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PubMedDate not supplied

Retirement among Florida's certified nurse-midwives: an impending workforce crisis.

An anonymous survey was mailed to 499 CNMs in Florida in May 2001 to examine the impact of CNM retirement on the Florida women's health provider workforce and to estimate the replacement demand for CNMs. The survey also investigated where Florida's CNMs studied midwifery, reasons for choosing education programs, reasons for moving to Florida, and causes of underemployment of CNMs. Two hundred eighty respondents returned the survey. Thirty-nine percent of respondents received their midwifery education in Florida. Eighty-one percent of respondents were working as CNMs. From 2010 through 2025, an average of 11 CNMs in Florida will reach age 65 each year. These data indicate that retirement will generate demand for new CNMs in the next two decades. These data, along with future research tracking midwifery education, employment, and retirement, could be used to plan program funding, clinical site needs, and legislative support of midwifery.

Aged↗

PubMed2005

Factors associated with academic achievement in children with recent-onset seizures.

Children with chronic epilepsy are more at risk for achievement problems than either children without seizures or children with other chronic disorders. Factors that lead to such problems in children with epilepsy, however, are not well understood. Exploring these factors is important because academic underachievement can lead to poor social outcomes and contribute to underemployment or unemployment in adulthood. This descriptive, cross-sectional study investigated a group of children who had been diagnosed with seizures approximately 12 months previously, providing the opportunity to describe relationships among family and child characteristics; parent, child, and teacher responses; and child academic achievement at the same point in time across the sample. Seventy-two children had standardized test total battery scores, 101 had a teacher's rating of performance, and 67 had scores for both. Data were analyzed using multivariable regression. Child adaptive competency and seizure severity were associated with higher teacher ratings of academic performance (beta=0.73, p<0.0001 and beta=2.38, p=0.0182, respectively). Child adaptive competency was associated with higher total battery scores (beta=0.73, p<0.0001). Contrary to findings in studies of children with chronic epilepsy, mean academic achievement in this sample of children with recent-onset seizures was in the average range; however, 25% of the children were at or below one standard deviation below the mean on the teacher's rating of performance and 10% on the total battery. It is therefore important for health professionals and educators to regularly assess the child's academic functioning and school performance to identify those at risk for problems. Health professionals and educators need to collaborate on assessment and interventions to help maximize child academic success.

Achievement↗

PubMed2004

Social inequality and depressive disorders in Bahia, Brazil: interactions of gender, ethnicity, and social class.

We conducted a study of the association between gender, race/ethnicity, and social class and prevalence of depressive disorders in an urban sample (N = 2302) in Bahia, Brazil. Individual mental health status was assessed by the PSAD/QMPA scale. Family SES and head of household's schooling and occupation were taken as components for a 4-level social class scale. Race/ethnicity (white, moreno, mulatto, black) was assessed with a combination of self-designation and a system of racial classification. The overall 12-month prevalence of depressive symptoms was 12%, with a female:male ratio of 2:1. Divorced/widowed persons showed the highest prevalence and single the lowest. There was a negative correlation with education: the ratio college educated:illiterate was 4:1. This gradient was stronger for women than men. There was no F:M difference in depression among Whites, upper-middle classes, college-educated, or illiterate. Prevalence ratios for single, widowed and Blacks were well above the overall pattern. Regarding race/ethnicity, higher prevalences of depression were concentrated in the Moreno and Mulatto subgroups. There was a consistent social class and gender interaction, along all race/ethnicity strata. Three-way interaction analyses found strong gender effect for poor and working-class groups, for all race/ethnicity strata but Whites. Black poor yielded the strongest gender effect of all (up to nine-fold). We conclude that even in a highly unequal context such as Bahia, Blacks, Mulattos and women were protected from depression by placement into the local dominant classes; and that the social meaning of ethnic-gender-generation diversity varies with being unemployed or underemployed, poor or miserable, urban or rural, migrant or non-migrant.

Adult↗

PubMed2002

Telemedicine and neurosciences in developing countries.

It is a universally accepted fact that the number of neurosurgeons in developing countries is woefully inadequate. It is also unrealistic to expect this limited number to work in professional isolation, in suburban and rural areas, without adequate infrastructure. Therefore, this has resulted in concentration of neurosurgeons in developing countries, in metropolitan areas, even at the risk of being underemployed. The phenomenal advances in communications and information technology in India are resulting in a new look at how secondary and tertiary health care can be provided to the underprivileged masses. Following a proof of concept validation ISRO (Indian Space Research Organization) in conjunction with the Apollo Hospitals, is ready to use satellite technology to provide specialist care not only to suburban and rural India but to other countries as well, by using the large number of highly qualified and trained specialists in urban India. The implications of these developments for the delivery of neurosurgical care to suburban and rural India is briefly reviewed.

