Employment status of physicians completing training.
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Health Workforce↗
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The changing nature of admissions to a spinal cord injury center: violence on the rise.
The purpose of this study was to analyze changing etiologies for admission to a spinal cord injury center. This study was designed to retrospectively analyze the etiology of admissions to a spinal cord injury center during a 15-year period, specifically gunshot versus nongunshot wound injuries. Gunshot wounds are a well-recognized cause of spinal cord injury. In some centers, up to 52% of admissions are due to this, and these trends are believed to be increasing. All patients with spinal cord injury admitted to our center between 1979 and 1993 were analyzed. Frequencies of specific etiologies were determined and then comparisons were made between gunshot wound and nongunshot wound groups. Factors analyzed included age, male/female ratio, ethnic make-up, marital status, employment status, level of injury, and neurologic status. One thousand eight hundred seventeen patients were included. Overall, gunshot wound spinal cord injuries compromised 16.9% of injuries. A clear trend of increasing numbers of admissions was seen between 1984 and 1993 because of this. Gunshot wounds and nongunshot wounds differed dramatically in terms of age, ethnic make-up, marital status, employment status, and neurologic status. Cost attributed to treating gunshot wound injuries at our center for 1993 was 5.4 million dollars. Gunshot wounds as a cause of spinal cord injury are increasing at an alarming rate. The demographics of the gunshot wounds and nongunshot wound spine cord injuries differ significantly.
Accidents, Traffic↗
Acute predictors of return to employment after traumatic brain injury: a longitudinal follow-up.
OBJECTIVE: To investigate the relation between selected acute injury and patient characteristics and subsequent return to work 1 to 5 years postinjury. DESIGN: Longitudinal design with prospectively collected data. Data were collected on patients at the time of injury and each year postinjury for up to 5 years. SETTING: Four medical centers in the federally sponsored Traumatic Brain Injury Model Systems project that provide emergency medical services, intensive and acute medical care, inpatient rehabilitation, and a spectrum of community rehabilitation services. PARTICIPANTS: Patients were selected from a national database of 538 rehabilitation inpatients admitted to acute care within 8 hours of traumatic brain injury (TBI) and seen at 1 to 5 years follow-up. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Employment status (employed vs not employed) at 1 to 5 years postinjury. Logistic regression analyses were performed to determine the extent to which selected variables predicted employment status at years 1 to 5 postinjury. RESULTS: At year 1 postinjury, preinjury productivity, age, education, and rehabilitation length of stay were all significantly associated with postinjury employment. Preinjury employment and productivity and age significantly predicted employment at postinjury year 2. At year 3 postinjury, preinjury productivity, age, and FIMtrade mark instrument discharge score significantly predicted employment status. Age was significantly associated with employment status at year 4 postinjury. Preinjury employment and productivity and Disability Rating Scale discharge score were found to be significant predictors of postinjury employment at year 5 follow-up. CONCLUSIONS: The relationship between certain acute injury and patient variables (eg, age, preinjury productivity, education, discharge FIM) and subsequent return to work may provide rehabilitation professionals with useful information regarding the intensity and types of services needed for individuals in the vocational rehabilitation planning process.
Adult↗
Effect of orthotopic liver transplantation on employment and health status.
