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This study is a follow-up of inpatients diagnosed with severe depression/melancholia between 1956 and 1969. During this period, all inpatients at the Department of Psychiatry, University Hospital, Lund, were rated on a multidimensional diagnostic schedule on discharge. There were 471 patients born from 1920 onward. In the present follow-up, 2006 to 2010, 169 survivors could be traced. They were asked to participate in the study involving a telephone interview, in which a structured life chart was used. Of the patients contacted, 16 were ill or confused and 3 did not remember ever being depressed, leaving 150 who could participate. Seventy-five of these agreed to participate in the study. Long-term course of depression was evaluated by cluster analysis and compared to background variables, such as heredity for depression, perceived parental rearing behaviour, and treatment of index depressive episode. Using a cluster analysis the patients could be separated into six clusters describing the course: i) single or few episodes followed by long-lasting remission; ii) single or few episodes followed by long-lasting remission, although shorter; iii) single or few episodes followed by late recurrence; iv) single or few episodes, but more frequently ill, followed by late recurrence; v) several episodes followed by lasting remission; vi) chronic course of episodes. Remission or recurrence could therefore occur even after more than a decade. In summary, there was a short-term course with or without recurrence or a chronic course with or without late remission. Heredity for depression was significantly related to a chronic course with or without late remission.

This study aims to investigate how stakeholders perceive the company's nonfinancial disclosure after a scandal has occurred. More specifically, the authors examine whether and how sustainability reporting practices in the aftermath of a scandal can influence the perceptions of stakeholders in terms of hypocrisy and legitimacy.

The present research represents a companion paper to another study in this issue that investigates the adaptation of companies' reporting behaviors after a scandal. The results of the initial qualitative study informed the subsequent quantitative study developed in this article. The authors build on the evidence of the main paper and perform a 2 × 2 between-subjects experiment to examine how stakeholders perceive the actions of companies that aim to restore their eroded legitimacy through social, environmental and sustainability (SES) reporting.

The results suggest that when companies take responsibility and develop remedial, socially responsible corporate activities are perceived as less hypocritical and more legitimate. Moreover, we show an interaction effect between taking responsibility and developing remedial socially responsible actions on hypocrisy and legitimacy perception.

The present research takes advantage of an experimental design to investigate the effects of the adaptation of SES reporting from the perspective of stakeholders. The study provides insightful theoretical and practical implications for managers regarding how to handle a reputational loss and avoid perceptions of hypocrisy.

Emergency care delivery is a process requiring input from various healthcare professionals within the hospital. To deliver efficient and effective emergency care, professionals must integrate rapidly at multiple interfaces, working across functional, spatial and professional boundaries. Yet, the interdisciplinary nature of emergency care presents a challenge to the optimization of patient flow, as specialization and functional differentiation restrict integration efforts. This study aims to question what boundaries exist at the level of professionals and explores how these boundaries may come to influence integration and operational performance.

To provide a more holistic understanding of the inherent challenges to integration at the level of professionals and in contexts where professionals play a key role in determining operational performance, the authors carried out an in-depth case study at a busy, Level 1 trauma center in The Netherlands. In total, 28 interviews were conducted over an 18-month period.

The authors reveal the existence of structural, relational and cultural barriers between (medical) professionals from different disciplines. The study findings demonstrate how relational and cultural boundaries between professionals interrupt flows and delay service processes.

This study highlights the importance of interpersonal and cultural dynamics for internal integration and operational performance in emergency care processes. The authors unveil how the presence of professional boundaries creates opportunity for conflict and delays at important interfaces within the emergency care process, and can ultimately accumulate, disrupting patient flow and increasing lead times.

This study aims to examine the rationales for and obstacles to developing a national qualifications framework (NQF) in Japan. From a research perspective, it attempts to propose a model of a qualifications framework in the national context to provoke further political discussion in developing the Japanese Qualifications Framework (JQF).

To propose a possible model of a qualifications framework in the Japanese context, this study employs a qualitative document analysis approach to known NQFs. Next, based on documents and the literature, including government data and the United Nations Educational, Scientific and Cultural Organization’s Tokyo Convention (2011a, b), this study analyzes the motives and challenges in developing the JQF.

Japanese motives to develop the JQF can be summarized in four conditions: (a) International expectations along with the Tokyo Convention and establishment of the National Information Center, (b) avoiding qualification holders’ disadvantages in mobility, (c) quality assurance of qualifications with a competence-based approach and (d) lifelong learning by promoting recognition of diverse learning. The challenges in developing the JQF are (a) fitness with the traditional employment system and (b) multiple stakeholders’ involvement. The current priority in developing an NQF in Japan is to make educational qualification information “visible” based on legal grounds, particularly entrance requirements, to facilitate mobility.

This study explores the possibility of the JQF by summarizing the background and roles of NQFs worldwide and clarifying the motives and challenges for developing the JQF. This study provides suggestions for the possible qualifications framework model in the Japanese context from academic and practical perspectives in Japan, where official discussions on establishing an NQF have not progressed. Ensuring the international compatibility of qualifications so that qualification holders can smoothly take the next step in their studies and employment is important.

Patient length of stay (LOS) is an important indicator of emergency department (ED) performance. Investigating factors that influence LOS could thus improve healthcare delivery and patient safety. Previous studies have focused on patient-level factors to explain LOS variation, with little research into service-related factors. This study examined the association between LOS and multi-level factors including patient-, service- and organization-level factors.

