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At least 1,027 records · Page 57Linked to original sources
PubMed1995

Work and meaning: disturbance of volition and vocational dysfunction in schizophrenia.

R. is a 40-year-old, divorced, White male with a diagnosis of schizophrenia, paranoid type, chronic. Shortly after his entrance into our work rehabilitation program, R. engaged one of the authors (P.L.) in a conversation about the nature of his illness. He reported that his most disabling and pervasive symptom was a persistent inability to pursue any goal in his life. R. recognized that he had other symptoms of psychiatric illness but stated that these did not account for his disability. He explained that the voice of God that counseled him when he felt overwhelmed and his fear that God was about to kill him as punishment for his sins put life in perspective and, consequently, were sometimes as comforting as they were distressing. R. explained that what had altered his life was a process, invisible to others, that left him unable to plan out and pursue a life course. He did not know whether it was a lack of knowledge or lack of motivation and energy that left him without the inner direction he needed. All he knew was that it was "schizophrenia," and it left him unable to work or to function like other people. What R. was describing as the foundation of his illness and his disability appears to be a disturbance of volition. Interestingly, self-understanding is more consistent with several of the early formulations of schizophrenia than it is with current formulations. To explore the merits of R.'s belief about his illness we offer a review of the role that disturbance of volition has played in historical conceptualizations of schizophrenia, the current nosology, and in theories of the negative or deficit syndrome. The history of R.'s illness is then presented. Lastly, we discuss what we learned from R.'s participation in a paid work program.

Adult↗
PubMed2005

Development of an instrument to measure the Practice Vocational Training Environment in Ireland.

The concept of the learning environment is increasingly recognized as an important feature within educational settings. Research on health-related educational environments has clearly demonstrated their impact on important outcomes such as student satisfaction and achievement, stress levels and ultimately on patient care. To date limited research has been carried out on the practice-based component of general practice training. This study was devised to measure the practice based training environment as experienced by GPs in training. A questionnaire was devised using a triangulated methodology and was administered to all practice-based general practice trainees in the Republic of Ireland. The results confirmed a high level of satisfaction with the educational environment in practice but several deficiencies were identified. These included the lack of availability of a stress support system, a lack of good clinical supervision at all times and a lack of understanding among practice staff regarding the role of the trainee in the practice. Having identified the deficiencies, the challenge to educators is to improve the educational environment for the benefit of the GPs in training and ultimately the communities they serve.

Ireland↗
PubMed1989

Tinker toy test performance and vocational outcome in patients with closed-head injuries.

Fifty patients who had suffered closed-head injury with no resultant physical disabilities and 25 normal controls were administered a modified version of Lezak's Tinker Toy Test. All head-injured patients were examined at least 24 months following medical clearance to return to work. Twenty-five of the head injured had been unable to return to work or sustain normal competitive employment as a result of their head injuries. The remaining 25 had returned to their previous jobs successfully or had been employed for at least 6 months prior to assessment. Whereas all but one of the head injured who returned to work scored normally on the Tinker Toy Test, nearly half of the nonreturnees performed below the level of the worst control.

Adult↗
PubMedDate not supplied

Accelerating the return to work (RTW) chances of coronary heart disease (CHD) patients: part 2--development and validation of a vocational rehabilitation programme.

PURPOSE: This paper, part 2 of the two-part paper, reviews return-to-work outcomes among individuals with coronary heart disease, who participated in an experimental field study reported in part 1 of the two-part paper. Study results reflected specific job stressors associated with physical and mental demands among various job tasks. Trends suggest that personality characteristics commonly associated with 'type a' personalities and cardiac disease risk factors may also serve as positive forces that influence return-to-work activity. METHODS/RESULTS: Relatively high levels of job satisfaction were reported among most experimental subjects. Despite having high return-to-work expectations, these patients lacked specific strategies and resources to facilitate a concrete return to work action plan. CONCLUSION: The researchers conclude that it is essential for cardiac rehabilitation staff, when creating a return to work transition for their cardiac patients, to explore the physical and psychosocial dimensions of jobs, the receptivity of the employer, and the accommodations needed to promote a safe and timely return to work.

Adult↗
PubMed2002

Improved cooperation in vocational rehabilitation with systematic rehabilitation group meetings.

PURPOSE: The present aim was to investigate the communicative pattern in two rehabilitation groups. The rehabilitation group consisted of the client, a supervisor, an employer representative, an occupational health physician, a rehabilitation counsellor from the national social insurance office and a support person. METHOD: Participatory observation of 22 rehabilitation meetings. The communication was tape-recorded and transcribed word for word. The transcripts were coded and analysed both qualitatively and quantitatively. RESULTS AND CONCLUSION: The client made the most utterances in the groups, but most often in the form of answers to questions from the other actors. Following the client, the physician made the next most frequent utterances, most often as questions. The subjects most discussed concerned the client's situation regarding work, health and material support. None of the "professionals" dominated the meetings, although one picture that emerged was that the physician and employer representative played more prominent roles as takers of initiative and as coordinators while the client was more passive than the other actors. The discussions were calm and much latitude was allowed for the participants to put forward their own requirements, thoughts and feelings. The rehabilitation group may be viewed as a meeting place for "experts" and clients. The further management of the rehabilitation was by the actor the client most immediately needed. In this, rehabilitation in the rehabilitation group differs from the "case management" common in the rehabilitation field.

