An exploration of the multiple motivations for spending less time at work

Funder: Cambridge Political Economy Society TrustThis article makes a significant empirical contribution to our understanding of why people in the United Kingdom without childcare responsibilities actively reduce or limit the amount of time they spend in paid employment. We show how the negative aspects of employment (push factors) and the desire to spend time in more varied and enjoyable ways (pull factors) interact to produce decisions to enact working time reductions (WTRs). The push factors include excessive workloads and difficult or tedious tasks which can result in stress and mental exhaustion. For people working non-standard schedules, their lack of control over hours can make it difficult to enjoy the free time that is available. The pull factors we have identified include traumatic experiences such as illness or the early death of a loved one which can lead to an increased awareness of the salience of time. Also important was the desire to develop skills and subjectivities unrelated to work-time identities. An overarching theme in the interviews was the idea that full-time work leads to a loss of autonomy, and a reduction in hours is a route to greater freedom. These motivations are contrasted with understandings of WTRs present in the empirical and predominantly quantitative literature which highlight the structural constraints that often force women in particular into part-time work as a result of childcare responsibilities. An exploration of the motivations of short-hour workers is pertinent, given increasing concern that long hours of work exacerbate multiple social, economic and environmental problems. We suggest that a deeper understanding of why individuals want to work less could help facilitate ‘priming’ campaigns aimed at increasing demand for WTRs more generally.</jats:p

Evaluation of a risk-stratification strategy to improve primary care for low back pain: the MATCH cluster randomised trial protocol

Background Despite numerous options for treating back pain and the increasing healthcare resources devoted to this problem, the prevalence and impact of back pain-related disability has not improved. It is now recognized that psychosocial factors, as well as physical factors, are important predictors of poor outcomes for back pain. A promising new approach that matches treatments to the physical and psychosocial obstacles to recovery, the STarT Back risk stratification approach, improved patients’ physical function while reducing costs of care in the United Kingdom (UK). This trial evaluates implementation of this strategy in a United States (US) healthcare setting. Methods Six large primary care clinics in an integrated healthcare system in Washington State were block-randomized, three to receive an intensive quality improvement intervention for back pain and three to serve as controls for secular trends. The intervention included 6 one-hour training sessions for physicians, 5 days of training for physical therapists, individualized and group coaching of clinicians, and integration of the STarT Back tool into the electronic health record. This prognostic tool uses 9 questions to categorize patients at low, medium or high risk of persistent disabling pain with recommendations about evidence-based treatment options appropriate for each subgroup. Patients at least 18 years of age, receiving primary care for non-specific low back pain, were invited to provide data 1–3 weeks after their primary care visit and follow-up data 2 months and 6 months (primary endpoint) later. The primary outcomes are back-related physical function and pain severity. Using an intention to treat approach, intervention effects on patient outcomes will be estimated by comparing mean changes at the 2 and 6 month follow-up between the pre- and post-implementation periods. The inclusion of control clinics permits adjustment for secular trends. Differences in change scores by intervention group and time period will be estimated using linear mixed models with random effects. Secondary outcomes include healthcare utilization and adherence to clinical guidelines. Discussion This trial will provide the first randomized trial evidence of the clinical effectiveness of implementing risk stratification with matched treatment options for low back pain in a United States health care delivery system

Long-term Psychological and Occupational Effects of Providing Hospital Healthcare during SARS Outbreak

TOC Summary Line: Healthcare workers in hospitals affected by SARS experience increased psychological stress 1–2 years after the outbreak

Anxiety and depression after prostate cancer diagnosis and treatment: 5-year follow-up

To document anxiety and depression from pretreatment till 5-year follow-up in 299 men with localized prostate cancer. To assess, if baseline scores were predictive for anxiety and depression at 1-year follow-up. Respondents completed four assessments (pretreatment, at 6 and 12 months, and at 5-year follow-up) on anxiety, depression and mental health. Respondents were subdivided according to therapy (prostatectomy or radiotherapy) and high vs low-anxiety. Pretreatment 28% of all patients were classified as ‘high-anxiety'; their average anxiety scores decreased significantly post-treatment, that is towards less anxiety. At all assessments, high-anxiety men treated by prostatectomy reported less depression than high-anxiety men treated by radiotherapy. Of men treated by radiotherapy, 27% reported clinical significant levels of depression while 20% is expected in a general population. The improvement in mental health at 6-months follow-up was statistically significant and clinically meaningful in all respondent groups. Sensitivity of anxiety at baseline as a screening tool was 71% for anxiety and 60% for symptoms of depression. We recommend clinicians to attempt early detection of patients at risk of high levels of anxiety and depression after prostate cancer diagnosis since prevalence is high. STAI-State can be a useful screening tool but needs further development

