Chiropractic treatment for low back pain (LBP) can often be divided into two phases: Initial treatment of the problem to attempt to remove pain and bring it back into its pre-clinical or maximum improvement status, and "maintenance care", during which it is attempted to maintain this status. Although the use of chiropractic maintenance care has been described and discussed in the literature, there is no information as to its precise indications. The objective of this study is to investigate if there is agreement among Swedish chiropractors on the overall patient management for various types of LBP-scenarios, with a special emphasis on maintenance care.The design was a mailed questionnaire survey. Members of the Swedish Chiropractors' Association, who were participants in previous practice-based research, were sent a closed-end questionnaire consisting of nine case scenarios and six clinical management alternatives and the possibility to create one's own alternative, resulting in a "nine-by-seven" table. The research team defined its own pre hoc choice of "clinically logical" answers based on the team's clinical experience. The frequency of findings was compared to the suggestions of the research team.Replies were received from 59 (60%) of the 99 persons who were invited to take part in the study. A pattern of self-reported clinical management strategies emerged, largely corresponding to the "clinically logical" answers suggested by the research team. In general, patients of concern would be referred out for a second opinion, cases with early recovery and without a history of previous low back pain would be quickly closed, and cases with quick recovery and a history of recurring events would be considered for maintenance care. However, also other management patterns were noted, in particular in the direction of maintenance care.To a reasonable extent, Swedish chiropractors participating in this survey appear to agree on the clinical management for different cases of LBP. According to experience, chiropractic treatment can often be divided into two phases: Initial treatment of the problem to attempt to bring it back into its pre-clinical or maximum improvement status, and "maintenance care", during which it is attempted to maintain this status. The first definition of maintenance care that we could find in the literature was provided by Breen in 1977 : "A regiAccording to the literature, spinal manipulative therapy is an important aspect of the maintenance care approach -7, but aDespite this lack of scientific support, it was shown that American chiropractors share a common understanding about the purpose and composition of maintenance care and that they recommend it to the majority of their patients . HoweverWe were interested in finding out whether there is agreement among chiropractors regarding their management for various types of patient groups. In particular, we wanted to find out when chiropractors would recommend maintenance care.Many patients who visit chiropractors suffer from low back pain (LBP). It was therefore logical to start this work on chiropractic patients with LBP. The results from this study may create a base from which further research into maintenance care can be conducted with the ultimate aim to investigate its clinical usefulness. Several such projects are presently underway.A questionnaire was designed describing various LBP-scenarios at the end of the initial more intensive treatment period, when a decision about maintenance care would be made. For each scenario the chiropractors could choose from a number of management strategies, including the option of maintenance care. In other words, the chiropractors were to match each scenario with the management strategy of his/her choice.The questionnaire was distributed to a group of Swedish chiropractors in the spring of 2006. Replies were returned in pre-printed and pre-stamped envelopes.The research team consisted of a group of seven chiropractors, having obtained their chiropractic degree in the US, Australia, UK or Denmark with a clinical experience ranging from 4 to 25 years. This group was supervised by a professional chiropractic researcher (CLY).A questionnaire was designed in English by the research team, with the purpose of describing a range of clinical scenarios and finding out which management strategies chiropractors would prefer to use for these scenarios. In addition, practitioners were asked if they use "maintenance care" in their practice and if so, the proportion of such patients on the day of the study. Similarly to a previous study , we purpIn order to make the questionnaire as brief and clear as possible, an uncomplicated case was used as a basis for nine possible outcomes that were briefly described ("scenarios"). The basic facts for this hypothetical patient were: "A 40-year old man who consults you for Low Back Pain with no additional spinal or musculoskeletal problems, and with no other health problems. His X-rays are normal for his age. There are no "red flags". Clearly, X-rays would not be indicated in real life  but thisThe nine different scenarios were described in relation to outcome after the initial treatment period. These outcomes had to be described in overall terms as all chiropractors do not use the same methods of evaluation of their patients' progress. Outcome was described on the basis of "pain" because it is highly relevant for both patients and chiropractors during the initial treatment of LBP, regardless how it is measured. Treatment regimes also differ between chiropractors, making it necessary also here to provide simplistic situations in relation to number of treatments and duration of treatment.After each of these nine scenarios there were six possible management strategies, preceded by the question: "What would you recommend?" It was also possible to suggest one's own management strategy alternative. For ease of reporting, brief terms will be used in this report to describe these management strategies , and that cases of concern would be referred out for a second opinion. Specifically, we expected that a prerequisite for maintenance care was that the patient experienced considerable improvement.In this study we defined improvement in relation to percent improvement of pain. Our scenarios included the following possibilities for pain outcome: "completely gone" (i.e. 100% better), "80% better", "50% better", and "20% better". The difference between 50% and 20% was deliberately made large in order to indicate that the 20% improvement was clinically unsatisfactory. Please, see Additional File Chiropractors were invited to the study if they were members of the Swedish Chiropractors' Association, "Legitimerade Kiropraktorers Riksorganisation" (LKR), and if they had previously actively participated in practice-based research project. The LKR, at the time of the study, consisted of 160 members.Over the past years, also locally trained so-called chiropractors have obtained legal recognition in Sweden. However, because their education, after inspection of their school, was not approved by the governmental body (the Swedish Board of Education) , and becThe data were analyzed manually by the members of the research team. The percentage of responses  for each hypothetical scenario was calculated. Explanations provided under "none of the above. Please explain..." (G) were scrutinized for contents and recoded into the correct box, if possible, or else left under G. An extra response possibility was added consisting of "multiple answers". Thereafter, the number of times that each strategy was selected for each scenario was calculated. Finally, the proportion of so-called "maintenance care" patients on the day of the survey was calculated for each practitioner to make it possible to estimate the mean and median proportion of maintenance care patients in the entire group of responders.All participants were anonymous and the questionnaire contained no information that could identify the participants. Studies of this type do not require permission from the local ethics committee.Fifty-nine chiropractors of the 99 potential participants (60%) returned their questionnaire. The proportion of patients who were reported to have been seen under a "maintenance care"-scheme, on the day of the survey, ranged between 2% and 95% (mean 28.6 and median 20).As can be seen in Table A closer look at the various preferred management strategies for the nine case scenarios told the following story: "Second opinion" would be recommended for the patient who got gradually worse (scenario 8) and for another patient, who did not improve and had signs of other problems (scenario 9). The "quick fix"-option was selected for scenario 1, the patient who improved quickly, was uncomplicated and had no past LBP-history. "Try again" was considered particularly relevant for scenarios 3,5,6 and 7; all patients who failed to improve quickly and well but did not appear to have any warning signs. "Symptom-guided maintenance care" was predominantly selected for scenarios 2 and 4. Case 2 was described as a patient without past LBP, who recovered quickly but feared future problems and case 4 made good recovery but had a history of recurrent problems. "Clinical-findings guided maintenance care" and "External help – keep in touch" were never first choice. The preferred pattern of management strategies was largely in agreement with the pre hoc choices made by the research team.Two of the strategies could be classified as "maintenance care" . When combined, some type of maintenance care achieved the second highest frequency of responses also for scenarios 1 and 5, whereas none of the respondents suggested this type of strategy for cases 8 and 9, who most thought were suitable for "second opinion". If the two types of maintenance care were combined, between 20% and 80% of the respondents would recommend maintenance care for all the scenarios but 8 and 9.Among the Swedish chiropractors who participated in this survey, a distinct pattern was found, in relation to the management strategies that they would choose for different types of LBP-scenarios. This pattern corresponded to that which the research team, arbitrarily, considered