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PubMed2000

Severe mental illness and substance use disorders among former Supplemental Security Income beneficiaries for drug addiction and alcoholism.

BACKGROUND: Recently enacted federal legislation targeted at curbing perceived abuses of cash benefits for former Supplemental Security Income beneficiaries for drug addiction and/or alcoholism (DA&A) may be creating a residual population that is too seriously impaired to work owing to psychiatric and substance use disorders. METHOD: Data in this report were derived from 1-year follow-up interviews of 204 randomly selected DA&A beneficiaries in Chicago who were initially interviewed between January 1997 and March 1997, immediately following their termination in the Supplemental Security Income DA&A program. Information on subjects' work and benefits status were collected along with DSM-III-R psychiatric and substance use disorder diagnostic information. Urine specimens were also collected and tested for recent use of marijuana, cocaine, opiates, phencyclidine, amphetamines, and methadone. RESULTS: Twenty-six percent had a past-year severe mental illness while 34% met the DSM-III-R criteria for drug dependence. Illegal drug use was also prevalent with about 50% of the sample testing positive for marijuana, cocaine, or opiates. Compared with those working and earning at least $500 a month, unemployed or underemployed subjects who had lost all federal benefits had a much greater likelihood of being dependent on drugs (odds ratio, 5.0; P<.005; 95% confidence interval, 1.6-15.7) and of having 2 or more comorbid psychiatric disorders (odds ratio, 6.9; P<.005; 95% confidence interval, 1.9-24.7). CONCLUSIONS: Those who have lost DA&A disability benefits and who continue to be unemployed or underemployed have elevated rates of drug dependence and psychiatric comorbidities; consequently, helping these cases make the transition from government assistance to sustained employment is increasingly difficult.

Alcoholism↗

PubMed1984

Occupational adjustment following neurosurgical treatment of epilepsy.

Occupational adjustment was investigated in a group of 32 adult epileptic patients followed for 1 to 10 years after cortical resection for intractable seizures. An employment status rating was assigned according to the following scale: (1) employed (working 75 to 100% of full time); (2) underemployed (25 to 74%); and (3) unemployed (0 to 24%). The number of patients employed increased from 14 to 23, whereas the number of underemployed decreased from 8 to 0. The unemployed group showed little change. An improvement or maintenance of employment status was correlated directly with improved postoperative seizure control. Conversely, poor occupational adjustment was often associated with fair or poor seizure control following operation. Unemployment was also related to the presence of preoperative psychiatric disorders, a history of past unemployment, and cognitive disturbances affecting nondominant hemisphere function. Although improvement in seizure control is important, this investigation suggests it is only one of many influences on the occupational adjustment of patients following surgical treatment of epilepsy.

Adolescent↗

PubMed1988

Labour insecurity and health: an epidemiological study in Zimbabwe.

Existing data on health status and health care provision in agricultural labour communities in Zimbabwe indicate that both are poor. In addition, there is evidence that the concentration of capital through increased areas of landholdings, through mechanisation and use of agrochemicals produces a rise in under- and unemployment within the agricultural sector, which increases the risk of ill health. This paper addresses this question in Zimbabwe by examining the nature of developments within the large scale agricultural sector in the last decade, and the consequent effects on employment and income. Rising capital intensity in the private large scale sector is found to be associated with increases in unemployment and underemployment. The impact of this socioeconomic pattern on health is assessed in a longitudinal assessment of 78 permanent labour families and 76 non-permanent (underemployed) labour families in the large scale farming sector. The study shows that while poor social, economic and health conditions exist in all groups, non-permanent labour households suffer greater insecurity of employment and income, poorer health status and lesser participation in sociopolitical structures important for negotiating primary health care gains.

Agriculture↗

PubMed2001

Epilepsy in Estonia: a quality-of-life study.

PURPOSE: To study the impact of epilepsy and its treatment on people with epilepsy in Estonia and to analyze how it is affected by the characteristics of epilepsy. METHODS: Clinical and demographic data about patients were obtained from medical notes and mailed self-completed questionnaires (including the RAND 36-Items Health Survey 1.0 (RAND-36)). RESULTS: Information was collected from 203 patients aged 20-74 years, who all had active epilepsy. A third of the respondents had been seizure free during the last year. Eighty-four percent were receiving monotherapy. More than half of respondents felt stigmatized by epilepsy, 24.7% of them highly so. A third were working full-time, 31.9% were underemployed workers, and 11%, unemployed. Sixty-two percent of these same unemployed or underemployed workers considered their epilepsy to be a significant reason for this situation. Overall, 44% believed they had been treated unfairly at work or when trying to get a job. Study respondents scored lower in all domains on the RAND-36 than did persons from the control group. The biggest differences were found in five domains: Social functioning, Role limitations-physical, Role limitations-emotional, General health, and Vitality. CONCLUSIONS: The clinical characteristics of this study were similar to those of most other series of prevalence cases of epilepsy. The level of employment among persons with epilepsy was not lower than that in the general population. The percentage of stigmatization was high. There were significant differences in the way respondents scored on the stigma scale and on the RAND-36 domains when measuring their health status, depending above all on seizure frequency and type.

