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PubMed2006

Sources of social support and burnout: a meta-analytic test of the conservation of resources model.

The Conservation of Resources (COR) model of burnout (Hobfoll & Freedy, 1993) suggests that resources are differentially related to burnout dimensions. In this paper, I provide a meta-analysis of the social support and burnout literature, finding that social support, as a resource, did not yield different relationships across the 3 burnout dimensions (emotional exhaustion, depersonalization, and personal accomplishment), challenging the COR model. However, when considering the source of the social support (work vs. nonwork) as a moderator, I found that work-related sources of social support, because of their more direct relationship to work demands, were more closely associated with exhaustion than depersonalization or personal accomplishment; the opposite pattern was found with nonwork sources of support. I discuss the implications of this finding in relation to the COR model and suggest future research directions to clarify the relationship between resources and burnout dimensions.

Burnout, Professional↗
PubMed2004

Interpersonal stressors and resources as predictors of parental adaptation following pediatric traumatic injury.

The authors examined the relationship of preinjury interpersonal resources and stressors to parental adaptation following pediatric traumatic brain injury (TBI) and orthopedic injury. Parents of children with severe TBI (n = 53), moderate TBI (n = 56), and orthopedic injuries (n = 80) were assessed soon after injury, 6 and 12 months after the initial evaluation, and at an extended follow-up with a mean of 4 years postinjury. General linear model analyses provide support for both main and moderating effects of stressors and resources on parental adjustment. Support from friends and spouse was associated with less psychological distress, whereas family and spouse stressors were associated with greater distress. The results also reveal a marked decline in injury-related stress over follow-up for families in the severe TBI group who reported a combination of high stressors and high resources. The decline suggests that interpersonal resources attenuated long-term family burden because of severe TBI. The findings are discussed in terms of their implications for intervention following TBI.

Adaptation, Psychological↗
PubMed2006

The soft constraints hypothesis: a rational analysis approach to resource allocation for interactive behavior.

Soft constraints hypothesis (SCH) is a rational analysis approach that holds that the mixture of perceptual-motor and cognitive resources allocated for interactive behavior is adjusted based on temporal cost-benefit tradeoffs. Alternative approaches maintain that cognitive resources are in some sense protected or conserved in that greater amounts of perceptual-motor effort will be expended to conserve lesser amounts of cognitive effort. One alternative, the minimum memory hypothesis (MMH), holds that people favor strategies that minimize the use of memory. SCH is compared with MMH across 3 experiments and with predictions of an Ideal Performer Model that uses ACT-R's memory system in a reinforcement learning approach that maximizes expected utility by minimizing time. Model and data support the SCH view of resource allocation; at the under 1000-ms level of analysis, mixtures of cognitive and perceptual-motor resources are adjusted based on their cost-benefit tradeoffs for interactive behavior.

Cognition↗
PubMed1990

Activity patterns in rats (Rattus norvegicus) as a function of the cost of access to four resources.

Patterns of eating, drinking, wheel running, and nesting were recorded in 2 experiments in which rats (Rattus norvegicus) lived in a laboratory environment that provided food, water, a running wheel, and a nest box. Access to each resource was contingent on the completion of a fixed ratio of bar presses and once earned remained available until the resource was not used for 10 consecutive min. In all cases an increase in the access price of a resource produced a decrease in the frequency with which the resource was accessed. This reduction in bout frequency was countered by an increase in bout size, which was compensatory for eating and nearly so for drinking, but which was only partially compensatory for wheel running. Nest bout size did not change significantly as nest price increased. The bout patterns of these 4 activities changed independently of one another, and the probabilities of behavioral transitions did not indicate strong links between any pairs of activities.

Animals↗
PubMed2003

Aging, memory load, and resource allocation during reading.

