Työntekijän sitoutuminen:psykologisen sopimuksen voima

Tiivistelmä. Moderni työelämä ja sen vaatimukset ovat muokanneet työntekijöiden ja organisaatioiden tarpeita. Yhteiskunnan ja teknologian kehittyessä yhä useampi työ vaatii tietointensiivistä asiantuntijaosaamista. Pätevistä työntekijöistä kilpaillaan kovempaa kuin koskaan aiemmin ja työntekijät ovat päättävässä asemassa työnantajaa valittaessa. Samanaikaisesti vakituisen ja pitkäaikaisen työsuhteen arvostus on vähenemässä, kun työntekijät haluavat kehittyä monipuolisesti ja edetä urallaan. Tämä yhtälö on aiheuttanut haasteen työntekijöiden sitouttamisessa ja vaihtuvuuden hallinnassa. Tämän pro gradu -tutkielman tavoitteena on tutkia miten psykologinen sopimus vaikuttaa työntekijän organisaatiositoutumiseen. Tutkimuksessa paneudutaan erityisesti psykologisen sopimuksen laiminlyönnin ja organisaatiositoutumisen yhteyteen. Psykologista sopimusta tarkastellaan työntekijän näkökulmasta. Tutkimuksen teoreettinen viitekehys luotiin monipuolisen aiemman tutkimuksen perusteella. Teoreettisessa viitekehyksessä tunnistettiin psykologisen sopimuksen muodostuminen, sen erilaiset alalajit ja sisältö sekä elinkaari. Lisäksi viitekehyksessä käsiteltiin psykologisen sopimuksen ja motivaation sekä organisaatiositoutumisen yhteyttä. Tutkimuksen empiirinen osuus toteutettiin puolistrukturoiduilla teemahaastatteluilla, jotka toteutettiin videon välityksellä. Tutkimukseen osallistui neljä asiantuntijatehtävissä työskentelevää henkilöä, jotka olivat lähiaikoina vaihtaneet työnantajaa ja täten myös päättäneet sekä luoneet uuden psykologisen sopimuksen. Tutkimuksen empiirisessä osiossa pyrittiin täydentämään ja laajentamaan teoreettisen viitekehyksen perusteella tehtyä mallia psykologisen sopimuksen ja organisaatiositoutumisen yhteydestä. Täydennetyssä mallissa otettiin huomioon myös työnantajabrändin ja organisaation ulkoisen viestinnän vaikutus, työntekijän kehittyminen ja eteneminen sekä koko psykologisen sopimuksen elinkaaren aikaisten tekijöiden huomioiminen organisaatiositoutumisessa. Tutkimuksella pyritään liikkeenjohdollisesti herättämään organisaatioiden ymmärrys psykologisen sopimuksen tärkeydestä työntekijöiden vaihtuvuuden hallinnassa. Tutkimuksen kontribuutiona voidaan pitää aiempaa tutkimusta laajempaa käsitystä psykologisen sopimuksen ja organisaatiositoutumisen yhteydestä sekä siihen vaikuttavista tekijöistä. Tutkimustulokset kuvastavat modernia työelämää ja täten täydentävät aiemmin luotua, uuden psykologisen sopimuksen mallia. Lisäksi tutkimustulokset auttavat työntekijöitä hahmottamaan psykologisen sopimuksen käsitettä ja sen sisältöä, keskustelemaan molemminpuolisista odotuksista ja velvollisuuksista sekä seuraamaan psykologisen sopimuksen toteutumista

