Working Longer in Good Health

Abstract Due to an ageing society, an increasing retirement age, and high prevalence of chronic health problems among older persons, it is important to understand how older employees [with health problems] can work for longer and productively, often this is termed ‘sustainable employability’. This context brought about the research presented in this thesis, financed by the Department of Public Health of the Erasmus MC and the Netherlands Organisation for Applied Scientific Research TNO. The longitudinal questionnaire study ‘STREAM’ (Study on Transitions in Employment, Ability and Motivation) was the basis for the research (www.tno.nl/stream). STREAM was financed by the Dutch Ministry of Social Affairs and Employment. The main conclusions of the thesis are as follows: • Highly engaged workers have greater improvement in physical and especially mental health during one-year follow-up than less engaged workers. • Employees with an active, non-avoidant, coping style have a better work ability than employees with a non-active and avoidant coping style. • Poor health adversely affects sustainable employability, this is especially the case for psychological health problems. However, favourable psychosocial work-related factors play an essential role, such as high autonomy and social support. These factors have a positive influence on sustainable employability, especially for workers with health problems. In conclusion, especially the promotion of favourable psychosocial work-related factors has the potential to greatly reduce that adverse health effects on sustainable employability

Longitudinal Relationships Between Organizational Justice, Productivity Loss, and Sickness Absence Among Older Employees

Purpose The aim of this study was to assess whether organizational justice lowers productivity loss and sickness absence, and whether there are reverse effects of productivity loss and sickness absence on organizational justice.Method A longitudinal study with 2 years of follow-up was conducted among employed persons aged 45–64 years from the Study on Transitions in Employment, Ability and Motivation (STREAM). Participants (N = 7011) yearly filled out an online questionnaire. Structural equation modeling in LISREL was conducted to assess the longitudinal relation-ships between distributive justice of salary, distributive justice of appreciation, procedural justice, productivity loss, and sick-ness absence. Results Both distributive justice of appreciation and procedur-al justice contributed to lower productivity loss and lower sickness absence at 1-year follow-up. Productivity loss in-creased perceptions of distributive justice of appreciation at 1-year follow-up, whereas sickness absence lowered both per-ceptions of distributive justice of appreciation and procedural justice at follow-up. Conclusion Improving organizational justice lowers the risk of productivity loss and sickness absence and may be a useful tool to improve the productivity of organizations

Оправдание науки

textabstractBackground With an ageing society and increasing retirement ages, it is important to understand how employability can be promoted in older workers with health problems. The current study aimed to determine whether (1) different chronic health problems predict transitions from paid employment to disability benefits, unemployment and early retirement, and (2) how workrelated factors modify these associations. Methods Self-report questionnaire data was used from the Dutch longitudinal Study on Transitions in Employment, Ability and Motivation with 3 years of follow-up (2010-2013), among employees aged 45-64 years (N=8149). The influence of baseline chronic health problems and work-related factors on transitions from paid employment to disability benefits, unemployment and early retirement during follow-up was estimated in a competing risks proportional hazards model. Relative excess risk of transitions due to the interaction between chronic health problems and workrelated factors was assessed. Results Severe headache, diabetes mellitus and musculoskeletal, respiratory, digestive and psychological health problems predicted an increased risk of disability benefits (HR range 1.78-2.79). Circulatory (HR=1.35) and psychological health problems (HR=2.58) predicted unemployment, and musculoskeletal (HR=1.23) and psychological health problems (HR=1.57) predicted early retirement. Work-related factors did not modify the influence of health problems on unemployment or early retirement. Psychosocial work-related factors, especially autonomy, modified the influence of health problems on disability benefits. Specifically, among workers with health problems, higher autonomy, higher support and lower psychological job demands reduced the risk of disability benefits by 82%, 49%, and 11%, respectively. Conclusions All health problems affected disability benefits to a similar extent, but psychological health problems especially predicted unemployment and early retirement. For older workers with health problems, promoting an optimal work environment has the potential to contribute to sustainable employment

Value-based person-centred integrated care for frail elderly living at home: a quasi-experimental evaluation using multicriteria decision analysis