Employment, functional status, health status, and prevalence of anxiety and depression were assessed in patients who had undergone orthotopic liver transplantation at Duke University from 1984 to 1993 to identify social and economic factors that might influence return to work after liver transplantation. Patients were asked to complete mailed questionnaires. A transplant nurse coordinator assigned patients a Karnofsky score, unaware of the questionnaire responses. The response rate was 71% (52 of 72 patients). The median age of the post-liver transplantation patients was 49 years. Median years of education were 13. Sixty-five percent of patients were male. Sixty percent of patients were employed posttransplantation. Employed and unemployed posttransplantation patients showed no significant difference in age, education, gender, marital status, race, family coping skills, or cause of liver disease. Return to work after transplantation did not correlate with socioeconomic status or spouse's employment. Posttransplantation return to work was highly correlated with pretransplant employment (P < .0005). The prevalence of anxiety and depression, assessed by the Hospital Anxiety and Depression Scale (HAD), was 9% and was no different in the employed or unemployed patients. Health status, as measured by Karnofsky score, was excellent; all patients received Karnofsky scores > or = 80%. Health perceptions were compared in employed versus unemployed posttransplantation patients with the SF-36, a 36-item short form survey developed by the investigators of the Medical Outcome Study. This revealed significantly different values in the subscale, physical functioning, with a mean score of 70.6 in the employed and a mean score of 48.4 in the unemployed posttransplantation patients (P = .004) and role-physical with a mean score of 61.8 in the employed and a mean score of 27.6 in the unemployed posttransplantation patients (P = .005). Eighty percent of patients not returning to work cited "problems with their health" as their major obstacle to employment. Although objective health status was good to excellent in all patients after transplantation, patients perceived that their health status was poor, with the lowest scores observed in unemployed posttransplantation patients.
Adult↗
Some social factors related to control of diabetes mellitus in adult Jamaican patients.
A population of 103 adult diabetic patients was interviewed at the Outpatient Clinic for diabetic patients of the University Hospital of the West Indies to examine the effects of severity of the illness and social variables, such as facilities at home, education attained, employment status, informal medication, and understanding of the illness in relation to its control. Patients were classified as severe if there were clinical evidence of vascular or neurologic complications of diabetes and as mild if there were no complications. Control of diabetes was regarded as good if the patients were free from or had less than 2+ glycosuria and as poor if they had had 2+ or more glycosuria during the six months before the study. We found that the quality of control was mainly determined by the severity of the disease. In the mild diabetic, proper diabetic control was not influenced by any social variable examined. In the severe diabetic the quality of control was associated with social amenities, educational status, employment status, and understanding of the disease.
Adult↗
Impact of demographic and medical factors on satisfaction with life after spinal cord injury: a normative study.
OBJECTIVE: The aim of this study was (1) to examine demographic and medical predictors of the Satisfaction With Life Scale (SWLS) among individuals with spinal cord injury (SCI) and (2) to provide a normative table for the SWLS that includes appropriate adjustments for the most important predictors of life satisfaction. STUDY DESIGN: We examined predictors of the SWLS including age, education, sex, race, injury duration, number of rehospitalizations, marital status, employment status, SCI etiology, and level of neurological impairment. PARTICIPANTS: Individuals in the National Spinal Cord Injury Statistical Center database [from 18 SCI model systems (1995-1999)] undergoing follow-up assessment were included for study. OUTCOME MEASURE: Satisfaction With Life Scale. RESULTS: Univariate analyses indicated that marital and employment status, race, sex, education, and injury duration were significant factors associated with scores on the SWLS. In general, individuals who were female, white, married, and currently employed and had a higher education and longer injury duration reported significantly higher scores on the SWLS (P < .01). Effect-size estimates for these factors ranged from 0.16 to 0.41. Regression analyses showed that education, employment status, and injury duration were the strongest unique predictors of satisfaction with life but accounted for only 10% of the variance. CONCLUSION: The SWLS is a global measure of life satisfaction and is relatively unrelated to demographic and medical characteristics. Normative tables are provided for epidemiologic comparison.
Adolescent↗
Health, functional status, and employment of adult survivors of bone marrow transplantation.