To test the notion that aging brings an inability to self-initiate processing, the authors investigated the effects of memory load on online sentence understanding. Younger and older adults read a series of short passages with or without a simultaneous updating task, which would be expected to deplete resources by consuming memory capacity. Regression analyses of word-by-word reading times onto text variables within each condition were used to decompose reading times into resources allocated to the array of word-level and textbase-level processes needed for comprehension. Among neither the young nor the old were word-level processes disrupted by a simultaneous memory load. However, older readers showed relatively greater levels of resource allocation to conceptual integration than the younger adults when under load, regardless of working-memory span or task priority. These results suggest that the ability to self-initiate the allocation of processing resources during reading is preserved among older readers.

Adolescent↗
PubMed2004

Neural gate keeping: the role of interhemispheric interactions in resource allocation and selective filtering.

The corpus callosum has been proposed to contribute to attention by modulating resource allocation between the hemispheres and filtering interhemispheric signal transmission (M. T. Banich, 1998). The resource allocation hypothesis predicts that interhemispheric interactions become more advantageous with increasing resource demands. The selective filtering hypothesis predicts that interhemispheric interactions become less advantageous as filtering requirements increase. The authors tested both predictions by comparing within- and across-hemisphere letter matching under dual-task (Experiment 1) and selective attention conditions (Experiment 2). Task-specific resource demands (i.e., letter processing load) alter the bihemispheric advantage, but the general demand imposed by an unrelated secondary task does not. Filtering requirements influenced the advantage from interhemispheric interactions, providing new evidence for the role of the corpus callosum in selective attention.

Adolescent↗
PubMed2004

Burnout patterns in rehabilitation: short-term changes in job conditions, personal resources, and health.

This longitudinal study reports the patterning of the burnout symptoms and the changes in employees' job conditions, personal resources, and psychological health 4 months after a rehabilitation intervention. The data were gathered by means of questionnaires before and after a rehabilitation period. Four patterns were identified: not burned out (n = 55), exhausted and cynical (n = 36), burned out (n = 26), and low professional efficacy (n = 18). These patterns differed in terms of job resources, personal resources, and depression. There were both positive and negative changes detected in participants' psychological health and job resources at the follow-up. The study shows the importance of identifying different burnout patterns in order to focus rehabilitation activities more effectively.

Burnout, Professional↗
PubMed2004

Implications of work and community demands and resources for work-to-family conflict and facilitation.

Based on a differential salience approach, this article examines the combined effects of work and community demands and resources on work-to-family conflict and facilitation. The study uses information from 2,507 employed respondents from the 1995 National Survey of Midlife Development in the United States. The findings indicate that work demands are relatively strongly related to work-to-family conflict, whereas work resources are relatively more important in relation to work-to-family facilitation. Social incoherence and friend demands are positively related to work-to-family conflict, whereas sense of community and support from friends have positive effects on facilitation. Community resources also show weak amplifying effects on some of the positive relationships between work resources and work-to-family facilitation. The findings provide modest support for the hypotheses.

Adult↗
PubMed2000

Variance in ecological consumer-resource interactions.

Food-web models use the effect size of trophic interactions to predict consumer-resource dynamics. These models anticipate that strong effects of consumers increase spatial and temporal variability in abundance of species, whereas weak effects dampen fluctuations. Empirical evidence indicates that opposite patterns may occur in natural assemblages. Here I show that spatial variance in the distribution of resource populations is sensitive to changes in the variance of the trophic interaction, in addition to the mean effect of consumers, relative to other causes of spatial variability. Simulations indicate that both strong and weak direct effects of consumers can promote spatial variability in abundance of resources, but only trophic interactions with a large mean effect size can reduce variation. Predictions of the model agree with the results of repeated field experiments and are consistent with data from published consumer-resource interactions, proving to be robust across widely varying environmental conditions and species' life histories. Thus, food-web models that embody variance in trophic interactions may have increased capacity to explain the wide range of effects of consumers documented in empirical studies.

Ecology↗
PubMed2004

"On Track"--an educational resource to support dental SHO training.