Objective To evaluate the value of the person-centred, integrated care programme Care Chain Frail Elderly (CCFE) compared with usual care, using multicriteria decision analysis (MCDA). Design In a 12-month quasi-experimental study, triple-aim outcomes were measured at 0, 6 and 12 months by trained interviewers during home-visits. Setting Primary care, community-based elderly care. Participants 384 community-dwelling frail elderly were enrolled. The 12-month completion rate was 70% in both groups. Propensity score matching was used to balance age, gender, marital status, living situation, education, smoking status and 3 month costs prior to baseline between the two groups. Intervention The CCFE is an integrated care programme with unique features like the presence of the elderly and informal caregiver at the multidisciplinary team meetings, and a bundled payment. Primary and secondary outcomes measures The MCDA results in weighted overall value scores that combines the performance on physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centredness, continuity of care and costs, with importance weights of patients, informal caregivers, professionals, payers and policy-makers. Results At 6 months, the overall value scores of CCFE were higher in all stakeholder groups, driven by enjoyment of life (standardised performance scores 0.729 vs 0.685) and person-centredness (0.749 vs 0.663). At 12 months, the overall value scores in both groups were similar from a patient’s perspective, slightly higher for CCFE from an informal caregiver’s and professional’s perspective, and lower for CCFE from a payer’s and policy-maker’s perspective. The latter was driven by a worse performance on physical functioning (0.682 vs 0.731) and higher costs (€22 816 vs €20 680). Conclusions The MCDA indicated that the CCFE is the preferred way of delivering care to frail elderly at 6 months. However, at 12 months, MCDA results showed little difference from the perspective of patients, informal caregivers and professionals, while payers and policy-makers seemed to prefer usual care.publishedVersio

Studies of Floral Morphhology in the Dioscorea Batatas DECNE.(2) : Development of embryo sac, fertilization and seed formation in "Yamato-Kurokawa"

It has already been established in the author's previous paper that the flower of 'Yamato-Kurokawa', a common species belonging to the Dioscorea Batatas, was the diocious plant (MIZUNO 1953). The present study is a cytological investigation of the development of embryo sac and the phenomena of fertilization during the course of flowering. The fertilization and seed formation of this species were found naturally occuring to some extent in the field. Pollens seem to be formed about a day before flowering, but many abotive pollens are numbered in the anther. Develoment of embryo sac is usually interpreted as the modified Normal Type (Monosporic 8-nucleate Polygonum type), and its formation seems to finish about 2 days after flowering. In many cases, however, the embryo sac shows irregular in the development of the megagametogenesis. Self-fertilization by means of the gametic fusion, is observed about 4-5 days after flowering. Moreover, fertilizations are numbered more at the early flowering (from the late of July to the early August) than the other time. In one botrys, just then, fertilizations of basal flower seem to be better than the upper parts. Formation of the endosperm is the nuclear type, that is, the nuclei are invested with a cytoplasmic wall and extended into the center of the embryo sac. Development of the embryo is very bad and it is nothing but doing two successive divisions at 2 months after fertilization. The author has not yet found normal development in to the seeds. In the early time of flowering, at the expiration of 2 weeks after pollination, the seeds seem to complete on irregular development; while in the late time, all ovules develop in to seed only with coat

Mental health issues and illness and substance use disorder (non-)disclosure to a supervisor:A cross-sectional study on beliefs, attitudes and needs of military personnel

Objectives Research suggests that military personnel frequently delay disclosing mental health issues and illness (MHI), including substance use disorder, to supervisors. This delay causes missed opportunities for support and workplace accommodations which may help to avoid adverse occupational outcomes. The current study aims to examine disclosure-related beliefs, attitudes and needs, to create a better understanding of personnel’s disclosure decision making.Design A cross-sectional questionnaire study among military personnel with and without MHI. Beliefs, attitudes and needs regarding the (non-)disclosure decision to a supervisor were examined, including factors associated with (non-)disclosure intentions and decisions. Descriptive and regression (logistic and ordinal) analyses were performed.Setting The study took place within the Dutch military.Participants Military personnel with MHI (n=324) and without MHI (n=554) were participated in this study.Outcome measure (Non-)disclosure intentions and decisions.Results Common beliefs and attitudes pro non-disclosure were the preference to solve one’s own problems (68.3%), the preference for privacy (58.9%) and a variety of stigma-related concerns. Common beliefs and attitudes pro disclosure were that personnel wanted to be their true authentic selves (93.3%) and the desire to act responsibly towards work colleagues (84.5%). The most reported need for future disclosure (96.8%) was having a supervisor who shows an understanding for MHI. The following factors were associated both with non-disclosure intentions and decisions: higher preference for privacy (OR (95% CI))=(1.99 (1.50 to 2.65)intention, 2.05 (1.12 to 3.76)decision) and self-management (OR (95% CI))=(1.64 (1.20 to 2.23)intention, 1.79 (1.00 to 3.20)decision), higher stigma-related concerns (OR (95% CI))=(1.76 (1.12 to 2.77)intention, 2.21 (1.02 to 4.79)decision) and lower quality of supervisor–employee relationship (OR (95% CI))=(0.25 (0.15 to 0.42)intention, 0.47 (0.25 to 0.87)decision).Conclusion To facilitate (early-)disclosure to a supervisor, creating opportunities for workplace support, interventions should focus on decreasing stigma and discrimination and align with personnels’ preference for self-management. Furthermore, training is needed for supervisors on how to recognise, and effectively communicate with, personnel with MHI. Focus should also be on improving supervisor–employee relationships

Seeking treatment for mental illness and substance abuse:A cross-sectional study on attitudes, beliefs, and needs of military personnel with and without mental illness