Developing Countries↗

PubMed2004

Adolescents with myelomeningocele: activities, beliefs, expectations, and perceptions.

The Carnegie Council on Adolescent Development, USA has identified activities, beliefs, and perceptions critical for healthy development. The aim of this study was to measure the activities, beliefs and expectations, and perceived outcomes of adolescents with myelomeningocele. In this descriptive study, 66 adolescents with myelomeningocele, aged 12 to 21 years and functioning at grade level, completed a structured interview. Thirty-eight (58%) of the participants were female. The level of lesion was distributed as follows: 30% had thoracic level lesions, 32% had lumbar level lesions, 15% had lumbosacral level lesions, and 23% of the sample had sacral level lesions. Instruments used had both established reliability and validity (WeeFIM, Harter's Self-Perception Profile, Austin's Child Attitude Toward Illness Scale, and Snyder's Hope Scale, Adolescent Decision-Making Inventory, Adolescent Coping Scale) or were scales developed for this study (Adolescent Activities Inventory, Future Expectations Scale, Communication Efficacy, and Adolescent Self-Management and Independence Scale). Scale reliabilities ranged from 0.70 to 0.88. These participants, though hopeful and positive in their attitudes toward myelomeningocele and generally able to perform activities of daily living independently, are not engaging in the full range of adolescent activities (decision making, friendship activities, and household responsibilities) and achieving positive outcomes (self-management and job) necessary to make a successful transition to adulthood. This might explain why so many individuals with myelomeningocele are underemployed and are not living independently as young adults.

Activities of Daily Living↗

PubMed2002

A description of a psychosocial/psychoeducational intervention for persons with recurrent suicide attempts.

This paper gives a description of a psychosocial/psychoeducational group intervention for individuals with a history of recurrent suicide attempts. The intervention was conceived to reduce the risk of future suicidal behavior and to modify the client's psychopathology. Three features are felt to make the intervention unique from others described in the literature. First, the intervention is targeted at both men and women from an inner-city population who are often underhoused, underemployed, and undereducated. 24 of 48 clients (50%) lived alone, and 24 of those (92%) were living in subsidized housing; 33% lived in supportive housing, and one lived on the street at the time of assessment. 48% had a high-school education or less. Second, the principles of our approach stressed client validation and participation in the development and delivery of the therapy. Our frame of reference was to name ourselves as professionals with a set of skills and access to some kinds of information and clients as the experts on the experience in their lives. Third, the group content incorporated a multimodal approach to meet the varied needs of the clients. Future reports will discuss the empirical evaluation of this intervention; however, the development of specific, targeted approaches for unique individuals with recurrent suicide attempts is clearly needed.

Adult↗

PubMed1996

Population growth in the 21st century: cause for crisis or celebration?

Between now and the end of the next century, the population of the planet is projected to grow from 5.7 billion to somewhere between 9 and 16 billion. In the next 25 years, continued rapid growth is inescapable because of the youthful age structures of many countries. Beyond that point much depends on fertility trends in the coming decades. Continued population growth does not make inevitable any global catastrophe but it will exacerbate greatly problems of underemployment. The prognosis for further fertility declines is good, because the communications revolution is hastening the spread of new ideas and political attitudes are becoming favourable.

Developed Countries↗

PubMed1999

Chinese migrants' mental health and adjustment to life in New Zealand.

OBJECTIVE: The purpose of this study was to identify and assess the relative importance of predictors of the self-rated adjustment and psychiatric morbidity of recent Chinese migrants. METHOD: Chinese migrants (n = 271) living in Auckland and aged 15 years or older completed a postal questionnaire that included the Chinese Health Questionnaire (CHQ). The majority of respondents came from Hong Kong and Taiwan. RESULTS: Most respondents did not report major adjustment problems. The psychiatric morbidity rate was 19%. Major predictors of experiencing problems included rejection by locals, being aged 26-35 years or over 45 years and low English proficiency. Major predictors of poor adjustment included unemployment, low English proficiency, lack of university education, younger age, shorter residency, expectations not met and regrets about coming to New Zealand. Predictors of minor mental disorder included regretting coming, female gender and younger age. For migrants resident 2 years or less, unemployment and underemployment were additional risk factors. Mothers with absent husbands and young people with absent parents also had elevated rates of mental disorder. CONCLUSIONS: Although the overall prevalence of mental disorder for this sample of recent migrants appears to be similar to that of the general population, significant risk factors were identified. The findings extend knowledge of the adjustment and the mental health of migrants and provide potential focal points for primary and secondary prevention interventions.