Chlamydia trachomatis infection and risk of cervical intraepithelial neoplasia

Objectives High-risk human papillomavirus (hrHPV) is the primary cause of cervical cancer. As Chlamydia trachomatis is also linked to cervical cancer, its role as a potential co-factor in the development of cervical intraepithelial neoplasia (CIN) grade 2 or higher was examined. Methods The placebo arms of two large, multinational, clinical trials of an HPV6/11/16/18 vaccine were combined. A total of 8441 healthy women aged 15-26 years underwent cervicovaginal cytology (Papanicolaou (Pap) testing) sampling and C trachomatis testing at day 1 and every 12 months thereafter for up to 4 years. Protocol-specified guidelines were used to triage participants with Pap abnormalities to colposcopy and definitive therapy. The main outcome measured was CIN. Results At baseline, 2629 (31.1%) tested positive for hrHPV DNA and 354 (4.2%) tested positive for C trachomatis. Among those with HPV16/18 infection (n = 965; 11.4%) or without HPV16/18 infection (n = 7382, 87.5%), the hazard ratios (HRs) associated with development of any CIN grade 2 according to baseline C trachomatis status were 1.82 (95% CI: 1.06 to 3.14) and 1.74 (95% CI 1.05 to 2.90), respectively. The results were comparable when only the 12 most common hrHPV infections were considered, but the excess risk disappeared when the outcome was expanded to include CIN grade 3 or worse. Conclusion Further studies based on larger cohorts with longitudinal follow-up in relation to the C trachomatis acquisition and a thorough evaluation of temporal relationships of infections with hrHPV types, C trachomatis and cervical neoplasia are needed to demonstrate whether and how in some situations C trachomatis sets the stage for cervical carcinogenesis. Trial registration NCT00092521 and NCT00092534

Towards a concentration closure of sub-6 nm aerosol particles and sub-3 nm atmospheric clusters

Atmospheric clusters play a key role in atmospheric new particle formation and they are a sensitive indicator for atmospheric chemistry. Both the formation and loss of atmospheric clusters include a complex set of interlinked physical and chemical processes, and therefore their dynamics is highly non-linear. Here we derive a set of simple equations to estimate the atmospheric cluster concentrations in size ranges of 1.5–2 nm and 2–3 nm as well as 3–6 nm aerosol particles. We compared the estimated concentrations with measured ones both in a boreal forest site (the SMEAR II station in Hyytiälä, Finland) and in an urban site (the AHL/BUCT station in Beijing, China). We made this comparison first for 3–6 nm particles, since in this size range observations are more reliable than at smaller sizes, and then repeated it for the 2–3 nm size range. Finally, we estimated cluster concentrations in the 1.5–2 nm size range. Our main finding is that the present observations are able to detect a major fraction of existing atmospheric clusters.Atmospheric clusters play a key role in atmospheric new particle formation and they are a sensitive indicator for atmospheric chemistry. Both the formation and loss of atmospheric clusters include a complex set of interlinked physical and chemical processes, and therefore their dynamics is highly non-linear. Here we derive a set of simple equations to estimate the atmospheric cluster concentrations in size ranges of 1.5–2 nm and 2–3 nm as well as 3–6 nm aerosol particles. We compared the estimated concentrations with measured ones both in a boreal forest site (the SMEAR II station in Hyytiälä, Finland) and in an urban site (the AHL/BUCT station in Beijing, China). We made this comparison first for 3–6 nm particles, since in this size range observations are more reliable than at smaller sizes, and then repeated it for the 2–3 nm size range. Finally, we estimated cluster concentrations in the 1.5–2 nm size range. Our main finding is that the present observations are able to detect a major fraction of existing atmospheric clusters.Peer reviewe

Age-specific vaccination coverage estimates for influenza, human papillomavirus and measles containing vaccines from seven population-based healthcare databases from four EU countries – The ADVANCE project

