The extent and breadth of benefits from participating in chronic disease self-management courses: a national patient-reported outcomes survey

Objective
To quantify the benefits that people receive from participating in self-management courses and identify subgroups that benefit most.

Methods
People with a wide range of chronic conditions attending self-management courses (N = 1341 individuals) were administered the Health Education Impact Questionnaire (heiQ). Baseline and follow-up data were collected resulting in 842 complete responses. Outcomes were categorized as substantial improvement (effect size, ES ≥ 0.5), minimal/no change (ES −0.49 to 0.49) and substantial decline (ES ≤ −0.5).

Results
On average, one third of participants reported substantial benefits at the end of a course and this ranged from 49% in the heiQ subscale Skill and technique acquisition to 27% in the heiQ subscale Health service navigation. Stratification by gender, age and education showed that younger participants were more likely to benefit, particularly young women. No further subgroup differences were observed.

Conclusion
While the well-being of people with chronic diseases tends to decline, about one third of participants from a wide range of backgrounds show substantial improvements in a range of skills that enable them to self-manage.

Practice implications
These data support the application of self-management courses indicating that they are a useful adjunct to usual care for a modest proportion of attendees.

Leadership, culture and employee deceit : the case of the National Australia Bank

The National Australia Bank (NAB), one of Australia's largest banks, announced losses in 2004 of AUD$360 million due to unauthorised foreign currency trading activities by four employees who incurred and deceptively concealed the losses. The NAB had in place risk limits and supervision to prevent trading desks ever reaching positions of this magnitude. However, the risk management policies and procedures proved ineffective. The purpose of this paper is to analyse the deceit, via a content analysis of official investigative reports and other published documents, to determine the extent to which the Bank's culture and leadership may have influenced the rogue traders' behaviour. The findings suggest that cultural issues, and the role played by the Bank's leaders, were influential in creating a profit-driven culture that ultimately impacted the Bank's foreign exchange operating activities.

Why invest in a national public health program for stroke? An example using Australian data to estimate the potential benefits and cost implications

Objectives: Stroke is the world’s second leading cause of death in people aged over 60 years. Approximately 50,000 strokes occur annually in Australia with numbers predicted to increase by about one third over 10-years. Our objectives were to assess the economic implications of a public health program for stroke by: (1) predicting what potential health-gains and cost-offsets could be achieved; and (2) determining the net level of annual investment that would offer value-for-money.

Methods: Lifetime costs and outcomes were calculated for additional cases that would benefit if ‘current practice’ was feasibly improved, estimated for one indicative year using: (i) local epidemiological data, coverage rates and costs; and (ii) pooled effect sizes from systematic reviews.

Interventions: blood pressure lowering; warfarin for atrial fibrillation; increased access to stroke units; intravenous thrombolysis and aspirin for ischemic events; and carotid endarterectomy. Value-for-money threshold: AUD$30,000/DALY recovered.

Results: Improved, prevention and management could prevent about 27,000 (38%) strokes in 2015. In present terms (2004), about 85,000 DALYs and AUD$1.06 billion in lifetime cost-offsets could be recovered. The net level of annual warranted investment was AUD$3.63 billion.

Conclusions: Primary prevention, in particular blood pressure lowering, was most effective. A public health program for stroke
is warranted

Integrating job stress and social exchange theories to predict employee wellbeing

This research examines the organizational characteristics that contribute to employee wellbeing in public sector agencies that have undergone substantial organizational change. Two studies were undertaken, the first involving 2,466 police officers working in a statebased law enforcement agency, whereas the second comprised 1,010 occupationally diverse employees working in a State Government authority. The research was guided by a theoretical framework that begins with a model underpinning many large-scale job stress investigations—the job strain model (JSM)—and is expanded to incorporate widely used social exchange variables (i.e., psychological contract breach and organizational fairness). The results of hierarchical regression analyses from both studies confirm the value of the JSM. There was also strong support for extending the JSM to include the breach and fairness variables; however, proposed interactions between job demands and organizational fairness failed to add to the explanatory value of the model. The implications of these results particularly for public sector organizations that have undergone extensive reforms consistent with New Public Management are discussed.