to be logical and responsible.However, also other patterns were apparent, sometimes favouring a prolonged management program, either symptom-guided or clinical-findings guided, indicating that some chiropractors have high expectations of "a happy ending" to many clinical conditions. The "quick-fix" alternative was not often selected but, then, only cases 1, 2 and 4 were described as completely improved, and therefore the only ones obviously suitable to be considered for closure.Nevertheless, it is reassuring to see that for the potentially serious cases 8 and 9, the most common strategy would have been referral for "second opinion" and that, for these, none of the participants would have considered any type of maintenance care.Another interesting finding is that some chiropractors seem to fail to grasp the concept of clinically significant improvement. For example, in case 5, an acute event of LBP of one week's duration that is only 20% better after one month and six visits does not appear to be the suitable recipient for clinical findings-guided maintenance care. Nonetheless, this approach was the second most commonly selected strategy for this case, and if both types of maintenance care were considered together, this approach was, in fact, the most preferred choice. It has been shown that patients need to experience more substantial reduction of pain before it can be considered clinically significant . In factAccording to a previous study of osteopaths, chiropractors and physiotherapists a subgroup of clinicians will provide prolonged treatment also for patients with LBP, who do not recover. The reasons for this seemed to be linked with a scope of care, which encompasses more than the immediate symptomatic relief . ObviousWhether these results can be trusted or not and whether they can be generalized or not, depends on several factors. First, the chiropractors who were invited to participate in the study would best be described as a convenience sample, as they consisted of colleagues who had participated in previous studies. It is possible that participants in research projects are more academically inclined than others, which obviously may have an impact on their practice pattern and the rationale for how they practice.Despite this pre-selection of participants, the response rate was rather low (60%). In comparison, the response rate was 44% in a North American questionnaire survey on maintenance practice patterns [In previous studies, the prevalence estimates of the use of maintenance care were 39% in a file search among British chiropractors in 1973–4 .The results, however, are not really comparable. The British study is more than 30 years old and included all types of patients and the Norwegian study had information from chiropractors' own file search regarding the participating patients, who all had persistent LBP. Obviously, it is not possible to judge the external validity of our study by comparing our percentage of maintenance care patients to those of previous studies of similar study populations.Having obtained the study subjects, it is also important that they understand the questionnaire and respond to it in a manner that corresponds to their clinical behaviour. Our participants had previously participated in several practice-based research projects and were experienced with questionnaires. The pilot study helped remove the obviously unsuitable questions and made the questionnaire easier to read and to answer. However, because the case scenarios were very simplistic, there would always be room for individualized interpretations that could affect the study results. Some of the respondents failed to answer all questions, but there were only between 1 and 5 "don't know" responses for the various cases, indicating that the questionnaire was relatively user-friendly.The issue of maintenance care is, by some, considered to be a sensitive issue. It was therefore important that the questionnaire was returned anonymously and we therefore assume that the respondents provided honest answers to the questions, even if these were considered "politically incorrect".The choice of clinical management programs may depend on the educational background. Swedish chiropractors are mainly educated in North America or UK. Only a few are educated at the University of Southern Denmark and all the included chiropractors had been working mainly in Sweden or other European countries. It is therefore not certain that the results from this study are typical for other groups of chiropractors.It is also important that the choice of responses cover most possible management possibilities. Some chiropractors claimed that they had an "other" alternative to those proposed in the questionnaire. However, when their responses were scrutinized, there remained only 16 replies that could not easily be placed under one of the pre-printed alternatives. Most of these consisted of general discussions of patient care and failed to address the question to be answered. No "new" alternatives were detected from the "other" alternative, indicating that our choice of management strategies was satisfactory. In our experience, it is not uncommon that clinicians claim that it is impossible to fit their answers into predefined boxes, such as describing a treatment program based on theoretical cases, because they claim that each case is unique. Nevertheless, this study showed that, at least, this group of chiropractors was able to do so to a large extent.Among those chiropractors who participated in this survey, a clinical management strategy pattern emerged for different cases of LBP. However, there were also subgroups of chiropractors with different practice cultures, sometimes favouring a maintenance care program. The rationale for their clinical decisions needs to be further elucidated, and the results of this study need to be verified in other study populations with a variety of study designs.The authors declare that they have no competing interests.IA was responsible for the design of the study, supervision of data collection, the analysis of data and the manuscript preparation, AR, AE, LH, KJ, FL and PWL were involved in the design, supervision of data collection and the analysis of data, CLY was supervising the study process and was involved in the manuscript preparation. All authors revised and approved the final manuscript.A Questionnaire mailed to 99 Swedish chiropractors asking them to match nine case scenarios with six specific management strategies.Click here for fileA description of the six specific management strategies for patients with low back pain receiving chiropractic care, from which the participants in the survey could select one for each of nine scenarios. Note: A brief description for each strategy is included in brackets, used in the report.Click here for fileA description of nine scenarios (cases 1 – 9), together with the clinical reasoning of the research team, and a description of their preferred management strategy for each scenario (not included in the questionnaire).Click here for file


Organizational performance can be attributed to a number of factors. However, there are certain organizational factors, the presence or absence of which can determine the success or failure of the organization. There are different ways in which organizations try to improve their performance by working on such factors. In the research presented in this article, an attempt is made to find out whether adoption of the Yoga Way of Life by managers can have a positive impact on such organizational performance indicators.To measure effect of yoga way of life on five different indicators through an empirical study.The five indicators are job satisfaction, job involvement, goal orientation, affective organizational commitment and organizational citizenship behavior.Pre- and post-data was measured using self-reported questionnaire. Independent T-test (Paired) and Pearson’s correlation test were conducted using SPSS.The results of the study show that Yoga has a significant positive impact on four out of five of these indicators. Only job involvement does not show significant improvement. The construct used for measuring job involvement had a Chronbach alpha of 0.613, which is an indicator of moderate reliability, which could be the main reason for not getting positive result. The globalization of the industrial world makes it imperative for organizations to put special emphasis on organizational innovation, flexibility, productivity, and responsiveness for changing the external conditions of their performance. Organizational performance can be measured in terms of different criteria for different organizations, and it depends to a great extent on the goals of an organization. However, one way of comparing organizations with different goals is to identify surrogate indicators of performance. In this article we have utilized the past studies and relevant literature to identify five organizational factors that can be used as alibis to assess the performance of an organization from the view point of the set objectives. These factors are common to most organizations, and therefore, can be used to make comparisons between companies or groups.Today, there is considerable interest among the management practitioners and researchers with regard to the role and benefits of introducing spirituality at the workplace. The Harvard Business School study, drawn over a period of 11 years, showed a marked relation between the strength of the organizations’ corporate culture and its profitability. maintainYoga is generally perceived to be a way of keeping oneself healthy and happy. However, if one truly understands the concept of yoga as a complete way of life, one can clearly see its benefit for changing the paradigms of its practitioners. Such a change in the psycho-motivation of people is useful at the organizational level also. However, so far, very few empirical studies have been undertaken to establish such a link. The main contribution of this article is to fill this gap. Using a controlled scientific experimentation of employees in a manufacturing unit, we provide an empirical assessment of the impact of the yoga way