WORKPLACE BULLYING, ANTECEDENTS AND MECHANISMS

RIASSUNTO Introduzione Il fenomeno del mobbing, la cui frequenza si stima essere di circa il 15% a livello mondiale, \ue8 ampiamente riconosciuto come uno dei maggiori fattori di stress nelle organizzazioni di lavoro. Il mobbing comporta una serie di conseguenze negative per chi ne \ue8 vittima ma anche per i testimoni ed i colleghi, con costi rilevanti per le organizzazioni lavorative e la societa\u2019 nel complesso. Alla luce della \u201cwork environment hypothesis\u201d del mobbing - un approccio teorico che enfatizza lo stretto legame tra la presenza di un ambiente di lavoro psicosociale sfavorevole e l\u2019emergere del mobbing -diversi studi hanno identificato una serie di antecedenti lavorativi del fenomeno quali ad esempio il carico di lavoro eccessivo, lo scarso livello di autonomia, il conflitto e l'ambiguit\ue0 di ruolo e la qualita\u2019 della leadership. In particolare, il ruolo di quest\u2019ultima quale fattore antecedente il mobbing costituisce un' area di indagine molto recente, sebbene Leymann - il precursore nello studio del mobbing - gia\u2019 ne avesse riconosciuta l'importanza fin dagli albori della ricerca sul fenomeno. Nonostante il substrato teorico alla base della relazione leadership-mobbing sia solido, tutti gli studi empirici condotti sinora si sono basati su un disegno di studio cross-sectional, limitando in tal modo la possibilita\u2019 di effettuare inferenze causali. Inoltre un importante gap nella letteratura corrente \ue8 costituito da una scarsa conoscenza dei possibili meccanismi (moderatori o mediatori) alla base della relazione tra ambiente di lavoro psicosociale e mobbing. Obiettivo Alla luce dello stato attuale della ricerca sul mobbing, l'obiettivo di questa tesi \ue8 duplice. Il primo obiettivo \ue8 quello di studiare la relazione tra alcune caratteristiche rilevanti dell\u2019ambiente psicosociale di lavoro, ossia pressione lavorativa e mancanza di autonomia (primo articolo) e scarsa qualita\u2019 della leadership (secondo articolo), e presenza di mobbing sul posto di lavoro. Il secondo obiettivo \ue8 quello di indagare la presenza di moderatori o mediatori nella relazione tra ambiente psicosociale di lavoro e mobbing, al fine di individuare alcuni possibili meccanismi alla base di questo fenomeno. In particolare, viene esaminato il senso di coerenza - una caratteristica individuale - come potenziale moderatore (primo articolo) e il senso di comunit\ue0 sociale sul posto di lavoro - una caratterstica del contesto lavorativo - come potenziale mediatore (secondo articolo). Metodi La tesi si basa su dati raccolti nell\u2019ambito di uno studio prospettico a due tempi di misura (2006-2008) denominato Workplace Bullying and Harassment Cohort (WBH), condotto tramite questionario autosoministrato su un campione di lavoratori impiegati in diverse organizzazioni di lavoro in Danimarca. Il campione utilizzato e' costituito da 3363 lavoratori nel 2006 (primo articolo) e da 1664 lavoratori nel 2008 (secondo articolo). Il campione e' composto per lo pi\uf9 da donne (67,2%), con un'et\ue0 media di 45,7 (SD = 10.11) e una anzianit\ue0 media nel posto di lavoro attuale di 11,1 anni (SD = 10.1). Circa due terzi del campione risulta impiegato in organizzazioni pubbliche come ospedali (22%), istruzione superiore (13,8%), settore assistenza agli anziani (8,6%), pubblica amministrazione e servizi (7,2%), scuole pubbliche (4,3%), scuole superiori (3,8%), ecc.; circa un terzo risulta invece impiegato in ambienti di lavoro privati, quali trasporti (11,6%), industria (10,8%), edilizia (3%), finanza e servizi alle imprese (2,3%); all\u2019incirca il 2,5% lavora infine come medico, dentista o veterinario. Risultati Nel primo articolo, basato su un disegno di studio cross-sectional, regressioni lineari gerarchiche hanno rivelato che le due dimensioni del modello job demand-control, ossia elevata pressione lavorativa e scarsa autonomia decisionale, sono significativamente associate ad una maggiore presenza di mobbing. Sebbene dal punto di vista statistico livelli piu\u2019 elevati di senso di coerenza siano risultati ridurre significativamente la relazione tra ambiente psicosociale di lavoro sfavorevole (elevata pressione lavorativa e scarsa autonomia sul lavoro) e mobbing, tale effetto di moderazione si e\u2019 rivelato di scarso impatto a livello pratico. Cio\u2019 suggerisce che condizioni psicosociali negative sul posto di lavoro possano essere associate al mobbing indipendentemente dalle caratteristiche personali dei soggetti target, almeno in termini di senso di coerenza. Nel secondo articolo, basato su un disegno di studio longitudinale, i risultati delle regressioni lineari gerarchiche mostrano che la scarsa qualit\ue0 della leadership svolge un ruolo significativo nella creazione di condizioni di lavoro favorenti il mobbing. Inoltre, l\u2019analisi di mediazione ha mostrato che il senso di comunita' sociale sul posto di lavoro opera come mediatore totale dell'effetto esercitato dalla scarsa qualit\ue0 della leadership sul mobbing. Conclusioni/implicazioni pratiche Una prima conclusione \ue8 che condizioni di lavoro psicosociale sfavorevoli portano ad un maggiore rischio di mobbing sul posto di lavoro. Il primo studio sottolinea in particolare l'importanza di progettare posti di lavoro in modo tale che ai lavoratori siano assegnati carichi di lavoro ragionevoli e un adeguato grado di autonomia nello svolgimento dei compiti lavorativi. Il secondo studio, confermando il ruolo di una scarsa qualita\u2019 della leadership nel creare condizioni di lavoro favorenti il mobbing, indica l'importanza di pianificare programmi di formazione per i leader in modo da aumentare in questi la consapevolezza di come i loro comportamenti possano avere influenza sui subordinati. Inoltre, la mediazione totale del senso di comunita\u2019 sociale sul posto di lavoro rilevata in questo studio nella relazione tra scarsa qualit\ue0 di leadership sul mobbing, suggerisce che le organizzazioni di lavoro dovrebbero operare forti investimenti nel miglioramento delle relazioni sociali sul posto di lavoro allo scopo di promuovere un ambiente di lavoro a ridotto rischio mobbing. Originalit\ue0 dello studio Il primo articolo contribuisce in maniera originale alla ricerca sul mobbing in quanto non esistono studi precedenti sul ruolo del senso di coerenza come moderatore della relazione tra ambiente psicosociale di lavoro e mobbing. Inoltre, il problema metodologico relativo alla significativita' statistica vs valore pratico