Adult↗

PubMed1997

[New labor relations and workers' health in Argentina: challenges and perspectives for epidemiology]

This paper analyzes changes in labor relations, legislation pertaining to work-related diseases and accidents, and the impact on workers' health in Argentina (1989-1995). The data indicate an increase in unemployment, underemployment, self-employment, and new hiring practices. The study shows the mechanisms by which the state has delegated responsibility for prevention of work-related risks to the private insurance sector. The theoretical discussion of causality thus acquires a political/practical dimension. The data show an increase in work-related accidents following labor reform. Research by universities, NGOs, and labor unions reveal changes in health profiles for salaried, self-employed, and underemployed workers. The three National Meetings on Employment and Health (1992-1994) established an area of exchange between academic and workers' knowledge, with some 128 presentations, research projects, and studies, pointing to an enhanced field for epidemiological surveillance and intervention. The paper reviews the surveys performed by the National Confederation of Workers in Education and the Public Employees' Association.

Journal Article↗

PubMed1988

American fertility and industrial restructuring: a possible link.

Despite the fact that economic and demographic factors conventionally are considered to be integrally related, researchers have overlooked recent changes in the structure of the American economy that may have affected fertility in the US. This article seeks to raise questions and explores the possibility that recent processes of industrial restructuring have created new employment patterns and socioeconomic conditions which have influenced American fertility positively. Specifically, conditions of underemployment and unemployment, generated by the service and manufacturing sectors, may be conducive to increased fertility.

Americas↗

PubMed1989

China: surplus labour and migration.

Surplus labor force and migration trends in China are examined, with emphasis on the impact of underemployment in rural areas. "Government policy encourages surplus labourers to transfer out of crop farming into agricultural sidelines or non-agricultural work. Peasants are urged to stay where they are, shifting jobs without shifting location; however, many rural areas are poorly endowed for providing alternative employment, so their surplus workers must also leave the village to find work. Many do not formally migrate, but rather move on a seasonal basis or set up 'temporary' residence in an urban place. This 'floating' population has been escalating rapidly in recent years....[The authors argue] that China's cities and towns can absorb millions of surplus labourers from rural areas each year, to the mutual benefit of sending and receiving areas."

Agriculture↗

PubMed1998

Employment-seeking experiences of resident physicians completing training during 1996.

CONTEXT: Studies analyzing the physician workforce have concluded that the United States is verging on a physician oversupply, yet we lack persuasive evidence that this is resulting in physician underemployment and/or unemployment. OBJECTIVE: To determine the degree to which graduating residents have difficulty finding or are unable to find employment in their primary career choices. DESIGN: Two 1-page surveys sent separately to residents and to program directors to collect information on the employment status of residents who were completing a graduate medical education program at the end of the 1995-1996 academic year. SETTING: A total of 25 067 resident physicians scheduled in the spring of 1996 to complete a residency program accredited by the Accreditation Council on Graduate Medical Education, and 4569 program directors in 31 specialties and subspecialties. MAIN OUTCOME MEASURE: Both the graduates' employment status and the degree of difficulty they experienced securing a practice position, as reported by resident physicians and program directors. RESULTS: After 6 months of data collection, 12135 (48.4%) of 25 067 resident physicians responded to the survey. Of the respondents, 11 200 had completed their training, and 7628 (68.1%) were attempting to enter the workforce, 28.4% were seeking additional training, and 3.5% were fulfilling their military obligations. Of the 7628 resident physicians who sought employment, 67.3% obtained clinical practice positions in their specialties, 15.5% took academic positions, 5.0% found clinical positions in other specialties, 5.1% had other plans, and 7.1% did not yet have positions but were actively looking. In addition, 22.4% of resident physicians who found clinical positions reported significant difficulty finding them. The subgroup reporting greater difficulty finding clinical positions included international medical graduates (more than 40%),those completing programs in the Pacific or East North Central region, and those in several specialties. The 1996 graduating residents reported significantly higher rates of difficulty finding suitable employment than program directors reported for their graduates (22.4% vs 6.0%); however, the percentage of graduates reported by both groups as entering the workforce was the same (68.1%). Program directors reported an unemployment rate of only 1.2%, for their 1996 graduates, which was less than the rate reported by the resident physicians (7.1%). CONCLUSIONS: Resident physicians' direct reports of their employment-seeking experiences differ from what program directors report. Program directors accurately determined the number of residents pursuing further training; however, they did not have complete information about the employment difficulties experienced by their graduates. Based on graduates' reports, we conclude that employment difficulties are greatest among international medical graduates and vary by specialty and geographic region.

