Validation of a self-reported instrument to assess work-related difficulties in patients with migraine: the HEADWORK questionnaire

Background: The degree to which work-related difficulties are recognized in headache research is poor and often carried out with inadequate information such as "reduced ability to work as usual", which do not capture at all the variety of difficulties and the factors that impact over them. The aim of this paper is to present the validation of the HEADWORK questionnaire, which addresses the amount and severity of difficulties in work-related tasks and the factors that impact over them.Methods: We developed a set of items based on a previous literature review and patients' focus groups and tested it on a wide set of patients with episodic and chronic migraine attending eight different Italian headache centers. HEADWORK factor structure was assessed with exploratory and confirmatory factor analysis; internal consistency and construct validity were addressed as well.Results: The validation sample (N= 373) was mostly composed of patients with episodic migraine without aura (64.3%) and of females (81%). Factor analysis retrieved two different scales: "Work-related difficulties", composed of eleven items which explain 67.1% of the total variance, and "Factors contributing to work difficulties", composed of six items which explain 52.1% of the total variance. Both HEADWORK subscales have good measurement properties, with higher scores being associated to higher disability, lower quality of life, lower productivity, higher headache frequency and pain intensity.Conclusions: HEADWORK is a 17-item, two-scale questionnaire addressing the impact of migraine on work-related difficulties in terms of difficulties in general or specific skills, and the factors contributing to these difficulties, defined as negative impact on work tasks. It can be used to address disability weights for the purpose of calculating the burden of migraine, and to assess the balance between therapeutic and side effects of medication on productivity

What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation

Background: Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption. Methods: Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff and members of the boards of directors (n=30). We used a constant comparative approach to develop a framework for guiding implementation. Findings: We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as ‘positions’. The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians’ perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related with the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians’ reasoning and fostering organizational learning. Discussion: Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians’ attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships and an organizational ethos of transparency and accountability need to considered when exploring the readiness of a hospital to adopt CDSSs.This work is supported by the Italian Ministry of Health (GR-2009-1606736), Regione Lombardia (D.R.G. IX/4340 26/10/2012), and the Wellcome Trust (WT097899)

Violent behavior of patients living in psychiatric residential facilities: A comparison of male patients with different violence histories

People with severe mental disorders and a history of violence are often seen as a difficult-to-manage segment of the population. In addition, this group is usually characterized by a high risk of crime recidivism, and poor compliance with community and aftercare programs. To investigate a sample of male patients living in Residential Facilities (RFs) with a history of violent behavior against people and to compare their characteristics with those of never-violent residents; to analyze the associations between aggressive behaviors in the last two years and a history of previous violence; and, to assess the predictors of aggressive behaviors. This study is part of a prospective observational cohort study which involved 23 RFs in Northern Italy. A comprehensive set of sociodemographic, clinical, and treatment-related information was gathered, and standardized assessments were administered to each participant. Also a detailed assessment of aggressive behaviors in the past two years was carried out. The study involved 268 males: 81 violent and 187 never-violent. Compared to never-violent patients, violent patients were younger, with a higher proportion of personality disorders, and have displayed an increased number of aggressive behaviors in the last two years. The presence of a history of violent behavior in the past significantly increases the probability of committing aggressive acts in the future

The effect of service satisfaction and spiritual well-being on the quality of life of patients with schizophrenia.

Quality of life (QOL) has been considered an important outcome measure in psychiatric research and determinants of QOL have been widely investigated. We aimed at detecting predictors of QOL at baseline and at testing the longitudinal interrelations of the baseline predictors with QOL scores at a 1-year follow-up in a sample of patients living in Residential Facilities (RFs). Logistic regression models were adopted to evaluate the association between WHOQoL-Bref scores and potential determinants of QOL. In addition, all variables significantly associated with QOL domains in the final logistic regression model were included by using the Structural Equation Modeling (SEM). We included 139 patients with a diagnosis of schizophrenia spectrum. In the final logistic regression model level of activity, social support, age, service satisfaction, spiritual well-being and symptoms' severity were identified as predictors of QOL scores at baseline. Longitudinal analyses carried out by SEM showed that 40% of QOL follow-up variability was explained by QOL at baseline, and significant indirect effects toward QOL at follow-up were found for satisfaction with services and for social support. Rehabilitation plans for people with schizophrenia living in RFs should also consider mediators of change in subjective QOL such as satisfaction with mental health services

Embedding impact in engaged research: Developing socially useful knowledge through dialogical sensemaking

NoThis paper explores how we can embed impact in research to generate socially useful knowledge. Our contribution lies in proposing a form of engaged research that draws upon situated knowledge and encompasses dialogical sensemaking as a way of making experience sensible in collaborative researcher−practitioner conversations. We draw attention to the intricacies of doing socially useful research and illustrate how five conversational resources can be used within dialogical sensemaking through an example of a research project in which impact and relevance were embedded and where researchers and practitioners worked together to resolve an important social and organizational issue

Autori di ambienti organizzativi

E’ possibile insegnare le competenze professionali? Le competenze sono un patrimonio privato del singolo individuo o sono distribuite all’interno delle comunità lavorative? E ancora quali azioni possono permettere un'innovazione continua delle pratiche lavorative e delle competenze professionali dei membri di un’organizzazione, facendole diventare un motore per lo sviluppo organizzativo? A tali complesse domande si cercherà di dare risposta sia attraverso il richiamo agli aspetti fondanti (teorici, metodologici ed empirici) delle teorie sociali e situate dell'acquisizione delle competenze e della psicologia culturale dei gruppi e delle organizzazioni, che presentando obiettivi, struttura e risultati di un Laboratorio per il Cambiamento Organizzativo, come caso di “successo” di costruzione, condivisione e innovazione delle pratiche lavorative in una comunità di coordinatori realizzato presso la Federazione Provinciale delle Scuole Materne di Trento. Il libro si rivolge ad operatori della scuola e della formazione, a studenti, consulenti e studiosi di processi organizzativi, a studenti di scienze dell’educazione e di scienze psicologiche organizzative

COSTRUIRE COMUNITA' DI PRATICHE RIFLESSIVE.

Nei contesti organizzativi è possibile introdurre dispositivi riflessivi che consentano alle comunità di pratiche di riflettere su se stesse, sulle proprie culture, sui propri repertori, sulle proprie pratiche tradizioni per attivare processi di trasformazione e cambiamento

Embedding Impact in Engaged Research: Developing Socially Useful Knowledge through Dialogical Sensemaking

This paper explores how we can embed impact in research to generate socially useful knowledge. Our contribution lies in proposing a form of engaged research that draws upon situated knowledge and encompasses dialogical sensemaking as a way of making experience sensible in collaborative researcher−practitioner conversations. We draw attention to the intricacies of doing socially useful research and illustrate how five conversational resources can be used within dialogical sensemaking through an example of a research project in which impact and relevance were embedded and where researchers and practitioners worked together to resolve an important social and organizational issue

The Psychological view and organization theory

The contribution proposes a reflection on the relevance of Thompson\u2019s work to modern times, from the perspective of Work and Organizational Psychology (WOP). The aim is to call for a renewed approach to the development of organizational theory in the WOP field. The examination of the relationship between Thompson\u2019s work and psychology is developed according to two lines of study: the first sought to identify in Thompson\u2019s contribution influences and traces of the psychological culture of his time; the second focused on the highlighting of anticipations and clues, echoes of which are found in subsequent theoretical frameworks in WOP