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Dealt with is the medical profession's legal status in the vocational education and vocational retraining centres. The legal basis for the medical doctor's activities in this type of facilities is clarified, drawing on the legislational history of various rehabilitation-related laws.
In our modern working world, young adults with disabilities not only face problems in securing employment, but, also, in finding adequate vocational training places. This had in the 1970s lead to the establishment of vocational training institutions. Local employment offices and employers however, again and again complain about poor organic capacity and endurance in young people trained in these centres. It consequently is very difficult for these young people to be placed in the open labour market. A study of the various principal demands on motor functioning and of pulmonary capacity was to clarify the extent to which deficits in motor and cardiopulmonary fitness exist. A total of 328 subjects (mean age 18:5 years), among them 17 wheelchair users, were examined relative to their motor and organic capacity. Significant deficits were found in nearly all component functions compared to nonhandicapped peers, with arm and trunk muscle strength the only exception to this negative performance picture. The motor deficits found were greatest in respect of dexterity and balance. Possible reasons for these motor deficits are discussed, and measures concerning disability-specific sports classes are discussed.
A longitudinal study was conducted to test the mediational role of efficacy expectations in relation to sex differences in the choice of a math/science college major. Data on 101 students were gathered prior to their entering college and then again after they had declared a major 3 years later. Path analytic results support the importance of both math self-efficacy beliefs and vocational interest in mathematics in predicting entry into math/science majors and mediating sex differences in these decisions. Also, students who described themselves as more extroverted were less likely to take additional math classes in high school. Students with stronger artistic vocational interests chose majors less related to math and science. School personnel are strongly encouraged to develop programs that challenge the crystallization of efficacy beliefs and vocational interest patterns before students enter college.
A survey of the educational and vocational achievement of the 423 adult hemophiliacs registered with the Commonwealth of Pennsylvania Hemophilia Program found that the hemophiliacs were significantly better educated yet somewhat less frequently employed than their age-matched cohorts in the Pennsylvania population. The discrepancy between educational achievement among hemophiliacs and their ability to obtain employment was most apparent for subjects with severe disease. This suggests that severity of disease remains a significant barrier to vocational achievement for some hemophiliacs, despite comprehensive care and their overall educational gains. Possible reasons for this discrepancy in achievement are discussed and the need for greater emphasis on research and the development of vocational services is stressed.
BACKGROUND: Although most needlestick/sharps injuries (NSIs/SIs) research focuses on health care workers (HCWs), students in hospital internships are also at risk. Investigations that examined NSIsS/SIs in student populations generally studied medical rather than nursing students (NSs). In 1999, approximately 17,000 Taiwanese nursing graduates were exposed to the hazard of NSIs/SIs. We examined the frequency and mechanism of NSIs/SIs among vocational school NSs in southern Taiwan. METHODS: Between July and December of 1999, within 1 week after the NSs completed their internship training, one of the researchers, who was a teacher in this vocational school, asked them to fill out questionnaires. RESULTS: Five hundred twenty-seven of 550 (92.6%) questionnaires were considered valid. Two hundred sixty-four of 527 (50.1%) responders sustained one or more NSIs/SIs. Ninety-six of 527 (18.2%) responders suffered contaminated NSIs/SIs. The average number of NSIs/SIs per student was 8.0 times/year (4.9 times/student/year for NSIs and 3.1 times/student/year for SIs). NSIs/SIs rates for NSs in 10-week and 4-week internships were significantly different ( P = .039): 53.3% versus 43.7%, respectively. The NSIs/SIs frequencies were influenced by length of internship: 7.3 times/student/year in 10-week internship and 11.7 times/student/year in 4-week internship. Logistic regression analysis indicated that length of internship rotation was statistically significant with respect to contaminated NSIs/SIs (OR = 1.682; 95% CI: 1.005-2.81; P = .048). CONCLUSIONS: The NSIs/SIs frequencies of NSs were higher than those for HCWs. We found that frequency of NSIs/SIs for vocational school NSs is above average. Whether the young age of these NSs put them at greater risk for NSIs/SIs warrants further inquiry.
Given the longstanding shortage of nurses in many jurisdictions, why could not nursing wages be raised to attract more people into the profession? We tell a story in which the status of nursing as a 'vocation' implies that increasing wages reduces the average quality of applicants attracted. The underlying mechanism accords with the notion that increasing wages might attract the 'wrong sort' of people into the profession and highlights an (in)efficiency wage mechanism, particular to vocations, which makes wages sticky up wards. The analysis has implications for job design in vocation-based sectors such as nursing and teaching.