Career Choice↗

PubMed1993

Sexual dimorphism in schoolchildren of the Villa IAPI neighborhood (Quilmes, Buenos Aires, Argentina).

Villa IAPI is a poor neighborhood of about 5,000 inhabitants in the overpopulated conurbano bonaerense at the outskirts of the city of Buenos Aires. Most of the adult male residents are construction workers; the rest are temporary workers, underemployed, or unemployed. The inhabitants of Villa IAPI suffer the effects of many adverse socio-economic conditions, including poor nutrition, deficient sanitation, and inadequate medical care. Seven anthropometric variables were measured on 765 children from 6 to 14 years old to test for the presence of an altered pattern of sexual dimorphism. It was found that there were practically no sex differences in standing height and upper-arm muscle circumference. In some age groups, there was a weak but significant sexual dimorphism in body weight and sitting height. The greatest and most persistent dimorphism was found in head circumference, and in triceps and subscapular skinfolds. In all except two age groups, head circumference in males was significantly greater than in females. The other dimorphic variables (body weight, sitting height, and triceps and subscapular skinfolds) showed the opposite relationship. Essentially, females showed increments in subcutaneous fat, while reduced growth in muscle and bone was evident in males. The hypothesis of "better female canalization" can explain the altered dimorphic pattern found in the malnourished Villa IAPI population.

Adolescent↗

PubMed1998

Condition-dependent timing of comb construction by honeybee colonies: how do workers know when to start building?

Colonies of honeybees, Apis mellifera, initiate new comb construction only when two conditions are met: (1) they are currently collecting nectar and (2) they have filled their available comb beyond a threshold level with brood and food. In this study I explored how the individual workers responsible for building might use readily accessible local cues to acquire this global information on colony and environmental state. In particular, I tested the hypothesis that comb is built by nectar receivers (bees specialized to receive nectar from foragers and store it in comb cells) that experience increased distension of their crops. Crop distension could serve as a cue that both conditions for building have been satisfied, because the bees' crops will fill up as they receive nectar from successful foragers and have difficulty finding comb in which to store it. However, two findings led to rejection of this hypothesis. First, very few nectar receivers participated in comb building. Most builders came from another, unidentified subpopulation of workers. Second, potential builders showed no increase in crop size correlated with the onset of new comb construction or with the development of conditions that favour comb building. This was true both for identified nectar receiver bees and for bees belonging to the age cohort at which wax secretion and comb building reach their peak levels. The behavioural repertoire of comb-building bees suggests that these builders come from a pool of underemployed bees that may evaluate colony state by direct inspection of comb cells. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗

PubMed1997

The transition to adulthood for youth who have serious emotional disturbance: developmental transition and young adult outcomes.

This article reviews studies that depict the developmental transition from adolescence to young adulthood of persons who have experienced serious emotional disturbance (SED) as children or adolescents. The literature demonstrates that their plight in young adulthood is grave. Youth with SED enter the transition phase delayed in their developmental maturation and face additional challenges relative to their nondisabled peers. As a group, they are undereducated, underemployed, and have limited social supports. Homelessness, criminal activity, and drug use are prevalent. This article defines the transitional youth population, describes the developmental tasks of transition, and summarizes the results of longitudinal studies that have tracked functional outcomes of transitional youth into young adulthood. The discussion focuses on the relevance of these findings to service provision.

Adolescent↗

PubMedDate not supplied

The social outcome of adults with constitutional growth delay.