Background: The Accelerated Development of VAccine beNefit-risk Collaboration in Europe (ADVANCE) is a public–private collaboration aiming to develop and test a system for rapid benefit-risk monitoring of vaccines using existing healthcare databases in Europe. We estimated vaccine coverage from electronic healthcare databases as part of a fit-for-purpose assessment for vaccine benefit-risk studies. Methods: A retrospective dynamic cohort study was conducted through a distributed network approach. Coverage with measles-vaccine for birth year 2006, human papillomavirus (HPV)-vaccine for birth years 1990–2000 and influenza-vaccine for birth years 1920–1950 was estimated using period-prevalence and inverse probability weighting methods. Seven databases from four countries participated: Italy (Pedianet, Val Padana), Spain (BIFAP, SIDIAP), UK (RCGP-RSC, THIN), Denmark (SSI/AUH). Database access providers extracted the data, transformed it into a common structure and ran an R-script locally. The created output tables were shared and pooled at a central server. Results: The total study population comprised 274,616 persons for measles-vaccine, 2,011,666 persons for HPV-vaccine and 14,904,033 persons for influenza-vaccine. Measles-vaccine coverage varied from 84.3% (Denmark) to 96.5% (Italy, Val Padana) for the first dose and from 82.8% (Italy, Val Padana) to 90.9% (UK) for the second dose at the age of 7 years. The HPV-vaccine coverage, aggregated over birth years 1997–2000, ranged from 60% (UK) to 88.3% (Denmark) at the age of 15 years. The influenza-vaccine coverage for the influenza seasons from 2009 to 2015 for persons aged 65 years and more was roughly stable around 43% in Denmark and around 68% in the UK while a decrease from 58 to 50% was observed in Catalonia (Spain). Conclusions: We obtained detailed, age-specific coverage estimates though a common procedure. We discussed between database comparability and comparability to published national estimates

Population-level effects of human papillomavirus vaccination programs on infections with nonvaccine genotypes

We analyzed human papillomavirus (HPV) prevalences during prevaccination and postvaccination periods to consider possible changes in nonvaccine HPV genotypes after introduction of vaccines that confer protection against 2 high-risk types, HPV16 and HPV18. Our meta-analysis included 9 studies with data for 13,886 girls and women ≤19 years of age and 23,340 women 20–24 years of age. We found evidence of cross-protection for HPV31 among the younger age group after vaccine introduction but little evidence for reductions of HPV33 and HPV45. For the group this same age group, we also found slight increases in 2 nonvaccine high-risk HPV types (HPV39 and HPV52) and in 2 possible high-risk types (HPV53 and HPV73). However, results between age groups and vaccines used were inconsistent, and the increases had possible alternative explanations; consequently, these data provided no clear evidence for type replacement. Continued monitoring of these HPV genotypes is important

Prior human papillomavirus‐16/18 AS04‐adjuvanted vaccination prevents recurrent high grade cervical intraepithelial neoplasia after definitive surgical therapy: Post‐hoc analysis from a randomized controlled trial

We evaluated the efficacy of the human papillomavirus (HPV)−16/18 AS04‐adjuvanted vaccine in preventing HPV‐related disease after surgery for cervical lesions in a post‐hoc analysis of the PApilloma TRIal against Cancer In young Adults (PATRICIA; NCT00122681). Healthy women aged 15–25 years were randomized (1:1) to receive vaccine or control at months 0, 1 and 6 and followed for 4 years. Women were enrolled regardless of their baseline HPV DNA status, HPV‐16/18 serostatus, or cytology, but excluded if they had previous or planned colposcopy. The primary and secondary endpoints of PATRICIA have been reported previously; the present post‐hoc analysis evaluated efficacy in a subset of women who underwent an excisional procedure for cervical lesions after vaccination. The main outcome was the incidence of subsequent HPV‐related cervical intraepithelial neoplasia grade 2 or greater (CIN2+) 60 days or more post‐surgery. Other outcomes included the incidence of HPV‐related CIN1+, and vulvar or vaginal intraepithelial neoplasia (VIN/VaIN) 60 days or more post‐surgery. Of the total vaccinated cohort of 18,644 women (vaccine = 9,319; control = 9,325), 454 (vaccine = 190, control = 264) underwent an excisional procedure during the trial. Efficacy 60 days or more post‐surgery for a first lesion, irrespective of HPV DNA results, was 88.2% (95% CI: 14.8, 99.7) against CIN2+ and 42.6% (−21.1, 74.1) against CIN1+. No VIN was reported and one woman in each group had VaIN2+ 60 days or more post‐surgery. Women who undergo surgical therapy for cervical lesions after vaccination with the HPV‐16/18 vaccine may continue to benefit from vaccination, with a reduced risk of developing subsequent CIN2+.139122812282

A pooled analysis of continued prophylactic efficacy of quadrivalent human papillomavirus (types 6/11/16/18) vaccine against high-grade cervical and external genital lesions

