On-call work and physicians’ turnover intention: the moderating effect of job strain

Physician shortage and turnover are major problems worldwide. On-call duties may be among the risk factors of high turnover rates among physicians. We investigated whether having on-call duties is associated with physicians’ turnover intention and whether job strain variables moderate this association. The present study was a cross-sectional questionnaire study among 3324 (61.6% women) Finnish physicians. The analyses were conducted using analyses of covariance adjusted for age, gender, response format, specialization status and employment sector. The results showed that job strain moderated the association between being on-call and turnover intention. The highest levels of turnover intention were among those who had on-call duties and high level of job strain characterized by high demands and low control opportunities. The lowest levels of turnover intention were among those who were not on-call and who had low strain involving low demands and high control. Also, job demands moderated the association between being on-call and turnover intention; turnover intention levels were higher among those with on-call duties and high demands than those being on-call and low demands. To conclude, working on-call was related to physicians’ turnover intention particularly in those with high job strain. Health care organizations should focus more attention on working arrangements and scheduling of on-call work, provide a suitable working pace and implement means to increase physicians’ participation and control over their job.     

Does emotional reasoning change during cognitive behavioural therapy for anxiety?

Emotional reasoning refers to the use of subjective emotions, rather than objective evidence, to form conclusions about oneself and the world. It is a key interpretative bias in cognitive models of anxiety disorders and appears to be especially evident in individuals with anxiety disorders. However, the amenability of emotional reasoning to change during treatment has not yet been investigated. We sought to determine whether emotional reasoning tendencies change during a course of routine cognitive-behavioural therapy (CBT). Emotional reasoning tendencies were assessed in 36 individuals with a primary anxiety disorder who were seeking treatment at an outpatient clinic. Changes in anxiety and depressive symptoms as well as emotional reasoning tendencies after 12 sessions of CBT were examined in 25 individuals for whom there was complete data. Emotional reasoning tendencies were evident at pretreatment assessment. Although anxiety and depressive symptoms decreased during CBT, only one of six emotional reasoning interpretative styles (pertaining to conclusions that one is incompetent) changed significantly during the course of therapy. Attrition rates were high and there was not enough information regarding the extent to which therapy specifically focused on addressing emotional reasoning tendencies. Individuals seeking treatment for anxiety disorders appear to engage in emotional reasoning, however routine individual CBT does not appear to result in changes in emotional reasoning tendencies.     

Breadth versus depth: Cumulative risk model and continuous measure prediction of poor language and reading outcomes at 12

This study examines whether, and how, multiple risks in early childhood are associated with an increased likelihood of a poor language or literacy outcome in early adolescence. Using data from 210 participants in the longitudinal Twins Early Developmental Study, we focus on the following risk factors at age 4: family risk, and poor language, speech, emergent literacy and nonverbal skills. The outcomes of interest at age 12 are language, reading fluency and reading comprehension. We contrast a ‘cumulative risk’ model, counting the presence or absence of each risk factor (breadth), with a model that also considers the severity of the early deficits (depth). A ‘cumulative risk index’ correlated modestly but significantly with outcome (r = 0.32–0.40). Odds ratios confirmed that having many risk factors (3–6) confers a higher probability of a poor outcome (OR 7.86–17.71) than having one or two (OR 3.65–7.28). Logistic regression models showed that predictive validity is not improved by including information about the severity of each deficit. Even with rich information on children's risk status at age 4, we can make only a moderately accurate prediction of the likelihood of a language or literacy disorder 8 years later (Area Under the Curve = 0.74–0.84; Positive Predictive Value = 0.33–0.55, Negative Predictive Value = 0.86–0.91). Taken together, and consistent with the idea of ‘cumulative risk’, these results suggest that the breadth of risk is a core predictor of outcome, and furthermore, that the severity of early deficits does not add significantly to this prediction.     

One of the troubles with outcome measures: Lost in translation

This paper presents the concerns of a client diagnosed with autism spectrum disorder about completing outcome measures. He was asked to complete CORE‐10 each time he attended a therapy session with the first author. This paper takes an epistemological position of co‐production, and written in response to the client's concerns, but this is limited by the client's wish and capacity to be involved in the writing up of this article. Implications of his experiences are drawn out for both clients with this diagnosis and more generally for all clients. Recommendations are made to recognise the limitations of measures and how to use outcome measures with more validity.     

