Organizational effectiveness. Primary care and the congruence model

The congruence model is a framework used to analyze organizational strengths and weaknesses and pinpoint specific areas for improving effectiveness. This article provides an overview of organizations as open systems, with examples in the primary care arena. It explains and applies the congruence model in the context of primary care issues and functions, including methods by which the model can be used to diagnose organizational problems and generate solutions. Changes needed in primary care due to the managed care environment, and areas of potential problems and sensitivities requiring organizational changes to meet market and regulatory demands now placed on PCOs are examined.     

Who Reaps the Benefits,Who Bears the Risks? Comparative Optimism,Comparative Utility,and Regulatory Preferences for Mobile Phone Technology

Although the issue of risk target (e.g., self, others, children) is widely acknowledged in risk perception research, its importance appears underappreciated. To date, most research has been satisfied with demonstrating comparative optimism, i.e., lower perceived risk for the self than others, and exploring its moderators, such as perceived controllability and personal exposure. Much less research has investigated how the issue of target may affect benefit perceptions or key outcomes such as stated preferences for hazard regulation. The current research investigated these issues using data from a public survey of attitudes toward mobile phone technology (N= 1,320). First, results demonstrated comparative optimism for this hazard, and also found moderating effects of both controllability and personal exposure. Second, there was evidence of comparative utility, i.e., users believed that the benefits from mobile phone technology are greater for the self than others. Third, and most important for policy, preferences for handset regulation were best predicted by perceptions of the risks to others but perceived benefits for the self. Results suggest a closer awareness of target can improve prediction of stated preferences for hazard regulation and that it would be profitable for future research to pay more attention to the issue of target for both risk and benefit perceptions.     

Characterising the Perceived Risks and Benefits of Some Health Issues

Previous work on perceived risk, particularly a study by Fischhoff et al. (1978), is critically examined with reference to its applicability to specific health related issues. Judgments were obtained from 159 subjects of 15 health-related items in terms of perceived risk, benefit, and a number of risk characteristics based on the Fischhoff et al. research. In addition, demographic details concerning sex of respondent, seat belt usage, smoking status, and birth order were collected. Using regression analyses it was found that the direction of the risk-benefit relationship was dependent on the issue being judged. Risk was found to be better explained by ratings of likelihood of mishap and likelihood of death as a consequence of mishap. Benefit was poorly explained by the risk characteristics and demographic data. However, subject group characteristics were shown to be important influences on risk and benefit perception in certain situations. The implications of these results for understanding behavioral decisions involving risk in relation to specific activities are discussed.     

Awareness of Bad News, Environmental Attitudes, and Subjective Estimates of Coastal Pollution

Questionnaires distributed to 154 holiday-makers on beaches in Southwest England assessed awareness of local hazards or incidents associated with either the electricity supply industry or the water and sewage industry and examined the relationship between awareness and evaluations of the industry, current and future levels of pollution on the beach in question, and general levels of concern about environmental pollution. With respect to electricity, those respondents who were more aware of reports claiming a higher incidence of childhood leukemia in the vicinity of a nearby nuclear plant evaluated the electricity industry as less competent or trustworthy, showed higher levels of environmental concern, and were more pessimistic in their estimates of present and future levels of specific pollutants on their beach. With respect to the water industry, similar effects were associated with greater awareness of an accident at a water treatment plant and agricultural pollution of a nearby estuary. These findings are interpreted as suggesting a cyclical relationship between risk awareness and concern. On the one hand, reports about environmental hazards may lead to generalized concern across specific contexts; on the other hand, greater levels of concern may sensitize individuals to such reports.     

Employment status, psychiatric disability and quality of life: comparison of men and women with schizophrenia in Malaysia

This study explores the association between employment opportunities, psychiatric disability and quality of life of male and female patients with schizophrenia. The data were collected from 100 male and 100 female patients and their primary caregivers through personal interviews. The Disability Assessment Schedule and the Quality of Life Interview were used to collect the data. The results of the present study indicate that a large number of both the men and women were unemployed, although they suffered from only mild psychotic symptoms and had no or only minimum psychiatric disability. However, in almost all areas and levels of psychiatric disability, a significantly higher number of men than women were employed. However, the subjective Quality of Life of the employed men was significantly lower than that of the unemployed. Keeping in mind these two results, the present study argues that there is minimal community recognition in Malaysia for the employment potential of people with schizophrenia. The study also argues that policy makers must legislate to create more appropriate workplaces for the mentally ill. People with schizophrenia are entitled to just and fair treatment, and workplaces should be made attractive to them.     