of life on positive organizational factors.We pose the question, “Can adoption of the yoga way of life make a positive impact on the factors which are responsible for the performance of organizations? If so, can we empirically observe this phenomenon and provide relevant literature support to explain this?” To the best of our knowledge, there is no empirical research available so far, to answer these questions. We study these issues in this article using an empirical study conducted in a manufacturing unit involving 84 executives.We show that adoption of the yoga way of life can bring about better job satisfaction, affective organizational commitment, organizational citizenship behavior, and goal orientation of managers. These factors indeed contribute to the performance of the organization as we have argued in the article. Through a rigorous literature review and understanding of the science of Yoga, as given in our scriptures, we also provide an explanation of how this happens. We also motivate the HR managers in organizations to explore ways of implementing the yoga way of life, as it promises to address the issue of organizational climate at a fundamental level.The rest of the article is organized as follows. In the next section we provide a review of the literature to introduce various factors contributing to the performance of an organization and the manner in which these contribute. On the basis of this, we identify the variables for our study. In Section 3, we discuss the role of yoga in management by a study of the literature. Based on these we also develop the hypothesis for our study. We present the study details in Section 4, and discuss the results in the following Section. Finally in Section 6, we conclude by highlighting the implications of our study.Organizational performance can be termed as the achievement of the goals of an organization. The goals of an organization may differ from organization to organization and may also include in its fold quantitative and qualitative aspects. When an organization achieves its goals, it is said to have performed well. As performance is the main reason for the survival of an organization, there is considerable interest among practitioners and researchers to understand what results in a better organizational performance.Marmol and Murray studied Prahalad, discusseCoping with ambiguities and uncertaintieseconciling the coexistence of oppositesManaging the diversity in terms of race, age, gender, culture, and intellectual person integritySelflessnessHumility and courageNetworking across organizationsContextual influence and authorityAccording to Tichy, the singThe quality and disposition of managerial level employees is thus a key to organizational performance. Some of the factors that can measure these qualities are job satisfaction, job involvement, goal orientation, organizational commitment, and organizational citizenship behavior. We present a review of their influence on the quality of leadership and organizational performance.According to Bullock, job satiIn the mid-seventies, Locke reviewedAbsenteeism is higher among dissatisfied employees15Dissatisfied employees are more likely to quitSatisfied employees enjoy better health and live longer17Job satisfaction is infectious and carries over to life outside the work placeIn a survey of 440 commercial bank employees in Bangladesh, Mosharraf concludeThese studies point to the role ‘job satisfaction’ plays in creating a positive ambience for the employees, motivating them and thereby ensuring high productivity. These in turn are likely to contribute to the performance of an organization.Job involvement is an important factor in the lives of most people. Work activities consume a large proportion of time and constitute a fundamentally important aspect of life for most people. People may be stimulated by and drawn deeply into their work or alienated from it mentally and emotionally. The quality of one’s entire life experience can be greatly affected by one’s degree of involvement in or alienation from work.24 A stat25Lawler and Hall defined The ‘individual difference perspective’ holds that job involvement results from socialization processes that inculcate the importance of work as a virtuous and necessary activity, as well as from other stable individual differences. This research draws on the work of Weber, with itsPrevious research has not established the causal ordering of job involvement with respect to job satisfaction and organizational commitment. We can classify job satisfaction as a consequence of job involvement, even though reciprocal causation is likely. One can consider job satisfaction primarily as a consequence, because cognitive appraisal of the potential for need satisfaction logically precedes actual need satisfaction. It is also likely that actual satisfaction then reciprocally influences job involvement. Conclusively, disentangling the causal priority of these two constructs empirically is likely to be difficult. Stumpf concluden=200) Pal,[Robbins has poin200) Pal, found th200) Pal,P<0.01.In a study conducted on 400 employees at the Indian Institute of Management Bangalore, Adhia found thIt appears from this that organizational commitment is an obvious contributor to organizational performance because loyalty to the organization significantly enables the organization to achieve its objectives. The primary difference between organizational commitment and job involvement is that job involvement primarily reflects one’s attitude toward a specific job, whereas, organizational commitment refers to one’s attachment to the organization.43 It wou44Organizational Citizenship Behavior (OCB) pertains to the employees’ behavior over and above the call of duty (job description and job specification), which is very important for organizational effectiveness. The globalization of the industrial world makes it imperative for organizations to put special emphasis on organizational innovation, flexibility, productivity, and responsiveness to changing external conditions for their performance. It has been increasingly felt that work behavior such as OCB, which is beyond the reach of traditional measures of job performance, holds promise for long-term organizational performance. A comprehensive theoretical discussion is available in the works of Organ, KonovskyIn 1983, Denis Organ and his colleagues were the first to use the term OCB.51 Later,This concept has also been characterized as including constructive and cooperative extra role gestures that are neither mandatory nor directly compensated by a formal organizational reward system. In addition such behaviors have been described as having an accumulative positive effect on organizational functioning. Bateman and Organ attempteClearly, the concept of OCB induces behavioral and attitudinal patterns on the part of managers that influence organizational performance.Goal orientation refers to taking one’s goals seriously and being persistent in pursuing the goal. Achievement goal theory and research suggest that employee job performance and job satisfaction depend on their goal orientations.57 Goal oPrevious research has shown that a person’s goal orientation was related to his or her performance in individual settings. In a stuOn the basis of the review of literature one can make certain inferences pertaining to factors influencing organizational performance. We summarize them below:The quality and disposition of managerial level employees is the key to organizational performance.These are indeed reflected in some organizational indicators, such as, job satisfaction, job involvement, goal orientation, organizational commitment, and organizational citizenship behavior.These factors are suitable for our study also, because they can be studied and measured in respect of any organization, irrespective of their goals or line of business.Karma Yoga (path of detached action), Jnana Yoga (knowledge of self), Bhakti Yoga (Trust in the supreme order) and Raja Yoga . Practicing this knowledge may bring about a complete transformation of one’s personality, on the physical, mental, emotional, and spiritual levels, which strengthens one’s ability and desire to put in one’s best. Yoga is one of the six foundations of Indian philosophy and has been used for millennia to study, explain, and experience the complexities of the mind and human existence.[Patanjali, an ancient yoga sage, defines yoga as a technique used to still the mental fluctuations of the mind to reach the central reality of the true self.[Patanjali’s Yoga Sutras outline a skillful way of conducting life that fosters moderation and harmony.[The yoga way of life encompasses the philosophy of xistence. Patanjalrue self. Patanjal harmony. These guAshtanga Yoga, the eight step path of yoga, encompasses cognitive learning, moral conduct, physiological practices, and psychological therapy. The first two steps of Yama and Niyama seek and shape external behavior and thought patterns and thus minimize disturbances in the mind and the body. On the behavioral side, abstinence is sought from violence, falsehood, dishonesty, sexual excess, and acquisitive tendencies. On the cognitive moral side, the ideals prescribed are — purity, contentment, austerity, self study, and forbearance. The stages of Asana and Pranayama are meant for disciplining the body and regulating subtle energy flows. In the fifth stage of Prayahara, the secondary input is regulated so the mind is not distracted. The stages of dharana, dhyana, and Samadhi are for uplifting one’s spiritual self and for heightening consciousness.According to Srinivas, a serieset al. that, ‘The stronger the spiritual factor of the personality the more the person exhibits altruistic and citizenship behavior’. Finally, these authors find that, ‘The stronger the spiritual factor of the personality, the more the person’s commitment to the organization and work group increases’.Spirituality in a workplace is a topic of hot discussion today. Wisnieski and Askar and Syed present In the article of Sangster, he re-emJurkiewicz and Giacalone stress yet al.