Search results

The purpose of this paper is to examine the rising public health phenomenon of workplace suicide drawing on comparative insights from the French and UK contexts. France has experienced what the media describes as a “suicide epidemic” in the workplace, with rising numbers of employees choosing to kill themselves in the face of extreme pressures at work.

The paper uses a comparative approach drawing on insights from the French context, in which workplace suicide is legally and officially recognised, to shed critical light on the UK context where workplace suicide remains a hidden phenomenon.

Whilst in France, workplace suicide is treated as an urgent public health phenomenon and data on suicides are collected centrally, in the UK, despite a deterioration in working conditions, suicide is not recognised in legislation and data are not collected centrally. Unless society recognises and document rising workplace suicides, we will be unable to deal with their profound human consequences for suicidal individuals, their families and society more widely.

Research on workplace suicides in the UK and many other national contexts is hampered by fragmentary statistical data on this phenomenon.

The paper calls for greater recognition, analysis and monitoring of workplace suicide in the UK. Suicide should be included in the list of workplace accidents that are reported to the authorities for further investigation. In a context where workplace conditions are deteriorating, society need to recognises the profound human costs of these conditions for the individual employee.

The paper has important implications for the contemporary workplace in terms of the contractual relationship between employer and employee.

Workplace suicide is an urgent, yet under-researched phenomenon. The paper brings a comparative and multidisciplinary perspective to bear on this phenomenon.

Although it is well recognised that the collapse of the Soviet Union and the subsequent widespread social and economic changes impacted on the levels and distribution of physical health, there is very limited evidence on the social patterning of mental health in the countries that emerged. The aim of this paper is to assess levels of psychological distress and describe its demographic, social and economic correlates in eight former Soviet countries.Cross‐sectional surveys using multi‐stage random sampling were conducted in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine. A standardised questionnaire was used for all countries, including the main outcome for this study of psychological distress, which consisted of 12 items on symptoms of psychological distress. Respondents who repor ted 10‐12 of the symptoms were considered to have a high psychological distress score. Multivariate logistic regression analysis was then used to investigate how demographic, social and economic factors were associated with a high psychological distress score.High psychological distress in seven of the eight countries ranges from 3.8% in Kazakhstan to 10% in Ukraine but was substantially higher (21.7%) in Armenia. Factors associated with psychological distress in the multivariate analysis included: being female; increasing age; incomplete secondary education; being disabled; experiencing two or more stressful events in the past year; lack of trust in people; lack of personal suppor t in crisis; being unemployed; and poor household economic situation.The study contributes evidence on the association of impoverishment and social isolation on psychological distress in countries of the former Soviet Union and highlights the impor tance of exploring ways of improving mental health by addressing its social determinants.

Proposed changes in medical staffing levels and pressure for reduced hours of work by junior doctors have focused attention on out‐of‐hours work by junior doctors in the United Kingdom. Junior doctors are on average on duty for over 90 hours per week, and preregistration house officers typically spend almost 70 hours per week actually working. There has been a decline in contracted hours for junior doctors during the 1980s, but an increase in the number of hours on duty and, in the cases of paediatrics and general surgery, an increase in the number of hours worked. Current policy is for expansion in consultant numbers and reduction in junior staff. Critics argue that the planned expansion of consultant posts is inadequate and the absence of registrars in some specialties is dangerous. Previous attempts to reduce the number of hours on duty had little success: suggested solutions have not been implemented widely. One possible solution may be reducing and reallocating out‐of‐hours work. It has been suggested that many of the current tasks undertaken by junior hospital doctors could be performed by non‐medical staff. A thorough examination of the tasks actually undertaken by junior hospital doctors outside normal working hours is required.

Using a complexity-informed approach, we aim to understand why introduction of a mobile service delivery model for osteoporosis across diverse organisational and country contexts in the UK National Health Service (NHS) met with variable success.

Six comparative case studies; three prospectively in Scotland using an action research-informed approach; and three retrospectively in England with variable degrees of success. The Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework explored interactions between multi-level contextual factors and their influence on efforts to introduce and sustain services.

Cross-boundary service development was a continuous process of adaptation and evolution in rapidly shifting healthcare context. Whilst the outer healthcare policy context differed significantly across cases, inner contextual features predominated in shaping the success or otherwise of service innovations. Technical and logistical issues, organisational resources, patient and staff actions combined in unpredictable ways to shape the lifecycle of service change. Patient and staff thoughts about place and access to services actively shaped service development. The use of tacit “soft intelligence” and a sense of “chronic unease” emerged as important in successfully navigating around awkward people and places.