The influence of locus of attribution, level of employee authority and employee concern on consumers postrecovery evaluations

This study employed a 3 x 2 x 2 full-factorial, between-subjects design experiment involving locus of attribution, concern, and the level of authority of the employee performing the recovery on consumers’ postcomplaint evaluations. The research, conducted in a restaurant context, involved a sample of 411 undergraduate students. Findings suggest that customers are less dissatisfied and more likely to revisit the restaurant when the location of the cause of the failure is internal (i.e., they are to blame). In addition, consumers are less likely to repurchase when the manager, as opposed to the waiter, is responsible for the service failure.

Reaching out to employees using B2E : the trials and tribulations

This paper is an extension of e-business models discussing business to employee (B2E) e- model. It describes the model, the technologies that support the model and benefits to the organisation identified from literature. To further understand the B2E issues a case study in a large organisation that manages its employees with the B2E model is included. Challenges, success factors and an analysis of the case study addressing a wide range of organisational benefits are included in the paper.

Benefits of a year-long workplace weight loss program on cardiovascular risk factors

Objective: To assess the effectiveness of a year-long workplace weight loss program in reducing risk factors of coronary heart disease.

Design: A randomised, controlled study of low fat (25% of dietary energy) diet- and/or moderate exercise-induced weight loss interventions in free-living, middle-aged men. Compliance was monitored from food and activity diaries at monthly blood pressure measurement sessions. Blood was sampled and body composition determined from dual energy X-ray absorptiometry before and after 12 months.

Subjects and setting: Fifty-eight overweight men (mean [+ or -] SD age: 43.4 [+ or -] 5.7 years; BMI 29.0 [+ or -] 2.6 kg/[m.sup.2]), recruited from a national corporation, were instructed into diet (n = 18) exercise (a 21) or control (n = 19) groups over 12 months; 16 control subjects combined diet and exercise (n = 16) for the subsequent 12 months.

Main outcome measures: At 12 months, weight, total and regional fat and lean mass, dietary energy and percentage dietary fat intake, physical activity indices, systolic and diastolic blood pressure, serum insulin, blood lipids and lipoproteins.

Statistical analyses: Differences between groups were tested using analysis of variance with Scheffe post hoc test. Differences between pre- and post-intervention variables were tested using Students' paired t-tests. Pearson's correlation coefficient and univariate linear regression identified association between dependent variables, multiple stepwise regression identified specific predictors.

Results: Weight loss with either diet or exercise resulted in a reduction in systolic blood pressure (-3.3 [+ or -] 1.7%), diastolic blood pressure (-4.8 [+ or -] 1.3%) and LDL cholesterol (-3.9 [+ or -] 2.8%), a rise in HDL cholesterol (+10.0 [+ or -] 3.8%) and a change in the LDL/HDL ratio (-8.9 [+ or -] 3.5%). Abdominal fat loss (-26.8 [+ or -] 3.6% after diet; -16.6 [+ or -] 4.5% after exercise; -21.0 [+ or -] 4.7% after diet and exercise) was the strongest predictor of change in blood pressure: twenty percent abdominal fat loss predicted a percentage fall of 2.4 [+ or -] 0.05% in systolic blood pressure and 5.4 [+ or -] 0.07% in diastolic blood pressure. Greater abdominal fat loss was associated with the greatest decrease in serum insulin (P < 0.05).

