Gender equality and managers' work in elderly and social care: A structural equation modelling approach.

AIM: The study explores whether, and how, gender equality is associated with key aspects related to operative managers' improvement work. We explore the possible associations between gender equality and; prioritization of social regulations in operative decision-making, engagement in operative improvement work, group dynamics challenges and collaboration between managers and subordinates. BACKGROUND: Regarding organizational relations and preconditions for providing good care and developing operative work in the social and elderly care sector, the value of having organizational gender equality is unknown. METHOD: Associations were analysed using structural equation modelling of questionnaire data. The questionnaire was distributed to first-line managers in a large city in Sweden (n = 598, response rate 56%). RESULTS: Positive perceptions of organizations' gender equality were significantly associated with more engagement in operative improvement work, fewer group dynamics challenges and higher priority of social regulations in unit decision-making, also when controlling for confounders. Gender equality had no association with managers' collaboration with subordinates in this study. CONCLUSION(S): This study demonstrates that equal opportunities for male and female workers could benefit operative managers' improvement work. IMPLICATIONS FOR NURSING MANAGEMENT: Organizations that strive to improve conditions for operative work, which strengthen preconditions for service development, should include values of gender equality.

Sex differences in dementia: on the potentially mediating effects of educational attainment and experiences of psychological distress.

BACKGROUND: Old-age dementias are known to disproportionally affect women as well as individuals with low educational attainment. The higher lifetime risk of dementia among women is usually attributed to their longer life expectancy. However, the impact of sex, and subsequent gender inequity, is likely to be more multifaceted than this explanation implies. Not least because of historical inequities in access to education between the sexes and the gender and socio-economic gradients in risk factors such as stress, depression and social isolation. Consequently, the present study sought to test whether differences in educational attainment and experiences of general psychological distress mediate the association between female sex and dementia. METHODS: The study utilizes data obtained through the Gothenburg H70 Birth Cohort Study and the Prospective Populations Study on Women (n = 892). Data were analysed using Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM) with Weighted Least Squares Means and Variance adjusted (WLSMV) estimation. General psychological distress was indicated by a latent variable and constructed from five manifest items (previous depression, stress, self-esteem, chronic loneliness and satisfaction with social situation) that were all measured at baseline. RESULTS: While the results could not corroborate that education directly mediates the effect of sex on dementia, level of distress was predicted by both female sex (0.607, p < .001) and education (- 0.166, p < .01) and, in turn, shown to be significantly associated with dementia (0.167, p < .05), also after controlling for confounders. When time from baseline to diagnosis was increased through sequential exclusion of dementia cases, the effect of distress on dementia was no longer significant. CONCLUSION: The overall findings suggest that social (dis) advantage predicts general psychological distress, which thereby constitutes a potential, and rarely acknowledged, pathway between female sex, education, and dementia. They further underline the importance of attending to both education and distress as 'gendered' phenomena when considering the nature of their associations with dementia. However, the possibility of reverse causality bias must be acknowledged and the need for longitudinal studies with longer follow-up stressed.

The impact of social networks and APOE ε4 on dementia among older adults: tests of possible interactions.

Objectives: Emerging evidence suggests that social networks may protect against the development of dementia among older adults. In this study we analysed the association between social networks, the apolipoprotein E (APOE) ε4 allele, and dementia. We also investigated whether there were gender-specific patterns in this respect.Method: The analyses used population-based longitudinal data from Gothenburg, Sweden: the H70 Birth Cohort Study and the Prospective Population Study on Women (PPSW). A total of 580 individuals born in 1930 underwent semi-structured neuropsychiatric examinations in 2000-2001. Follow-up examinations were carried out in 2005-2006 and 2009-2010. The timing of dementia onset was analysed using Cox proportional hazards regression.Results: The presence of the APOE ε4 allele affected the risk of developing dementia in both genders. Among women, distant social networks had a protective effect on dementia, while among men the significant associations between close social networks and dementia did not remain after controlling for covariates. Significant interactions between social networks and the APOE ε4 allele were not found.Conclusion: Strong social networks do not seem to moderate the increased risk of dementia implied by the APOE ε4 allele. Nevertheless, our results underline the importance of strong social networks in postponing dementia onset and indicate that their impact may differ among men and women.