This paper describes the development, implementation and evaluation of an educational resource, "On Track", designed to support dental SHOs throughout their time in post, thereby helping them gain optimum benefit from this important stage in their early postgraduate training. The need for such a resource was highlighted by a previous study undertaken by the paper's key authors with SHOs and their trainers in a UK dental school. Among several areas of change identified by both trainers and trainees were the needs to develop the SHO experience into more than an apprenticeship by improving the trainer/trainee relationship, and to encourage trainee-centred learning and self-appraisal. The key aims of "On Track" were therefore to define the outcomes of SHO training, to facilitate the relationship between SHO and educational supervisor (trainer), and to encourage the SHO in reflective learning and self-appraisal."On Track" was subject to developmental testing with both trainers and trainees to ensure that it could achieve these aims and the resultant resource is described, along with its implementation and evaluation. "On Track" met with mixed success and the reasons behind this and conclusions drawn for the introduction of any future similar resources are outlined.

Clinical Competence↗
PubMed2005

In-patient medical resource utilization for high-level cervical spinal cord injury without bone fracture in Taiwan.

STUDY DESIGN: Retrospective review of secondary data obtained from the Bureau of National Health Insurance (BNHI) on medical resource utilization in in-patient cervical spinal cord injury patients in Taiwan. OBJECTIVES: Since the start of the National Health Insurance Program in Taiwan in 1995, costs have continued to increase each year. High-level cervical spinal cord injury, a catastrophic illness, consumes a large amount of medical resources. Appropriate control of in-patient costs for these patients is mandatory. Analyses of the factors influencing the health-care costs of these patients are needed, so cost-containment policies can be established by the BNHI to conserve health-care resources. SETTING: Health-care institutions throughout Taiwan. METHODS: We obtained secondary data on a randomized basis for diagnostic codes 952.00, 952.01, 952.02, or 952.03 of the International Classification of Diseases, Ninth Revision, Clinical Modification from the BNHI files of annual in-patient expenses during the period from 1998 to 2000. There were 184 hospital admission records studied. RESULTS: The lengths of stay and in-patient costs were significantly different among different hospital types. Length of stay also was statistically different according to patient, gender, and age. The lengths of stay and in-patient costs were influenced by the hospital accreditation level and patient gender. Medical orders were influenced by patient age. CONCLUSIONS: Basic and selective diagnostics and therapeutics for high-level spinal cord injury without bone fracture should be established. Thus, patient needs for appropriate medical care will be met and overuse of medical resources will be prevented. Communication among doctors also should be strengthened.

Adolescent↗
PubMed1997

Patient-perceived severity of irritable bowel syndrome in relation to symptoms, health resource utilization and quality of life.

AIM: In this study of patients with irritable bowel syndrome (IBS), we evaluated the relationship between patient-rated severity of IBS and patients' physical and psychological symptoms, health care resource use and quality of life. METHODS: One hundred and twenty-six patients diagnosed with IBS were administered a series of questionnaires, including the Bowel Symptom Checklist, the Symptom Checklist-90-R (a psychological symptom checklist), the IBSQOL (a disease-specific quality of life instrument), the SF-36 (a general health status instrument), and a health resource utilization assessment that measured health care use, time loss from work, impact on productivity, and days worked with symptoms. RESULTS: No relationship was found between IBS severity and gastrointestinal symptoms, except for a feeling of unpassed stool. IBS severity was also not related to psychological symptom severity. Direct traditional indicators of resource use (e.g. physician visits, hospital admissions and emergency room visits) were not significantly associated by severity level; however, indirect measures of resource use (e.g. number of days with pain, productivity and number of bed days) were related to severity. Quality of life was clearly associated with perceived IBS severity. Patients who rated themselves as very severe reported the lowest scores and had the poorest health for all quality of life dimensions measured. CONCLUSIONS: These findings suggest that perceived IBS severity is defined by the limitations the disease imposes, rather that by the symptoms. Patients with reduced productivity and decreased functioning for most of the quality of life indicators were those who rated their IBS as very severe.

Absenteeism↗
PubMed2001

Healthcare resource utilization in the management of oesophageal adenocarcinoma.

