A process evaluation of implementing a vocational enablement protocol for employees with hearing difficulties in clinical practice

Objective: A multidisciplinary vocational rehabilitation programme, the Vocational Enablement Protocol (VEP) was developed to address the specific needs of employees with hearing difficulties. In the current study we evaluated the process of implementing the VEP in audiologic care among employees with hearing impairment. Design: In conjunction with a randomized controlled trial, we collected and analysed data on seven process parameters: recruitment, reach, fidelity, dose delivered, dose received and implemented, satisfaction, and perceived benefit. Study sample: Sixty-six employees with hearing impairment participated in the VEP. The multidisciplinary team providing the VEP comprised six professionals. Results: The professionals performed the VEP according to the protocol. Of the recommendations delivered by the professionals, 31% were perceived as implemented by the employees. Compliance rate was highest for hearing-aid uptake (51%). Both employees and professionals were highly satisfied with the VEP. Participants rated good perceived benefit from it. Conclusions: Our results indicate that the VEP could be a useful treatment for employees with hearing difficulties from a process evaluation perspective. Implementation research in the audiological setting should be encouraged in order to further provide insight into parameters facilitating or hindering successful implementation of an intervention and to improve its quality and efficacy.     

Workplace status and risk of hypertension among hourly and salaried aluminum manufacturing employees

An inverse relationship between workplace status and morbidity is well established; higher job status has been associated with reduced risks of heart disease, hypertension, and injury. Most research on job status, however, has focused on salaried populations, and it remains unclear whether job status operates similarly among hourly workers. Our objectives were to examine whether hourly status itself influences risk of hypertension after adjustment for socioeconomic confounders, and to explore the role of fine-scale job grade on hypertension incidence within hourly and salaried groups. We examined data for 14,999 aluminum manufacturing employees in 11 plants across the U.S., using logistic regression with adjustment for age, sex, race/ethnicity and other individual characteristics. Propensity score restriction was used to identify comparable groups of hourly and salaried employees, reducing confounding by sociodemographic characteristics. Job grade (coded 1 through 30, within hourly and salaried groups) was examined as a more refined measure of job status. Hourly status was associated with an increased risk of hypertension, after propensity restriction and adjustment for confounders. The observed effect of hourly status was stronger among women, although the propensity-restricted cohort was disproportionately male (96%). Among salaried workers, higher job grade was not consistently associated with decreased risk; among hourly employees, however, there was a significant trend, with higher job grades more protective against hypertension. Increasing the stringency of hypertension case criteria also increased the risk of severe or persistent hypertension for hourly employees.     

Mature-age entrants to medical school: a controlled study of sociodemographic characteristics, career choice and job satisfaction

A comparison of 121 mature-age and 270 normal-age entrants who graduated from the University of Queensland Medical School between 1972 and 1987 shows that mature-age entrants are some 7 years older, are more likely to come from public (state) schools and less likely to have parents in professional/technical occupations. Otherwise, the two groups were similar in terms of gender, marital status, number of children, ethnic background and current practice location. The educational background of mature-age entrants prior to admission includes 44.6% with degrees in health-science areas and 31.4% with degrees in non-health areas. Reasons for delayed entry of mature-age entrants include late consideration of medicine as a career (34.7%), financial problems (31.4%), dissatisfaction with previous career (30.6%), poor academic results (19.8%), or a combination of the above factors. Motivations to study medicine include family influences (more so in normal-age entrants), altruistic reasons (more so in mature-age entrants) and a variety of personal/social factors such as intellectual satisfaction, prestige and financial security (similar for both groups) and parental expectations (more so in normal-age entrants). Mature-age entrants experienced greater stress throughout the medical course, especially with regard to financial difficulties, loneliness/isolation from the students and family problems (a greater proportion were married with children). While whole-course grades were similar in both groups, normal-age entrants tended to win more undergraduate honours/prizes and postgraduate diplomas/degrees, including specialist qualifications. Practice settings were similar in terms of group private practice, hospital/clinic practice or medical administration, but there was a greater proportion of mature-age entrants in solo private practice, and a smaller proportion in teaching/research. If given the time over, some two-thirds of both groups would choose medicine as a career. Reasons for job satisfaction include helping patients, intellectual stimulation and financial rewards. Reasons for dissatisfaction include pressure of work, red-tape/paperwork, 'doctor-bashing', long working hours, emotional strain, financial pressure, unfulfilled career expectations and irritation with trivial medical complaints.     

Are Continuity Clinic Patients Less Satisfied When the Resident Is Postcall?

Due to recent public debate and newly imposed resident work hour restrictions, we decided to investigate the relationship of resident call status to their ambulatory patients' satisfaction. Resident continuity clinic patients were asked to rate their level of satisfaction on a 10-point Likert-type scale. Using multiple regression approaches, these data were then assessed as a function of resident call status. We found that in 646 patient encounters, patient satisfaction scores were significantly less when the resident was postcall, 8.99 ± 1.8, than when not postcall, 9.31 ± 1.3. We herein discuss etiologies and implications of these findings for both patient care and medical education.     

