Variation in symptoms of depression and anxiety in midlife women by menopausal status

Objectives To examine the association between menopausal status and the risk of symptoms of depression and anxiety in a community-based sample of Australian midlife women. Study design Female participants (mean age 50.6 - 1.5) who were premenopausal (n = 237), perimenopausal (n = 249) or naturally postmenopausal (n = 225) were drawn from the Personality and Total Health (PATH) Through Life Project, a longitudinal study. Main outcome measures Symptoms of depression and anxiety were measured using the Goldberg Depression Scale and Goldberg Anxiety Scale. Generalised linear regression models with a negative binomial log link were used. Results Relative to premenopause and after adjusting for all relevant covariates, being perimenopausal was associated with increased risk of greater symptoms of depression (incidence rate ratio [IRR] = 1.29, p = 0.001), while being postmenopausal was associated with increased risk of greater symptoms of anxiety (IRR = 1.15, p = 0.041). Being perimenopausal or postmenopausal was associated with an increased risk of greater symptoms of depression (IRR = 1.35, p = 0.008; IRR = 1.31, p = 0.029) and anxiety (IRR = 1.22, p = 0.030; IRR = 1.32, p = 0.006) in women without a history of probable major depressive disorder or generalised anxiety disorder. Risk of symptoms did not differ with menopausal status in women with this history. Conclusions Menopausal status is associated with the risk of symptoms of depression and anxiety. There is a greater likelihood of increased symptoms of depression during perimenopause and symptoms of anxiety during postmenopause. In women without a history of depression or anxiety, the perimenopause and postmenopausal stages are associated with increased risk of greater symptoms of anxiety and depression relative to premenopause.This study was supported by the National Health and Medical Research Council (NHMRC) of Australia [grant numbers 973302, 179805, 157125]. SM is funded by the Australian Government Research Training Program Scholarship. KJA is funded by NHMRC Research Fellowship [number 1002560]. KJA and RA are funded by the Australian Research Council [number CE110001029]

Death and organization: Heidegger’s thought on death and life in organizations

Mortality has not been given the attention it deserves within organization studies. Even when it has been considered, it is not usually in terms of its implications for own lives and ethical choices. In particular, Heidegger’s writing on death has been almost entirely ignored both in writing on death and writing on organizational ethics, despite his insights into how our mortality and the ethics of existence are linked. In this paper, we seek to address this omission by arguing that a consideration of death may yield important insights about the ethics of organizational life. Most important of these is that a Heideggerian approach to death brings us up against fundamental ethical questions such as what our lives are for, how they should be lived and how we relate to others. Heideggerarian thought also reconnects ethics and politics, as it is closely concerned with how we can collectively make institutions that support our life projects rather than thwart or diminish them

The twilight of the Liberal Social Contract? On the Reception of Rawlsian Political Liberalism

This chapter discusses the Rawlsian project of public reason, or public justification-based 'political' liberalism, and its reception. After a brief philosophical rather than philological reconstruction of the project, the chapter revolves around a distinction between idealist and realist responses to it. Focusing on political liberalism’s critical reception illuminates an overarching question: was Rawls’s revival of a contractualist approach to liberal legitimacy a fruitful move for liberalism and/or the social contract tradition? The last section contains a largely negative answer to that question. Nonetheless the chapter's conclusion shows that the research programme of political liberalism provided and continues to provide illuminating insights into the limitations of liberal contractualism, especially under conditions of persistent and radical diversity. The programme is, however, less receptive to challenges to do with the relative decline of the power of modern states

Constitutivism

A brief explanation and overview of constitutivism

Assessing organisational readiness for change:Use of diagnostic analysis prior to the implementation of a multidisciplinary assessment for acute stroke care

BACKGROUND: Achieving evidence-based practice in health care is integral to the drive for quality improvement in the National Health Service in the UK. Encapsulated within this policy agenda are challenges inherent in leading and managing organisational change. Not least of these is the need to change the behaviours of individuals and groups in order to embed new practices. Such changes are set within a context of organisational culture that can present a number of barriers and facilitators to change. Diagnostic analysis has been recommended as a precursor to the implementation of change to enable such barriers and facilitators to be identified and a targeted implementation strategy developed. Although diagnostic analysis is recommended, there is a paucity of advice on appropriate methods to use. This paper addresses the paucity and builds on previous work by recommending a mixed method approach to diagnostic analysis comprising both quantitative and qualitative data. METHODS: Twenty staff members with strategic accountability for stroke care were purposively sampled to take part in semi-structured interviews. Six recently discharged patients were also interviewed. Focus groups were conducted with one group of registered ward-based nurses (n = 5) and three specialist registrars (n = 3) purposively selected for their interest in stroke care. All professional staff on the study wards were sent the Team Climate Inventory questionnaire (n = 206). This elicited a response rate of 72% (n = 148). RESULTS: A number of facilitators for change were identified, including stakeholder support, organisational commitment to education, strong team climate in some teams, exemplars of past successful organisational change, and positive working environments. A number of barriers were also identified, including: unidisciplinary assessment/recording practices, varying in structure and evidence-base; weak team climate in some teams; negative exemplars of organisational change; and uncertainty created by impending organisational merger. CONCLUSION: This study built on previous research by proposing a mixed method approach for diagnostic analysis. The combination of qualitative and quantitative data were able to capture multiple perspectives on barriers and facilitators to change. These data informed the tailoring of the implementation strategy to the specific needs of the Trust

Feedback reporting of survey data to healthcare aides

BackgroundThis project occurred during the course of the Translating Research in Elder Care (TREC) program of research. TREC is a multilevel and longitudinal research program being conducted in the three Canadian Prairie Provinces of Alberta, Saskatchewan, and Manitoba. The main purpose of TREC is to increase understanding about the role of organizational context in influencing knowledge use in residential long-term care settings. The purpose of this study was to evaluate healthcare aides&rsquo; (HCAs) perceptions of a one-page poster designed to feed back aggregated data (including demographic information and perceptions about influences on best practice) from the TREC survey they had recently completed. MethodsA convenience sample of 7 of the 15 nursing homes participating in the TREC research program in Alberta were invited to participate. Specific facility-level summary data were provided to each facility in the form of a one-page poster report. Two weeks following delivery of the report, a convenience sample of HCAs was surveyed using one-to-one structured interviews. ResultsOne hundred twenty-three HCAs responded to the evaluation survey. Overall, HCAs&rsquo; opinions about presentation of the feedback report and the understandability, usability, and usefulness of the content were positive. For each report, analysis of data and production and inspection of the report took up to one hour. Information sessions to introduce and explain the reports averaged 18 minutes. Two feedback reports (minimum) were supplied to each facility at a cost of CAN$2.39 per report, for printing and laminating. ConclusionsThis study highlights not only the feasibility of producing understandable, usable, and useful feedback reports of survey data but also the value and importance of providing feedback to survey respondents. More broadly, the findings suggest that modest strategies may have a positive and desirable effect in participating sites. <br /

Philosophy of action

The philosophical study of human action begins with Plato and Aristotle. Their influence in late antiquity and the Middle Ages yielded sophisticated theories of action and motivation, notably in the works of Augustine and Aquinas.1 But the ideas that were dominant in 1945 have their roots in the early modern period, when advances in physics and mathematics reshaped philosophy