Marginal Trust in Risk Managers: Building and Losing Trust Following Decisions Under Uncertainty

Although a considerable amount of research has examined correlates of baseline public trust in risk managers, much less research has looked at marginal changes in public trust following specific events. Such research is important for identifying what kinds of events will lead to increases and decreases in public trust and thus for understanding how trust is built and lost. Using a taxonomy based upon signal detection theory (SDT), the current article presents two experimental studies examining marginal trust change following eight different types of events. Supporting predictions, cautious decisionmakers who accepted signs of danger (Hits and False Alarms) were more likely to be trusted than those who rejected them (All Clears and Misses). Moreover, transparency about an event was associated with higher levels of marginal trust than a lack of transparency in line with earlier findings. Contrary to predictions, however, trust was less affected by whether the decisions were correct (i.e., Hits and All Clears) or incorrect (i.e., False Alarms and Misses). This finding was primarily due to a "False Alarm Effect" whereby Open False Alarms led to positive increases in trust despite being incorrect assessments of risk. Results are explained in terms of a cue diagnosticity account of impression formation and suggest that a taxonomy of event types based on SDT may be useful in furthering our understanding of how public trust in risk managers is gained and lost.     

Long-term low-dose dehydroepiandrosterone replacement therapy in aging males with partial androgen deficiency

Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) age-related withdrawal is very likely to be involved in the aging process and the onset of age-related diseases, giving rise to the question of whether preventing or compensating the decline of these steroids may have endocrine and clinical benefits. The aim of the present trial was to evaluate the endocrine, neuroendocrine and clinical consequences of a long-term (1 year), low-dose (25?mg/day) replacement therapy in a group of aging men who presented the clinical characteristics of partial androgen deficiency (PADAM). Circulating DHEA, DHEAS, androstenedione, total testosterone and free testosterone, dihydrotestosterone (DHT), progesterone, 17-hydroxyprogesterone, allopregnanolone, estrone, estradiol, sex hormone binding globulin (SHBG), cortisol, follicle stimulating hormone (FSH), luteinizing hormone (LH), growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels were evaluated monthly to assess the endocrine effects of the therapy, while β-endorphin values were used as a marker of the neuroendocrine effects. A Kupperman questionnaire was performed to evaluate the subjective symptoms before and after treatment.

The results showed a great modification of the endocrine profile; with the exception of cortisol levels, which remained unchanged, DHEA, DHEAS, androstenedione, total and free testosterone, DHT, progesterone, 17-hydroxyprogesterone, estrone, estradiol, GH, IGF-1 and β-endorphin levels increased significantly with respect to baseline values, while FSH, LH and SHBG levels showed a significant decrease. The Kupperman score indicated a progressive improvement in mood, fatigue and joint pain.

In conclusion, the present study demonstrates that 25?mg/day of DHEA is able to cause significant changes in the hormonal profile and clinical symptoms and can counteract the age-related decline of endocrine and neuroendocrine functions. Restoring DHEA levels to young adult values seems to benefit the age-related decline in physiological functions but, however promising, placebo-controlled trials are required to confirm these preliminary results.     

Risk Perceptions of Mobile Phone Use While Driving

Numerous governments have introduced regulations governing the use of mobile (cellular) telephones while driving. Despite significant research into the "objective" risks, there is relatively little research into risk perceptions either in relation to other in-car distractions or with respect to the factors underlying such perceptions. The current article reports on two studies addressing these issues. Study 1 ( N = 199) found that whereas the use of hand-held sets is seen as one of the riskiest activities to perform while driving, the risks of using a hands-free kit are perceived to be relatively small. Study 2 ( N = 1,320) found that nearly half of all drivers in the sample with a mobile phone reported having used it while driving and that, overall, the probability of having an accident was perceived to be less for oneself than for one's peers, indicating an optimistic bias. Two factors underpinned risk perceptions, "impact" including perceived severity and equitability, and "controllability" including immediacy, detectability, and probability. While higher "impact" scores were associated with increased preferences for restrictions on the use of hand-held mobiles while driving, the "controllability" scores moderated this relationship such that when perceived "controllability" was low, restriction preferences were high irrespective of perceived "impact." However, when "controllability" was high, restriction preferences remained high when "impact" was high but were low when "impact" was low. Given the growing number of in-car technological innovations, it is suggested that regulators act strategically, rather than finding themselves developing a series of "hazard-specific" regulations, which may ultimately lack coherence.     

"Trust me, I''m a scientist (not a developer)": perceived expertise and motives as predictors of trust in assessment of risk from contaminated land

Previous authors have argued that trust may be based on the extent to which risk communicators are seen as good at discriminating safety from danger, are unbiased in their assessments, and share their audience's values. Residents of two English urban regions rated their trust in six potential sources of information about the risk of contaminated land in their neighborhood (independent scientists; local council property developers; residents' groups; friends and family; local media), and how expert, open, accurate, or biased these sources were and how much they had residents' interests at heart. Overall, scientists were trusted most and developers least, but this was only partly due to their greater perceived expertise. Resident groups and friends/family were also trusted, despite being seen as relatively inexpert, since they scored highly on openness and shared interests, these latter two attributes being more important predictors of trust in individual sources than perceived expertise. We conclude that, where a source is seen as motivated to withhold, distort, or misinterpret information, this will undermine public trust even in apparently knowledgeable sources, hence supporting the view that trust depends on a combination of perceived expertise and perceived motives as complementary processes.