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PubMed1975

Career attainment - chance or choice. Survey of career experience of doctors graduating in Scottish medical schools in 1962.

A survey was carried out of the career experience of the doctors who graduated from Scottish medical schools in 1962. Few of those in general practice in the UK had undergone the minimum period of vocational training now considered necessary for new entrants to practice. Of those in the hospital and specialist services, 53% were consultants. There was a tendency for early career decisions to be made, leading to an increasing number of doctors obtaining postgraduate training almost exclusively in one specialty. Many married women doctors were underemployed. A quarter of the doctors were living overseas, including those of the nonBritish nationals who had returned to their country of origin.

Career Choice↗

PubMed1980

Futher validation of the WPSI vocational scale: comparisons with other correlates of employment in epilepsy.

The present study evaluates the relationships between employment status and five types of variables: years of education, intelligence, emotional adjustment, neuropsychological impairment, and psychosocial adjustment. The latter two areas were evaluated by procedures specifically developed for work with seizure patients and include use of the Neuropsychological Battery for Epilepsy and the Washington Psychosocial Seizure Inventory. Fifty-eight patients were divided into groups based on their employment histories and classified as unemployed, underemployed, and employed. Results indicated that the two types of procedures developed specifically for work with clients having seizures demonstrated the most potent and consistent relationships with employment status. The study suggests that the use of these procedures in the evaluation of employability may be more effective than using only those variables which traditionally have been applied.

Adolescent↗

PubMedDate not supplied

Psychosocial dimensions of epilepsy: a review of the literature.

The literature on psychosocial dimensions of epilepsy has been reviewed utilizing the framework developed by Dodrill et al. (Epilepsia 1980; 21:123-35). Factors considered were family background, emotional adjustment, interpersonal adjustment, vocational adjustment, financial status, adjustment to seizures, and medicine and medical management. The published studies highlighted a number of issues and sometimes rendered varying and contradictory conclusions. In general, epilepsy fosters certain reactions in family members. If negative, these reactions may be detrimental to the person with epilepsy. The association between specific emotional adjustment factors and epilepsy is not conclusive. Studies have been published which support as well as refute this association. Studies indicate that persons with epilepsy experience lower rates of marriage and more sexual difficulties than do nonepileptic persons. Studies report greater unemployment and underemployment in epileptic persons than in the population at large. Studies suggest that some persons with epilepsy manifest an attitude of nonacceptance of self. Some are reluctant to disclose their disability to others. The studies also indicate the presence of a discriminatory attitude by some nonepileptic persons toward epileptic persons. Several factors are associated with successful medical management of epilepsy. The emphasis in research studies with regard to psychosocial aspects of epilepsy focuses predominantly on individual deficiencies rather than on strengths and abilities.

Aggression↗

PubMed1982

Suicide in Detroit 1975: changes and continuities.

Data on 193 cases of suicide in Detroit are analyzed to assess changes and continuities in the etiology of suicide. A significant change in the correlates of suicide is a shift in the group with the highest rate of suicide from the elderly to the relatively young age cohorts. A tentative explanation for this new pattern is suggested in terms of youth culture and underemployment. Continuities in the traditional etiology of suicide included the findings that males, persons in manual occupations, whites, and immigrants had relatively high rates of suicide.

Adolescent↗

PubMed1995

Interpreting the new illness question in the UK census for health research on small areas.

STUDY OBJECTIVE: The study aimed to identify the various factors that seem to influence the average response to the new census question on limiting, long standing illness at the small area level, to assess the extent to which the new questions adds to information already available in the census and elsewhere, and to discuss how useful the data are likely to be for those planning health and social services. DESIGN: This was a cross sectional analysis of the relationship between rates of limiting, long standing illness (standardised for age and sex) and a large number of indicators of health and socioeconomic status at the small area level. SETTING: The study used data relating to 4985 small areas covering the whole of England. The average population was about 10 000. PARTICIPANTS: The 1991 census of population was addressed to the entire population of England. MAIN RESULTS: There are wide variations in the levels of self reported long standing illness between small areas, 70% of which are explained by demographic factors. Variation in age/sex standardised responses to the new census question at the small area level can largely be explained by census data on self reported disability among those of working age, standardised mortality ratio, and by indicators of socioeconomic circumstances relating to social class, ethnicity, and the elderly living alone. These does not seem to be a significant reporting bias due to underemployment. CONCLUSION: Unlike the disability question in the census, the standardised, self reported long standing limiting illness ratio covers the entire population and it is not skewed towards men. Although the variable is a synthesis of the health and social determinants of perceived morbidity, it does not provide much information that was not already available. In addition, it is available every 10 years only and thus may be rather inaccurate as an indicator of relative need towards the end of the decade. Moreover, in future censuses, individuals' answers might be influenced by the knowledge that their responses will affect the volume of resources allocated to the area in which they live.