Conclusion: Modest changes in diet and exercise effected by a low cost workplace-based education program achieved weight loss, loss of abdominal fat, reduced blood pressure and serum insulin and improved blood lipid concentrations. (Nutr Diet 2002;59:87-96)

The UK perspective: a review of research on organisational stress management interventions

There are an increasing number of studies that have monitored the impact of Stress Management Interventions (SMls) and the results of these studies can play a vital role in informing the development of more effective, evidenced-based SMIs. In this paper, the authors have undertaken a review of United Kingdom (UK)-based research that has tested the impact of SMIs. Sixteen studies were examined and the results revealed that the vast majority of interventions were targeted at the individual employee, although there was a tendency for more recent research to focus on organisational level interventions. While all intervention levels were found to have some human and/or organisational benefits, strategies aimed at the individual level were less likely to result in longer-term benefits. An examination of the research methods used in the 16 studies indicated that UK-based researchers are beginning to adopt more rigorous research methods. However, there was a tendency for researchers to evaluate interventions over a relatively short time-frame. The implications of these findings for future research are discussed.

Sustained weight loss in obese subjects has benefits that are independent of attained weight

Objective: To explore the hypothesis that sustained weight loss in severely obese patients may have benefits that are independent of their attained BMI. Research Methods and Procedures: We conducted a comparison of two weight-stable groups with BMI in the 30 to 35 kg/m2 range. Subjects (n = 79) were selected obese patients 3 years after laparoscopic adjustable gastric band surgery, and controls (n = 79) were obese patients seeking weight loss therapy. Subjects were selected in a de-identified manner from our database to best match the control group. A range of clinical, biochemical, and questionnaire measures were obtained to assess obesity-related health status Results: Subjects maintained a mean weight loss of 32.8 plusminus 18 kg after surgery. The weight loss subjects had significantly lower fasting plasma glucose, insulin, and triglyceride concentrations, along with higher high-density lipoprotein-cholesterol levels and better indirect measures of insulin sensitivity when compared with controls (p < 0.05 for all). In addition, aminotransferase levels, neutrophil counts, and globulin levels were also significantly lower in weight loss subjects. All differences in laboratory variables remained significant after controlling for BMI. The subjects also reported better health-related quality of life, fewer symptoms of depression, and greater satisfaction with their appearance than controls. Discussion: These findings suggest that the post-weight loss state conveys benefits that are greater than predicted by the attained BMI. These findings may have important implications regarding the expectations of weight loss therapy, and mechanisms for this effect should be carefully sought.

How can managers reduce employee intention to quit?

This paper reports on an investigation of the variables that may be predictive of intentions to leave a job, and tests a model that includes mediating variables. A total of 173 retail salespeople completed questionnaires measuring commitment to the organization for which they worked, job satisfaction, stress, supervisor support, locus of control, self-esteem, the perceived stressors in the job and their intention to quit. Path analysis was used to test the relationships hypothesized in the model. The majority of hypotheses were supported, with the variables included accounting for 52 per cent of the variance in intention to quit. Emotional support from supervisors and self-esteem mediated the impact of stressors on stress reactions, job satisfaction, commitment to the organization and intention to quit. It is suggested that to ameliorate intention to quit and in turn reduce turnover, managers need to actively monitor workloads, and the relationships between supervisors and subordinates in order to reduce and manage stress. Managers also need to monitor both the extrinsic and intrinsic sources of job satisfaction available to employees. These activities could assist in maintaining and increasing job satisfaction and commitment to the organization.

Corporate ethics in TQM: management versus employee expectations and perceptions

Purpose – The objective of this research is to develop and describe a conceptual framework of corporate ethics in total quality management (TQM).

Design/methodology/approach – The research is based on a summarised in-depth and longitudinal case illustration. The summarised case describes corporate ethics in an intra-corporate relationship.

Findings – TQM requires human resources and failing to care for them will affect accordingly the success of TQM. The case description illustrates the evolution of management versus employee expectations and perceptions of corporate ethics. It has an emphasis on the human resources of a company that strives towards TQM. As the quality of corporate ethics decreases the outcome of TQM is also affected (i.e. directly or indirectly). The case is initialised in an atmosphere of management and employee optimism and positivism of corporate ethics, which is a requisite from both parties in order to ensure prosperous TQM. The successive change towards pessimism and negativism of corporate ethics in the intra-corporate relationship concludes the in-depth case description.