[Transcendental Meditation is a skill of effortlessly minimizing mental activity so the body settles into a state of rest deeper than deep sleep, while the mind becomes clear and alert. At the University of Texas, Orme-Johnson et al. showed tet al. completeet al. increaseet al. and highet al.73 associet al. Previouset al.niskam karma (working sincerely without being preoccupied with the outcome) experience less work-related stress. Misra[Pande and Naidu reportedss. Misra found thss. Misra79 providFrom a complete review of the literature, one finds that there have been attempts in the past research to capture the positive impact of some aspect of yoga (such as asana or meditation) on personal factors such as stress, and so on. However, there has been no attempt to capture the effect of the adoption of complete yoga philosophy on organizational factors. As we have seen in the literature review, Yoga has a deeper psychological impact on a person, in terms of changing paradigms of one’s life. Similarly most of the organizational factors selected for this study are psycho-motivational in nature. There is, therefore, enough ground for us to hypothesize that adoption of yoga as a philosophy and practice helps in increasing the levels of positive organizational factors. This research is an attempt to prove or disprove this hypothesis.This controlled experiment was conducted at a manufacturing company in Gujarat, called Birla Celluloise, located at Kosamba, one of the units manufacturing Viscose Staple Fiber, owned by the Grasim Industry, located at Kharach village near Bharuch. This unit has more than 120 people in the managerial cadre and more than 1000 in the workers category. Most of them stay in the township of the company, which makes it easy to conduct the intervention of Yoga. Grasim Industries Limited, a flagship company of the Aditya Birla Group, ranks among India’s largest private sector companies, with consolidated net revenues of Rs. 141 billion and a consolidated net profit of Rs. 20 billion (FY2007). Starting as a textiles manufacturer in 1948, today Grasim’s businesses comprise viscose staple fiber (VSF), cement, sponge iron, chemicals, and textiles. Its core businesses are VSF and cement, which contribute to over 90 percent of its revenues and operating profits. The Aditya Birla Group is the world’s largest producer of VSF, commanding a 21 percent global market share. The company meets India’s entire domestic VSF requirements. Grasim’s VSF plants are located at Nagda in Madhya Pradesh, Kharach in Gujarat, and Harihar in Karnataka, with an aggregate capacity of 270,100 tons per annum (tpa). The VSF plant at Kharach, where this experiment was conducted, was set up in 1996.The salient aspects of the study methodology are summarized below:The managers of the company were given the option of joining this experiment after explaining to them the purpose and modality of this experiment and making clear to them the expectations of regularity and so on. Written consent for being a part of the experiment was obtained.Those who opted were initially divided in two equal groups of 42 each — Group one was called the Yoga group and Group 2 was called the physical exercise group, which was the control group for this experiment.Raja Yoga, Karma Yoga, Jnana Yoga and Bhakti Yoga) on life, analysis on the aspects of true happiness in life, ashtanga yoga steps, central theme of universality of consciousness as given in Vedanta, and so on. The practice was given for asanas, pranayama, Kriya, and relaxation by a well-trained yoga instructor.The Yoga group was given 30 hours of yoga practice (75 minutes every day) and 25 hours of theory lectures on the philosophy of yoga. The total intervention period was six weeks. The theory lectures were given by the first author of this article and included topics such as the definition of the yoga way of life, implications of the four types of yoga . This was thought necessary in order to obviate the possibility of the Hawthorne effect on the experiment group. The topics for theory given to this group included — Success and Happiness, Importance of Attitude, Self-Image, Good Relationship with Others, Goal Setting, Power of sub-conscious mind, Communication, Motivation, and leadership. The practice given to this group was fast exercises such as spot jogging, bending, body rotation, hand and leg movements, and the like.In order to prove or disprove the hypotheses, variables were measured for both the groups, before and after the experiment, with the help of a standard self-reported questionnaire. In addition, the measurement of certain physical parameters such as weight, BMI, BP, Blood Sugar, and so on, were taken for all, both pre- and post-experiment.The pre-measurement data was taken on 17 September, 2007. The intervention to both the groups was simultaneously given between the 18 September and 24 October, 2007. The post-measurement data was taken on 24 October, 2007.Out of the group of 42 in both groups, there were some who did not attend all theory and practice classes on many days, and hence only top 30 (in terms of regularity) were included for both groups in the final sample, for the analysis. This came to a minimum attendance figure of 65% approximately for both groups. In short, people with less than 65% aggregate attendance were excluded from both groups. The profile of the sample finally included in the experiment can be seen in Tables Questionnaires were both easy to administer and inexpensive, due to tet al.,[Affective Organizational Commitment was measured using eight items pertaining to the affective component of organizational commitment, from the instrument developed by Allen and Meyer,84 which et al., with resOrganizational Citizenship Behavior (OCB) was measured using a slightly modified version of the scale developed by Moorman and Blakely, based onet al. It is argued that while measuring goal orientation, it is optimal to refer to the same situations for all respondents, due to project difference. However, Frese, et al. have showed that there is no need to provide a situational input for the goal, as there is a certain degree of cross-situational generality in the goal orientation scale. The four items used to measure goal orientation were anchored on a seven-point scale with 1 standing for ‘strongly disagree’ and 7 standing for ‘strongly agree’.Goal orientation was measured with a scale developed by Frese, The data collected was analyzed using SPSS. The sample profile given in Tables t test). It can be concluded from Tables t test), unlike in the physical exercise group where the post intervention impact on indicators do not show a statistically significant difference in any of the five indicators. Today, there is considerable interest among the management practitioners and researchers on the role and benefits of introducing spirituality at the workplace. The Harvard Business School study drawn over a period of 11 years showed a marked relation between the strength of the organizations’ corporate culture and its profitability.[karma advantage are balanced. According to Sharma, the Indian word ‘Udyoga’ (which means Industry) contains in itself the word ‘yoga’. Thus, in Indian management thought, Udyoga is a yoga (Udyog hi yog hai/Udyog bhi ek yog hai). In popular terms Sharma[According to Sharma,88 Indianms Sharma88 refersVedanta in management implies management by higher values and higher vision. Thus, YVK  constitute three ‘Eastern Doors’ that can be combined with ‘Western Windows’ . These ideas can be combined with various wisdom traditions to arrive at a new philosophy of what Sharma calls ‘WKarma Yoga are useful in changing outcome orientation to effort orientation, and in reducing the managers’ expectations from the job. The system of Yoga is analytical and makes an individual more aware of his situation and allows him to give a considered rather than an intuitive response to it.How can we explain the result, obtained in this experiment, is a moot question? Yoga Way of Life, the concept presented in this article is an integrated approach of the changing physical, mental, vital, and emotional personality of an individual. It aims at making managers more evolved individuals, with a better understanding of their job situation in the overall context of life. The teachings of atman) in terms of different levels of being. The inner-most core or atman is covered by hierarchy of five sheaths or layers. This continuation of layers corresponds to a sort of stepwise ladder, leading inward to the atman; the journey inward forms the basis of growth and development: Biological evolution from a protozoan to man, psychological evolution from child to adult, consciousness enhancement from mere cognitive to universal consciousness, wherein there is no ego and there is realization that the concerns and needs of all people are the same, and that what is good for one is good for all. In this growth process, feeling and emotions are accepted as having a place, they are not considered wrong or repressed, but are transformed and redirected.[Yoga psychology conceives the self , trust in God’s justice system (Bhakti Yoga), and seeking the knowledge of self (Jnan Yoga). Such an integrated approach can yield superior results for individual happiness and also for organizational performance.There are certain organizational factors, such as Job Satisfaction, which have a crucial bearing on organizational effectiveness. Our study confirms the useful role that the Yoga way of life can play in improving these factors positively among managers. The results show a significant difference among those who are introduced to the practice of the yoga way of life. However, in order to get the benefit of yoga in its entirety, one has to adopt yoga as a technique of life management. This would include not only the Raj Yoga practices of On the basis of our study we are motivated to recommend similar experimental studies in multiple organizational settings to further refine these findings and insights. One approach is to conduct a similar study with a large sample size, which may corroborate this initial attempt. Also in case of other similar experiments, different instruments for measuring these factors may be tried, in order to take care of social desirability.