OBJECTIVE: To determine the health, functional ability, and employment status of adults who survive bone marrow transplantation. DESIGN: Inception cohort study. SETTING: Patients who received transplants at a single referral-based center. PATIENTS: Adults of 18 years of age or older who had received bone marrow transplants at least 6 months previously and who were not in a life-threatening relapse were surveyed a mean of 47 months after transplant (median, 37 months; range, 6 to 149 months). Of 171 eligible patients, 157 were contacted and 135 (86%) responded. MEASUREMENTS AND MAIN RESULTS: Patients completed a mailed survey. Medical records were also reviewed. Most patients (93%) reported they could do normal activities with minor or no physical problems (Karnofsky scores, greater than or equal to 80%). Global health was described as good to excellent by 67% of subjects. Most perceived social activities (80%) or physical functional abilities (67%) to be unimpaired or only slightly affected. Moderate or severe pain was uncommon (13%). Sixty-five percent had returned to full- or part-time employment, and one third of those who were not employed were attending school. Job discrimination and problems in obtaining insurance were reported by 23% and 39%, respectively. Among those who had been employed before illness, loss of employment was associated with lower social functioning, chronic graft-versus-host disease, greater job discrimination, and female gender using multivariate logistic regression. CONCLUSIONS: Most subjects surviving bone marrow transplant reported good to excellent health and functional ability. Three fourths were employed or enrolled in school. These outcomes are comparable to outcomes in survivors of cancer who received less intensive treatments.
Activities of Daily Living↗
Socio-economic conditions, health status and employment among persons living with HIV/AIDS in France in 2001.
To investigate employment levels and identify barriers to work among persons living with HIV/AIDS in France in 2001, we conducted a cross-sectional study among HIV-infected patients seen in the hospital outpatient clinics of the two French regions most affected: Ile-de-France (IDF) and Provence-Alpes-Côte-d'Azur (PACA). Of the 840 outpatients included in the study, 58.8% in IDF and 46.8% in PACA were currently employed, and 28.1 and 47.8%, respectively, were receiving disability benefits. Among unemployed patients, 32.1% in IDF and 29.6% in PACA reported that they planned to (re)enter the workforce. Current and planned employment status were associated with characteristics indicative of the patients' social and demographic situation before the HIV diagnosis (region of residence, educational level, HIV transmission group, age, nationality) and with their health status at the interview (HIV progression, HCV co-infection). Receiving disability benefits was negatively associated with plans to return to work. HIV-related discrimination at work was reported by 11.9% of the patients in IDF and 9.2% in PACA, and was not associated with occupational status. Thus, social interventions should seek to prevent patients, particularly the most socially vulnerable, from leaving their jobs at acute stages of their illness and should promote (re)entry into the workforce among unemployed patients.
Acquired Immunodeficiency Syndrome↗
Employment factors in outpatient recovery of alcoholics: a multivariate study.
This study examined the effects of patient and treatment variables on alcoholic outpatient recovery over a one year period. One-hundred-seventy-four subjects, dichotomized by age (less than or equal to 42 or greater than 42) and employment status (employed or unemployed), were randomly assigned to one of three treatment groups (medical check-up, medication, or multi-therapy). Seventy-eight percent of these subjects were available for follow-up. Dependent measures included neuropsychological functioning and subject ratings of mood and alcohol consumption. Statistical analysis was by a 2 X 3 X 2 MANOVA. Employment status was a significant variable relative to positive outcome changes on mood and neuropsychological functioning. Moreover, older employed alcoholics showed a significant reduction of confusion. No group differences were noted at outcome with respect to age or treatment. The implications of the results for conventional alcoholism outpatient treatment are discussed.
Adult↗
Comparing treatments for dual diagnosis: twelve-step and self-management and recovery training.
The purpose of this study was to compare the effectiveness of 12-step and cognitive-behavioral (Self-Management and Recovery Training [SMART]) approaches for persons with a dual diagnosis of serious mental illness and substance use disorder in an intensive outpatient/partial hospitalization setting. Participants (n = 112) were alternately assigned to the two treatment conditions, with 50 participants completing the 6-month treatment program. Assessments occurred at baseline, 3 months, and 6 months during treatment, and at 3- and 12-month follow-ups. Analyses were conducted on participants who had completed 3 months of treatment (n = 70). The 12-step intervention was more effective in decreasing alcohol use and increasing social interactions. However, a worsening of medical problems, health status, employment status, and psychiatric hospitalization were associated with the 12-step intervention. SMART was more effective in improving health and employment status, but marijuana use was greater for SMART participants. Improvements in alcohol use and life satisfaction occurred in both approaches. Covariates associated with treatment outcome were identified, with greater attendance being positively related to outcome. Involvement with the criminal justice system was positively related to treatment completion but negatively associated with medical problems. Less alcohol use, fewer medical problems, and better financial well-being at baseline were associated with better attendance.
