The Benefits of Interventions for Work-Related Stress Essay Example for Free

The Benefits of Interventions for Work-Related Stress Essay Objectives. This quantitative metaanalysis sought to determine the effectiveness of occupational stress–reducing interventions and the populations for which such interventions are most beneficial. Methods. Forty-eight experimental studies (n = 3736) were included in the analysis. Four intervention types were distinguished: cognitive–behavioral interventions, relaxation techniques, multimodal programs, and organizationfocused interventions. Results. A small but significant overall effect was found. A moderate effect was found for cognitive–behavioral interventions and multimodal interventions, and a small effect was found for relaxation techniques. The effect size for organization-focused interventions was nonsignificant. Effects were most pronounced on the following outcome categories: complaints, psychologic resources and responses, and perceived quality of work life. Conclusions. Stress management interventions are effective. Cognitive– behavioral interventions are more effective than the other intervention types. (Am J Public Health. 2001;91:270–276) Jac J. L. van der Klink, MD, MSc, Roland W. B. Blonk, PhD, Aart H. Schene, PhD, MD, and Frank J. H. van Dijk, PhD, MD The efficacy and cost-effectiveness of interventions designed for patients with emotional difficulties is a relevant topic in general practice.1 Such considerations also apply in occupational health care. With the increases in workloads of the past decades, the number of employees experiencing psychologic problems related to occupational stress has increased rapidly in Western countries.2 At the societal level, costs are considerable in terms of absenteeism, loss of productivity, and health care consumption. In Britain, it is estimated that 40 million workdays are lost to the nation’s economy owing to mental and emotional problems.3 At the individual level, there are costs in terms of high rates of tension, anger, anxiety, depressed mood, mental fatigue, and sleep disturbances. These problems, usually referred to in aggregate as distress, are often classified as neurasthenia, adjustment disorders, or burnout. Incidence rates in the Netherlands vary from 14 to 50 cases per year per 1000 patients.4 Interventions designed to reduce occupational stress can be categorized according to focus, content, method, and duration. In regard to focus, interventions can be categorized as (1) aiming to increase individual psychologic resources and responses (e.g., coping) or (2) aiming to change the occupational context. The first category of intervention is usually referred to as stress management training. However, stress management is the common denominator of an assortment of interventions ranging from relaxation methods5 to cognitive– behavioral interventions6,7 and client-centered therapy.8 The second category refers to interventions such as organizational development9,10 and job redesign.11 We distinguished 4 intervention types according to categorizations used in previous reviews12–14: cognitive–behavioral approaches, relaxation techniques, multimodal interventions, and organization-focused interventions. Cognitive–behavioral approaches aim at changing cognitions and subsequently reinforcing active coping skills.6,7 Relaxation techniques focus on physical or mental relaxation as a method to cope with the consequences of stress. Multimodal interventions emphasize the acquisition of both passive and active coping skills. The fourth intervention type involves a focus on the organization as a whole. Several reviews have been conducted of interventions designed to reduce occupational stress.2,5,12,14–16 The general finding of these reviews is that such interventions are effective. However, the reviews have been qualitative in nature and thus provide limited information on which type of intervention is most effective and for whom. Recently, Bamberg and Busch conducted the first meta-analysis on occupational stress–reducing interventions.17 However, they included only cognitive–behavioral interventions in their quantitative analyses. In the present quantitative review, the following research questions were posed: (1) Are stress interventions effective, as suggested by qualitative reviews of the literature? (2) If so, which type of stress intervention is most effective, and on which outcome measures? In addition to these research questions, exploratory analyses were conducted to determine what moderator variables (e.g., job characteristics, preventive/remedial nature of interventions, length of treatment) were related to the effectiveness of the interventions. Methods Search and Inclusion Criteria Two strategies were used to locate appropriate studies. First, 4 databases—Medline (1966–1996), ClinPsych (1980–1996), Current Contents (1997), and Nioshtic (1970– 1996)—were used to conduct a computerized search. Three groups of terms were composed for this search: (1) terms linked to stress-related psychologic problems (psychologic stress, work stress, job stress, neurasthenia, burnout, minor psychiatric problems, mental fatigue, minor depression, neurosis, distress, nervous breakdown, and adjustment disorder), (2) terms related to the intervention (therapy, treatment, protocol, program, intervention, primary care, prevention, and employee assistance program), and (3) terms related to