Adolescent↗

PubMedDate not supplied

Talking to patients about food insecurity.

Food insecurity is highly prevalent in the United States. Even in the best of times, some 10% of the U.S. population self-reports food insecurity in the U.S. annual census instrument, and some 23.3 million Americans use the community-based emergency food system. Unemployed or underemployed individuals, the elderly, single parents, substance abusers, and uninsured or underinsured individuals with medical illnesses are at increased risk for food insecurity. This article discusses clinical approaches to food-insecure individuals. Measurement tools developed to define and document the extent of hunger and food insecurity in the U.S. population are presented as templates for discussion between doctor or dietitian and patient. Information is provided to help clinicians guide patients with food insecurity to appropriate resources.

Agriculture↗

PubMed2002

An evaluation of a perceived overqualification scale across work settings.

The authors extended and evaluated the dimensionality of the L. J. Khan and P. C. Morrow (1991) subjective underemployment scale. They used data from 3 independent samples to assess the measurement properties of the scale. The results of confirmatory factor analyses supported 2 dimensions and indicated that the measurement model parameters partially generalized across samples. Correlational and additional confirmatory factor analytic results rendered empirical support for most of the postulated relationships of the 2 overqualification dimensions with the somatization, job satisfaction, and organizational commitment variables. The findings indicate that the scale of perceived overqualification needs to be further developed and validated in different samples. The implications of the findings for person-job fit are discussed.

Adult↗

PubMed1986

The use of hypnosis in establishing a holding environment to facilitate affect tolerance and integration in impulsive patients.

This paper is concerned with the use of hypnosis in establishing a facilitating and holding environment in the treatment of impulsive behavior across a range of diagnoses. The reason for this cross-diagnostic viewpoint is to underscore the common sources of such action and the needs to be met in its treatment. Illustrations from work with two patients are presented: One was a hypomanic and bulimic woman who was successful in her profession; the other was an underemployed and sometimes unemployed schizophrenic man. Both were inclined to self-defeating impulsive action-bulimia in the woman, assault in the man.

Adult↗

PubMedDate not supplied

Recent Chinese migrants' health, adjustment to life in New Zealand and primary health care utilization.

A community survey of 271 Chinese migrants aged 15 years and older living in Auckland was conducted to assess self-rated adjustment and health. The majority of respondents came from Hong Kong and Taiwan. Despite significant changes in their lives, including the absence of family members, unemployment and underemployment, most did not report major adjustment problems or regret having come to New Zealand. Few considered their health to be poor. Forty-two per cent reported having consulted a doctor within the past 12 weeks. Factors significantly associated with having experienced major problems included being aged 26-35 years, rejection from locals and having low English proficiency. Factors associated with poor adjustment included expectations not having been met, regretting coming, low proficiency in English, recent arrival in New Zealand, unemployment, younger age and lower levels of education. Self-rated fair or poor health was found to be associated with Chinese-only reading knowledge, residency of more than 5 years and regretting having come to New Zealand.

Acculturation↗

PubMed2004

Agricultural workers' return to work following spinal cord injury: a comparison with other industry workers.

PURPOSE: To investigate the impact of spinal cord injury on employment outcomes as experienced by agricultural workers in comparison with persons employed in other industries. Because of the challenges associated with working in many of the agricultural industries, it was anticipated that agricultural workers would achieve inferior return-to-work outcomes. METHOD: Survey of all employed persons who experienced a traumatic spinal cord injury in southeastern Australia between 1990 and 1996 (inclusive). RESULTS: Contrary to expectation, agricultural workers had a significantly higher rate of return to work (61.7% vs. 41.1%). However, an investigation into the hours spent working and agricultural workers' satisfaction with their employment activities, indicated that most were underemployed and had the potential to achieve even better outcomes. CONCLUSION: Results indicate that more can be done to help injured agricultural workers achieve their employment potential.

Adult↗

PubMedDate not supplied

Functional engineered channels and pores (Review).