Adult↗
[Change in the quality of life following aortocoronary bypass and heart valve replacement: assessment of subjective surgical success].
Life quality of 100 consecutive male patients, half with coronary heart disease and half with valve diseases, was assessed 2 days prior to operation (A in the Tab.) as well as 1 year postoperatively (B in the Tab.) by standardized interview. The questionnaire included the physical condition and the emotional status, employment status, social interaction and sexuality. By far the majority of the interviewed patients showed a distinct improvement in all fields confirming a clearly positive effect of the heart operation on life quality: The number of persons employed increased by a third. The length of preoperative sick leave seems to be a good indicator for returning to work again: from 52 persons, having been preoperatively on sick leave for more than 2 weeks, 21 retired early after operation, 6 remained on sick leave and only 6 patients returned to full-time work again. On the other hand, 20 of the 24 patients who worked up to the time of operation took up their employment again postoperatively. Postoperative employment status does not seem to be primarily a question of physical improvement. Anxiety and fear of infarction recurrence or economic factors seem to be much more decisive for returning to work. However, the patients reported a distinct improvement of physical and emotional status: 85 described their physical condition, 63 their emotional status as "clearly improved" or "better". Less drugs were used in general, and the use of tranquillizers and soporifics was cut down to a third.(ABSTRACT TRUNCATED AT 250 WORDS)
Adaptation, Psychological↗
Sex roles, occupational roles, and symptom-reporting: a test of competing hypotheses on sex differences.
The sick-role, fixed-role obligations, symptom-reporting, and nurturant-role hypotheses of sex differences in utilization of health services and symptom-reporting were tested against each other. Fifty-one nontraditional college students completed the Cornell Medical Index (CMI), the Bem Sex Role Inventory, and questions regarding their employment status. Employment status and feminine characteristics emerged as the best predictors of symptom-reporting on the CMI and suggested that the sick-role hypothesis may be empirically superior to the others.
Adolescent↗
Visual impairment in a Taiwanese population: prevalence, causes, and socioeconomic factors.
PURPOSE: We sought to estimate the prevalence of visual impairment among an elderly population in urban Taiwan, determine the causes of visual impairment, and gain information about certain socioeconomic factors associated with visual impairment. METHODS: A population-based survey of ocular diseases in residents aged 50 years or older was conducted in Peitou Precinct, Taipei, Taiwan. All participants underwent a comprehensive ophthalmic examination, including visual acuity measurement, using standardized protocols. Demographic data, marital status, employment status, and educational level were gathered through an interview. RESULTS: A total of 2034 participants completed the visual acuity measurements. The prevalence of visual impairment (defined as best-corrected visual acuity in the better eye <6/18) among this population was 2.75% (95% confidence intervals: 2.04%-3.46%). Three major causes of visual impairment were cataract (30.4%), high myopic macular degeneration (25.0%), and age-related macular degeneration (14.3%). In multivariate analysis, age was positively correlated with visual impairment (P < 0.001), and higher education level was associated with a significant decrease in the odds of being visually impaired (P < 0.001). No relation was found between visual impairment and sex, or marital and employment status. CONCLUSIONS This study provides the first information about the prevalence and causes of visual impairment in Taiwan, and identifies age and educational level as the most important factors related to visual impairment. Additional educational programs should be developed to improve individual awareness of age-related ocular diseases and the availability of current ophthalmic intervention.
Age Distribution↗
Effects of primary care depression treatment on minority patients' clinical status and employment.