the population (employee, occupational, vocational, rehabilitation, work, job, absenteeism, and sickness leave). Within each group of terms, searches were added. Subsequently, these searches were combined. Second, a manual search of relevant reviews, book chapters, and articles was conducted, with the objective of finding relevant references missed in the computerized search. To be included in our database, a study had to meet several criteria. First, the intervention was required to be specifically designed to prevent or reduce psychologic complaints related to occupational stress. Second, in terms of the target population, participants had to be recruited from the working population because of imminent or already-manifested stressrelated psychologic problems not diagnosed as involving a major psychiatric disorder (e.g., depression or posttraumatic stress disorder) or a stress-related somatic disorder (e.g., hypertension, coronary heart disease). Third, an experimental or quasi-experimental design involving a no-treatment control group had to be used. Within the quasi-experimental studies, we required that the experimental group and the control group be recruited from identical populations and have identical baseline values on dependent variables. In this high-quality group of primary studies, we applied no ranking for methodological quality aspects because the consequent choice of a weighting factor in the quantitative analyses would introduce an element of subjectivity. Fourth, outcome variables had to be well defined and of sufficient reliability. Finally, we required that the study be published as a journal article in English. Definitions The variables used in the meta-analysis included intervention-related variables, outcome variables, and population characteristics. February 2001, Vol. 91, No. 2 Intervention-related variables were (1) type of intervention, (2) total number of hours, (3) number of weeks, and (4) number of sessions. The latter 3 variables could be considered indexes of the intensity and extent of the intervention. Because they were relevant in assessing the cost-effectiveness and practical applicability of a program, we used these variables as moderators in the exploratory analyses. As described earlier, 4 intervention types were included; 3 involved a focus on individuals and 1 involved a focus on the organization. In several reviews, a third focus has been discerned: the interaction between the individual and the organization.14,18 Thus far, however, intervention studies conducted with this focus have been uncontrolled.19 The outcome variables included were placed into 5 categories: (1) quality of work life, including such aspects as job demands, work pressure, job control, working conditions, and social support from management and colleagues; (2) psychologic resources and responses, including measures of self-esteem, mastery, beliefs, and coping skills20; (3) physiology, including measures such as tension, electromyographic activity, (nor)adrenaline, and cholesterol level; (4) complaints, including stress or burnout rates or symptoms, somatic symptoms, and mental health status and symptoms (because of their significance in general health practice, depressive symptoms and anxiety symptoms were considered as separate subcategories); and (5) absenteeism. A number of population characteristics, such as sex, age, years of employment, occupational status, and baseline stress level, may be important moderators of treatment effects and thus may provide information on which types of interventions are effective and for whom. However, for most of these characteristics, the specific information required was not available in the studies; the exceptions were baseline stress level and occupational status. The predictive influence of these characteristics on treatment effects was investigated in a number of exploratory analyses. In line with Newman and Beehr12 and with Murphy,2 2 baseline stress level categories were distinguished, preventive and remedial. In the present meta-analysis, a study was considered preventive if no participant selection had taken place in regard to stress levels. A study was considered remedial if participants were selected by means of a criterion. As noted by Karasek and Theorell, occupational status may be indicative of level of job control.20 On the basis of Karasek and Theorell’s ratings, we categorized study samples as â€Å"high control† or â€Å"low control.† Two studies involving samples with mixed occupations were classified as low control because most of the participants in these studies had low-control jobs.21,22 Two studies were excluded from these exploratory analyses because of a lack of sufficient information.23,24 Statistical Analysis The Advanced BASIC Meta-Analysis program25 was used in conducting statistical analyses. In this program, several statistics (e.g., F, t, r, and P) can be entered, and a product–moment correlation is obtained. These effect size correlations are transformed to Fisher z scores. Subsequently, mean Fisher z scores are calculated and transformed back to effect size (r) values. If F or t values were reported, we used these values; if such values were not reported, they were computed if the required information was available. If this computation was not possible, P values were used; effects reported as nonsignificant were rated as P=0.5.26 A problem in meta-analyses is that studies with a