Hospital in the home programs have been implemented in several countries and have been shown to be safe substitutions  to in-patient hospitalization. These programs may offer a solution to the increasing demands made on tertiary care facilities and to surge capacity. We investigated the acceptance of this type of care provision with nurse practitioners as the designated principal home care providers in a family medicine program in a large Canadian urban setting.Patients requiring hospitalization to the family medicine service ward, for any diagnosis, who met selection criteria, were invited to enter the hospital in the home program as an alternative to admission. Participants in the hospital in the home program, their caregivers, and the physicians responsible for their care were surveyed about their perceptions of the program. Nurse practitioners, who provided care, were surveyed and interviewed.Ten percent (104) of admissions to the ward were screened, and 37 patients participated in 44 home hospital admissions. Twenty nine patient, 17 caregiver and 38 provider surveys were completed. Most patients (88%–100%) and caregivers (92%–100%) reported high satisfaction levels with various aspects of health service delivery. However, a significant proportion in both groups stated that they would select to be treated in-hospital should the need arise again. This was usually due to fears about the safety of the program. Physicians (98%–100%) and nurse practitioners also rated the program highly. The program had virtually no negative impact on the physician workload. However nurse practitioners felt that the program did not utilize their full expertise.Provision of hospital level care in the home is well received by patients, their caregivers and health care providers. As a new program, investment in patient education about program safety may be necessary to ensure its long term success. A small proportion of hospital admissions were screened for this program. Appropriate dissemination of program information to family physicians should help buy-in and participation. Nurse practitioners' skills may not be optimally utilized in this setting. Within Canada, current policy priorities include enhancements to primary healthcare and home care . The rolBasic requirements of these models are the provision of care in the patient's home that: (1) reduces or eliminates inpatient hospital stay; (2) is similar to care provided in hospital and clinically appropriate; and (3) is not provided by usual community based home care services. HITH programs may allow for the re-allocation of beds to deal with wait times, and the provision of culturally appropriate care, while reducing iatrogenic complications, and public costs .An evaluation of such programs should have multiple dimensions. The program must achieve quality patient outcomes, be economically efficient, and be acceptable to those involved ,7. A sucHITH programs have been successfully implemented in several countries and may be one approach for the Canadian healthcare system to address its policy priorities. However, HITH interventions may have different components and varied outcome potentials in different health care systems. The current study evaluates the acceptance of a HITH program, managed and provided by nurse practitioners in a family medicine program, among patients, caregivers, nurse practitioners, and physicians  in one community in Ontario, Canada.We used surveys and semi-structured interviews to evaluate patient, caregiver and care provider acceptance of a new HITH intervention.The study was conducted in the province of Ontario, in Canada. Canada has a public funded health care system which covers 100% of the hospital services costs.Participants were recruited from the 14 bed inpatient unit of the Family Medicine Service (FMS) or directly from the emergency department of the Ottawa Hospital, Civic Campus if they required admission to the FMS  were the designated principal home care provider. The lead program NP was seconded from department of family medicine for the period of the study. Additional NPs were hired to the FMS and trained for their role as home care provider in the HITH study. Direct care was delivered in patients' homes almost exclusively by NPs, who provided rehabilitative and supportive care, including education, coordination of services, and counseling. In Ontario, NPs are licensed as extended class Registered Nurses. The NPs worked for nine hours daily from Monday to Friday, and four hours daily on weekends. The FMS family physicians call group provided after hour coverage for patients as well as backup support to NPs. Immediately following each patient's transfer to the home, an NP made a home visit, performed a physical examination and initiated care provision. The NP continued to visit the patient daily and maintained telephone contact until discharge. The provision of care was based on the patient's care needs and was determined in consultation with the family medicine resident, attending staff physician and other health care professionals at the time of transfer to the home. Care was reviewed with the hospital medical team as required, throughout the care period, and patients were discharged from the HITH service when the team agreed there was no further requirement for hospitalization.Upon admission, the NPs recorded patient demographic information, such as the patient's living arrangement and current main activity. NPs also administered both the Short Form-12 (SF-12) quality of life questionnaire (4 weeks version)  and HealProgram acceptance was evaluated using a questionnaire adapted from another Ontario HITH study . At discAn assessment survey was mailed, immediately following discharge, to the patient's family physician and the hospital medical staff (resident and attending) overseeing the care of the patient. Questions pertained to their perception of the quality of care delivered, the quality of the collaboration with the nurse practitioner and the impact of the program on their practice.NPs involved in the program completed a survey and were interviewed with questions addressing program suitability and job satisfaction midway through the 18 month study period. Interviews were coded by hand to identify thematic areas and triangulate with the quantitative data.On all surveys, satisfaction questions were assessed on a 5 point Likert scale. Other questions required yes/no answers or short written responses.Sample size calculation was based on quality of care outcomes. Based on a previous randomized controlled trial , we estiDuring an 18 month period (November 2003–May 2005), approximately 1,000 patients were admitted to the FMS ward and received in-hospital care for an average of 8.4 days. Of these, 104 admissions were closely screened for participation in the study. The majority of patients were not considered because of obvious non-eligibility, usually evidently too well or too ill. Also, while the NP had home admissions to manage, the time spent reviewing potentially new patients was limited. Of those screened, twelve patients refused participation in the program, half of whom felt they were too sick to go home. Forty eight were deemed ineligible in accordance with the exclusion criteria . Thirty seven eligible patients agreed to be enrolled in the program, representing 44 different admissions to the program. Three patients had two, and two patients had three admissions into the program (each admission requiring a separate consent). Among the 44 admissions, 4 were admitted directly from the emergency room and 40 were transferred from the inpatient hospital ward, after an average 6.3 days stay, to the HITH program. In each case, the patient would have required a continued in-hospital stay.Patients were usually older adults, living with relatives or friends and not working. Demographic information is presented in Table Twenty nine patient surveys were completed. One patient with three admissions and one with two admissions responded to the first survey but not subsequent ones, five patients refused, five others could not be contacted, and two died within weeks after discharge of unrelated events. Too few patients were enrolled to allow a detailed comparison between responders and non-responders, except to suggest that non-respondents were more likely to be working for pay (25% vs 8%) but were otherwise similar to respondents.The majority reported high levels of satisfaction across all survey questions regarding the HITH program (range of satisfied/very satisfied): 88% – 100%. In contrast, the reference question measuring satisfaction with the promptness of other services had moderate satisfaction levels (satisfied/very satisfied 62%) , education level, sex, and distribution of diagnoses or living arrangement. However, patients with previous hospitalization (70% vs 34%) for the same illness and those with more complex admissions  appeared more likely to select hospital, but this did not reach statistical significance.Most (83%), felt "confident" or "very confident" that the program was right for them. However, when asked to identify their preferred site  for their care, 37% reported a preference for hospital. Reasons given included "Seventeen caregiver surveys were completed. The caregivers of patients with multiple admissions completed a survey for the patients' first admission only; 13 refused, and 7 others could not be reached. We had not collected caregiver information on non-respondents that would allow a comparison with respondents.The caregivers were mostly females (82%) and the majority were spouses of the patients (53%). Their average age was 66 (95% CI: 59–72). Few (18%) had remunerated work, and all who did, missed work during the home hospitalization period. When asked to put a dollar value on their role in the care of their family member in the program, the majority did not expect compensation for this type of work: four said $10–15/hour and one would expect payment for lost wages. The added costs