Background Often, military personnel do not seek treatment for mental illness or wait until they reach a crisis point. Effective, selective, and indicated prevention is best achieved by seeking treatment early. Aims We aimed to examine military personnel's attitudes, beliefs, and needs around seeking treatment for mental illness. We compared those who sought treatment to those who did not and those with and without the intention to seek treatment. Finally, we examined factors associated with intentions of not seeking treatment. Method We conducted a cross-sectional questionnaire study of military personnel with (N = 324) and without (N = 554) mental illness. Descriptive and regression analyses (logistic and ordinal) were performed. Results The majority of the personnel believed treatment was effective (91.6%); however, most preferred to solve their own problems (66.0%). For personnel with mental illness, compared to those who sought treatment, those who did not had a higher preference for self-management and found advice from others less important. For those without mental illness, those with no intention to seek treatment indicated a higher preference for self-management, stigma-related concerns, denial of symptoms, lower belief in treatment effectiveness and found it less important to be an example, compared to those with treatment-seeking intentions. A clear indication of where to seek help was the most reported need (95.7%). Regression analyses indicated that not seeking treatment was most strongly related to preference for self-management (OR(95%CI) = 4.36(2.02–9.39); no intention to seek treatment was most strongly related to a lower belief that treatment is effective (OR(95%CI) = .41(0.28–0.59) and with not having had positive earlier experiences with treatment seeking (OR(95%CI) = .34(0.22–0.52). Conclusions To facilitate (early) treatment seeking, interventions should align with a high preference for self-management, mental illness stigma should be targeted, and a clear indication of where to seek treatment is needed

The Influence of Multi-morbidity on the Work Ability of Ageing Employees and the Role of Coping Style

Purpose With an ageing workforce, employees are increasingly confronted with multi-morbidity. Especially physical and mental health problems often occur together. This study aims to (i) explore the effect of multi-morbidity on work ability of ageing employees, more specifically the effects of the number of health problems and the combination of physical and mental health problems, and to (ii) explore to what extent the effects of physical and mental health problems on work ability are explained by applying differing coping styles. Methods A 1 year follow up study (2012–2013) was conducted among 7175 employees aged 45–64 years. Linear regression analyses were conducted to examine longitudinal relationships between multi-morbidity, coping styles and work ability. To determine whether coping styles mediate the effects of multi-morbidity on work ability, Sobel tests were conducted. Results A higher number of health problems was related to poorer work ability, but this negative effect stabilized from three health problems onwards. The combination of physical and mental health problem(s) was more strongly related to poorer work ability than only physical health problems. The negative relation between physical health problems and work ability was partly suppressed by active coping, while the negative relation between the combination of physical and mental health problem(s) on work ability was partly explained by avoidant coping. Conclusions Ageing employees with multi-morbidity have a reduced work ability, especially when mental health problems are present. The greater negative effects of the combination of physical and mental health problems on work ability are partially due to unfavorable coping styles

Міські проекції в ранній ліриці Лесі Українки

У статті вивчаються особливості художнього осмислення міського простору в ранній ліриці Лесі Українки. Звертається увага на те, що в процесі свого літературного становлення поетеса використала досвід різних традицій. Сентиментально налаштована героїня її творів оцінює місто як меркантильне, нелюдяне, байдуже до природної краси. В окремих поезіях переважає романтичний погляд: міський простір розглядається як тісний і задушливий, такий, що нівелює неповторність окремої особистості. Низка творів авторки репрезентує погодження неокласичних і романтичних тенденцій. Ключові слова: сентименталізм, романтизм, неокласицизм, лірика.В предлагаемой статье исследуются особенности художественного осмысления городского пространства в ранней лирике Леси Украинки. Учитывается тот факт, что в процессе своего литературного становления поэтесса использовала опыт различных традиций. Сентиментально настроенная героиня ее произведений оценивает город как меркантильный, исполненный безразличия к естественной красоте. В отдельных поэзиях преобладает романтический взгляд: городское пространство рассматривается как тесное, нивелирующее неповторимость отдельной личности. Ряд произведений Леси Украинки представляет взаимодействие романтических и неоклассических тенденций. Ключевые слова: сентиментализм, романтизм, неоклассицизм, лирика.In the article the features of early lyric poetry of Lesya Ukrainka are explored. That is taken into account, that in the process of the literary becoming a poetess used experience of different traditions. The sentimentally adjusted heroine gives preference to natural beauty. A romantic look prevails in separate poetries: urbanism space appears as incompatible with the uniqueness of individual. Romantic and neoclassical tendencies co-operate in a number of works of Lesya Ukrainka. Keywords: sentimentalizm, romanticism, neoclassicism, lyric poetry

Integrated care for frail elderly: A qualitative study of a promising approach in the netherlands

Introduction: Increasingly, frail elderly need to live at home for longer, relying on support from informal caregivers and community-based health-and social care professionals. To align care and avoid fragmentation, integrated care programmes are a