The I and the Others. Articulations of Personality and Communication Structures in the Lyric

The paper discusses articulations of personality and communication structures in the lyric: who is speaking in a poem? What is the status of the person who speaks, or the one who is spoken about? Is it the author himself who is speaking, or is it someone else – an autonomous being, completely different and detached from the subject developed in the text? Who is addressed in and by a poem? It is made clear that conventional concepts of Stimmung (mood), Erlebnis (experience), and lyrisches Ich (the ›lyric I‹) should be set aside and the nature of lyric communication should be redetermined. For this purpose, a precise examination of the specific use of personal pronouns in poems is necessary, especially of the pronouns ›I‹, ›you‹ and ›we‹. The indistinct ›lyric I‹ should be substituted by the term ›articulated I‹. The poetic text as a whole is being structured by a superordinate entity, the Textsubjekt (›textual subject‹). Every speaking entity in a poem has a counterpart being addressed by it. Analyzing communication structures in poetry thus means first of all looking for an addressee who is constituted by the text. Only in a second step should we figure out if the address refers to the intended reader

How to improve intervention research on the psychosocial work environment?

In this era of evidence-based medicine, the randomized controlled trial (RCT) has become the gold standard in determining whether a new intervention has beneficial effects. Although in recent years the RCT has given way to more flexible approaches, the strong reliance on this type of decisive study design in evidence production has had unintended consequences (1). An example in occupational health research would be that an RCT examining a health promotion app is more feasible than one assessing a workplace intervention, hence, there is disproportionately more robust evidence on individual-oriented behavioral interventions than organizational-level ones. Likewise, it would easier to evaluate a training program than an organizational intervention targeting work schedules. Indeed, a recent review on workplace mental health interventions concluded that interventions tended to focus on individual-level rather than organizational or system-level factors (2). The recent guidelines on mental health from the World Health Organization also illustrate that recommendations for individual interventions are more common than recommendations for organizational interventions (3). In the current debate about prevention, there is a strong plea for a shift in content and mode of delivery of prevention, specifically targeting the environments in which disadvantaged groups live and work (4). While targeting these environments, the traditional RCT paradigm cannot be used as an evaluation strategy for dynamic interventions with multiple interrelated changes in behavior and environments over time (5, 6). In occupational health we face the same challenge: with mental health as a premier concern in the workforce, we need to shift our attention from individual behaviors towards the psychosocial work environment, and our research methods should change accordingly to be able to demonstrate how we can improve it.There is compelling evidence that psychosocial work factors may introduce health effects (7). A recent meta-review of 72 reviews concluded that there is evidence for associations between high job strain and long working hours as exposures and, most notably, coronary heart diseases and (ischemic) stroke as outcomes (8). Despite many intervention studies, the insight about effective strategies to mitigate the impact of a strenuous psychosocial work environment on health is still limited. We know certainly more about the importance of the psychosocial work environment for health than we know how to improve it.In this issue of the Scandinavian Journal of Work Environment and Health, Aust and colleagues (9) have undertaken the courageous effort of conducting a meta-review of 52 reviews covering 957 original studies in an effort to uncover which organizational-level interventions are effective in improving the psychosocial work environment and workers’ health. Their analytical framework has some interesting choices. First, they restricted the review to the effectiveness of organizational-level interventions at the workplace, arguing that how work is organized and conducted determines the psychosocial work environment. Hence, their focus was on primary prevention strategies to improve the work environment rather than individually targeted interventions to support individual workers in coping with psychosocial factors at work. Second, the review distinguished improvements in the psychosocial work environment (eg, increased levels of job control) from improvements in workers’ health (eg, reduced sickness absence). This distinction seems obvious, but rather surprisingly previous reviews often lack this information. This restricts our understanding about the mechanism of how an intervention can be effective.This editorial is not the place to summarize the evidence of a meta-review, which itself summarizes the evidence of 52 reviews. Read the article yourself and be surprised by the quality and density of information on the evidence of organizational-level interventions. However, the meta-review shows some findings that should challenge the research community.First, 28 out of 52 reviews focus on the healthcare sector. Healthcare organizations are apparently easily accessible and reachable, and have plenty of study participants. The feasibility of a research project seems more important than scientific or societal considerations. Hence, the available evidence is extremely biased towards the specifics of work environments in healthcare with low generalizability to other workplaces. We must ask ourselves the question whether our research priorities reflect sufficiently societal needs.Second, the synthesis of evidence presented in the 52 reviews seldom demonstrates that improvements in the psychosocial work environment are causally linked to improvements in workers’ health. In line with the terminology of the authors, it remains to be seen in many interventions whether proximal effects are associated with distal ones. The noticeable exceptions were: (1) interventions increasing the influence of workers on work tasks or organization, thus increasing job control, had a positive effect on health and (2) interventions on teamwork, workflow changes, and the like, which resulted in substantial improvement in the work environment that in turn led to a reduction in occurrence of burnout. A linked issue, noted by the authors, is that the quality of the psychosocial work environment may moderate the effectiveness of the intervention. There is certainly a need for more advanced study designs that unravel the mechanism of how and when interventions are effective.Third, linked to the discussion about the appropriate study design for evaluating effectiveness of interventions in occupational health, in most reviews the majority of original studies had some type of control group, but the use of an RCT design was low. This illustrates the intrinsic difficulty of randomization of workplaces for many different reasons (10). The disadvantages of not being able to conduct a (cluster) RCT should be counteracted with designs for observational studies that offer better insights into the influence of the organizational context and the quality of implementation on successful organizational-level interventions.The meta-review of Aust and colleagues is not only of interest because of its specific content, it also raises important considerations for intervention research. I propose the following five guiding principles for intervention research on the psychosocial work environment:1. Define the target population and subsequent prevention strategy carefully In primary prevention strategies, the essential choice is between selective or universal prevention (11). An organizational-level intervention targeting every worker in the company, ie, the universal prevention strategy, should be able to demonstrate a shift in the distribution of risk in the population, eg, flexible working time arrangements are used by a substantial proportion of the workers. Alternatively, selective prevention is more appropriate when particular groups in the company have an increased risk. In such a situation, organizational-level interventions must be much more aligned with the needs of these high-risk groups, eg, teamwork training in units with high sickness absence.2. Choose your outcome measure wisely In intervention studies with a short follow-up period, it is sensible to focus on proximal endpoints, ie, changes in the psychosocial work environment, rather than distal endpoints such as sickness absence or workers’ health.3. Consider the potential impact of the intervention When the proportion of workers’ health attributed to the risk factor of interest is modest then the reduction in the risk factor due to the intervention must be large to have a discernable impact on workers’ health. Remember that most workers are quite healthy, thus, large effects in universal interventions cannot be expected.4. Evaluate the pathway of effectiveness of the intervention We often lack insight into whether an organizational intervention introduces improvements in the psychosocial work environment, and, consequently, that through these improvements the beneficial effects on workers’ health are achieved. Without insight into the pathway of effectiveness, interventions will remain a black box.5. Determine the impact of implementation and context on effectiveness It is a misconception that the effectiveness of an intervention is primarily determined by its content and quality of delivery. The implementation and specific context in the organization are equally as important. New analytical evaluation methods may be required, acknowledging that individual behavior and circumstances, specific working conditions, and higher-level contextual factors interact continuously

