The Role of Nonstandard Workers in Client-Organizations

This paper examines the diversity and complexities of nonstandard work. Two types of nonstandard workers are studied: workers employed by temporary help agencies (THAs) and contract company workers, both of which are involved in a triadic employment relationship. The analyses are based on interviews with managers in three service-sector companies in Norway. The paper discusses the dilemmas managers in client-organizations face when agency temporaries and contract company workers are integrated and do work similar to what is done by the regular workers in the firm. Managers in client-organizations require loyalty from nonstandard workers, and under certain conditions, nonstandard workers are able to form pressure groups. The findings are discussed in relation to the highly regulated labour market in Norway, in a period of labour shortage.Cet essai traite de la manière dont les organisations clientes utilisent les travailleurs qui sont recrutés par des agences d’emploi. Les observations montrent comment des agences temporaires et des travailleurs d’entreprises à contrat soulèvent des dilemmes en termes de loyauté et de relations de pouvoir au sein des organisations clientes. L’étude est conduite dans un marché hautement réglementé, lequel offre un contexte nouveau à la littérature actuelle traitant du travail atypique.J’analyse ici un certain type de travailleurs atypiques, ceux qui sont recrutés par des agences d’emploi : (1) des travailleurs venant d’agences d’aide temporaire, qui sont à l’emploi d’une agence, mais supervisés par des organisations clientes ; (2) des travailleurs contractuels qui sont à l’emploi d’une entreprise contractante et également supervisés par cette même entreprise. Contrairement à des travailleurs permanents, ils se retrouvent dans une relation triangulaire, leur employeur demeurant à l’extérieur de l’organisation cliente.L’étude a recours à une approche qualitative pour analyser le rôle des travailleurs des agences d’aide temporaire et des travailleurs à contrat dans l’entreprise cliente. Les données proviennent d’entrevues effectuées principalement chez les dirigeants de trois entreprises. J’ai conduit les entrevues avec l’aide de 28 personnes dans les trois compagnies : Finance I, Finance II sont des compagnies du domaine de l’assurance employant 600 et 1000 personnes respectivement. L’assurance, les services bancaires et les produits d’investissement constituent leurs sphères principales d’activités. La portion des travailleurs syndiqués était de 70 % dans Finance I et de 55 % dans Finance II. Telecom était une entreprise de télécommunication non syndiquée fondée en 1996 et le nombre de ses employés s’élevait à 430.L’étude a été conduite en Norvège, un contexte particulier à cause de son marché du travail qui est très réglementé et à cause de sa forte densité syndicale. La législation relativement sévère de protection de l’emploi (à cause de ses obstacles à la terminaison des contrats à durée indéterminée) laisse entendre que les employeurs préfèrent des contrats de travail à durée déterminée, qui sont moins coûteux à résilier. De plus, le régime de sécurité sociale de la Norvège fournit aux travailleurs un accès important aux permissions d’absence, ce qui crée le besoin de remplacer les gens, par exemple, par du travail temporaire. Puisque tous les citoyens bénéficient de l’assurance-santé en Norvège, la possibilité d’économiser sur les avantages sociaux en recourrant à des travailleurs atypiques est de moindre importance que dans bien d’autres pays. La Norvège a un régime national d’avantages en cas de maladie et tous les employés, incluant ceux des agences d’aide temporaire et des travailleurs à contrat, ont droit à une rémunération durant un congé de maladie.L’étude révèle que les travailleurs à contrat et ceux des agences temporaires sont retenus dans des activités vitales; ils sont fortement intégrés aux travailleurs permanents et parfois détiennent des positions stratégiques. Dans un tel contexte, les dirigeants exigent de la loyauté de la part des travailleurs atypiques et ces derniers sont en mesure de constituer des groupes de pression dans les organisations clientes. Ces observations peuvent se comprendre en référant à la relation d’emploi triadique. Puisque les travailleurs atypiques relèvent d’employeurs à l’extérieur des entreprises clientes, la direction des entreprises clientes doute parfois de leur loyauté. Également, la composition de cette main-d’oeuvre exerce une influence sur la loyauté et le pouvoir potentiel des agences temporaires. Lorsque les travailleurs atypiques forment une partie importante de la main-d’oeuvre, les enjeux de pouvoir et de loyauté deviennent plus prononcés.En dépit du caractère distinct de cet environnement institutionnel, un nombre important de ces observations demeure congruent avec la littérature récente sur le travail atypique qu’on connaît dans le monde anglo-saxon. Cependant, même si des études comparatives devraient être effectuées pour arriver à des conclusions plus solides, ces similitudes indiquent que des employeurs dans des contextes institutionnels différents peuvent avoir des politiques semblables à l’endroit des travailleurs atypiques.Les conclusions de cet essai corroborent celles de la littérature récente sur l’emploi atypique en montrant que des travailleurs atypiques ne sont pas toujours inférieurs et qu’ils ne refusent pas des assignations secondaires. Le contexte institutionnel de la Norvège renforce cette conclusion. Puisque les avantages sociaux sont offerts sur une base universelle en Norvège, il existe peu de possibilité pour une entreprise d’économiser sur les coûts de main-d’oeuvre. Ceci implique que les travailleurs atypiques, tels que ceux des agences temporaires et des entreprises sous-traitantes, touchent en principe les mêmes avantages que les travailleurs permanents, rendant les emplois ainsi occupés pas nécessairement « mauvais ». Cette constatation a une incidence sur la notion de travail atypique. L’analyse et l’environnement institutionnel à l’arrière plan démontrent que les travailleurs atypiques ne sont pas vraiment aussi problématiques que le concept le laissait penser à l’origine. Pour être plus explicite sur ce point, un effort ultérieur de recherche devrait inclure des analyses comparatives.Este documento examina la diversidad y las complejidades del trabajo atipico. Dos tipos de trabajadores atípicos son estudiados: los trabajadores empleados por las agencies de trabajo temporal y los trabajadores de compañías subcontratistas, ambos envueltos en una relación de empleo en triada. Los análisis se basan en entrevistas con directores de tres compañías de servicios de Noruega. El artículo discute los dilemas que enfrentan los directores de las organizaciones clientes cuando los trabajadores de agencias y de subcontratistas son integrados y hacen un trabajo similar al de los trabajadores regulares de la firma. Los directores de las organizaciones clientes requieren la lealtad de los trabajadores atípicos y bajo ciertas condiciones, los trabajadores atípicos son capaces de formar grupos de presión. Los resultados son discutidos en relación con en Mercado laboral altamente regulado de Noruega, en un periodo de escasez de mano de obra