Conditions for distributed leadership practices among managers in elder- and disability care organizations: A structural equation modeling approach.

Background: Against the backdrop of worldwide increases in life expectancy, there is a growing concern about the future of health and social care services in many countries, including Sweden. This is not least due to expected cutbacks in tax revenues and increasing staff shortages in the welfare sector. Challenges such as these have spurred leadership reforms aimed at mobilizing employee engagement and promoting job attractiveness. For instance, distributed leadership, whereby leader responsibilities are distributed and shared among team members, has gained momentum in recent decades. Nevertheless, there is still limited knowledge as to whether and how organizational conditions impact first-line managers' inclination to distribute influence and control. Objective: This study aims to examine the organizational precursors of two interrelated aspects of distributed leadership among first-line managers in municipal elder- and disability care: collaborative decision-making and the presence (or lack of) a participatory leadership approach. Methods: Utilizing survey data from managers working in the elder- and disability care sectors in the municipality of Gothenburg, Sweden (N = 250), associations between conditions and aspects of distributed leadership were analyzed by means of Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM). Results: Both aspects of distributed leadership were positively and significantly associated with managers' perceptions of having well-functioning collaborations with their employees (ß = 0.277 [0.122-0.432]; ß = 0.492 [0.346-0.637]) as well as with the managers' active participation in development work aimed at, e.g., promoting organizational trust (ß = 0.242 [0.039-0.446]; ß = 0.251 [0.103-0.398]). No significant associations between distributed leadership and support from senior management or positive collaborations with support functions were observed in the controlled analyses. However, managers' perceptions of organizational governance deficits were shown to be significantly and positively associated with having a more participatory leadership approach (ß = 0.261 [0.032-0.491]). Conclusions: In line with the notion of distributed leadership as a "collective activity", which is realized in the interaction between managers and their employees, the findings demonstrate that trusting collaborations with responsible and knowledgeable employees play a key role in its practical implementation. Also, distributed leadership, and the work team relations through which it is enabled, are likely to mutually and positively reinforce each other. Additionally, the analyses revealed that managers' experiences of poor organizational governance appear to promote certain distributed leadership practices. Potentially, this could be because such deficits encourage them to seek support and guidance from their employees, but more research exploring these mechanisms is needed.

Socioeconomic status, gender and dementia: The influence of work environment exposures and their interactions with APOE ɛ4.

It is a well-established fact that unfavourable social and economic conditions have a negative impact on health and longevity. Recent findings suggest that this is also true of age-related dementias. Yet most common indicators of socioeconomic status (SES) say very little about the actual mechanisms at play in disease development. The present paper explores five work exposure characteristics, all of which have a clear social gradient, that could potentially shed further light on the relationship between SES and dementia. Specifically, it investigates whether these exposures could moderate the impact of a well-known genetic risk factor: the APOE ɛ4 allele. The empirical analyses are based on data from a Swedish population study (n = 1019). Main occupation was linked to The Job Exposure Matrix to estimate the individuals' exposure to the following work environment factors: work control, support, psychological demands, physical demands and job hazards. All analyses were conducted using binary logistic regression and focused specifically on gene-work exposure interactions. A significant main effect of work control on dementia risk was detected for males (OR = 0.68; p< 0.05), but not for females. However, control was found to significantly moderate the effect of APOE ɛ4 in both genders, albeit in different ways. These findings do not only underscore the importance of considering interactions between social and genetic risk factors to better understanding multifactorial diseases such as dementia. They also propose that gender- and class-based inequities interact, and hence must be considered simultaneously, also in relation to this particular disease.