“Chronic unease” and “soft intelligence” can be used to help individuals and organisations “tame” complexity, identify hidden threats and opportunities to achieving change in a particular context, and anticipate how these may change over time. Understanding how patients think and feel about where, when and how care is delivered provides unique insights into previously unseen aspects of context, and can usefully inform development and sustainability of patient-centred healthcare services.

This study has uniquely traced the fortunes of a single service innovation across diverse organisational and country contexts. Novel application of the NASSS framework enabled comparative analysis across real-time service change and historical failures. This study also adds to theories of context and complexity by surfacing the neglected role of patients in shaping healthcare context.

The purpose of this paper is to compare levels of psychological distress in 2001 and 2010 in eight countries of the former Soviet Union and to explore how these changes vary for different population groups.

Data were collected using two related studies from 2001 (n=14,242) and 2010 (n=15,081). Both studies consisted of nationally representative cross‐sectional household surveys in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine using a standardized questionnaire. Psychological distress was measured using a 12 item instrument, with scores of 10‐12 indicating high psychological distress. Changes in prevalence of high psychological distress were measured between 2001 and 2010 by country, gender, age group, educational level, disability status, personal support and household economic status using descriptive and prevalence rate ratio analysis.

Levels of high psychological distress decreased from 8.7 per cent in 2001 to 4.9 per cent in 2010 for the whole study region (4.5 per cent to 2.8 per cent for men; 12.0 per cent to 6.5 per cent for women). All study countries recorded decreases in high psychological distress. The adjusted relative rate ratios indicate the observed decreases have not been experienced by men, older age groups, less educated respondents, those with a disabling health condition, low levels of support and bad household economic status.

The study shows decreases in levels of high psychological distress in the study countries, but that decreases were less for socially and economically marginalised populations. This highlights the cycle of poverty, social exclusion and poor mental health in the region. Despite decreases of psychological distress among women, they continue to bear a significantly higher burden than men.

This chapter explores age-based variations in the healthcare experiences of transgender people. Specifically, we outline how transgender people narrate their experiences with coming out and transition in later life as well as possibilities for future research and clinical practice concerning older transgender populations. To this end, we begin with a review of the limited literature on older transgender populations including the ways such findings converge and diverge from studies of younger transgender populations. Then, we analyze data gathered from older transgender people throughout the United States concerning their experiences with health events, healthcare providers, and healthcare settings. For this empirical analysis, we draw on over 250 qualitative responses from transgender people over the age of 40. The findings of this chapter demonstrate the importance of adjusting existing healthcare protocols to provide adequate care for aging transgender populations. Specifically, our analyses highlight gaps in access and quality of healthcare delivery as well as issues related to medical education, trans-inclusive protocols, and sex-gender segregated medical traditions. The implications of our work here reveal important possibilities for expanding transgender healthcare access as well as existing barriers to such access. We specifically utilize the case of our respondents and the existing literature to illuminate gaps in needs assessment and healthcare delivery concerning older transgender populations. We will conclude the chapter with recommendations for bridging such gaps in research, education, and system operation.

The purpose of this paper is to compare the response to HIV/AIDS and drug use (drugs harm reduction) with tobacco harm reduction.

Analysis of historical and contemporary sources, combined with personal knowledge of key stakeholders in the history and development of both fields.

Both drugs harm reduction and tobacco harm reduction share a similar objective – to reduce health risks for people who are unwilling or unable to stop using their drug of choice. Both also share a broader public health aim of helping people to make healthier decisions. Drugs harm reduction – as a response to HIV/AIDS – included the adoption of a wide range of radical harm reduction interventions and was a public health success. It became an established part of the professional Public Health agenda. In contrast the Public Health response to e-cigarettes and tobacco harm reduction has ranged from the negative to the cautious. A recent Public Health England report is exceptional for its endorsement of e-cigarettes.

Highlights contradictions in Public Health responses to drugs and tobacco; and that public health interventions can be implemented without and despite the contribution of professional Public Health.

The purpose of this research is to investigate the impact of consumer satisfaction survey respondents' demographics, satisfaction level and behavioral intentions on response rates and item completion rates.

A consumer satisfaction survey was sent to 2,000 individuals immediately after receipt of a service experience. The respondents to this initial survey were then mailed another survey one to two years following the service experience in order to identify individual consumers who could then be tracked to see who responded to the survey.

The findings indicate that age impacts survey response rates, intention to return impacts item completion rates, and satisfaction impacts both response and item completion rates.

Ensuring the accuracy of consumer satisfaction data is invaluable to an organization, as the findings are the basis from which many important decisions are made. Unfortunately, many consumers do not respond or may not completely fill out surveys, leaving the organization with imprecise results. To assess consumer perceptions properly, managers must be certain of accurate and unbiased results to be able to make key operational changes.