relatively large number of outcome measures disproportionately affect the metaanalytic results. To counteract this problem, Rosenthal and Rubin27 proposed a method of computing a mean effect size in which the intercorrelation of outcome measures is taken into account.25(pp45–47) For all analyses, outcome variables were combined according to this method. We used all outcome measures reported in a study in calculating effect sizes. We report effect sizes in Cohen’s d, which can be derived directly from r values. Cohen’s d represents the standardized mean difference between the intervention group mean and the control group mean. Thus, a d value of 1 indicates that the intervention group performed 1 standard deviation above the control group on a particular outcome variable. Results Description of Studies Forty-eight studies10,21–24,28–67 conducted between 1977 and 1996 met the inclusion criteria; findings from these studies were published in 45 different articles. None of the 48 studies had a curative orientation in the usual sense (i.e., target population consisting of people seeking help). Four studies were considered remedial, because there was selection in regard to baseline stress level. Forty-one studies involved employees with jobs categorized as high in job control. Five studies evaluated an organizationfocused intervention, 18 evaluated a cognitive– behavioral intervention, 17 evaluated a relaxation technique, and 8 evaluated a multimodal approach. In all studies, several outcome analyses were conducted. The result was 99 intervention–outcome combinations. American Journal of Public Health 271 Twenty of the studies involved a followup assessment. In most cases, follow-up was either uncontrolled or reported in a way that allowed no retrieval of statistical metrics. Therefore, only the first postintervention assessment was included in the meta-analysis. The mean interval between preintervention and postintervention assessment was 9 weeks for interventions that focused on individuals (SD= 6 weeks). This deviation was merely due to dif- ferences in intervention duration. Differences in interval between intervention types were not significant. The interval for organizationfocused programs was considerably longer (38 weeks) owing to longer program durations and longer postintervention assessment intervals. Pretest-to-posttest dropout rates varied from 0% to 40%. The mean dropout rate for programs that focused on individuals was 11%; differences between intervention types were nonsignificant. Organization-focused programs had a mean dropout rate of 26%.

Affirmative Action :: essays research papers

Affirmative Action has been frivolously debated throughout the past 135 years. Citizens of the United States question whether the government should grant certain advantages to races that have endured bigotry in the past. This plan goes by the name of Affirmative Action. Affirmative Action is a federally subsidized program that encourages universities and other educational institutions, to accept a greater number of minority students. Throughout the years, Affirmative Action and the different advocates have changed, but racial inequality remains stagnant. Affirmative action has various proponents and opponents, both of whom seek the eventual goal of an integrated, educated middle class society. The opponents of Affirmative Action argue that it is not the responsibility of the current majority to make up for prior actions; and imposing these types of programs would be a form of so-called, reverse discrimination. The proponents argue that it is everybody’s responsibility to create a society, which gives everybody an equal opportunity regardless of race, and the only way to ascertain this goal is through Affirmative-Action programs. How can this nation come together and disregard the color of a persons skin? Will we reach this goal by subsidizing programs that assist minorities, or shall we sit and wait for time to establish equal opportunity for all? The history of Affirmative Action dates back to the days when the nation attempted to rebuild its society after the civil war. Reconstruction attempted to establish virtuous relations between the white Europeans and black Africans that made up a large part of the American society. The nation was torn on how to establish these relations. Many call Reconstruction the low point of race relations in the United States. This era included the ratification of the Fourteenth Amendment, defining national citizenship so as to include blacks. This Amendment passed Congress in June 1866 and was ratified, despite rejection by most Southern states (July 28, 1868). In response to the newfound freedom of African Americans, whites incited numerous accounts of violence. White hatred of the black race created an era that experienced the most lynchings in the history of the United States. Whites also began using contemporary forms of labor exploitation to maintain control of their socio-economic advantage. Something needed to be done so that the nation would not split at its seams. One side argued that time was the only solution to racial problems. Creating government programs would make African’s dependent and give them an unfair advantage. â€Å"They were said to be fat state subsidies that unfairly penalized innocent whites and taught blacks self-destructive habits of indolence and independence.† This argument was sustained by the Democratic Party who