Preference awareness education as stress management training for academic staff

This paper describes a response directed stress management intervention (SMI) in the form of a Jungian based preference awareness education (PAE). It uses the Insights System of personality types to increase awareness of behaviour and communication preferences of self and different others. Eighteen self‐recruited academic employees participated for 7 weeks and received feedback about work preferences and personality type. The aim was to reduce perceptions of stress and interpersonal stress and to increase feelings of job satisfaction and interpersonal satisfaction. The data were analysed using two‐tailed t‐tests. No significant findings were observed for the total sample after training, however, interesting results were found for certain sub‐sample groups. Extravert‐thinking types, reported decreased stress levels (p > 0.018), and participants suffering high stress/interpersonal stress pre‐PAE, reported decreased stress levels (p > 0.010–0.018). Participants suffering low job/interpersonal satisfaction pre‐PAE, reported increased job satisfaction (p > 0.015–0.016). These results suggest that individuals who report high levels of stress and dissatisfaction are most likely to benefit from this type of intervention. Future PAE research might: (a) use pilot studies to meet the intervention preferences of employees that are reluctant to participate in SMIs; (b) include a wait‐list control group; use: (c) a follow up education/measures; (d) and organizational level (stressor directed) SMIs at the same time as response directed initiatives. Copyright © 2005 John Wiley & Sons, Ltd.     

Parent satisfaction with paediatric day-surgery: a questionnaire-based study

Potential advantages of paediatric day-surgery are cost saving, improved utilization of staff and hospital facilities, and reduction of stress for the paediatric patient and their family. A successful programme requires careful case selection, full operating and anaesthetic facilities and good follow-up. Current practice is reviewed with regard to initial assessment, preparation for surgery and overall management during the day admission. To provide information on how patients and their parents experience essential aspects of daycare paediatric surgery, a questionnaire-based study on parental satisfaction of paediatric day-surgery was performed. Most children were back to normal, within a few days. Recovery from paediatric day-surgery was rapid and the overall level of parent satisfaction was high.     

Psychiatric nurses' satisfaction: the effects of closure of a hospital

A survey by questionnaire was carried out to examine the level of nursing staff satisfaction with the acute psychiatric services. Comparisons were made between views of older psychiatric hospitals and newer district general hospital units, and before and after the closure of Friern Barnet Hospital, London, England when the service was reorganized to include fewer beds. The importance of nurses having their say is emphasized, and areas in which improvements can be made are suggested.     

'Not everything that can be counted counts and not everything that counts can be counted'– towards a critical exploration of modes of satisfaction measurement in sheltered housing

This paper reflects on a research project funded by a consortium of leading sheltered housing (SH) providers and their regulatory body, the Housing Corporation. The project aimed to ascertain which aspects of SH older people perceived to be central to their satisfaction and the methods they judged most appropriate to measuring this. We outline key policy developments of importance to SH (specifically the development of performance measurement regimes), and changes in the nature of SH, which are driving providers to re‐evaluate how they measure user satisfaction. We discuss the aims of the project, our methodology and findings, and conclude by raising critical questions about the process of measuring satisfaction within an increasingly managerialised housing system. We argue that this favours standardised methods of information gathering (such as questionnaires) rather than engage with clients in order to develop methods and systems capable of eliciting qualitative issues of concern to them. Our conclusions are, we believe, applicable to health and social care provision, where similar tensions exist around performance measurement and user satisfaction.     

Psychosocial factors at work and perceived health among agricultural meat industry workers in France

Objective  The objective of this study was to describe the perceived health status of the meat industry employees—i.e., working in the slaughtering, cutting, and boning of large animals and poultry—and its relation to their organisational and psychosocial constraints at work. Methods  This postal survey included all 3,000 employees of the meat industry (beef, pork and poultry) in four districts in Brittany, France, whose companies were affiliated with the agricultural branch of the national health insurance fund. The questionnaire asked for social and demographic data and information describing their job and the organisation of their work. The psychosocial factors at work were described according to Karasek’s questionnaire (demand, latitude and social support at work). Perceived health was measured with the Nottingham Health Profile perceived health indicator. Results  This study shows the high prevalence of poor health reported by the workers in this industry. This poor perceived health was worse in women and increased regularly with age. Among the psychosocial factors studied, high quantitative and qualitative demand at work, inadequate resources for good work and to a lesser extent, inadequate prospects for promotion appear especially associated with poor perceived health. Other factors often associated with poor perceived health included young age at the first job and work hours that disrupt sleep rhythms (especially for women). Conclusion  Our results show that this population of workers is especially vulnerable from the point of view of perceived physical and psychological health and is exposed to strong physical, organisational and psychosocial constraints at work. They also demonstrate that poor perceived health is associated with some psychosocial (such as high psychological demand and insufficient resources) and organisational factors at work. These results, in conjunction with those from other disciplines involved in studying this industry, may help the companies to develop preventive activities.     

The effects of oestrogen therapy on the sex life of post-menopausal women

The literature concerning sexual behaviour around the time of the menopause is reviewed. Mentioned is a decline in sexual activity and satisfaction in women which is attributed to the changes in the women themselves, and not merely a reaction to the decline in the sexual capacity of their husbands.

Forty women were treated during 1 yr with oestrogens. The eventual effect of this treatment on sexual activity and satisfaction was investigated and compared with a group who had undergone partial treatment only. The results show that in the completely treated Group A, symptoms such as hot flushes and depression diminished, and the pain of sexual relations was relieved. As a consequence of this improvement, coital activity and satisfaction were more gratifying. The partially treated Group B showed a clear decline in sexual activity and in sexual satisfaction.