矛盾态度对决策后自我评价的影响：有中介的双阶段调节作用

矛盾态度不仅影响信息搜索、态度形成和决策行为, 而且影响决策后自我评价。本研究构建了一个基于不确定性的中介作用、决策困难水平和结果效价的双调节作用的矛盾态度与决策后自我评价关系模型, 3个实验通过设计冲突情境对矛盾态度进行操纵, 冲突情境包括选择一所大学和就业企业, 运用SPSS 20.0软件对数据进行分析, 发现矛盾态度对决策后自我评价存在积极影响, 矛盾态度通过不确定性影响决策后自我评价的中介过程受到决策困难水平和结果效价的调节。矛盾态度和决策困难水平对不确定性产生影响, 不确定性和结果效价对决策后自我评价产生影响, 由于不确定性的分离效应, 使矛盾态度和决策困难水平对决策后自我评价产生相互冲突的双重作用结果。当获得负面结果时, 相较于低决策困难水平, 高决策困难水平的个体, 矛盾态度通过不确定性对决策后自我评价产生积极影响; 当获得正面结果时, 相较于高决策困难水平, 低决策困难水平的个体, 矛盾态度通过不确定性对决策后自我评价产生积极影响。     

基于正念的干预与自我同情的关系：一项元分析

运用元分析方法对国内外有关基于正念的干预与自我同情的关系问题进行了探讨, 通过文献检索, 纳入文献65篇, 总样本量为8103。异质性检验发现, 选择随机效应模型比较合适; 敏感性分析显示, 使用One-study removed逐步删除异质性较高研究, 基于正念的干预与自我同情呈显著正相关; 次群体检验表明, 基于正念的干预与自我同情关系受对比方式的调节与影响, 但不受群体和测量工具的影响。研究结果表明, 正念对自我同情水平会产生不同程度的积极影响, 同时随着对比方式的不同对基于正念的干预与自我同情的关系会产生不同的调节作用, 而群体和测量工具对基于正念的干预与自我同情的关系并无调节效应。     

Tobacco Use Predicts Treatment Dropout and Outcome in an Acute,Transdiagnostic Psychiatric Treatment Setting

Tobacco use is consistently associated with greater levels of depression and anxiety, broadly, and preliminary evidence suggests that current tobacco use is a significant predictor of dropout from psychiatric treatment. The current study extends past work to examine the impact of tobacco use on treatment dropout and outcomes in an acute psychiatric treatment setting. Upon intake to a partial hospitalization program (PHP), patients completed a battery of measures assessing sociodemographic characteristics, current tobacco use, depression and generalized anxiety, and substance use. Patients at the PHP also completed measures assessing levels of depression and generalized anxiety again upon discharge from the program. In line with hypotheses, current tobacco use was a significant predictor of dropout from treatment at the PHP. Importantly, this relationship remained significant when statistically controlling for demographic variables and psychiatric and substance use severity (such as number of previous inpatient psychiatric hospitalizations and degree of alcohol or drug problems). Results from the current study indicate that tobacco use is a significant risk factor for treatment dropout. Further research is needed to replicate these findings and to determine the mechanism underlying this link between tobacco use and treatment dropout for people receiving intensive psychiatric care.     

Neurocognitive outcomes in children with unilateral basal ganglia arterial ischemic stroke and secondary hemidystonia

Dystonia is a movement disorder that involves excessive, involuntary muscle contractions resulting in repetitive movements and/or abnormal posturing. One common cause of unilateral dystonia in childhood is ischemic stroke involving the basal ganglia and/or thalamus. Virtually nothing is known about neuropsychological outcomes in children who have dystonia following basal ganglia stroke. The present study explored whether or not children with secondary dystonia experience additional cognitive challenges when compared to children with similar patterns of brain injury, but no dystonia. We examined intellectual function, academics, and several aspects of executive function in children with unilateral basal ganglia stroke during childhood, comparing those with dystonia and those without. Although groups did not differ in terms of lesion size, we found significantly lower performance on measures of verbal and nonverbal reasoning, inhibitory control, and academic ability in children with secondary dystonia compared to those without. In contrast, there were no significant group differences on parent ratings of their child’s executive function in daily life. These findings suggest that maladaptive reorganization following basal ganglia stroke may contribute to the development of secondary dystonia and also to poor intellectual and academic outcomes in this group.