Journey to Sakhalin

The Saline project was the first Russian production-sharing agreement (AS) with foreign corporations. A AS is a commercial contract between investor(s) who are willing to make a large, long term and high risk investments with the host country that has the natural recourses (usually oil and/or gas) to exploit. The terms behind AAAS are usually deferent than regular commercial contracts, as they usually bypass some of the regulations that the host country imposes on foreign Investments.The agreements also last for the Lifetime of the project. Under the terms of the AS, the investing company gets the larger share of venues at the beginning of the contract to recoup the cost of investment. As time goes by, the net revenues (revenues after the cost of operations) are shared between the investment companies and the host country, usually a 20/80 split. AAAS are controversial In Russia because they bypass some of the taxes and licenses that a foreign company would have to pay.Previous foreig n companies had worked In Russia under the regular tax system, therefore It was argued that AAAS don't treat all businesses equally and create a sense of unfairness. Furthermore, AAAS apply only to Greenfield.. Greenfield are unexploited, undeveloped large pieces of lands with exploitable resources, and some circles felt that Russia should not cheaply bargain away these coveted lands. AAAS are agreements between the foreign direct investors (FED) and the federal Russian government; thereby limiting the power of the mid-level establishment, traditionally and politically a powerful group In Russian Pollock.At the time of the agreement, the local Saline Government, led by Governor Igor Verification, was a key player in the decision, mainly because Verification was politically influential and in favor of the project. After the fall of the communist regime, Russian GAP fell by 50% and up to half of the population was living below the poverty line. Oil and gas constituted the main export earnings of Russia, whose borders encompassed the largest supply of gas In the world (30%). Attempts by Russia to privative state-owned energy firms had mixed results.The OLL Industry produced a number of vertically integrated firms such as Skidpan and Subnet, which formed the basics of a competitive environment. Conversely, prevarication of the gas industry produced a single, dominant company: Gazpacho. At times, it appeared that he Russian Government acted on behalf of Gazpacho due to the significantly higher impact this Industry had on the Russian economy, and because It was a 38% stakeholder In the company. As Gazpacho controlled 20% of the worlds gas production, tenure were gallants political Interests escalated Witt ten development of this industry in Russia.Thus far, Russian's exports were mainly to Europe, as Russia had been unable to build pipelines to East Asia and Japan. The energy sector constituted 20% of GAP, and Gazpacho alone was responsible for 8%. The growing econo mies of the Far East, combined with Russian's need to exploit its oil and gas serves (both for economic reasons, as well as for political influence) helped push Russia to seek Foreign Direct Investment (FED). Russia also required foreign expertise, as transportation of gas to Asia would require a Liquefied Natural Gas (LONG) facility; something they did not have the technical ability to create.Foreign partnerships then offered the fastest and most efficient way of developing previously inaccessible resource field as well as exporting to new markets. Previous administrative scandals (BP Amoco) showed Russia to be politically and financially risky, causing a decrease in FED. A AS agreement would prove a good faith gesture from Russia that it was ready to enter the world economy, and to overcome the bureaucratic history and corruption that has scared away foreign companies.Shell would not have invested $108 in the Saline II project [exhibit 1] without a AS. Russia needed this first AS to attract future FED, and as such would likely be most generous with the terms of its first AS. Successful execution of a AS by Shell, could create future opportunities to exploit additional Greenfield development in Russia. Despite these advantages, there were several downsides. Protectionism by members of the Russian Dumb meant that this AS was rapidly becoming politicized and might face ongoing challenges..One term of the AS was that Saline Energy Investment Company (SIC) needed to use 70% Russian labor and goods for the part of the project measured as measured man- hours and volume of material; however the oil industry in Russia was mainly functioning on ground and had very little experience with offshore activities as exampled by Russian's inability to build and maintain a Liquefied Natural Gas (LONG) plant. The terms of this part of the agreement were particularly vague, as it was roll defined what would be considered Russian â€Å"content† in the project.Additionally, enforcement of the AS would be difficult due to the geographical remoteness of the project. * Investments in Saline did not Just include the production facilities, but also contributions to the local administration. SIC was responsible for the upgrade (or construction) of the island infrastructure as well as other wish-lists of improvements. The SIC also had to provide local community sponsorships of facilities, scholarships and grants as well as maintaining