ProsCan for Men: Randomised controlled trial of a decision support intervention for men with localised prostate cancer

Background: Prostate cancer is the most common male cancer in the Western world but is highly heterogeneous in disease progression and outcomes. Consequently, the most substantial morbidity may actually arise from the adverse psychosocial impact of distress in decision-making and long term quality of life effects such as impotence. This paper presents the design of a randomised controlled trial of a decision support/psychosocial intervention for men newly diagnosed with localised prostate cancer. Methods/Design: 350 men per condition (700 men in total) have been recruited after diagnosis and before treatment through urology private practices and hospital outpatient clinics and randomised to 1) a tele-based nurse delivered five session decision support/psychosocial intervention or 2) a usual care control group. Two intervention sessions are delivered before treatment that address decision support, stress management and preparation for treatment. Three further sessions are provided three weeks, seven weeks and five months after treatment that focus on adjustment to cancer, problem solving and coping with treatment side effects. Participants are assessed at baseline (before treatment) and 2, 6, 12, 24 and 36 months post-treatment. Outcome measures include: cancer threat appraisal; decision-related distress and bother from treatment side effects; involvement in decision making; satisfaction with health care; heath care utilisation; use of health care resources; and a return to previous activities. Discussion: The study will provide recommendations about the efficacy of early decision support to facilitate adjustment after prostate cancer. As well the study will identify men diagnosed with localised prostate cancer at risk of poorer long term psychosocial adjustment

“Just the freedom to get good at things and stuff like that”: Why spending less time at work would be good for individual, social and environmental wellbeing

A reduction in the average length of the working week is a policy response which is gaining increasing political and popular support for its potential help to address a number of key societal challenges, particularly the declining health and wellbeing of workers and social cohesion. Drawing on a series 40 of in-depth interviews with people who have voluntarily reduced the amount of time they spend in formal employment we use Self-Determination Theory (SDT) to show the mechanisms through which these improvements are likely to occur. SDT is a well-validated psychological theory which suggests there are three innate psychological needs which when fulfilled lead to enhanced wellbeing: relatedness, competence and autonomy. Interviews showed that when people reduced time in formal employment they dedicated more time to activities which increased the likelihood that these three psychological needs would be adequately met. The activities undertaken were also broadly compatible with a degrowth imaginary. These findings are important as they help to develop the empirical case for a transition away from an economic model focused on ever increasing economic growth and instead illustrate the potential individual, social and environmental benefits of a less work focused way of living

Extracorporeal Perfusion of the Calf Liver

This paper describes the use of the calf liver as an alternative to the pig liver for extracorporeal perfusion and hepatic support. Despite a more difficult dissection during hepatectomy, the calf liver functions biochemically similarly to the pig liver and appears to be an acceptable alternative. Perfusion through the umbilical vein in the calf is described as a means of reducing warm ischemia time. It is noted that addition of India ink to the perfusion circuit may show up areas of poor perfusion despite apparently satisfactory biochemical function. Copyrigh

What matters more for employees' mental health : job quality or job quantity?

Recent debates about whether the standard full-time working week (35-40 hours) can be replaced by a shorter working week have received extensive attention. Using 2015 European Working Conditions Survey data, this study contributes to these debates by exploring the relationships between job quantity, job quality and employees’ mental health. Overall, we find that a job’s quality matters more than its quantity as measured in hours per week. The results show that actual working hours are hardly related to employees’ mental health but job quality, especially intrinsically meaningful work, less intensified work and having a favorable social environment, has positive effects on employee mental health, even in jobs with short working hours. Moreover, although working less than one prefers (under-employment) has negative effects, these negative effects become much smaller in size and non-significant in good quality jobs, especially in jobs with skill discretion and good job prospects. These findings develop the debates about a shorter standard working week by emphasizing the continued and crucial importance of job quality in debates on the future of work. These results also suggest that policy makers should pay particular attention to job quality when addressing the dramatic reduction in total hours of employment in Europe following the COVID-19 crisis