BACKGROUND: The response of ethnic minorities to mental health care is largely unstudied. OBJECTIVE: To determine the effect of appropriate care for depression on ethnic minorities. DESIGN: Observational analysis of the effects of evidence-based depression care over 6 months on clinical outcomes and employment status is examined for ethnic minorities and nonminorities. Selection into treatment is accounted for using instrumental variables techniques, with randomized assignment to the quality improvement intervention as the identifying instrument. SETTING: Six managed care organizations across the United States. Patients One thousand three hundred fifty-six depressed adults, including 601 white, 258 Latino, 56 African American, and 24 Asian or Native American patients. Intervention Quality improvement interventions aimed at increasing guideline-concordant depression care. RESULTS: At 6 months, minority patients who received appropriate care, compared with those who did not receive it, had lower rates of probable depressive disorder (20.5% vs 70.5%); the findings were similar for nonminority patients (24.3% vs 71.2%). Nonminority patients who received appropriate care were found to have higher rates of employment than were those who did not receive appropriate care (71.4% vs 52.4%). This was not true of minority patients (68.2% vs 56.5%). CONCLUSIONS: Evidence-based care for depression is equally effective in reducing depressive disorders for minority and nonminority patients. However, functional outcomes of care, such as continued employment, may be more limited for minority than nonminority patients. Because minority members are less likely to get appropriate care, efforts should be made to engage minority members in effective care for depression.
Adolescent↗
Correlates of employment history and employability in a British epilepsy sample.
This study examined the inter-relationships between employment status, employment experiences, background, educational and epilepsy-related variables in a community sample of 1709 people with epilepsy in England and Wales. A postal questionnaire yielded information which included attitudes to careers advice, experiences with fellow employees and management when in work, experiences of being questioned about epilepsy, and the perceived effect of having epilepsy on employment prospects. In a principal components analysis, a factor of 'employability' was identified that had high loadings for educational qualifications, socioeconomic status and employment history. Good employability was found to be related to perceptions that epilepsy had little or no effect on job prospects, good experiences with work colleagues and management, low seizure severity and good seizure control. Further data analyses which focused on people's actual employment histories confirmed the importance of past experiences in employment, educational qualifications, seizure severity and seizure frequency for distinguishing between groups. The study findings are discussed and, taken together, they imply that quality of medical care, employability and good employment history are interconnected in important ways.
Adult↗
The relation of socioeconomic factors to the incidence of proliferative diabetic retinopathy and loss of vision.
PURPOSE: To investigate the relations between socioeconomic factors and the incidence of proliferative retinopathy and loss of vision. METHODS: A population-based sample of younger-onset persons with diabetes 25 years of age or older (n = 334) and older-onset persons with diabetes (n = 906) was followed over a 4-year period. Education, occupational status, employment status, and marital status were measured at baseline and follow-up. Main outcome measures were incidence of proliferative retinopathy and loss of vision measured using standard protocols. RESULTS: Proliferative retinopathy was more likely to develop in younger-onset women with less education than in those with more education; no relation was found in the older-onset group. Education was associated inversely with incidence of loss of vision in younger-onset women and older-onset men. CONCLUSION: These data suggest that education is associated with the development of loss of vision, independent of other risk factors. The associations vary between men and women and between younger-onset and older-onset people with diabetes. Further understanding of these relationships may lead to interventions to prevent loss of vision in people with diabetes.
Adult↗
Characteristics of psychiatric patients who engage in assaultive or other fear-inducing behaviors.
The hospital records of 1687 psychiatric patients were rated for the presence of assaultive or other fear-inducing behaviors associated with the reasons for their hospital admissions. Data analyses indicated that significant associations existed between these behaviors and sex, race/ethnicity, diagnosis, previous admissions, referral source for hospitalization, legal status at admission, and legal status at discharge. No associations were found for age, education, marital status, employment status, number of days hospitalized during the index hospitalization, and referral at discharge. A comparison of these results with the results of studies by other investigators led to the conclusion that clinical variables appear to have a more consistent relation to violent behavior than demographic variables. Future research examining for the correlates of violent behavior in psychiatric patients may be more productive by focusing on the type and degree of patients' psychopathologies rather than on patients' demographic characteristics.
Adolescent↗
[Diagnostic investigation of clients seeking contraception in a general practive. Diagnostic probability for pronounced menstrual discomfort, sexual complaints and pathological gynecologic findings in a woman's age, marrital status, parity, employment, and social status].
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Age Factors↗