good relationships with environmental activists. Saline Island is a pristine environment.In order to be successful, social and public relations have to be a priority, which could prove to be challenging since the business of exploiting oil and gas is usually brutal to the environment as well as the economic and social landscape of local communities. Care in negotiations had to be achieved in order to sponsor projects that would keep the local residents happy and friendly, and yet keep a tight control on spending for these proje cts and not inflame environmentalists. * Navigation of local politics was also a challenge.In the first stages of a project like this, good relations with local government employees are sometimes more important than relations with politicians higher up in ten unlearning as most approvals are cone locally. As ten project progressed, Ethereal authorities became more important as Putting attempted to reinstitution central authority. Another obstacle was the legal system. Difficulties and delays in obtaining approvals for the Technical and Economic Substantiation for Construction (TCO) as well as a lack of stabilization in the Russian legal system endangered the project as it would not proceed as scheduled without them.Without changes to the legal system, arms of the Saga's agreements that conflicted with current Russian laws could not be enforced and increased the risks associated with the investment. Despite these obstacles Shell should invest in Saline. There are very few Greenfield available with the production capacity of Saline. Exploitation of non-developed lands allows for the building of new technology instead of maintaining old equipment. This is more efficient and therefore more profitable. The initial costs are lower as there is no need to dismantle old facilities to build new ones.It allows Shell to gain a foothold in Russia which has a large reserves of oil and gas. When at full capacity, Saline could produce up to 5% of the world LONG needs making this a critical strategic investment for Russia. Russia needs to rebuild its economy and is now ready to offer better deals then it would in the future. It does not have the technology to build offshore platforms and LONG producing capabilities. It needs these facilities to access new markets and the location of Saline in the Arctic has great potential in these regards.The Saline II AS agreement has terms that will be difficult to match in the future and has the advantage of reducing the influence of the R ussian oligarchy in the business dealings. Russia would not Jeopardize its standing as a 68 country and is motivated to have successful foreign investments. Of course one company to watch is Gazpacho. It is a major player in Russian politics and may feel threatened to have the East Asian market closed to them. Shell should be open to the idea of having Gazpacho be part of the Consortium.To mitigate the risk, Shell should try to attract more investors to distribute the risk, at least at the beginning while costs are high, then buy the shares back once production brings in stable revenues. They should follow the given requirements very carefully and ensure that they keep maintain heir end of the bargain by hiring the requisite local contractors and labor force. Shell should behave as a good neighbor as much as possible by making sure that the environment is being taken care of.Natural resource industries require large capital investments and are politically difficult to navigate. They have such a significant geopolitical impact that the Coos of these companies do not make agreements with the heads of other companies, but rather with heads of state. Their decisions do not just affect the shareholders of the company, but also the access of energy by their win country as well. If the political climate changes with a new government hostile to the home country of the company, no commercial contract can be legally enforced.A company could lose all of its investments in the host country should they be removed from the operations while the plants and equipment remain. Depending on the level of hostility and the impact the resources of a country have on the global energy supply, escalation may involve military force to secure indispensable resources. Usually the countries with the companies that have the most technical expertise do to own the lands that contain the resources and the countries with the resources do not have the technical expertise to exploit them.It creat es a mutual (although wary) Interdependence. An 011 company cannot easily select to another site Ana move Its platforms, refineries and pipelines, while the host country cannot operate the equipment without the technical knowledge of the companies (which is the company's only leverage). Both sides need to do a a diplomatic dance, constantly negotiating give and takes on the exploitation of these resources. Exhibit 1: Saline 2 project

Morning Quotes to Inspire You to Enjoy the Gift of Life