International trends in education and training in occupational hygiene

In many countries occupational hygiene has become an indispensable discipline in managing long-term risks to the health of workers. The international collaboration on education and training started with a workshop in Luxembourg in 1986 (sponsored by the EC and WHO). This meeting provided useful groundwork in defining the scope and function of training and education in occupational hygiene. Subsequent meetings in Geneva in 1989 and 1991 progressed many of the matters raised at the Luxembourg meeting. There is a fair agreement on the educational prerequisites for the professional occupational hygienist. Academic qualifications are regarded as essential since problem-solving, in contrast to rule-following, is best trained at academic level. For this reason a mandatory research project should be included in the curriculum. The general outline of an educational programme includes basic knowledge of physics, mathematics and chemistry, basic knowledge of supportive disciplines such as toxicology, epidemiology and biostatistics, risk analysis and engineering principles, and core and specialized topics in occupational hygiene such as measurement strategies, design techniques, health risk evaluation, principles of control inclusive ventilation, management and laws and legal requirements. Discussions pertains to the preferable educational routes, on the balance between methodology and professional practice, and the focus on prevention and engineering rather than exposure assessment. Currently, the International Occupational Hygiene Association has launched a programme for interchangeability and harmonization of the different certification schemes for professional occupational hygienists. International cooperation among educational resource centres should be strongly encouraged by exchange of students and faculty, as well as educational materials and information

Intra-industry trade between The United States and México: 1993-1998

This paper examines changes in intra-industry trade, IIT, in manufactured goods between the US and Mexico over the first five years of the North American Free Trade Agreement. Most industries experienced large increases in, IIT. An examination of various indexes of intra-industry specialization indicates that few industries in either country are candidates for significant adjustment problems. These findings should lessen opposition to greater regional economic integration in the Western Hemisphere

Werken aan volksgezondheid: van woorden naar daden

Rede, In verkorte vorm uitgesproken ter gelegenheid van het aanvaarden van het ambt van gewoon hoogleraar met als leeropdracht Determinanten van de Volksgezondheid aan het Erasmus MC, faculteit van de Erasmus Universiteit Rotterdam op 24 september 201

Fifty years of research in the Scandinavian Journal of Work, Environment & Health

Objective The Scandinavian Journal of Work, Environment &amp; Health was launched 50 years ago. In this paper we describe how research topics have changed over time. Methods A complete list of all 2899 articles in the past 50 years was compiled. Each article was coded for type of exposure, type of health outcome, research design, first author, and country of correspondence address. Count of citations was based on the Scopus database. Results Overall, the attention for chemical exposure in the first 30 years has shifted towards the psychosocial work environment, shift work, and physical work load. These shifts in exposure are mirrored by increased attention over time for mental disorders and musculoskeletal disorders. Cardiovascular disorders and cancer have been studied consistently over the past 50 years. Researchers from Scandinavian countries have been responsible for about 50% of the Journal’s content, while authorship has broadened to about 30 countries in recent years. Conclusion During the past 50 years, some research topics have consistently remained highly visible in the Journal, whereas other topics have gained or lost interest. In terms of authors’ contribution, the Journal has its roots in research from the Nordic countries, but has evolved over time as a truly international periodical with a well-recognized position in research on occupational health.</p