It is well established that children with extreme short stature, secondary to GH deficiency (GHD) or achondroplasia, face a disability that may affect their adult psychosocial outcome, while contrasting data are reported for short normal children. In our hands, adults with GHD have shown an unsatisfactory psychosocial adjustment due to the low adult height and hypothetically to the persistent GHD. This study has been carried out to evaluate the influence of growth in height on the social outcome in 45 adults with constitutional growth delay (CGD). Interviews with subjects and parents were used for assessment. Data obtained were compared with those found in an age, sex and social matched control group of adults with normal height. Some issues were also compared with the data we previously found in adults with GHD. Present mean age of the patients is 24 +/- 2 yr. A high percentage (32.8%) of unemployment or underemployment (part-time work) was found. Four patients (8.8%) were married, while 84.4% lived with their parents or relatives, confirming the notion of prolonged economic dependency on the family. The patients preferred single sporting activities, avoiding team work. Surprisingly, scholastic achievement was in general similar to that observed in controls. Similar findings have been previously observed in patients with GHD. Since no defect in GH secretion has been documented in CGD, the presence of a negative psychosocial outcome more probably seems to be due to the final unsatisfactory height rather than to a GH defect.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2003

Informal work and common mental disorders.

BACKGROUND: In many developing countries, a large proportion of people work without the social and legislative protection accorded to those in the "formal" labour market. Formal and informal work are very distinct labour market destinations for those leaving unemployment. From a policy perspective, the value of encouraging unemployed people to take informal work depends both on how quickly individuals can be moved out of unemployment into informal work compared to other destinations, and how well individuals fare once in informal work. This paper investigates the association between informal work and common mental disorders in Northeast Brazil. METHOD: A cross-sectional survey of a random sample of private households included 683 adults aged 15 years and over living in area II of Olinda, Recife Metropolitan Region, Pernambuco, Brazil. Informal workers comprised self-employed and underemployed. The self-reporting questionnaire (SRQ) was used to estimate the prevalence of common mental disorders. RESULTS: Informal workers had a higher prevalence of common mental disorders compared to those in formal employment. This was true before and after adjustment for sex, age, marital status and migration (OR 2.16, 95% CI 1.3-3.7) and for education and household per capita monthly income (OR 1.83, 95% CI 1.1-3.1). CONCLUSIONS: Understanding causes of common mental disorders in different societies requires an understanding of the differing socioeconomic circumstances around the world. Working outside the protection of employment legislation is very common in many poorer countries and may have adverse consequences for psychological health.

Adult↗

PubMed2006

Pharmacy-managed anticoagulation: assessment of in-hospital efficacy and evaluation of financial impact and community acceptance.

BACKGROUND: The dangers of thrombosis are well known and yet current therapy presents a paradox; effective methods of pharmacological anticoagulation are available, but underemployed. The risks associated with the use of anticoagulants, especially warfarin, and the requirement of meticulous dosing with subsequent vigilant monitoring provides some explanation for this discrepancy. Efforts have been made to address this incongruity and increase anticoagulation treatment while mitigating complications; these include the development of dosing nomograms, patient self-monitoring of anticoagulation status, and increased pharmacist participation in anticoagulation management. Although the latter option has proven effective in outpatient clinics, its in-hospital application has received less attention. Therefore, our primary goal was to review the published literature to evaluate the efficacy of in-hospital, pharmacy-managed anticoagulation. In addition, our secondary goals were to assess the potential financial benefit and community acceptance of such pharmacist management. METHODS: Potentially relevant studies were identified by searching PubMed; however, because some pharmacy journals are not included in this database, we also used internet search engines to locate articles. We subsequently employed the Science Citation Index to find additional papers that had referenced articles identified by our initial searches. RESULTS: Several pilot studies, focusing primarily on adherence to warfarin dosing guidelines, found general equivalence between pharmacist and physician management and specifically illustrated the potential benefit gained simply through adherence to protocols. Nevertheless, these studies frequently lacked appropriate statistical analysis and examined small, and often heterogeneous, patient groups. Larger comparative studies also possessed some of the same flaws; however, taken together the equivalence and, in some cases improvement, in patient outcomes (e.g., greater control of International Normalized Ratios and decreased length of hospital stay) that they demonstrated suggest the value of increased pharmacist participation in anticoagulation therapy. Studies using heparin-based anticoagulation reported similar positive findings and hence support the warfarin results. Both published studies examining financial implications of in-hospital pharmacy management indicated potential for considerable savings. Finally, although we identified no in-hospital studies of community acceptance, positive survey results indicted that the majority of physicians and patients accepted pharmacy-managed outpatient anticoagulation. CONCLUSIONS: The reported outcomes of pharmacy-managed in-hospital anticoagulation therapy appear at least equal, and sometimes superior, to those obtained through standard care; however, the lack of large well-designed trials prevents drawing definitive conclusions. Nevertheless, the continued and likely increased future need for anticoagulation in general and warfarin therapy in particular suggests that increased pharmacist involvement could enhance the quality of patient care.