Why Give Birth in Health Facility? Users' and Providers' Accounts of Poor Quality of Birth Care in Tanzania.

In Tanzania, half of all pregnant women access a health facility for delivery. The proportion receiving skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out to increase health facility deliveries by skilled care. The aim of this study was to describe the weaknesses in the provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric fistula, nurse-midwives at both BEmOC and CEmOC health facilities and local community members. Semi-structured interviews involving 16 women affected by obstetric fistula and five nurse-midwives at maternity wards at both BEmOC and CEmOC health facilities, and Focus Group Discussions with husbands and community members were conducted between October 2008 and February 2010 at Comprehensive Community Based Rehabilitation in Tanzania and Temeke hospitals in Dar es Salaam, and Mpwapwa district in Dodoma region. Health care users and health providers experienced poor quality caring and working environments in the health facilities. Women in labour lacked support, experienced neglect, as well as physical and verbal abuse. Nurse-midwives lacked supportive supervision, supplies and also seemed to lack motivation. There was a consensus among women who have suffered serious birth injuries and nurse midwives staffing both BEmOC and CEmOC maternity wards that the quality of care offered to women in birth was inadequate. While the birth accounts of women pointed to failure of care, the nurses described a situation of disempowerment. The bad birth care experiences of women undermine the reputation of the health care system, lower community expectations of facility birth, and sustain high rates of home deliveries. The only way to increase the rate of skilled attendance at birth in the current Tanzanian context is to make facility birth a safer alternative than home birth. The findings from this study indicate that there is a long way to go

Burden and Well-Being Among a Diverse Sample of Cancer, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease Caregivers

Three important causes of death in the U.S. (cancer, congestive heart failure [CHF], and chronic obstructive pulmonary disease [COPD]) are preceded by long periods of declining health; often, family members provide the majority of care for individuals who are living with serious illnesses and are at risk for impaired well-being

Caregiver Experience During Advanced Chronic Illness and Last Year of Life

Caregivers of patients with serious illness endure significant burden, yet it is not clear at what stage of advanced illness patient and caregiver needs are greatest. This study compared prevalence and predictors of caregiver esteem and burden during two different stages of patients’ illnesses – advanced chronic illness and the last year of life

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Background: Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs). Methods: We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature. Findings: From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece. Interpretation: Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases

The postural effects of load carriage on young people – a systematic review

BACKGROUND: Spinal pain in young people is a significant source of morbidity in industrialised countries. The carriage of posterior loads by young people has been linked with spinal pain, and the amount of postural change produced by load carriage has been used as a measure of the potential to cause tissue damage. The purpose of this review was to identify, appraise and collate the research evidence regarding load-carriage related postural changes in young people. METHODS: A systematic literature review sought published literature on the postural effects of load carriage in young people. Sixteen databases were searched, which covered the domains of allied health, childcare, engineering, health, health-research, health-science, medicine and medical sciences. Two independent reviewers graded the papers according to Lloyd-Smith's hierarchy of evidence scale. Papers graded between 1a (meta-analysis of randomised controlled trials) and 2b (well-designed quasi-experimental study) were eligible for inclusion in this review. These papers were quality appraised using a modified Crombie tool. The results informed the collation of research evidence from the papers sourced. RESULTS: Seven papers were identified for inclusion in this review. Methodological differences limited our ability to collate evidence. CONCLUSIONS: Evidence based recommendations for load carriage in young people could not be made based on the results of this systematic review, therefore constraining the use of published literature to inform good load carriage practice for young people

The Cardiovascular Intervention Improvement Telemedicine Study (CITIES): Rationale for a Tailored Behavioral and Educational Pharmacist-Administered Intervention for Achieving Cardiovascular Disease Risk Reduction

Background: Hypertension, hyperlipidemia, and diabetes are significant, but often preventable, contributors to cardiovascular disease (CVD) risk. Medication and behavioral nonadherence are significant barriers to successful hypertension, hyperlidemia, and diabetes management. Our objective was to describe the theoretical framework underlying a tailored behavioral and educational pharmacist-administered intervention for achieving CVD risk reduction. Materials and Methods: Adults with poorly controlled hypertension and/or hyperlipidemia were enrolled from three outpatient primary care clinics associated with the Durham Veterans Affairs Medical Center (Durham, NC). Participants were randomly assigned to receive a pharmacist-administered, tailored, 1-year telephone-based intervention or usual care. The goal of the study was to reduce the risk for CVD through a theory-driven intervention to increase medication adherence and improve health behaviors. Results: Enrollment began in November 2011 and is ongoing. The target sample size is 500 patients. Conclusions: The Cardiovascular Intervention Improvement Telemedicine Study (CITIES) intervention has been designed with a strong theoretical underpinning. The theoretical foundation and intervention are designed to encourage patients with multiple comorbidities and poorly controlled CVD risk factors to engage in home-based monitoring and tailored telephone-based interventions. Evidence suggests that clinical pharmacist-administered telephone-based interventions may be efficiently integrated into primary care for patients with poorly controlled CVD risk factors

Telemedicine cardiovascular risk reduction in Veterans

Patients with co-occurrence of hypertension, hyperlipidemia, and diabetes have an increased risk of cardiovascular disease (CVD) events. Comprehensive programs addressing both tailored patient self-management and pharmacotherapy are needed to address barriers to optimal cardiovascular risk reduction. We are examining a Clinical Pharmacy Specialist (CPS), telephone administered intervention, relying on home monitoring, with a goal of providing tailored medication and behavioral intervention to Veterans with CVD risk

Losing the Ability in Activities of Daily Living in the Oldest Old: A Hierarchic Disability Scale from the Newcastle 85+ Study

Objectives: To investigate the order in which 85 year olds develop difficulty in performing a wide range of daily activities covering basic personal care, household care and mobility. Design: Cross-sectional analysis of baseline data from a cohort study. Setting: Newcastle upon Tyne and North Tyneside, UK. Participants: Individuals born in 1921, registered with participating general practices. Measurements: Detailed health assessment including 17 activities of daily living related to basic personal care, household care and mobility. Questions were of the form ‘Can you … ’ rather than ‘Do you… ’ Principal Component Analysis (PCA) was used to confirm a single underlying dimension for the items and Mokken Scaling was used to determine a subsequent hierarchy. Validity of the hierarchical scale was assessed by its associations with known predictors of disability. Results: 839 people within the Newcastle 85+ study for whom complete information was available on self-reported Activities of Daily Living (ADL). PCA confirmed a single underlying dimension; Mokken scaling confirmed a hierarchic scale where ‘Cutting toenails ’ was the first item with which participants had difficulty and ‘feeding ’ the last. The ordering of loss differed between men and women. Difficulty with ‘shopping ’ and ‘heavy housework ’ were reported earlier by women whilst men reported ‘walking 400 yards ’ earlier. Items formed clusters corresponding to strength, balance, lower and upper bod