Work performance and health of junior hospital doctors a review of the literature

Concern has been expressed for a number of years about the long working hours and consequent sleep loss often experienced by junior hospital doctors. In recent months there has been renewed pressure for the demanding work schedules, common in many hospitals, to be changed. Concern centres on two related areas, namely the potential effects on the doctors work performance and the effects on their health. This paper reviews the literature relating to both areas and assesses how far the expressed need for change is supported by existing evidence. In addition attention is drawn to aspects of sleep loss and work performance requiring further investigation.     

Analysis of longitudinal data with non-ignorable non-monotone missing values

A full likelihood method is proposed to analyse continuous longitudinal data with non-ignorable (informative) missing values and non-monotone patterns. The problem arose in a breast cancer clinical trial where repeated assessments of quality of life were collected: patients rated their coping ability during and after treatment. We allow the missingness probabilities to depend on unobserved responses, and we use a multivariate normal model for the outcomes. A first-order Markov dependence structure for the responses is a natural choice and facilitates the construction of the likelihood; estimates are obtained via the Nelder–Mead simplex algorithm. Computations are difficult and become intractable with more than three or four assessments. Applying the method to the quality-of-life data results in easily interpretable estimates, confirms the suspicion that the data are non-ignorably missing and highlights the likely bias of standard methods. Although treatment comparisons are not affected here, the methods are useful for obtaining unbiased means and estimating trends over time.     

Medicaid State Plan personal care services: trends in programs and policies

Policymakers face mounting pressures from consumer demand and the 1999 Olmstead Supreme Court decision to extend formal (paid) programs that deliver personal care to the elderly, chronically ill, and disabled. Despite this, very little is known about the largest program that delivers personal care: the Medicaid State Plan personal care services (PCS) optional benefit. This paper presents the latest available national program (participant and expenditure) trend data (1999-2002) on the Medicaid PCS benefit and findings from a national survey of eligibility and cost control policies in use on the program. The program trends show that, over the study period, the number of states providing the Medicaid PCS benefit grew by four (from 26 to 30), and national program participation, adjusted for population growth, increased by 27%. However, inflation-adjusted program expenditures per participant declined by 3% between 1999 and 2002. Findings from the policy survey reveal that between 1999 and 2002 there was a marked decline in the range of services provided, and by 2004, almost half the programs operated a cap on the hours of services provided.     

Disadvantaged Neighborhoods and Adolescent Aggression: Behavioral Genetic Evidence of Contextual Effects

This study used behavioral genetic methods to examine differences in genetic and environmental influences on adolescent aggression across adequate and disadvantaged neighborhoods. Analyses used National Longitudinal Study of Adolescent Health data from 2,342 monozygotic twin, dizygotic twin, full‐sibling, and half‐sibling pairs classified into structurally adequate and disadvantaged neighborhoods according to Census data on the proportion of single‐parent households with children, proportion of families in poverty, and unemployment levels in sibling pairs' block groups. Separately estimating genetic and environmental influences across adequate and disadvantaged neighborhoods revealed that although genetic influences are significant in both adequate and disadvantaged neighborhoods, shared environmental influences (e.g., family influences shared by siblings) were significant only among adolescents from disadvantaged neighborhoods. These results provide insight into differences in individual‐level influences that contribute to adolescent aggression within these different types of neighborhoods. Significant shared environmental influences in disadvantaged neighborhoods suggest the importance of family processes is increased by neighborhood disadvantage.     

Construct redundancy in leader behaviors: A review and agenda for the future

Leadership remains a popular and heavily researched area in the social sciences. Such popularity has led to a proliferation of new constructs within the leadership domain. Here, we argue that such construct proliferation without pruning is unhealthy and violates the principle of parsimony. Our purpose was to examine construct redundancy via a comprehensive review of task-oriented, relational, passive, and inspirational leader behaviors as well as values-based and moral leadership behaviors. Our findings, as indexed via meta-analytic correlations, reveal that construct redundancy remains problematic for the leadership literature. In addition, many of the values-based and moral behavior models correlated heavily with constructs traditionally examined as outcome variables (e.g., trust, LMX, justice). Implications for future research are discussed in regards to construct redundancy and how to avoid endogeneity bias in primary studies in the leadership literature.     

