Suicidal tendency,physical health problems and addictive behaviours among general practitioners: their relationship with burnout

The aim of this article is to analyse further the association of burnout with (poor) physical health, addictive behaviours and suicidal tendency among general practitioners (GPs). Four hypotheses were studied: (H1): burnout (i.e. emotional exhaustion, EE, and depersonalization, DP) will be positively associated with suicidal tendency; (H2): will be negatively related to physical health (i.e. large number of physical symptoms and long-lasting impairment); and (H3): positively linked to addictive behaviours (i.e. addiction to alcohol and psychotropic medication) of GPs. Based on the “spiral of losses” depicted by the conservation of resources theory, we also considered whether physical health mediates the relationships of burnout/suicidal tendency and burnout/addictive behaviours (H4). 1890 French GPs completed a questionnaire administered by phone. Information was collected on burnout, three physical health indicators (BMI, number of physical symptoms and lasting physical health problems), four health behaviours (consumption of tobacco, alcohol, anxiolytics and antidepressants) and suicidal tendency (ideation, plan and attempt). Concerning EE, the results supported the hypotheses, except for alcohol consumption. However, the findings showed that DP was associated with more positive outcomes when controlling for exhaustion. The difference in findings for EE and DP are discussed, together with the need for GPs to develop strategies for resilience.     

Assessing switchability for biosimilar products: modelling approaches applied to children's growth

The present paper describes two statistical modelling approaches that have been developed to demonstrate switchability from the original recombinant human growth hormone (rhGH) formulation (Genotropin^®) to a biosimilar product (Omnitrope^®) in children suffering from growth hormone deficiency. Demonstrating switchability between rhGH products is challenging because the process of growth varies with the age of the child and across children. The first modelling approach aims at predicting individual height measured at several time‐points after switching to the biosimilar. The second modelling approach provides an estimate of the deviation from the overall growth rate after switching to the biosimilar, which can be regarded as an estimate of switchability. The results after applying these approaches to data from a randomized clinical trial are presented. The accuracy and precision of the predictions made using the first approach and the small deviation from switchability estimated with the second approach provide sufficient evidence to conclude that switching from Genotropin^® to Omnitrope^® has a very small effect on growth, which is neither statistically significant nor clinically relevant. Copyright © 2015 John Wiley & Sons, Ltd.     

From parental engagement to the engagement of social work services: discussing reductionist and democratic forms of partnership with families

Social work has moved from a child protection discourse towards a child welfare discourse that views the relationship between social workers and families as a partnership. Partnership with families in the field of child protection and child welfare, however, mirrors diverse ideological motives of social policy, civil society and practice. We engage in a theoretical discussion of different interpretations of partnership. We draw a primary distinction between reductionist and democratic forms of partnership with families. In a reductionist approach, social workers activate parents in order to realize the goals set by social work. A democratic approach to partnership refers to a shared responsibility between social workers, parents and children. In this approach, effective partnership is not something to be realized as an outcome, but a point of departure that implies a joint search for meaning and an experiment with which social workers engage. This engagement presents ‘non‐participation’ not as problematic but as an essential element of participation. The focus then shifts from a methodical approach to partnership – how to activate people to participate in the care process – to the question of how the engagement of social workers can be constructed together with families.     

Perceived inequity, communal orientation and burnout: The role of helping models

A large amount of empirical evidence has shown that professional helpers who perceive inequity in their relationships with their clients experience burnout. However, in such a situation, communal orientation (a desire to give benefits in response to the perceived needs of others), has been found to buffer burnout. In the present study, this buffering effect was investigated from the perspective of helping models. French nurses ( n =60) and social workers ( n =68) completed a questionnaire designed to evaluate perceived inequity, communal orientation and burnout. The results showed that, as expected, the buffering effect of communal orientation greatly depends on the helping model. Among professionals who endorsed a medical model of helping (wherein recipients are expected to be relatively passive to get better), those high on communal orientation experienced a low level of burnout when they perceived inequity. However, among professionals with a compensatory helping model (wherein recipients are expected to be active to get better), not only had perceived imbalance no buffering effect but also it reduced personal accomplishment. It was speculated that with a medical model, a perceived imbalance in the relationships does not hinder the desire to respond to the perceived needs of others. However, within a compensatory model, a perceived imbalance probably impedes the self efficacy of professionals high in communal orientation, that is who desire to respond to the perceived needs of others.     