OBJECTIVE: To study the natural history of oesophageal adenocarcinoma in terms of utilization of the healthcare resources and associated medical costs. METHODS: All 29 patients treated at the University of New Mexico Health Center between 1 January 1992 and 1 December 1998 for an oesophageal adenocarcinoma were included in the study. For each individual patient, all medical resources utilized, facility costs, and physician fees were retrieved from the computerized databases of the collection departments. RESULTS: During the progress of the disease, the same type of diagnostic or therapeutic procedure became necessary a number of times, and patients underwent, on average, three (range one to eight) upper gastrointestinal endoscopies, five (range one to 11) computerized tomography scans, 35 (five to 143) X-ray examinations, and 28 (three to 46) radiation therapies or 39 (10 to 74) chemotherapies. The large variation in the numbers of resources utilized was also reflected by a corresponding variation in total healthcare costs. The mean cost per patient was $48 127, ranging between $13 454 and $139 721. Facility costs comprised 88% of all costs compared to physician fees which comprised 12%. The largest cost items, in declining order, were physician encounters ($16 916), radiation plus chemotherapy ($9909 plus $4891, respectively), and pharmacy prescriptions ($7565). CONCLUSIONS: The prolonged disease process and the many diagnostic and therapeutic procedures result in complications, side-effects, inconclusive tests, or failed therapies that all markedly increase the use of healthcare resources. Because such outcomes are the rule rather than the exception, the management of oesophageal adenocarcinoma is expensive.

Adenocarcinoma↗
PubMed2002

Drug reimbursement: indicators of inappropriate resource allocation.

AIMS: In many countries, governments and third parties find themselves paying for (reimbursing) unproven, inadequate products limiting their ability to invest in therapies with evidence of relevant patient benefit. We examined how three characteristics, level of therapeutic evidence, susceptibility of inappropriate prescribing, and intercountry variation can be used to identify inefficiencies in pharmaceutical reimbursement among four European Union countries, Austria, Belgium, the Netherlands and Sweden. METHODS: Specific classes of medicines were chosen to provide useful examples of how healthcare resources could be reallocated. A high level of therapeutic evidence was defined as a substantial body of evidence in at least one indication with clear-cut support of relevant patient benefit. The susceptibility of inappropriate prescribing was defined as the likelihood of prescribing a drug outside the scenario for which clear-cut evidence (if any) has been documented to produce relevant benefit for the patient. The intercountry variation represents the variation in utilization of reimbursed drugs across the four countries. RESULTS: The combination of these characteristics provides a useful tool for assessing appropriate reimbursement decisions. It would be beneficial to healthcare payers as well as patients to move resources from products that have a low level of therapeutic evidence and a high susceptibility of inappropriate prescribing to products with a high level of therapeutic evidence and low susceptibility of inappropriate prescribing, and to use intercountry variation as a signal of drug classes that should be subject to further scrutiny. CONCLUSIONS: A method is presented to help policy-makers identify inefficiencies in the spending of limited health care resources, and to reallocate resources to products that have been shown to improve patient care through evidence-based medicine.

Austria↗
PubMed2002

Developing a cardiac rehabilitation education resource for rural health workers in Queensland: reviewing the process and outcomes.

The provision of cardiac rehabilitation services to people living in rural and remote areas is often limited to the nearest large hospital situated in urban coastal centres, leaving a gap in the rehabilitation of cardiac patients. This paper discusses the development, composition and the results of a process evaluation of a cardiac rehabilitation education resource for rural health workers. The development of the structure and content of the manual were informed by a review of current rehabilitation literature, the results of focus groups with 60 rural health workers in five Queensland rural centres, and survey results of 135 rural cardiac patients admitted to five Queensland hospitals. The draft manual was trialled by health workers in seven rural centres throughout Queensland by the National Heart Foundation (Queensland Division). The results of the process evaluation provided valuable feedback on the efficacy of the manual as an educational resource for rural health workers in the cardiac rehabilitation of their patients. Specific content in the educational resource was strengthened as a result of this evaluation. The limitations of the evaluation and suggestions for its improvement are also discussed. The paper highlights the importance of this level of evaluation in the development of health promotion education resources.