dell\u2019effetto di moderazione \ue8 stato raramente affrontato e discusso in letteratura. Il secondo studio, essendo di natura longitudinale, porta un sostanziale contributo alla letteratura sul mobbing in quanto conferma, mediante un disegno di studio robusto, precedenti studi cross-sectional sul ruolo sostanziale svolto dai leader nel processo di mobbing. Inoltre, nella relazione tra leadership e mobbing, il senso di comunit\ue0 sociale sul posto di lavoro agisce come mediatore totale, risultato che contribuisce significativamente al dibattito scientifico attuale sui meccanismi - a tutt\u2019oggi poco noti - coinvolti nel processo di generazione del mobbing.SUMMARY Background Broadly recognized to be one of the major stressors in organizations, with a global estimate of about 15%, workplace bullying has detrimental consequences for victims, witnesses, organizations, and the society at large. Within the work environment hypothesis of bullying, which emphasizes the important link between a stressful and poorly organized work environment and bullying, a large number of antecedents have been identified, such as workload, low level of autonomy, role conflict, role ambiguity, and leadership. In particular, the role of leadership as antecedent of bullying is a relatively recent research area, although Leymann - the pioneer in the study of bullying - has recognized its importance since the origins of research on the phenomenon. Despite the existence of a solid theoretical basis for the relationship between leadership and workplace bullying, almost all empirical studies conducted so far are based on a cross-sectional study design, thereby limiting the possibility to draw causal inferences. In addition, to date there is scarce evidence concerning the possible mechanisms (moderators and mediators) involved in the relationship between the psychosocial work environment and workplace bullying. Aims In light of the current state of the art in the research on workplace bullying, the aim of this thesis is twofold. The first objective is to investigate the relationship between some important characteristics of the psychosocial work, such as work pressure and lack of autonomy (Paper I) and poor quality of leadership (Paper II), and the occurrence of bullying at work. The second objective is to examine moderators and mediators of the relationship between the psychosocial work environment and workplace bullying and identify possible mechanisms underlying this phenomenon. In particular, my thesis examines sense of coherence - an individual feature - as a potential moderator (Paper I), and social community at work - a characteristic of the work environment - as a potential mediator (Paper II). Methods The thesis is based on the Workplace Bullying and Harassment Cohort (WBH). This cohort consists of 3,363 employees at baseline (2006) (Paper I and Paper II) and 1,664 employees at follow-up (2008) (Paper II). At baseline, the sample was composed mostly of female employees (67.2%); the mean age was 45.7 years (SD = 10.11) and the mean job seniority in the current workplace 11.1 years (SD = 10.1). Approximately two thirds of the sample were employed in public organizations such as hospitals (22%), high education (13.8%), the eldercare sector (8.6%), public administration and services (7.2%), public schools (4.3%), high schools (3.8%), etc.; approximately one third were employed in private workplaces such as transportation (11.6%), industries (10.8%), construction (3%), finance, and business service (2.3%) or as doctors, dentists, vets (2.5%) etc. Results In Paper I, based on a cross-sectional study design, hierarchical linear regressions revealed that the two dimensions of the job demand-control model, i.e. high work pressure and low decision latitude, are significantly associated with an increased presence of bullying at work. Moreover, a higher sense of coherence was found to significantly moderate the relationship between higher job demands and higher work-related bullying, and that between lower job control and higher person-related bullying. However, the effect size of these interactions was very low. This suggests that negative psychosocial conditions in the workplace are likely to be associated with bullying regardless of the personal characteristics of the targets, at least in terms of sense of coherence. In Paper II, based on a longitudinal study design, the results of hierarchical linear regressions showed that poor quality of leadership plays a significant role in the creation of conditions favouring bullying. Furthermore, the mediation analysis showed that social of community at work operates as a full mediator of the effect exerted by poor quality of leadership on workplace bullying. Conclusions/practical implications My first conclusion is that adverse psychosocial working conditions may lead to an increased risk of bullying at work. Paper I highlights in particular the importance of designing jobs so that workers are assigned reasonable workloads and an appropriate degree of autonomy in their work tasks. Paper II, confirming the role of poor quality of leadership in creating working conditions that favour bullying, indicates the importance of planning training programs for leaders so as to increase their awareness of how their behaviours may affect subordinates. In addition, the full mediation of social community at work in the relationship between poor quality of leadership and workplace bullying suggests that organizations should improve social relations at work in order to promote work environments with a low risk of workplace bullying. Originality of the study Paper I gives an original contribution to the existing literature on workplace bullying since there are no previous studies on the role of sense of coherence as a moderator of the relationship between the psychosocial work environment and bullying. Moreover, the methodological problem concerning the statistical vs practical value of the moderating effect has been rarely addressed and discussed in the literature. Paper II, based on a longitudinal study, gives a substantial new contribution by supporting, through the adoption of a robust design, previous cross-sectional studies on the important role played by leaders in the process of workplace bullying. Moreover, the finding that social community at work acts as full mediator of the relationship between quality of leadership and workplace bullying contributes significantly to the scientific debate over the poorly known mechanisms involved in the generation of bullying