Most of us have heard the adage Rise and shine — the early bird gets the worm, but do you really know the meaning behind these words? Its widely believed that early risers have more time to achieve their goals. If youre an early riser, you know how blissful mornings can be. At dawn, the first rays of the sun gently caress the earth, like a mother gently waking her child up. From then on, it is a flurry of activity, with a soundtrack of birds chirping enthusiastically. Theres not much better than catching the morning rays of the sun on your face and basking in the warm golden rays. Take a brisk walk in the fresh air, and enjoy the gentle morning breeze on your face. Inspirational Morning Quotes Here are some inspiring morning quotes to motivate you to jumpstart your day and achieve your goals. Share these morning quotes and encourage others to rise early with you. Maya AngelouIf you have only one smile in you, give it to the people you love. Dont be surly at home, then go out in the street and start grinning Good morning at total strangers. Samuel GoldwynI had a monumental idea this morning, but I didn’t like it. Cary GrantMy formula for living is quite simple. I get up in the morning and I go to bed at night. In between, I occupy myself as best I can. Mohandas GandhiPrayer is the key of the morning and the bolt of the evening. Marcus AureliusWhen you arise in the morning, think of what a precious privilege it is to be alive -- to breathe, to think, to enjoy, to love. Mark TwainIf its your job to eat a frog, its best to do it first thing in the morning. And if its your job to eat two frogs, its best to eat the biggest one first. Author UnknownIf people were meant to pop out of bed, we’d all sleep in toasters. Emily DickinsonMorning without you is a dwindled dawn. Bertrand RussellIve always thought respectable people scoundrels, and I look anxiously at my face every morning for signs of my becoming a scoundrel. Rabindranath TagoreDo not say, It is morning, and dismiss it with a name of yesterday. See it for the first time as a newborn child that has no name. E. B. WhiteI arise in the morning torn between a desire to improve the world and a desire to enjoy the world. This makes it hard to plan the day. William BlakeThink in the morning. Act in the noon. Eat in the evening. Sleep in the night. Salvador DaliEach morning when I awake, I experience again a supreme pleasure — that of being Salvador Dali. Elbert HubbardBe pleasant until ten oclock in the morning and the rest of the day will take care of itself. Ogden NashThe bed is a bundle of paradoxes: we go to it with reluctance, yet we quit it with regret; we make up our minds every night to leave it early, but we make up our bodies every morning to keep it late. Kahlil GibranIn the dew of little things the heart finds its morning and is refreshed. Billy WilderYou have to have a dream so you can get up in the morning. Jeb DickersonMorning is when the wick is lit. A flame ignited, the day delighted with heat and light, we start the fight for something more than before. Monica BaldwinI have always felt that the moment when you first wake up in the morning is the most wonderful of the twenty-four hours. No matter how weary or dreary you may feel, you possess the certainty that, during the day that lies before you, absolutely anything may happen. And the fact that it practically always doesnt, matters not a jot. The possibility is always there. Rig VedaBy getting up early in the morning one also gets more time at his disposal for work as compared to late-risers. Scholar and thinkers get up early in the morning and contemplate. Ralph Waldo EmersonHow cunningly nature hides every wrinkle of her inconceivable antiquity under roses and violets and morning dew! Marcus AureliusThe breeze at dawn has secrets to tell you. Don’t go back to sleep. Eleanor RooseveltProbably the happiest period in life most frequently is in middle age, when the eager passions of youth are cooled, and the infirmities of age not yet begun; as we see that the shadows, which are at morning and evening so large, almost entirely disappear at midday. Henry David ThoreauIn my afternoon walk I would fain forget all my morning occupations and my obligations to society. Arthur SchopenhauerEach day is a little life: every waking and rising a little birth, every fresh morning a little youth, every going to rest and sleep a little death. Aldous HuxleyIt was one of those evenings when men feel that truth, goodness and beauty are one. In the morning, when they commit their discovery to paper, when others read it written there, it looks wholly ridiculous. Jesse JamesI knew, however, that the next morning after the fight I would have to get away, and I did just in time, for a full company came early to look for me and were furious because I had escaped them. Quentin TarantinoI always do an all-night horror marathon on Saturdays where we start at seven and go until five in the morning. Van MorrisonA famous person to themselves, they don’t get up in the morning and think, I’m famous. I’m not famous to me. Famous is a perception. Jonas SalkIt is always with excitement that I wake up in the morning wondering what my intuition will toss up to me, like gifts from the sea. I work with it and rely on it. It’s my partner. Samuel Taylor ColeridgeHow like herrings and onions our vices are in the morning after we have committed them. Franz SchubertEvery night when I go to bed, I hope that I may never wake again, and every morning renews my grief. Friedrich Max MullerThe morning hour has gold at the mouth. Ambrose BierceDawn: When men of reason go to bed. Thomas JeffersonWhether I retire to bed early or late, I rise with the sun. Richard WhatelyLose an hour in the morning, and you will be all day hunting for it. Josh BillingsNever work before breakfast; if you have to work before breakfast, eat your breakfast first.