Of Disasters and Dragon Kings: A Statistical Analysis of Nuclear Power Incidents and Accidents

We perform a statistical study of risk in nuclear energy systems. This study provides and analyzes a data set that is twice the size of the previous best data set on nuclear incidents and accidents, comparing three measures of severity: the industry standard International Nuclear Event Scale, the Nuclear Accident Magnitude Scale of radiation release, and cost in U.S. dollars. The rate of nuclear accidents with cost above 20 MM 2013 USD, per reactor per year, has decreased from the 1970s until the present time. Along the way, the rate dropped significantly after Chernobyl (April 1986) and is expected to be roughly stable around a level of 0.003, suggesting an average of just over one event per year across the current global fleet. The distribution of costs appears to have changed following the Three Mile Island major accident (March 1979). The median cost became approximately 3.5 times smaller, but an extremely heavy tail emerged, being well described by a Pareto distribution with parameter α = 0.5–0.6. For instance, the cost of the two largest events, Chernobyl and Fukushima (March 2011), is equal to nearly five times the sum of the 173 other events. We also document a significant runaway disaster regime in both radiation release and cost data, which we associate with the “dragon‐king” phenomenon. Since the major accident at Fukushima (March 2011) occurred recently, we are unable to quantify an impact of the industry response to this disaster. Excluding such improvements, in terms of costs, our range of models suggests that there is presently a 50% chance that (i) a Fukushima event (or larger) occurs every 60–150 years, and (ii) that a Three Mile Island event (or larger) occurs every 10–20 years. Further—even assuming that it is no longer possible to suffer an event more costly than Chernobyl or Fukushima—the expected annual cost and its standard error bracket the cost of a new plant. This highlights the importance of improvements not only immediately following Fukushima, but also deeper improvements to effectively exclude the possibility of “dragon‐king” disasters. Finally, we find that the International Nuclear Event Scale (INES) is inconsistent in terms of both cost and radiation released. To be consistent with cost data, the Chernobyl and Fukushima disasters would need to have between an INES level of 10 and 11, rather than the maximum of 7.     

Refugees and Migrants, Migrants and Refugees. An Ethnological Approach

This essay addresses the cultural dimension of the concepts refugee and migrant in order to better define their practical validity and authenticity. Examples are drawn from doctoral research and field work with South-East Asian refugees both in camps and in France.     

Qualitative Heuristics For Balancing the Pros and Cons

Balancing the pros and cons of two options is undoubtedly a very appealing decision procedure, but one that has received scarce scientific attention so far, either formally or empirically. We describe a formal framework for pros and cons decisions, where the arguments under consideration can be of varying importance, but whose importance cannot be precisely quantified. We then define eight heuristics for balancing these pros and cons, and compare the predictions of these to the choices made by 62 human participants on a selection of 33 situations. The Levelwise Tallying heuristic clearly emerges as a winner in this competition. Further refinements of this heuristic are considered in the discussion, as well as its relation to Take the Best and Cumulative Prospect Theory.     

Accounting for variability in individual hierarchical clinical trial data

Meta-analytical approaches have been extensively used to analyze medical data. In most cases, the data come from different studies or independent trials with similar characteristics. However, these methods can be applied in a broader sense. In this paper, we show how existing meta-analytic techniques can also be used as well when dealing with parameters estimated from individual hierarchical data. Specifically, we propose to apply statistical methods that account for the variances (and possibly covariances) of such measures. The estimated parameters together with their estimated variances can be incorporated into a general linear mixed model framework. We illustrate the methodology by using data from a first-in-man study and a simulated data set. The analysis was implemented with the SAS procedure MIXED and example code is offered.     

La tournée des facteurs Normes gestionnaires, régulation collective et stratégies d’activité

The work of mailmen is mainly defined by the delivery routes to which they are assigned. Since this special organization of work grants them broad autonomy, the processes for delimiting, defining, and conducting routes must be analyzed by taking into account observations from three levels. The first one focuses on the French Post Office’s managerial standards, which, though increasingly determined by objectives for making a profit, have little impact on mail deliverers’ activities. The second centers around this occupational group’s own regulations, which stem from a hierarchy based on seniority and control over mail delivery and routes. The third level of observation takes into view the strategies for delivering mail that postmen adopt on their routes. These strategies reflect different relations to managerial objectives and to customers; and they reveal contrasting conceptions of the job of delivering mail. Emphasis is laid on the fact that the situations for working at lower levels in the service sector cannot be separated from the factors defining and organizing these situations.     

Job demands,emotional dissonance and elderly abuse: The moderating role of organizational resources

ABSTRACT

The present study focuses on elderly abuse committed by caregivers in nursing homes. It aimed at a better understanding of neglect and abusive behaviors by considering the working context and the emotional dissonance of these professionals. To achieve this goal, direct effects of emotional dissonance, job demands (workload and emotional demands) and organizational resources (high-quality relationships with the colleagues and the supervisor) on neglect and abusive behaviors were analyzed. Moreover, the moderating role of organizational resources was explored. The study was conducted among 481 nurses and healthcare assistants from different French nursing homes. Overall, results contributed to the literature by pointing out the impact of emotional dissonance and caregivers’ working context on neglect and abusive behaviors. Moreover, results highlighted the moderating effect of high-quality relationships with the colleagues and the supervisor and give rise to potential implications in preventing elderly abuse in nursing homes.