Bacteremia Due to Viridans Streptococcus in Neutropenic Patients with Cancer: Clinical Spectrum and Risk Factors

Between 1988 and 1991, 26 episodes of bacteremia due to viridans streptococci occurred in 25 neutropenic patients undergoing intensive chemotherapy for hematologic malignancies. Complications related to the bacteremia were observed in 10 episodes: unilateral pulmonary infiltrates (4), acute respiratory distress syndrome (ARDS) (4), hypotension (3), and endocarditis (2). All patients with ARDS had received high doses of cytosine arabinoside and had bacteremia due to Streptococcus mitis. Death occurred in three patients (12%) but was possibly related to bacteremia in only one case. Case patients who had received prophylaxis with quinolones were compared with matched control patients who received similar prophylaxis but who did not have bacteremia due to viridans streptococci. Multivariate analysis of predisposing factors showed that high doses of cytosine arabinoside (P = .01), the presence of mucositis (P = .02), and the absence of previous therapy with parenteral antibiotics (P = .01) were independent risk factors for the development of viridans streptococcal bacteremia. Of 259 patients who had received quinolone prophylaxis during the study period, 22 (8.5%) developed an episode of viridans streptococcal bacteremia as compared with three episodes (3.7%) in 82 patients who had received a quinolone and penicillin (P = .07). However, the latter three episodes were caused by strains with decreased susceptibility to penicillin, thus suggesting that resistance to penicillin might limit the use of this antibiotic as a prophylactic agent in the futur