Research limitations/implications – Four parameters of corporate ethics are used to incorporate corporate ethics into TQM, namely management versus employee expectations and perceptions. Internal corporate quality management should always be regarded as dependent upon the achieved equilibrium between management and employee perceptions. It is also dependent upon the derived equilibrium between management and employee previous expectations.

Practical implications – An important insight of this research is that TQM requires the continuous attention to the management versus employee expectations and perceptions inherent in corporate ethics of internal business operations. Furthermore, corporate ethics is complementary to business ethics.

Originality/value – The case description has shown that TQM may be running well and accomplishing the hard goals. However, TQM is not only about figures, profits and costs. It is also a business approach that should penetrate all activities inside and outside that are related to the company, including the soft issues.

Broadband : benefits and problems

The striving of nations to build a broadband-based information society is paralleled by individuals striving to improve their personal lot and by organisations seeking a competitive advantage—all supposedly to be achieved via broadband. However, the social and economic impact of broadband may be surrounded in controversies. This paper argues that these controversies need to be identified and addressed if public policy decisions about broadband are to be made with confidence. While literature on broadband abounds, it is rarely directed at the impact of broadband on social and personal issues. Rather, that literature typically focuses on broadband's economic aspects, but with poor benefit identification and measure difficulties, the findings tend to be steeped in rhetoric. Largely, what we are left with is literature on the impact of narrowband Internet. While research on the Internet abounds, its findings are typically indeterminate and often disputed. The paper works with literature on broadband and extrapolates from the literature on narrowband with its disputed impacts to identify possible impacts of broadband. In so doing it identifies a core set of controversies regarding broadband at the national, individual and organisational levels. It then calls for diversity of analysis of possible broadband outcomes. Only with such analysis will it be possible to place the likely broadband future in the context of broader national, individual and organisational aspirations.

The “Lunatic Fringe” -- Barry Goldwater and the Conservative Revolution of the 1960s --

How did conservatives, who had become effectively ostracized by their party following the Great Depression and the societal reforms of the New Deal, regain leverage within the GOP during the 1960s? My hypothesis is two-fold. First, I contend that a small group of conservative activists led by F. Clifton White, in spite of a dearth of resources and manpower, managed to infiltrate Republican infrastructure and “hijack” the delegate- selection process. The distinctly conservative and recalcitrant disposition of the Goldwater delegates demonstrates that these activists succeeded. Second, I argue that in addition to temporarily overpowering the national convention in 1964, conservatives thereafter retained control of the party insofar as subsequent GOP candidates were obliged to garner the support of conservative pockets of the country in order to win the presidential nomination. The resulting rightward shift of the Republican Party following the 1960s is a direct corollary of the conservative takeover outlined in this study.

Making long-term economic growth more sustainable: evaluating the costs and benefits

Currently, traditional development issues such as economic stagnation, poverty, hunger, and illness as well as newer challenges like environmental degradation and globalisation demand attention. Sustainable development, including its economic, environmental and social elements, is a key goal of decisionmakers. Optimal economic growth has also been a crucial goal of both development theorists and practitioners. This paper examines the conditions under which optimal growth might be sustainable, by assessing the costs and benefits of growth. Key environmental and social aspects are considered. The Ecol-Opt-Growth-1 model analyses economic–ecological interactions, including resource depletion, pollution, irreversibility, other environmental effects, and uncertainty. It addresses some important issues, including savings, investment, technical progress, substitutability of productive factors, intergenerational efficiency, equity, and policies to make economic growth more sustainable—a basic element of the sustainomics framework. The empirical results support growing concerns that costs of growth may outweigh its benefits, resulting in unsustainability. Basically, in a wide range of circumstances, long term economic growth is unsustainable due to increasing environmental damage. Nevertheless, the model has many options that can be explored by policy makers, to make the development path more sustainable, as advocated by sustainomics. One example suggests that government supported abatement programs are needed to move towards sustainable development, since the model runs without abatement were infeasible. The optimal rate of abatement increases over time. Abatement of pollution is necessary to improve ecosystem viability and increase sustainability. Further research is necessary to seek conditions under which alternative economic growth paths are likely to become sustainable.