associated with the program were identified as an increased amount of laundry (3), food (2), electricity , and the purchase of a new bed (1).The majority (77%), felt prepared for what to expect during the home hospitalization, and almost all (94%) said they had been comfortable managing the patient in the home. The feedback provided on various aspects of health service delivery was positive ("satisfied"/"very satisfied" or "agree"/"strongly agree") (range 92% – 100%) Figure .With his condition, I wonder if [HITH] would have the medical equipment he needs", "for those times when he is especially bad", and "if he can be, for the convenience and comfort". There was no association between caregiver satisfaction level and preferred site.Informal caregivers were also asked to identify whether the hospital or home was the preferred location of care for this episode. A considerable minority preferred hospital (35%). This preference was generally consistent with the respective patient's preferred choice for location of care, although no statistical comparison was performed due to the small sample size. The reasons given included "Fifteen attending physicians and 23 residents were involved in the care of study participants (seven family physicians and ten residents cared for 2 – 11 patients in the program). The patients had 31 different personal family physicians. Twelve attending physicians responded to at least one survey (27 responses). Those who did not respond were involved in a single admission. Only 9 residents completed surveys (13 responses), and 9 personal family physicians returned the survey. The most common reason for not responding was that they had no involvement in the specific care episode and had no information to provide.Good program for this patient. Wife needs a lot of support", "Very good in concept but applicability is a bit limited. Would like to use that system more often", and "Allows us to follow patients without needing him to stay in hospital – excellent".Due to the small sample size and consistency of responses between the 3 groups , the results are presented combined. Virtually all respondents were very satisfied with the in-home services and the NP's performance Figure . Eleven Six NPs provided care throughout the program, and 5 responded to the survey and participated in in-depth interviews. At the time of their interviews, 4 NPs were no longer actively working in the program. One NP, who could not be reached, had left the program after a very short stay. NPs who provided care had been practicing as nurse practitioners for an average of 5 years and had worked extensively in the field of nursing in diverse areas such as walk-in clinics, street outreach for homeless individuals, northern nursing, outpost nursing, palliative care, public health, and other forms of community nursing.I think the quality of care was exceptionally high... [W]e had the time to come to know individuals and their health care needs at a very intimate level." NPs also highlighted some of the program drawbacks. They felt that clients in the HITH program did not have immediate access to diagnostic testing and specialists that would be available in a hospital environment. They also perceived that, while patients felt more control over their personal health needs, they experienced some day-to-day physical challenges such as having to prepare meals, and difficulty accessing bathroom facilities. They also voiced concerns over the continuity of care, when their involvement in patient care was limited to the few days of home hospitalization. "An ongoing problem in encounters with the health care system has been one of continuity of care. Patients are frequently expressing a sense of having been abandoned by a care provider that they have come to know." Over the course of the program, NPs worked to address these concerns and improve this transition by collaborating on the development of a common care plan with the community home care agency.All NP respondents felt the patients received very good quality of care and that the program met  the needs of their patients. NPs felt this was due to a combination of their advanced education; the amount of time the NPs were able to spend with each patient; and the information they provided on medications, chronic illness management, pain management, and caregiver support. "There was] little opportunity to develop relationships with residents. I am not sure there was enough "buy in" from docs; there was subtle resistance to it. That changed over time as more of the attendings came to know us. Even though they rotate every two weeks, eventually they get to know you." However, NPs felt that the interdisciplinary team approach to care was beneficial to clients and important to establish.There were challenges when developing relationships, defining roles and establishing program 'buy-in' with the medical staff, especially residents due to their bi-weekly rotations. " [The majority were satisfied with the extent of their participation in decision-making. They felt that they were given the opportunity to be autonomous and essentially drive the care of each patient. However, most NPs also felt that the NP profession was not the most appropriate for this position. While some said that the care did not require the expertise of an advanced practice nurse and that their skill set was not optimally utilized in the HITH study, others felt that patients were too ill to be cared for by NPs outside the hospital.This study demonstrates that the provision of hospital level care in the home is acceptable to care providers and the majority of patients and their caregivers. Physicians felt the program offered excellent care and had minimal impact on physician workload. Nurse practitioners also rated the care very highly, but reported that the initial phase of the program required significant education of the medical staff, and that such a program would not exploit all of their skills. Patients and caregivers were highly satisfied with their care episode. However, a considerable number continued to have reservations about the safety of the program despite its very safe implementation. Four out of ten patients reported a preference for in-hospital admissions. This response possibly reflects apprehensions associated with exposure to a non traditional model of care, and one in which 24 hour on site coverage is not provided. Of the 44 admissions, only one patient required a home visit by the family physician. While this reflects non-problematic management of the patients, the absence of physician contact with patients may have impacted on patient perceptions of the program.This pilot study has important limitations that require a full implementation study to address. We were unable to provide a contemporaneous comparison group, and the dimensions evaluated are subjective to the respondent's perspective and may be affected by a number of uncontrolled factors including setting, previous experience, knowledge, etc. The response rates to the follow-up surveys for all respondents were also mediocre, and we cannot rule out the possibility that the results, presented herein, are representative of a biased sample. Also, the study was set in an academic teaching practice, and the views expressed by the participants may not generalize to non university affiliated community based practices. Only 10% of individuals managed in the FMS ward during the study period were screened for participation in this study. The majority were felt to be too ill or too well at the onset to be considered. For a program of this type to be viable and to achieve economies of scale, it would need to be expanded to other hospital units. However, the limitations that we encountered in our pilot have been successfully addressed in large scale studies, so that successful implementation is feasible .pp. 171–172). The current study supports this finding through the perspective of both patients and informal caregivers. In randomized controlled trials, the satisfaction level of patients treated in the home was at least comparable with those treated in hospital [Consistent with two previous studies, patients and their informal caregivers reported high levels of satisfaction with the care received through this hospital replacement program ,14. In mhospital .Informal caregivers were mostly females, and not working for pay. Despite the novelty of the program, virtually all were comfortable with their role as the caregiver. Other studies have shown that informal caregivers are confident in their role; that they would act as caregivers again; and they would recommend the role to others . In the Despite a high level of satisfaction, approximately one third of patients and informal caregivers expressed a preference for hospital over home for their care. These were more often observed in patients with more complex illnesses, although this did not reach statistical significance. The most commonly cited reason for this choice was concern about the availability of emergency services should the need arise. This may reflect the novelty of the program and a public's lack of awareness of the extent to which such programs are safely implemented in other regions. Supporting participants with additional information, at the time of admission, may improve comfort levels with the program. Randomized controlled trials showed that the level of burden on informal caregivers, of patients managed in the home, was not different from those managed in hospital and that the disruption was lower ,21. HoweThe NPs offered comprehensive levels of care and provided the patients with information concerning the nature of their illness along with functional measures to better self-manage their health. These were key features in the success of other studies ,16,17. PConcern about the increase in workload to general practitioners associated with HITH was not reflected in the current study . The phyThis study builds on Canada's experience in the use of home hospitalization