Adolescent↗

PubMed2000

How do types of employment relate to health indicators? Findings from the second European survey on working conditions.

STUDY OBJECTIVE: To investigate the associations of various types of employment with six self reported health indicators, taking into account the part played by demographic variables, individual working conditions and four ecological indicators at the country level. DESIGN: Cross sectional survey (structured interview) of a sample of the active population of 15 European countries aged 15 years or over. Main independent variables were nine types of employment categorised as follows: small employers, full and part time permanent employees, full and part time fixed term employees, full and part time sole traders and full and part time temporary contracts. Main outcome measures were three self reported health related outcomes (job satisfaction, health related absenteeism, and stress) and three self reported health problems (overall fatigue, backache, and muscular pains). Logistic regression and multilevel models were used in the analyses. SETTING: 15 countries of the European Union. PARTICIPANTS: 15 146 employed persons aged 15 or over. MAIN RESULTS: Precarious employment was consistently and positively associated with job dissatisfaction but negatively associated with absenteeism and stress (as compared with full time permanent workers). Fatigue, backache and muscular pains also tended to be positively associated with precarious employment, particularly with full time precarious employment. Small employers reported high percentages of stress and fatigue, but absenteeism was relatively low. Sole traders generally reported high percentages of all outcomes, except for absenteeism, which was low. For each type of employment (except temporary contracts), full time workers tended to report worse health outcomes than part time workers. Patterns were generally consistent across countries. Associations persisted after adjustment for individual level working conditions and were not modified by country level variables. CONCLUSIONS: This study is the first to examine the relations between various types of employment and six health related indicators for all 15 member states of the European Union. Suggestive patterns worthy of further exploration have been found. Standardised definitions of types of underemployment and health related outcomes, more potent epidemiological designs and the inclusion of socioeconomic information (for example, social security systems, incapacity benefit schemes) at the regional level are proposed for inclusion in further research.

Adolescent↗

PubMed1996

Health and unemployment.

This paper reviews the relationship between health and inadequate employment, especially unemployment. Poor physical or mental health can lead, via poor work performance, to job loss; however, studies that control for such selection effects are still scarce except for a few health outcomes. For example, aggregate-level studies typically find a positive association between unemployment and suicide rates over time. At the individual level of analysis, panel surveys of laid-off workers tend to find increased psychiatric problems such as depression and substance abuse. Few studies have evaluated interventions to prevent or reduce the adverse health effects of job loss. There have been even fewer studies of the health effects of other types of inadequate employment such as the increasingly prevalent forms of underemployment.

Adaptation, Psychological↗

PubMed2001

Impact of growth hormone (GH) therapy on quality of life along the lifespan of GH-treated patients.

The relationship between growth hormone (GH) deficiency (GHD) and quality of life (QOL) is coming into sharper focus. Psychological studies of short GHD children referred for GH treatment sometimes show that they have a poor QOL, often due to their feelings of anxiety, depression, social isolation and difficulties maintaining attention. These difficulties may lead to low academic achievement and impoverished interpersonal skills, both of which impact on life satisfaction and productivity. Recent observations suggest that short children who are not referred for medical diagnosis do not experience the same problems. We have observed that after patients are started on GH therapy the incidence of behavioral problems declines to within normal limits on standardized psychometric tests. Pediatric GHD patients are not generally followed closely after growth targets are achieved. Over the past 25 years, several observers have noted that many patients treated with GH in childhood report poor QOL during young adulthood despite achievement of acceptable height and replacement of necessary hormones. They appear, as a group, to be underemployed, often unmarried, and sometimes unhappy. Some have suggested that this may be due to their overprotected early childhood. We have examined a cohort of young adults treated with GH during childhood and found they exhibit symptoms of previously undetected psychiatric disorder. Anxiety, depression, panic disorder and obsessive compulsive disorder were found. Strikingly, the incidence of a particularly disabling anxiety disorder, social phobia, was detected in 38% of one of our groups. This disorder occurs in approximately 13% of the general population. Similar QOL outcomes have been reported in adults who became GHD in later life. We conclude that the spectrum of potential disabilities tied to GHD is broader than previously thought. Management of these patients should include consideration of QOL issues throughout their lifespan. Potential treatment strategies may include continuation of GH therapy as indicated, psychotropic medication, or psychosocial support and rehabilitation.