Australia↗
PubMed1995

Anxiety levels of pregnant women during ultrasound examination: coping styles, amount of feedback and learned resourcefulness.

Anxiety levels were measured before and after ultrasound examination in 183 women who underwent the procedure as part of their routine prenatal care. Women were classified according to their preferred mode of information gathering, their amount of available cognitive resources and predetermined feedback conditions. The results indicated significant reductions in state or situational anxiety levels for all subjects while trait anxiety was unaffected. In addition, the results suggested a correspondence between learned resourcefulness and informational coping styles. Women who had higher levels of cognitive resources and actively sought out information showed significantly greater decreases in state anxiety levels. This finding was also true for women who had lower levels of cognitive resources and tended to block out information. The impact of the scan was more profoundly affected by personality repertoires and informational coping styles than by either of the feedback conditions.

Adaptation, Psychological↗
PubMed1995

What have we achieved in ovarian cancer? A comparison of survivals and resources in two different periods.

In a geographically well-defined region in Denmark, survival and resource spending for strictly defined epithelial ovarian cancer patients treated during the periods 1973-1978 and 1981-1986 were compared. Almost all epithelial ovarian cancer patients diagnosed during the periods involved were identified; in both periods 206 patients were found. The number of patients was cross-checked with the Danish Cancer Registry. Treatment strategy was totally different in the two periods. In the first period debulking surgery was not routine and postoperative treatment consisted of pelvic irradiation and alkylating agents. In the second period the patients were treated according to national protocols prescribing debulking surgery, second-look laparotomy, and allocation to randomized trials. Advanced ovarian cancer patients were treated with combination chemotherapy with cisplatinum. Median survival was superior for the period 1981-1986, but long-term survival was similar in the two periods, 5-year survival being 27.5% for the period 1973-1978 and 26.9% for the period 1981-1986. The resources spent on ovarian cancer patients were calculated for the two periods, expressed as 'bed-days' spent on ovarian cancer. An estimate of the price of the extra resources used was made; in the second period $1.18 million $US more were spent on ovarian cancer. The costs were correlated with survival and the cost per gained year of life was estimated as $36 493. In conclusion, the study shows that for all stages of ovarian cancer an improvement of median survival was found, but not of long-term survival. The survival gain was associated with extra resource spending.

Journal Article↗
PubMed2002

Health care resource utilization and the impact of anemia management in patients with chronic kidney disease.

BACKGROUND: Limited information exists on resource utilization patterns and overall patient management of chronic kidney disease (CKD) before the initiation of dialysis therapy. METHODS: A retrospective claims analysis from January 1997 to December 1999 was conducted using a managed care database on 1,936 incident dialysis patients, examining the 12 months preceding dialysis initiation to evaluate whether managed care patients with CKD are receiving expected interventions and appropriate management of CKD. RESULTS: Mean age was 66.8 years, 46% were women, 91.2% had claims for facility services, 97.6% had claims for professional services, and 95.7% had claims for outpatient pharmacy, with mean costs per patient of $26,204, $9,623, and $1,503, respectively. Sixty-two percent of patients were hospitalized, averaging 1.3 admissions annually ($14,818/admission; average, 7.8 d/admission). Despite high overall resource use, treatments for preparation for dialysis therapy, appropriate tests, and nutritional supplements (eg, phosphate binders, B-complex combinations, and vitamins with iron) were administered infrequently. Comorbid conditions, such as anemia (47.4%) and diabetes (53%), were appropriately addressed with erythropoietin (10.5%) and angiotensin-converting enzyme inhibitors (38%) in only a minority of cases. In preparation for dialysis therapy, only 20.8% underwent a vascular access procedure. CONCLUSION: Although patients consumed significant amounts of resources during the 12 months before dialysis initiation, many were not using expected resources for the appropriate management of CKD. A number of opportunities exist to improve predialysis care through better management of these conditions.

Aged↗