as a viable alternative to in-hospital care. While few reports are published on these Canadian programs, those available support their use -26.Patients were recruited from an academic hospital in an urban centre. The efficacy  of HITH programs will depend on a number of factors in the health-care environment and also on the selection of appropriate patients for the program. In our setting the care processes involved in the HITH program were acceptable to patients, informal caregivers and healthcare providers. The impact of the program on the physician's workload was minimal, but the NPs, educated as Primary Care Nurse Practitioners, were not satisfied with their role in the program. The role of a 'Hospital in the Home' Nurse Practitioner requires further investigation as a longer term strategy to deal with an expansion of hospital services that can be delivered at home. During program implementation, attention should be paid to educating participants about the safety of such programs and clarifying the functional roles of clinicians. The results suggest that patients and informal caregivers are prepared to accept this intervention as a positive change that will help the future health system better align resources to needs.Encouraging findings from our pilot program and contemporary literature support further development of this model of Hospital in the Home into a fully fledged program.The author(s) declare that they have no competing interests.The authors contributed to the article as follows: WEH, JL, RS and GV conceived the hospital in the home program. WEH and JL managed the implementation of program and lead the study. Clinical management meetings: JL and WEH, CDA, SD, JAD and JPN assisted with ongoing conception and design, drafting of data collection instruments and other materials and assisted with data analysis/interpretation. WZ assisted with the drafting of data collection instruments and other materials as well as data analysis and interpretation. All authors have given approval to the manuscript presented here.The pre-publication history for this paper can be accessed here:


Social support is an important predictor of the health of a population. Few studies have analyzed the influence of caregivers’ personal networks from a gender perspective. The aim of this study was to analyze the composition, structure, and function of informal caregiver support networks and to examine gender differences. It also aimed to explore the association between different network characteristics and self-perceived health among caregivers. We performed a social network analysis study using a convenience sample of 25 female and 25 male caregivers. A descriptive analysis of the caregivers and bivariate analyses for associations with self-perceived health were performed. The structural metrics analyzed were density; degree centrality mean; betweenness centrality mean; and number of cliques, components, and isolates. The variability observed in the structure of the networks was not explained by gender. Some significant differences between men and women were observed for network composition and function. Women received help mainly from women with a similar profile to them. Men’s networks were broader and more diverse and they had more help from outside family circles, although these outcomes were not statistically significant. Our results indicate the need to develop strategies that do not reinforce traditional gender roles, but rather encourage a greater sharing of responsibility among all parties. The number of dependent people in Spain is rising, partly because of the progressive aging of the population. Most people who require assistance for activities of daily living are cared for by informal caregivers, who do not receive payment for this work and are largely members of the family . Informal caregiving is unpaid work generally provided by a person (frequently a woman) who is emotionally attached to the person in need of care; it is a private, domestic (invisible) task that is undervalued both socially and economically . Almost Numerous studies have found that caregiving has both negative physical and psychological health effects ,7,8,9, aCaregiving also has a different effect on men and women . AccordiSocial support is one of the main predictors of caregiver health ,15,16, aIt has been shown that the structure and cohesion of personal networks are important factors for social support exchanges and that support is key for resolving personal concerns and health problems . NonetheOne SNA study helped to characterize the social support networks of people with chronic pain and highlighted the important roles that network structure, composition, and function have in terms of the provision of support and satisfaction with support received . AnotherThe main aims of the present study were to characterize the structure, composition, and function of personal caregiver networks and to investigate whether these characteristics vary between women and men. To do this, we examined differences between male and female networks in terms of the sociodemographic profile of the members, the structure, the type of support received, and the composition in terms of the characteristics of people providing support in the form of help with specific caregiving tasks. As a secondary objective, we also explored the association between the characteristics of the networks and self-perceived caregiver health.We undertook a cross-sectional SNA study , in whicThe study population was formed by informal caregivers aged 18 years or older living in a family home in the province of Granada, Spain who provided unpaid care to a dependent person living in the same or another home. Participants had to form part of the CUIDAR-SE project, which is a longitudinal study being conducted by our group that involves 404 people registered as caregivers in the Granada Health District. Already having detailed information on the profile of these caregivers, on the care they provide, and on their health is a particular strength of this study. Participants were included in a registry of caregivers from the primary health care services. All the caregivers were taking care of a person in a situation of dependency that required help to perform the activities of daily life for at least one year. This dependence could be caused by very diverse causes, physical or mental or both. We excluded people who might have had difficulty answering the survey questions because of language barriers or circumstances that would have prevented them from participating in the follow-up stages.We selected a convenience sample of 50 caregivers, stratified by gender (25 women and 25 men). Other criteria analyzed to investigate the heterogeneity of each of the gender groups were age, level of education, time as caregiver, place of residence , and level of burden according to the Zarit Burden Interview  .These variables and self-perceived health were collected through the structured questionnaire of the CUIDAR-SE project. The question about self-perceived health was asked as follows: “In general, you would say that your health is excellent, very good, good, fair, or bad (only one option)”. The first three categories were grouped in “good health” and the last two in “poor health”.The information of networks was collected during personal interviews held between September 2017 and March 2018. The people selected to participate in the survey were contacted by telephone. The interviews were held in a place chosen by the interviewee and all efforts were made to create an intimate environment. Prior to the interview, the participants were informed of the objectives and ethical issues surrounding the project and asked to sign an informed consent form agreeing to the interview and its tape-recording. The information was recorded using the EgoNet software program ,28 via aEgoNet provided the numbers and percentages for the different variables describing the composition and function of each of the personal networks analyzed, the means of the structure variables, and the centrality metrics for each of the alters in the networks. It also produced graphs depicting some of the most representative results related to the composition of the male and female caregivers’ networks.t test for structural variables and the χ2 test for composition and function variables. Density refers to the number of ties as a percentage of all possible ties in the network; degree centrality refers to the total number of alters to which each alter is directly connected; betweenness centrality refers to the extent to which an alter lies on the shortest paths between other alters; isolates are alters who are connected to the ego, but not to anybody else; components are a set of alters who are connected to one another directly or indirectly; and cliques are a set of alters who are all directly tied to each other [A descriptive analysis stratified by gender was made in the statistical program SPSS. We have taken into account the following dimensions and variables of analysis in order to characterize the structure, composition, and function of personal networks of the caregivers: (a) composition of personal caregiver networks: gender, age, place of residence, type of relationship, and proximity; (b) structure of the personal networks: density, degree centrality mean, betweenness centrality mean, number of isolates, number of components, and number of cliques; and (c) functional social support: type of help with specific care tasks, financial support, and emotional support. For the descriptive analysis, we analyzed frequencies and percentages. Associations with gender were investigated using the ch other ,29. We performed three bivariate analyses via binary logistic regression to examine associations between the dependent variable—self-perceived health (good vs. bad)—based on information collected in the CUIDAR-SE project, and three independent variables related to the characteristics of the personal networks: (a) degree