Adolescent↗

PubMed1987

Are we training too many psychiatrists?

In contrast to the past decade's concerns about an undersupply of psychiatric manpower, the authors point out that the profession may soon be facing the prospect of an oversupply of psychiatrists. Given the present rate of producing psychiatrists, shifts in demands for psychiatric services, changing payment and access patterns regarding specialty medical care, increasing numbers of nonpsychiatrist mental health professionals, and a probable surfeit of primary care physicians, underemployment of psychiatrists may become commonplace. Future psychiatrists will likely be used more as consultants, and the profession will need fewer, but better trained, graduates. The authors present alternative proposals to deal with service needs related to such reductions.

Community Psychiatry↗

PubMedDate not supplied

Differences in transitional needs of high school students with and without learning disabilities.

Studies investigating the post-high-school vocational status of individuals with disabilities have frequently found that these individuals are more likely to be unemployed, underemployed, or employed part-time, when compared to nondisabled peers. Transition programs are needed for adolescents with disabilities to facilitate their vocational success. The current study surveyed 80 high school students with learning disabilities (LD) and 80 nondisabled (NLD) peers to determine their transitional needs. Results indicated that (a) more students with LD than NLD students are involved in transition programs; (b) career goals were established by the majority of both groups; (c) parents provided most of the assistance in making career decisions; and (d) twice as many NLD students as students with LD wanted to go to college, while twice as many students with LD as NLD students wanted to enter the job market. More students with LD than NLD students were aware of vocational rehabilitation (VR) services, but the number was still below 50%. The majority of the information about VR services came from the school.

Adolescent↗

PubMed1994

Beyond 'clinical'?: four-dimensional medical education.

Medical education is in crisis. Undergraduates experience an excessive burden of information, develop attitudes to learning that are based on passive acquisition of knowledge than on curiosity and exploration, and suffer from progressive disenchantment with medicine. There is also a serious problem of providing adequate clinical experience for medical students at existing teaching sites, largely because of reduction in bed numbers, increased patient throughput and clinical specialization. This problem was identified over a decade ago in London but has not been solved by the merger of medical schools. A recent survey in one London teaching hospital showed underemployment of students and limited patient contact. A review of clinical clerkships in an Australian medical school revealed that one-third of teachers were perceived as unconcerned, discouraging, derogatory or hostile, and only one-half were rated as effective educators. One consequence has been the development of a wide-ranging debate on changing medical education. Traditionalists have diminishing room for manoeuvre in defence of existing educational practices, as cautious bodies like the General Medical Council (GMC) opt for fundamental reform.

Community Medicine↗

PubMed2005

The effect of family size on incentive effects of welfare transfers in two-parent families: an evaluation using experimental data.

Family size is an important determinant of family well-being, and it is a good predictor of poverty. This study examines effects of waiving the 100-hour rule, by family size, and distinguishes between the "work-incentive effects" and the "eligibility effects" of the waiver. The 100-hour rule limits eligibility to aid to two-parent families in which the principal earner is unemployed or underemployed (works fewer than 100 hours per month). The study uses data from the Link-Up randomized experiment, conducted in California's Central Valley, from 1992 to 1994. The findings show that the eligibility effect of the waiver does not differ by family size, but the work-incentive effect does.

California↗

PubMed2003

Marital violence in a martial town: husbands and wives in early modern Portsmouth, 1653-1781.

Sessions papers from early modern Portsmouth survive from 1653 on and are nearly continuous for eighty-five years, that is, from 1696 to 1781. They include 356 cases of wife beating in addition to 7,658 other assaults; as such, the town's records allow for a comparison of the violent behavior of individual wife beaters both inside and outside of their marriages. These comparisons suggest that assaults on wives were more severe than assaults on strangers and acquaintances: not only were many wives assaulted on several occasions before lodging a complaint, the attacks themselves often resulted in greater injury, reflecting (1) a greater tendency to use potentially lethal weapons and (2) a differential in strength between most husbands and wives. The motives of individual wife beaters are less clear; what can be said with certainty is that wife beatings, like assaults in general, tended to rise whenever soldiers were demobilized and men were either unemployed or underemployed.