Adult↗
PubMed2004

Vocational rehabilitation acceptance in the USA: controlling for education, type of major disability, severity of disability and socioeconomic status.

PURPOSE: The aim of the study was to investigate whether there were differences in acceptance rates for VR services among African Americans, White Americans, Native American or Alaskan Natives, and Asian or Pacific Islanders with disabilities in the USA? METHOD: The study was based on a population 599 444 customers who sought VR or Bureau of Visual Service Agency services in the USA from 1 October, 1997, through 30 September, 1998. The subsample of customers with no missing values on the variables under investigation included African Americans (n = 13 287), White Americans (n = 38 048), Native American or Alaskan Natives (n = 599), and Asian or Pacific Islanders (n = 596). The chi-square test of homogeneity of proportions was the test statistic. The final random subsample included African Americans (n = 300), White Americans (n = 300) Native American or Alaskan Natives (n = 300), and Asian or Pacific Islanders (n = 300) was drawn from the population of VR customers in the USA. RESULTS: The study supports the hypothesis that African Americans were more likely to be found ineligible for VR services, while Asian or Pacific Islanders were more likely to be accepted for VR services. CONCLUSION: While discovering that African Americans are more likely to be rejected for VR services was not surprising, discovering that Asians or Pacific Islanders are more likely to be accepted for VR services than African Americans was unexpected, given that past VR acceptance research adduced that White Americans, not Asian or Pacific Islanders, are more likely to be accepted for VR services when compared to African Americans with disabilities. While a preponderance of VR research indicates that White Americans are more likely to be accepted for VR services than African Americans, it was also unexpected that White Americans were not statistically significant when education, type of major disability, disability severity, and SES were controlled.

Black or African American↗
PubMed2006

Effects on work resumption of a co-operation project in vocational rehabilitation. Systematic, multi-professional, client-centred and solution-oriented co-operation.

PURPOSE: The present aim was to evaluate the effect of systematic multi-professional co-ordinated rehabilitation (the Stockholm Co-operation Project) on the number of days' sick leave during the first and second half-years after the rehabilitation co-ordination period, compared to the year before. Another aim was to evaluate the economic effects at national level. METHOD: A matched-pairs design was used. The study group was based on 64 rehabilitees employed by a public employer in Stockholm, who took part in a systematic multi-professional co-operation project. To obtain pairs, the 64 individuals were individually matched with 64 people who received conventionally organised rehabilitation. Thus, there were 128 subjects altogether. RESULTS: The study group had substantially less sick leave days per month than the comparison group during the second half-year after the rehabilitation co-ordination period. The effect was even greater in a subgroup with more previous sick leave. During the first half-year after the intervention the comparison group had relatively more sick leave. No effect was found for a subgroup with less previous sick leave. The economic benefit of the intervention was estimated to 1,278 euros per month and person based on the whole group, and to 2,405 euros per month and person based on those with more sick leave. CONCLUSIONS: People who undergo co-ordinated rehabilitation have more working days after the intervention period than those with conventional rehabilitation. This way for rehabilitation actors to co-operate gives better outcomes for rehabilitation cases with long previous sick leave, but not for cases with less previous sick leave. It also generates economic gains at several levels.

Case-Control Studies↗
PubMed2004

Vocational rehabilitation of participants with severe substance use disorders in a VA veterans industries program.

There are approximately 100 Veterans Industries work therapy programs in the Veterans Health Administration (VHA) throughout the U.S. The majority of participants are veterans with severe substance use disorders and their length of stay ranges from 3 to 12 months. This study examines the Veterans Industries work therapy model at one site where veterans are referred from an addictions partial hospitalization treatment program. The study period was from 1996--97 and includes 80 patients. The characteristics of the participants are described. Barriers to employment are identified including unemployment rates, homelessness, drug of choice, age, and disability status. Outcome rates are reported including employment, abstinence, and housing support.

Adult↗
PubMed1988

Physiological cost of vocational activities after myocardial infarction.

Oxygen consumption was measured during 30 min of work in 16 patients, after a myocardial infarction (anterior or posterior), and compared with 16 normal subjects, of the same age, involved in the same activities, in a steel factory. The VO2 at work of the patients was a little lower than in normals. The mean heart rate for 8 h was also a little lower in patients than in normals. The patients used a higher percentage of their residual capacity (VO2 max) as evaluated on a bicycle ergometer in the laboratory; the difference may be important between patients with a residual coronary insufficiency and controls. There are no important differences in the psychological attitudes of the two groups; the patient seems to be more motivated. From this study, based on a limited number of patients who had returned to work and had no complaints in daily life, it appears that the patients were working more 'economically' that the normals, that they are able to use a higher percentage of their residual physiological capacity and that the psychological attitude is comparable in the two groups towards work. Return to previous work should never be excluded a priori in post-infarction patients with good clinical progress.

Activities of Daily Living↗