Arousal and Affective Differences Between Student Gamblers and Non-gamblers during a Card Game

The current study examined the differences in arousal (physiologically and subjectively) between gamblers and non-gamblers. Thirty students from a mid-sized university took part in the study for a chance to win money in a gambling task. Nearly half of the participants identified themselves as non-gamblers and slightly more than half of the participants considered themselves gamblers. Findings indicated that gamblers experienced a significantly higher increase in physiological arousal (heart rate) compared to non-gamblers during the gambling experience. The results suggests the possibility that physiological arousal may play a role in the appeal of gambling to certain types of people. Furthermore, when gamblers suffered a loss at the end of the game, they reported feeling worse as compared to the non-gamblers and relative to their state before playing. Moreover, this affective change explained 28.6% of the variance in gambling behavior according to self-reports. Findings suggest that gamblers in our study may have been more personally invested in the gambling tasks, such that losing was more disappointing to the habitual gamblers than the non-gamblers.     

Competing risk analysis in a large cardiovascular clinical trial: An APEX substudy

Competing risk methods are time‐to‐event analyses that account for fatal and/or nonfatal events that may potentially alter or prevent a subject from experiencing the primary endpoint. Competing risk methods may provide a more accurate and less biased estimate of the incidence of an outcome but are rarely applied in cardiology trials. APEX investigated the efficacy of extended‐duration betrixaban versus standard‐duration enoxaparin to prevent a composite of symptomatic deep‐vein thrombosis (proximal or distal), nonfatal pulmonary embolism, or venous thromboembolism (VTE)–related death in acute medically ill patients (n = 7513). The aim of the current analysis was to determine the efficacy of betrixaban vs standard‐duration enoxaparin accounting for non‐VTE–related deaths using the Fine and Gray method for competing risks. The proportion of non‐VTE–related death was similar in both the betrixaban (133, 3.6%) and enoxaparin (136, 3.7%) arms, P = .85. Both the traditional Kaplan‐Meier method and the Fine and Gray method accounting for non‐VTE–related death as a competing risk showed equal reduction of VTE events when comparing betrixaban to enoxaparin (HR/SHR = 0.65, 95% 0.42‐0.99, P = 0.046). Due to the similar proportion of non‐VTE–related deaths in both treatment arms and the use of a univariate model, the Fine and Gray method provided identical results to the traditional Cox model. Using the Fine and Gray method in addition to the traditional Cox proportional hazards method can indicate whether the presence of a competing risk, which is dependent of the outcome, altered the risk estimate.     

Change and inertia in the New York state medicaid personal care services program: an institutional case study

This study analyzes how competing logics (belief systems) of stakeholders have influenced patterns of change and inertia in the development of the New York Medicaid Personal Care Services (PCS) program. A case-study methodology was used to collect documents, statistics, and interview data from four key stakeholder groups: state and city officials, PCS agencies, a labor union, and consumer advocates covering the period 1999 to 2005. The New York PCS program is one of the oldest, largest, and most stable programs in the United States. Its early unionization of workers resulted in relatively generous wages and benefits and made New York number one nationally in PCS spending per capita. In spite of wide support from stakeholder groups, the overall number of participants has gradually declined since 1999. A consumer-directed model of personal care developed in 1995 challenged the status quo and has grown steadily. Resistance by public officials, agency providers, and union representatives to the consumer-directed model has resulted in a small program that is often targeted toward individuals labeled "difficult to serve." Dominant stakeholders in New York have ensured a stable personal care program that has resisted change and led to program inertia.