Domestic Violence↗

PubMed2006

Common mental disorders in the workforce: recent findings from descriptive and social epidemiology.

OBJECTIVE: To review the recent descriptive and social epidemiology of common mental disorders in the workplace, including prevalence, participation, work disability, and impact of quality of work, as well as to discuss the implications for identifying targets for clinical and preventive interventions. METHOD: We conducted a structured review of epidemiologic studies in community settings (that is, in the general population or in workplaces). Evidence was restricted to the peer-reviewed, published, English-language literature up to the end of June 2005. We further restricted evidence to studies that used recent classification systems; then, if evidence was insufficient, we reviewed studies that used standardized psychiatric screening scales. To distinguish this article from recent reviews of health and work quality, we focused on new areas of investigation and new evidence for established areas of investigation: underemployment, organizational justice, job control and demand, effort-reward imbalance, and atypical (nonpermanent) employment. RESULTS: Depression and simple phobia were found to be the most prevalent disorders in the working population. The limited data on rates of participation suggested higher participation among people with depression, simple phobia, social phobia, and generalized anxiety disorder. Depression and anxiety were more consistently associated with "presenteeism" (that is, lost productivity while at work) than with absenteeism, whether this was measured by cutback days or by direct questionnaires. Seven longitudinal studies, with an average sample size of 6264, showed a strong association between aspects of low job quality and incident depression and anxiety. There was some evidence that atypical work was associated with poorer mental health, although the findings for fixed-term work were mixed. CONCLUSIONS: Mental health risk reduction in the workplace is an important complement to clinical interventions for reducing the current and future burden of depression and anxiety in the workplace.

Adolescent↗

PubMed1978

Early retirement pensions in Sweden: trends and regional variations.

The total number of early retirement pensiones has risen sharply since the end of the 1960s. The increase was greatest during the early 1970s following a reform in 1970 which extended the right to early retirement pension to older workers because of labour market considerations. This article discusses various conceivable explanations for the growth in the number of early retirement pensioners and regional variations of this phenomenon. The following explanatory factors are considered: (a) The prospects of getting (keeping) a job. (b) Work capacity. (c) The nature of the pension scheme. (d) Alternative possibilities of support. (e) Preferences concerning early retirement pensions. The discussion focuses on two explanations highlighted in the public debate in Sweden: changes in pension legislation and the role of the solidarity wages policy. An empirical analysis of variations at the provincial level reveals a definite correlation between the proportion of early retirement pensioners and various indices of unemployment and underemployment.

Age Factors↗

PubMed1995

Coming of age in hard times.

Young people are facing very serious problems of unemployment and underemployment in the current job market. Disadvantaged youth are enduring the most difficult struggle. One plausible reason is that youth are undereducated and insufficiently skilled to meet job requirements. This article explores forty in-depth interviews with young people from three high-unemployment neighborhoods to closely examine experiences in high school and in the post-high school work entry phase. The purpose was to determine whether the youths were receiving the skill set components advanced by Comprehensive Collaborative Models. Policy implications are drawn from the lack of fit between model prescriptions and actual experiences.

Adolescent↗

PubMed2003

Welfare to what? A policy agenda.

The Ohio Works First Program went into effect on October 1, 1997. In October 2000 the first round of individuals will be terminated from receiving cash assistance due to passage of the Personal Responsibility and Work Opportunity Act of 1996. The purpose of this study was to identify barriers/hindrances to self-sufficiency among a selected sample of welfare consumers. Describing a portion of those who are in a self-sufficiency program in Northeast Ohio, the study indicates specific obstacles to self-sufficiency such as unemployment and underemployment, transportation, housing, child care, self-efficacy, and county sanctions. Recommendations for policy makers along with a policy agenda and recommendations for service agencies are included.

Adult↗

PubMed2004

Children with developmental delays twenty years later: where are they? How are they?

Data from parents and young adults were collected as part of a 20-year follow-up of children with developmental delays who had been identified at age 3 years. The young adults and their parents provided information through questionnaires and personal interviews. Findings documented a broad range of outcomes, with some young adults leading independent and productive lives, whereas the majority were un- or underemployed, living with and financially dependent upon their families, and socially isolated. Three types of parent-young adult relationships were identified. For both parents and young adults, IQ was significantly and negatively related to perceived life satisfaction.

Adult↗