This study examined the role of vocational behaviors in the treatment of 80 crack users. The study had two general aims: (a) to predict which crack users had acquired jobs after 30 days in treatment; and (b) to examine if vocational behaviors assessed at admission and follow-up accounted for variations in recovery motivation, psychological functioning, and treatment completion. Multivariate analyses identified four predictors (race, having a polysubstance problem, 12-step sponsor, and specific job skill) of job acquisition. Multivariate analyses also indicated that past year employment was negatively related to recovery motivation but positively related to psychological functioning and treatment completion, and that job acquisition was negatively related to one measure of recovery motivation but positively related to psychological functioning. Future research should use multiple group designs to examine the effects associated with including a vocational component in treatment programs.
STUDY DESIGN: Non-experimental (ex post facto) survey research design involving the use of a fixed alternative format questionnaire. OBJECTIVES: To investigate variables influencing vocational outcome, to identify barriers to gaining and sustaining employment and to identify the effects of variables on the type of work engaged in following spinal cord injury. The two sets of independent variables considered were, individual and injury-related factors (age at onset of injury, time since injury, extent/level of injury, highest educational qualification achieved pre-injury, and pre-injury occupation) and circumstantial factors (means of transport, access difficulties, perceived workplace discrimination, financial disincentives to work and perceived level of skill). SETTING: The Princess Alexandra Hospital Spinal Injuries Unit, Queensland, Australia. METHODS: Data on the variables and the vocational outcomes of having ever worked or studied post-injury, current employment status and post-injury occupation were obtained from survey responses. Demographical and medical data were gathered from medical records. RESULTS: Forward stepwise logistic regression revealed that having ever worked or studied post-injury was associated with all individual and injury-related factors except pre-injury occupation, and two circumstantial factors, namely means of transport and access difficulties. Current employment was associated with all circumstantial factors as well as age at injury and pre-injury occupation. Standard multiple regression analyses revealed that post-injury occupation was correlated with all individual and injury-related factors as well as means of transport and perceived workplace discrimination. CONCLUSIONS: Tailored rehabilitation programs for individuals with characteristics associated with less successful vocational outcomes may facilitate their employment status after injury.
In Hong Kong, the understanding of the vocational experience of sheltered workshop workers with intellectual disability is still relatively meagre. Twenty-three participants with intellectual disability and four professionals from their sheltered workshops were interviewed using mainly open-ended questions. Content analysis and constant comparative method were adopted to categorize the descriptive data into themes that were salient to the participants' vocational aspirations to try open employment. The insider perspective showed that all participants were motivated to have employment. Thirteen participants with intellectual disability preferred to try open employment and they had individual vocational preferences which mainly belonged to unskilled and manual work. The professionals pointed out that sheltered workshop workers with intellectual disability needed professionals' assistance and parents' consent in moving on to open employment, and parents were the key people in this decision-making process. These findings indicate that sheltered workshop workers with intellectual disability have limited self-determination in the work arena. The need to empower people with intellectual disability, improve the quality of sheltered employment services and increase the involvement of their family members are discussed.
The aim of the present study was to assess the point-prevalence of psychiatric disorders according to DSM-III-R criteria and the hidden morbidity in individuals with intellectual disability working in a vocational setting. The present study was carried out in a vocational centre in Southern Spain which is considered to be a model for social integration. One hundred and thirty workers with intellectual disability were interviewed by two experienced clinicians using the Assessment and Information Rating Profile, DSM-III-R criteria, and the General Assessment of Functioning and Clinical Global Impression scales. The point-prevalence of psychiatric morbidity, hidden morbidity and treatment adequacy were estimated. Morbidity was hidden (i.e. not previously diagnosed) in 50% of psychiatric cases. Forty-two (32.3%) subjects had a psychiatric diagnosis with the following distribution: schizophrenia (17.7%), other psychotic disorders (9.23%), mood disorders (4.61%), adaptive disorders (2.31%), anxiety disorders (1.54%) and other psychiatric disorders (6.15%). Treatment was judged inadequate in 30% of subjects. The point-prevalence of psychiatric problems in a vocational setting in Spain was similar to that found in other environments. Hidden morbidity was similar to that found in primary care. The present study highlights the need for standardized instruments for psychiatric assessment in non-clinical settings as well as specific training in this area.