This study uses a retrospective observational design to identify a cohort of patients from arrival to discharge from ED. A year-long data regarding patients flow trhoguh ED were analyzed using analytics techniques and multi-regression models. The response variable was patient LOS, and the independent variables were patient characteristics, service-related factors and organizational variables.

The findings of this study showed that older patients, middle triage and hospitalization were all associated with longer LOS. Service-related factors such as complexity of care provided, initial ward designation and ward transfer had a significant impact as well. Finally, prolonged LOS was associated with a higher ratio of patients per medical doctor and per nurse. In contrast, a higher number of residents in the ED were associated with longer patient LOS.

Previous studies on patient LOS have focused on patient-level factors, with little research on service-related factors. This study has addressed that gap by examining the association between LOS and multi-level factors including patient-, service- and organization-level factors. Patient-level factors included demographics, acuity, arrival shift, arrival mode and discharge type. Service-level factors consisted of first ward, ward transfer and complexity of care provided. Organizational factors consisted of three ratios: patients per MD, patients per nurse and patients per resident. The results add to the current understanding of factors that increase patient LOS in EDs and contribute to the body of knowledge on ED performance, operation management and quality of care. The study also provides practical and managerial insights that could be used to improve patient flow in EDs and reduce LOS.

This paper aims to assess the tie-in between psychological contract breach (PCB) and job satisfaction (JST) amongst medical doctors (MDs) working in two stress-prone regions of Ghana, and further analyses the moderating effect of openness to experience (OPE) on this tie-in.

Responses from 214 MDs were analysed. Questionnaires were self-administered. Research philosophy was positivism, research approach was quantitative, research design was explanatory and study design was cross-sectional. Test of normality, Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett’s test of sphericity were applied. Both reflective measurement and structural models were assessed. Path coefficients were analysed using partial least squares (PLS) algorithm tool and moderation effect was conducted using the product indicator approach. Control variables were sex (GEN1), age (GEN2), employment type (GEN3) and tenure (GEN1). A significant level was set at 5%. Smart PLS 2.0 M.3 software was used.

The analysts found support for a significant moderating effect of OPE on the tie between PCB and JST, such that the consequences of PCB on JST was minimised for MDs who scored high on OPE trait.

PCB, if not addressed, may lead MDs to be less satisfied with their jobs. In stress-prone health zones where PCB exists, MDs who are inspired, creative, self-sufficient, experimenting and visionary are more likely to be satisfied with their job.

This study offers health-care literature on the moderating role of OPE personality dimension on the bond between PCB and JST, using PLS-structural equations modelling, which is a superior and robust analytical tool.

Many patients referred by their GP for an assessment by secondary mental health services are unlikely to ever meet eligibility thresholds for specialist treatment and support. A new service was developed to support people in primary care. “the authors evaluate” whether the phased introduction of the Lambeth Living Well Network (LWN) Hub to a population in south London led to: a reduction in the overall volume of patients referred from primary care for a secondary mental health care assessment; and an increase in the proportion of patients referred who met specialist service eligibility criteria, as indicated by the likelihood of being accepted in secondary care.

The evaluation applied a quasi-experimental interrupted time series design using electronic patient records data for a National Health Service (NHS) provider of secondary mental health services in south London.

Scale-up of the Hub to the whole of the population of Lambeth led to an average of 98 fewer secondary care assessments per month (95% CI −118 to −78) compared to an average of 203 assessments per month estimated in the absence of the Hub; and an absolute incremental increase in the probability of acceptance for specialist intervention of 0.20 (95% CI; 0.14 to 0.27) above an average probability of acceptance of 0.57 in the absence of the Hub.

Mental health outcomes for people using the service and system wide-service impacts were not evaluated preventing a more holistic evaluation of the effectiveness and cost-effectiveness of the LWN Hub.

Providing general practitioners with access to service infrastructure designed to help people whose needs cannot be managed within specialist mental health services can prevent unnecessary referrals into secondary care assessment teams.

Reducing unnecessary referrals through provision of a primary-care linked mental health service will reduce delay in access to professional support that can address specific mental-health related needs that could not be offered within the secondary care services and could prevent the escalation of problems.

The authors use NHS data to facilitate the novel application of a quasi-experimental methodology to deliver new evidence on whether an innovative primary care linked mental health service was effective in delivering on one of its key aims.

The choices that international students make regarding abroad study destination selection or leave the host country after graduation are influenced by a variety of factors that are both related to positive and negative aspects of the host country.

This study builds on the push-pull factor theory and examines the factors that influence international students' decision to choose abroad study destination (Finland) or leave the country after their graduations. The data were collected through an online survey of 195 international students currently studying in Finland and were analysed using partial least squares structural equation modelling (PLS-SEM) technique. This method offers a flexible and robust approach to test relationships, particularly in situations where sample size and the conceptual model are small and complex.

The results show that international students' choice of study destination (Finland) is influenced by the host country's quality of life, academic excellence and economic factors such as salary and benefits. Unfamiliarity with the culture and language barriers have a negative impact on their decisions to stay in the host country after graduation.

By utilising a comprehensive analysis of both push and pull factors in relation to the host country, this study unveils a novel perspective in the field of international student mobility. The results provide insights to the institutional leaders and policymakers into how to attract and retain international students by focusing on the factors that matter most to international students. To attract more international students, higher education institutions (HEIs) should include career development activities, e.g. job fairs, language training, scholarships and internships in their curriculum. Moreover, it provides recommendations on how to create a welcoming and supportive environment that promotes academic excellence and career development.