Giant Sigmoid Diverticulum: A Rare Presentation of a Common Pathology

Although colonic diverticulum is a common disease, affecting about 35% of patients above the age of 60, giant sigmoid diverticulum is an uncommon variant of which only relatively few cases have been described in the literature. We report on our experience with a patient affected by giant sigmoid diverticulum who was treated with diverticulectomy. Resection of the diverticulum is a safe surgical procedure, provided that the colon section close to the lesion presents no sign of flogosis or diverticula; in addition, recurrences are not reported after 6-year follow-up

Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors.

Between 1988 and 1991, 26 episodes of bacteremia due to viridans streptococci occurred in 25 neutropenic patients undergoing intensive chemotherapy for hematologic malignancies. Complications related to the bacteremia were observed in 10 episodes: unilateral pulmonary infiltrates (4), acute respiratory distress syndrome (ARDS) (4), hypotension (3), and endocarditis (2). All patients with ARDS had received high doses of cytosine arabinoside and had bacteremia due to Streptococcus mitis. Death occurred in three patients (12%) but was possibly related to bacteremia in only one case. Case patients who had received prophylaxis with quinolones were compared with matched control patients who received similar prophylaxis but who did not have bacteremia due to viridans streptococci. Multivariate analysis of predisposing factors showed that high doses of cytosine arabinoside (P = .01), the presence of mucositis (P = .02), and the absence of previous therapy with parenteral antibiotics (P = .01) were independent risk factors for the development of viridans streptococcal bacteremia. Of 259 patients who had received quinolone prophylaxis during the study period, 22 (8.5%) developed an episode of viridans streptococcal bacteremia as compared with three episodes (3.7%) in 82 patients who had received a quinolone and penicillin (P = .07). However, the latter three episodes were caused by strains with decreased susceptibility to penicillin, thus suggesting that resistance to penicillin might limit the use of this antibiotic as a prophylactic agent in the future

Long-Term Trends of HIV Type 1 Drug Resistance Prevalence among Antiretroviral Treatment-Experienced Patients in Switzerland

Background. Accurate quantification of the prevalence of human immunodeficiency virus type 1 (HIV-1) drug resistance in patients who are receiving antiretroviral therapy (ART) is difficult, and results from previous studies vary. We attempted to assess the prevalence and dynamics of resistance in a highly representative patient cohort from Switzerland. Methods. On the basis of genotypic resistance test results and clinical data, we grouped patients according to their risk of harboring resistant viruses. Estimates of resistance prevalence were calculated on the basis of either the proportion of individuals with a virologic failure or confirmed drug resistance (lower estimate) or the frequency-weighted average of risk group-specific probabilities for the presence of drug resistance mutations (upper estimate). Results. Lower and upper estimates of drug resistance prevalence in 8064 ART-exposed patients were 50% and 57% in 1999 and 37% and 45% in 2007, respectively. This decrease was driven by 2 mechanisms: loss to follow-up or death of high-risk patients exposed to mono- or dual-nucleoside reverse-transcriptase inhibitor therapy (lower estimates range from 72% to 75%) and continued enrollment of low-risk patients who were taking combination ART containing boosted protease inhibitors or nonnucleoside reverse-transcriptase inhibitors as first-line therapy (lower estimates range from 7% to 12%). A subset of 4184 participants (52%) had ⩾1 study visit per year during 2002-2007. In this subset, lower and upper estimates increased from 45% to 49% and from 52% to 55%, respectively. Yearly increases in prevalence were becoming smaller in later years. Conclusions. Contrary to earlier predictions, in situations of free access to drugs, close monitoring, and rapid introduction of new potent therapies, the emergence of drug-resistant viruses can be minimized at the population level. Moreover, this study demonstrates the necessity of interpreting time trends in the context of evolving cohort population