BACKGROUND: GP registrars, in common with other doctors, frequently experience high levels of stress; however, little is known about the nature and outcomes of personal and educational problems experienced during vocational training for general practice. OBJECTIVES: The purpose of our study was to elicit the nature, causes and effects of more severe problems experienced during vocational training for general practice from the registrar's viewpoint and put these into the context of their personal circumstances and background. METHODS: This qualitative study used detailed semi-structured telephone interviews with a selected subgroup of 33 of the 1999 entry cohort of general practice registrars in Australia who had reported serious self-defined problems during an earlier longitudinal questionnaire study. Registrars were asked about the nature, antecedents and outcomes of problems experienced during GP training, actions taken to resolve the problem, and their perceptions of what might have helped prevent or minimize the problem. RESULTS: Problems reported by registrars fell into five major themes: isolation (structural isolation, social isolation and professional isolation); flexibility and choice (administrative issues and balancing work with personal life); change and uncertainty (within general practice and training, intergenerational changes); teaching problems; and work conditions. Actions taken and effects of problems are also discussed in the light of workforce imperatives. Results have been used to develop a list of suggestions for the providers of general practice training. CONCLUSIONS: Registrars commonly experience problems during vocational training. These may be related to structural, social and professional isolation, or a lack of flexibility in training arrangements and balancing work and other commitments. Some of these problems may be amenable to relatively simple solutions involving term placements, selection of training practices and administrative adjustments.
The vocational development of 547 disabled students in the United States and the Federal Republic of Germany was compared with a group of able bodied students in the U.S. on the Goldberg Scale of Vocational Development (GSVD), measuring plans, realism, initiative, work values, commitment, and occupational awareness. The students were classified into 8 groups, and covaried by age. The average scores from high to low on vocational development were: able bodied, cystic fibrosis, congenital heart, orthopedic, facial burns, delinquent, developmental disability, learning or mental retardation. The German students made plans specifically tailored to training courses whereas the American students made more varied and open ended plans with higher aspirations for the future. All 7 disabled groups scored lower than the able bodied group, with only the cystic fibrosis group approaching normality.
This investigation evaluated the psychosocial consequences of the diagnosis and treatment of acute lymphoblastic leukemia (ALL) on the long-term adjustment of a sample of 46 patients less than 20 years of age at diagnosis (mean age: 7.46 years). Subjects were followed up for an average of 15.4 years after diagnosis and were a mean of 22.87 years old at assessment. A sample of Hodgkin's disease and non-Hodgkin's lymphoma survivors served as a comparison group. Patients completed standardized measures of well-being, stress reaction, vocational satisfaction, and a questionnaire assessing defensiveness regarding their history of cancer treatment, experienced job discrimination, and social involvement. Overall, the subjects appeared to be well-adjusted; female subjects, however, exhibited an increased tendency to experience anxiety in stressful situations. Vocational discrimination did not appear to be a significant problem for this group of survivors, and subjects exhibited levels of vocational satisfaction that did not differ from population norms. Greater defensiveness regarding a history of cancer treatment was associated with lower levels of well-being and heightened stress reaction. Survivors who received CNS prophylaxis that included cranial irradiation had lower well-being scores than did those survivors receiving only intrathecal methotrexate.
PURPOSE: To evaluate the long-term social effect of illness and its treatment on young-adult survivors of pediatric cancer by addressing a selection of general social adjustment criteria. METHODS: In a cross-sectional case-control study, 30 young-adult survivors of childhood cancer were compared with (1). controls with no history of serious illness, matched by sex, age, and geographic area of residence, and (2). general population norms on the subject of educational and vocational factors, habitation, family/partner relationships, parenthood, and leisure activities. RESULTS: The educational status of survivors was similar to that of controls, although a smaller proportion of the patients expressed concrete plans for future vocational or educational advancement. Survivors had less frequently entered higher education compared with general population norms. A longer duration of treatment was related to a lower estimated socioeconomic level, and poor psychological coping with the illness experience was associated with the fact that they were still living with their parents, a shorter education, and a lower socioeconomic level. CONCLUSIONS: The social, vocational, and educational adjustment of relapse-free survivors from childhood cancer appears as only moderately, if at all, negatively affected by the illness and treatment history. However, the treatment intensity and particularly the survivors' coping with their illness experience may influence their ability to achieve long-term social goals. These findings suggest that special attention should be given to matters concerning education and partner relationships at long-term follow-up of pediatric cancer patients.
