may influence follower attribution and identification processes. Third, we outline a number of boundary conditions of the effects proposed by our lifespan model of leadership, including leader-follower relationship duration, situational characteristics, as well as the cultural, social, and historical context. We conclude the chapter by discussing our model’s implications for future research and organizational practice.

Information sharing in distance collaboration: A software engineering perspective

Information sharing in distance collaboration: A software engineering perspective, QueenslandFactors in software engineering workgroups such as geographical dispersion and background discipline can be conceptually characterized as "distances", and they are obstructive to team collaboration and information sharing. This thesis focuses on information sharing across multidimensional distances and develops an information sharing distance model, with six core dimensions: geography, time zone, organization, multi-discipline, heterogeneous roles, and varying project tenure. The research suggests that the effectiveness of workgroups may be improved through mindful conducts of information sharing, especially proactive consideration of, and explicit adjustment for, the distances of the recipient when sharing information.