Quadrivalent human papillomavirus (HPV) vaccine has been shown to provide protection from HPV 6/11/16/18-related cervical, vaginal, and vulvar disease through 3 years. We provide an update on the efficacy of the quadrivalent HPV vaccine against high-grade cervical, vaginal, and vulvar lesions based on end-of-study data from three clinical trials. Additionally, we stratify vaccine efficacy by several baseline characteristics, including age, smoking status, and Papanicolaou (Pap) test results. A total of 18,174 females ages 16 to 26 years were randomized and allocated into one of three clinical trials (protocols 007, 013, and 015). Vaccine or placebo was given at baseline, month 2, and month 6. Pap testing was conducted at regular intervals. Cervical and anogenital swabs were collected for HPV DNA testing. Examination for the presence of vulvar and vaginal lesions was also done. Endpoints included high-grade cervical, vulvar, or vaginal lesions (CIN 2/3, VIN 2/3, or ValN 2/3). Mean follow-up time was 42 months post dose 1. Vaccine efficacy against HPV 6/11/16/18-related high-grade cervical lesions in the per-protocol and intention-to-treat populations was 98.2% [95% confidence interval (95% CI), 93.3-99.8] and 51.5% (95% CI, 40.6-60.6), respectively. Vaccine efficacy against HPV 6/11/16/18-related high-grade vulvar and vaginal lesions in the per-protocol and intention-to-treat populations was 100.0% (95% CI, 82.6-100.0) and 79.0% (95% CI, 56.4-91.0), respectively. Efficacy in the intention-to-treat population tended to be lower in older women, women with more partners, and women with abnormal Pap test results. The efficacy of quadrivalent HPV vaccine against high-grade cervical and external anogenital neoplasia remains high through 42 months post vaccination. ©2009 American Association for Cancer Research

Risk of first cervical HPV infection and pre-cancerous lesions after onset of sexual activity: analysis of women in the control arm of the randomized, controlled PATRICIA trial

BACKGROUND: More information is needed about time between sexual initiation and human papillomavirus (HPV) infection and development of cervical precancer. METHODS: The objectives were to investigate the time between first sexual activity and detection of first cervical HPV infection or development of first cervical intraepithelial neoplasia (CIN), and associated factors in women from the double-blind, multinational, 4-year PATRICIA trial. PATRICIA enroled women aged 15-25 years with no more than 6 lifetime sexual partners. Women were randomized 1:1 to the HPV-16/18 AS04-adjuvanted vaccine or to control, but only women from the control arm who began sexual intercourse during the study or within 6 months before enrolment, and had no HPV infection detected before the recorded date of their first sexual intercourse, were included in the present analysis. The time between onset of sexual activity and detection of the first cervical HPV infection or development of the first CIN lesion was analyzed using Kaplan-Meier and univariate and multivariable Cox proportional-hazards models. RESULTS: A total of 9337 women were enroled in the control arm of PATRICIA of whom 982 fulfilled the required inclusion criteria for analysis. A cumulative total of 28%, 44%, and 62% of the subjects had HPV infection within 12, 24, and 48 months, respectively. The overall incidence rate was 27.08 per 100 person-years. The most common oncogenic types associated with 6-month persistent infection were HPV-16 (incidence rate: 2.74 per 100 person-years), HPV-51 (2.70), HPV-52 (1.66), HPV-66 (1.14), and HPV-18 (1.09). Increased infection risk was associated with more lifetime sexual partners, being single, Chlamydia trachomatis history, and duration of hormone use. CIN1+ and CIN2+ lesions were most commonly associated with HPV-16, with an overall incidence rate of 1.87 and 1.07 per 100 person-years, respectively. Previous cervical HPV infection was most strongly associated with CIN development. CONCLUSIONS: More than 25% of women were infected with HPV within 1 year of beginning sexual activity. Without underestimating the value of vaccination at older ages, our findings emphasize its importance before sexual initiation. TRIAL REGISTRATION: clinicaltrials.gov: NCT00122681

Risk of first cervical HPV infection and pre-cancerous lesions after onset of sexual activity : analysis of women in the control arm of the randomized, controlled PATRICIA trial

Peer reviewe