centrality mean (structure); (b) type of relationship, that is, presence of direct relatives (composition); and (c) help with specific caregiving tasks (function). The strength of association was estimated using odds ratios with 95% confidence intervals. All the analyses were stratified by age, but not by gender, as gender was not found to be significantly associated with self-perceived health.The sample was formed by 25 men and 25 women. Although multiple variables were analyzed within each gender group to investigate sources of heterogeneity , the results showed only slight differences between the groups. The main ones are summarized in Men were older than women; 52% were aged over 65 years versus 28% of women. Women were less educated, as 60% (vs. 52% of men) had only secondary education or less. A slightly higher proportion of women lived in a rural environment (52% vs. 48% for those living in an urban environment). Men were more likely to live in a town or city (56% vs. 44%). Almost a third of both men and women had been providing care for less than two years and around half had been doing it for between 2 and 10 years. Just 20% of men and 16% of women had been working as informal caregivers for over 10 years. A majority of both men and women were severely burdened (56%) and 40% of women and 36% of men reported good health. The main differences between the composition of women’s and men’s personal networks are shown in In total, 45.0% of network members were aged between 46 and 65 years; the distribution of men among the different age groups was more diverse. Women also had a higher number of alters living in the same house as men (5.1% vs. 2.9%). The alters in the men’s personal networks were mainly located in the same town or province (79.8%). In other words, men had more support from people living in the same province, but not so much from people living in the same household. There were also differences, albeit without statistical significance, between men and women in terms of the type and closeness of the relationship they had with their alters. Direct relatives  and neighbors were more common in the women’s networks. Women also received less support from work colleagues and external support services  than men. Men had a slightly lower proportion of geographically and affectively close contacts than women (82.7% vs. 79.8%).The following graphs show differences in composition for a 48-year-old women a and a 3As can be seen in More women than men provided help with specific caregiving tasks in both types of networks, but the difference was greater in the men’s networks. a) than men (b), who receive considerable support from women in this area. The graphs in Men received more help than women with tasks such as personal care or household chores, which is where the greatest gender-based difference was noted (45.6% of men received help with household chores compared with 35.3% of women). Women, however, received more help than men with caregiving tasks outside the home and mobility tasks. Special mention should also be given to differences observed regarding the composition of alters providing help with specific caregiving tasks. Men received more support from people aged between 46 and 64, while women had more helpers in the younger age brackets and in the 65 and older bracket. Women also received more help from direct relatives and people living with them. Paid help, however, was less present in their networks. Women had a worse perception of their health than men, although the association between gender and self-perceived health was not significant. For the whole group combined and considering men and women in the same age groups, the likelihood of perceiving oneself to be in good health decreased as the number of direct relatives in the personal networks increased. This association, however, was not statistically significant.To the contrary, the likelihood of perceiving poor health (again for men and women of a similar age) decreased with increasing degree centrality mean.Finally, for men and women in the same age bracket, we observed a non-significant association between a higher number of alters and poor self-perceived health. Women had a worse perception of their health than men, although the association between gender and self-perceived health was not significant .The results of this study add to the little information that has been published on the association between informal caregiving and health from the perspective of SNA and gender. Our characterization of support networks provides important insights that help to understand the different ways in which men and women manage their caregiving responsibilities and use resources from their personal network to meet these needs. We found some significant gender differences between the networks in terms of composition  and function , but not in structure. A limitation of the study is the poor statistical significance observed, perhaps because of the small size of the sample. Nonetheless, some evidence in other studies could be useful for this discussion. Although the network structures varied somewhat, the differences between genders were not significant. Men and women did differ, however, in terms of their alters and the type of support received. Although gender differences in network composition have already been described , it is lThe personal networks of both men and women in our study featured a high proportion of women, although more so in the latter case. Women’s personal networks are mainly composed of other, predominantly middle-aged, women who were either living in the same home or in another province. Men had almost an identical number of male and female alters in their networks and their ages were more diverse; men also received more help than women from colleagues and paid services. This predominance of women in the networks is consistent with findings from other studies. One study of caregivers of dependent elderly people concluded that caregivers with networks featuring more women received more help than those with networks with a predominance of men . This suFindings from the literature also indicate that certain sociodemographic characteristics, such as gender, age, and social class, are frequently similar across networks, in line with the principle of homophily ,36. NeveIn our study, we have not observed statistically significant differences. However, our results could be consistent with those that have been found in other studies, that is, both men and women received more informal support from women than from men. Those providing help to men tended to be middle-aged, while those providing help to women tended to be in younger age brackets or 65 years or older. It is also noteworthy that compared with men, women use paid services less and received less support from people living close by. The profile of alters providing help with specific caregiving tasks coincides with reports in the literature. There is evidence that men play a complementary, secondary role in family caregiving and also use external services more ,39,40,41The literature suggests that men seem to find it easier to seek help from people within their close social circles, be they work colleagues, friends, or neighbors, and that they also see this help as legitimate considering they are fulfilling a role for which they have not prepared. Our results could be in line with this, although they are not significant. The situation of women, by contrast, might reflect a certain refusal on their part to seek help from friends or neighbors to fulfil a role for which they are supposedly prepared for, whatever the circumstance. These differences in help-seeking patterns support reports from other studies conducted in Spain . Men’s gThe findings of our survey show that both men and women receive very little financial support. Emotional support was greater in both groups, supporting previous findings. One study of 23 caregiver networks found that 65.6% of alters offered emotional support compared with just 17.3% offering material support . The SNAAs for specific types of help with caregiving tasks, our findings suggest that men receive more assistance with personal care and less assistance with physical mobility tasks. Women, by contrast, receive more support for caregiving tasks outside the home. The men, and in particular the women interviewed, reported that they received little help with household chores. Although this does not have statistical significance, according to a recent study published by our group , women aOur results did not show statistical significance in the relationship between care and self-perceived health. However, the evidence from other studies leads us to the need to deepen this relationship from complementary approaches, such as qualitative ones. In fact, there is clear evidence from other studies that women report worse health because of the greater burden they bear and that the differences between men and women in this respect shrink or disappear when the burden on men increases . ObservaThe findings of this study provide preliminary data for helping to understand the different ways in which male and female caregivers interact with members of their personal networks to meet their caregiving needs. The poor statistical significance of our study could be because of the small size of the sample. The personal networks of both genders were similar in structure, but varied significantly in terms of composition and function. Men had broader, more diverse networks than women and also received more support from alters outside the family circles, such as work colleagues and paid professionals and non-professionals. Women’s networks were less diverse and mainly featured women with similar sociodemographic profiles to theirs and often from the same family. Our findings highlight the need to develop public strategies that do not reinforce traditional gender roles, but rather encourage a sharing of responsibility among all stakeholders.