Anticoagulants↗

PubMed1987

Injuries caused by personal violence.

Injury is the leading cause of death for Americans from infancy to middle age. Thirty-seven per cent of injuries admitted to this faculty are the result of personal violence. A prospective pilot study sought to elucidate the circumstances of such injuries. Medical records of all admissions for gunshot wounds, stab wounds or assault during a 30-day period were reviewed (N = 105). A subset (N = 32) were interviewed and given psychometric tests. Distribution by mode of injury was assault, 46 per cent; stabbing, 42 per cent; shooting, 12 per cent. Single, black males aged 18-44 dominated the sample. Injuries tended to occur in or near bars (82 per cent), between 1800 and 0600 hours (79 per cent) and were accompanied by alcoholic intoxication (63 per cent). Un- or underemployment was prevalent (56 per cent). Thirty-eight per cent of incomes were below the official poverty level. Some victims were illiterate. Histories of previous violent encounters (mean number = 22) during the year before the injury and hospital treatment for previous injury were common (56 per cent). Those interviewed reported high frequencies of recent and developmental stresses. The yearly cost of the acute care of patients with injuries caused by violence and treated at this hospital is estimated to be $8,000,000. Of this 80 per cent is paid for with public funds. Personal violence is a serious but neglected part of public health.

Adolescent↗

PubMed1991

Length of stay in a general hospital psychiatric unit.

Fifty psychiatric inpatients with a prolonged length of stay were compared to 50 control admissions for factors associated with prolonged hospitalizations in a general hospital. Seven variables were found to be significantly overrepresented among the long stayers, including treatment with electroconvulsive therapy, medical consultations, underemployment, dementia, disposition to a place other than home, absence of alcohol or drug abuse, and presence of psychosis without affective symptoms. The clinical and policy implications of these finding are discussed.

Cost Control↗

PubMed1983

Career preferences and perceptions of the medical labor market among Mexican interns.

This paper examines the relationship between choice of career and perception of the medical labor market, as well as the effects of social origin, type of medical school, and place of internship. The data are derived from a survey of interns which was conducted in Mexico during 1978, when a substantial proportion of physicians was unemployed or underemployed. Career preferences were operationalized in terms of type of activity (general practice or specialty), site (ambulatory or hospital) and institution (public assistance, social security or private). Perceptions of the medical labor market were measured as an 'objective' feasibility perception and a 'subjective' opportunity assessment. Additionally, composite indices of career preferences and perceptions were constructed in order to take account of two integrated career patterns: dominant (or majority preference) vs alternative (or minority preference). Analysis of the data consistently revealed that perception of the medical labor market had a much stronger impact on preference for alternative than for dominant career patterns. Whereas social origin had no effect on career preference, type of medical school and place of internship exhibited a statistical interaction with career preference, suggesting that certain structural conditions of the medical school and the teaching hospitals led to preference for alternative rather than dominant careers. The implications of the findings are discussed with regard to health manpower policy, to conceptions of rational career choice and to the professional status of medicine in Mexico.

Analysis of Variance↗

PubMed1984

Where there is a doctor: strategies to increase productivity at lower costs. The economics of rural health care in the Dominican Republic.

The study of a rural health district in the Dominican Republic found relatively high levels of public and out-of-pocket primary health expenditures and poor quality of care. The inefficient use of public resources and low efficacy were attributed to: (1) underutilization of health services, (2) low productivity of human and physical resources, which in turn were caused by poor managerial practices, shortages of medicines, dispersion of the population and the compulsory 1-year rural social service required from all graduating physicians (known as pasantía in some Latin American countries and medicatura rural in others). Out-of-pocket health expenditures responded to unnecessary self-referrals and excessive self-medications. The findings suggest that the quality of care can be improved and the public and out-of-pocket expenditures reduced by: (1) the replacement of the social service (pasantía) by permanent physicians, (2) the organization of communal pharmacies and (3) the establishment of outreach health posts. It is argued that today in the Dominican Republic as in many other Latin American countries unemployed or underemployed physicians are willing to take permanent positions in rural areas. The study suggests that rural physicians need and will be willing to accept the fact that much of their medical training has no applicability to the rural setting. The retraining or recycling of rural physicians for their new health roles is discussed also.

Community Health Services↗