Significant progress has been made in membrane protein engineering over the last 5 years, based largely on the re-design of existing scaffolds. Engineering techniques that have been employed include direct genetic engineering, both covalent and non-covalent modification, unnatural amino acid mutagenesis and total synthesis aided by chemical ligation of unprotected fragments. Combinatorial mutagenesis and directed evolution remain, by contrast, underemployed. Techniques for assembling and purifying heteromeric multisubunit pores have been improved. Progress in the de novo design of channels and pores has been slower. But, we are at the beginning of a new era in membrane protein engineering based on the accelerating acquisition of structural information, a better understanding of molecular motion in membrane proteins, technical improvements in membrane protein refolding and the application of computational approaches developed for soluble proteins. In addition, the next 5 years should see further advances in the applications of engineered channels and pores, notably in therapeutics and sensor technology.

Animals↗

PubMed1986

The world economic crisis. Part 1: Repercussions on health.

The widespread economic crisis has resulted in a fall in living standards in the western hemisphere of over 9% (1981-83) and in Sub-Saharan Africa they have fallen to the level of 1970. Food production in the African countries most seriously affected by drought dropped by 15% between 1981 and 1983. Living standards also fell in some countries in Europe and in some of the poorest countries of Asia. The high cost of fuel, the heavy burden of interest payments and unfavourable terms of trade in Africa and Latin America led to serious unemployment, devaluation of national currencies and formidable austerity policies. While some countries have succeeded in protecting their health services from cuts in public expenditure, in many others cuts in health budgets have been substantial. The effects of the crisis in some countries have amounted to the virtual disintegration of rural health services. There are limited data available to show what has been happening to levels of expenditure on health, but those presented here demonstrate that levels of health expenditure per head have fallen in many countries. The cumulative effects on health of increased poverty, unemployment, underemployment and famine, and the reduced capacity of health services to respond to health problems can be documented with facts for a number of countries in Latin America and Africa. Malnutrition has increased and improvements in infant mortality have been checked or reversed. The economic crisis has placed at risk the health of the most vulnerable.

Africa↗

PubMed1991

Everything I know about health care I learned in the Pentagon in World War II.

This is a brief autobiographical account by the chief logistical adviser to the surgeon general of the army of his experiences during World War II, when at peak army hospitals had 600,000 patients in bed on one day and used 40,000 physicians, 100,000 nurses, and 600,000 medical corpsmen to care for them. The recapitulation of that experience calls attention to the fragility of hospital planning, the dangers that underemployed physicians will overtreat patients, the advantages of using nurses as patient care managers in hospitals, and the desirability of not operating too close to the margin. These events of World War II also provide background for understanding the origins of three major post-World War II transformations of U.S. medicine, specifically the much-enhanced demand by the American public for access to a much higher level of medical care than that to which they had earlier been accustomed; the greatly enlarged expenditures of the federal government for basic biomedical research, which derived momentum from the success of research during World War II; and the victory of specialism that captured U.S. medical education and treatment.

Delivery of Health Care↗

PubMed1985

Career preferences under conditions of medical unemployment. The case of interns in Mexico.

This article presents a multivariate analysis of the career preferences of 923 Mexican interns. Such preferences were operationalized along two dimensions: type of activity (general/family practice, primary specialties, or subspecialties) and type of institution (public assistance, social security, or private). There were six independent variables: father's occupation, father's education, type of medical school, place of internship, assimilation to the internship hospital, and perception of the medical labor market. The appearance in recent years of unemployment and underemployment among Mexican physicians made labor market issues particularly salient. Thus the study offered an appropriate occasion to test the relative strengths of alternative explanations of career choice that are based on social mobility, professional socialization, or responses to labor market signals. Results obtained through multiple regression revealed that the most important variable in the determination of activity preference was medical school, although the two social origin variables retained the important role of directing students into different schools. With regard to institution preference, the most important factor was shown to be place of internship, as it interacted with the level of assimilation to the hospital. Although perception of the medical labor market was a significant predictor of both dimensions of career preference, the greater importance of the other variables indicated that, even under extreme conditions of medical unemployment, explanations of career choice must go beyond simple models of rational decisionmaking to include the experiences that socialize future physicians into dominant paradigms about medical practice.

Career Choice↗

PubMed2005

Vocational assessment and intervention for people with epilepsy.

Employment restrictions have been experienced by many people with epilepsy. In many cases, the restrictions are unjustified and based on stigma or a stereotypical image of the person with epilepsy. Unjustifiable restrictions are a form of discrimination and lead to unemployment and underemployment. Unfortunately, much of the research in this area has been difficult to interpret because of differences in the definition of "people with epilepsy" and differences in the definition of "employment restrictions or problems." I report on an attempt to develop a classification structure and examine some survey results collected by the IBE Employment Commission from professionals and people with epilepsy concerning the sources of employment restrictions and possible methods to overcome these restrictions.

Attitude to Health↗