The purpose of this descriptive study was to determine the perceptions of activity and vocational status in women with cardiac illness. A convenience sample of 20 women with the diagnosis of coronary heart disease or hypertrophic cardiomyopathy participated. Subjects underwent an audiotaped interview, using a semistructured interview guide, which was then transcribed into the Ethnograph software program (Qualis Research Associates, Salt Lake City, UT). Transcripts were analyzed for common themes via content analysis. There were four themes identified for activity: variable activity patterns, fatigue, guilt, and depression. There were four themes identified for vocational status: desire to work, social aspects of work, unpaid work, and struggle to maintain the status quo. In conclusion, the themes of fatigue, guilt over unmet activity expectations, and the common occurrence of unpaid work validated prior research findings. The themes of variable patterns of activity management, feelings of depression about lowered activity levels, the desire to return to a prior vocation, the importance of the social nature of work, and the struggle to balance both home and work roles were new findings.
PURPOSE: To assess the pre- and postsurgical frequency of memory, emotional, and vocational impairments in patients who underwent anterior temporal lobectomy (ATL), and to assess the relationship between emotional disturbance and memory abilities after ATL. METHODS: Retrospective analysis of data was performed on 90 patients with medically intractable complex partial seizures who underwent ATL between 1981 and 2003. Patients were evaluated an average of 5 months before surgery and 11.3 months after surgery. RESULTS: A moderate to high frequency of memory impairment (44.4%; verbal or nonverbal), emotional disturbance (38.9%) and unemployment (27.8%) existed in the same individuals both before and after surgery. There were small to moderate rates of new onset memory (18.9%), emotional (11.1%), and vocational (7.8%) difficulties after surgery often regardless of seizure control outcome. Patients who underwent left-ATL and had emotional disturbance after surgery had the lowest verbal memory test scores. CONCLUSIONS: Results highlight the importance of taking into account emotional status when assessing memory abilities after ATL. Results replicate the finding of moderate to high frequencies of memory impairment, emotional disturbance, and unemployment both before and after ATL. Results provide support for the rationale that cognitive, psychiatric and vocational interventions are indicated to mitigate the problems that exist before and persist after ATL.
OBJECTIVES: To examine the content of hospital obstetric vocational training for general practice, the beliefs of general practitioner trainees about this training, and their perceived competence at practical obstetric procedures and the effect of training. DESIGN: Confidential postal questionnaire. SUBJECTS: A random one in four sample of all general practitioner trainees in the United Kingdom on vocational training schemes or in training practices in Autumn 1990. MAIN OUTCOME MEASURES: Trainees' competence and beliefs on Likert scale, numbers of procedures witnessed and performed, type of maternity care trainees intended to provide. RESULTS: Of 1019 trainees sent questionnaires, 765 (75.1%) replied; 517 had done some hospital obstetric training. After six months as a senior house officer 232/367 (63%) believed they were competent to perform a normal delivery unaided, 228 (62%) to manage a severe postpartum haemorrhage, and 227 (62%) to resuscitate a newborn infant. 272 (35.6%) trainees intended to provide intrapartum care and 56 (7.5%) to book home deliveries in the future. Hospital training increased confidence in performing most obstetric procedures in all trainees. However, a greater proportion of trainees who intended to provide full care than shared care felt competent at performing a normal vaginal delivery (63% (170/272) full v 45% (215/473) shared), low forceps delivery (38% (103) v 17% (79)), manual removal of placenta (24% (65) v 17% (82)), and intubating a neonate (42% (114) v 34% (161)). Trainees who had done any obstetric training were less likely to think that training encouraged future provision of intrapartum care (113/509 (22%) training v 65/213 (31%) no training). CONCLUSION: Hospital vocational obstetric training increases the perceived competence of trainees but fails to encourage them to use obstetric skills.
OBJECTIVES: To identify doctors who are vocationally trained but not currently practising as principals in general practice; their reasons for not practising as principals; and whether the prospect of a re-entry course would appear to this group. DESIGN: Postal questionnaire survey based on semistructured interviews. SUBJECTS: Doctors who had been vocationally trained but were not currently practising as principals: 351 possible subjects identified by a process of "networking." SETTING: Trent Regional Health Authority. RESULTS: 166 of the doctors who replied fitted the criteria (100 women; 66 men). The out of hours commitment was ranked as the most important factor for not practising as a principal--95 women and 50 men rated it important--followed by difficulty in combining work with family commitments--84 women, 31 men. 82 respondents (49%) said they would be interested in a re-entry course if one were available. CONCLUSIONS: There is a pool of vocationally trained doctors in Trent region who are not practising as principals in general practice. More flexible working patterns and the availability of a re-entry course could make the post of principal in general practice a more attractive proposition to these doctors.