Work, disability and rehabilitation: making the best job of it

The relationship between a person's health and their work was recognised as central to the good practice of medicine by Charles Turner Thackrah (1795-1833) in his seminal work, The effects of arts, trades and professions on health and longevity (1823). The connection is largely forgotten in current clinical practice; the UK has a high level of dependence on benefits mainly in those with non-severe disabilities. Recognition of the value of preventing this by access to early, usually multidisciplinary, rehabilitation and prevocational rehabilitation via a general practitioner and in hospital practice is needed as a priority. This requires that all NHS staff adopt a biopsychosocial approach to illness and are taught about the workplace needs of patients and the value of early rehabilitation. Communications within the NHS and with other agencies have to be improved by the development of better pathways with dedicated staff time for this activity. The creation of the Director of Health and Work position and the refocusing of occupational medicine present an unrivalled opportunity to improve our practice.     

Function in job seekers with mental illness and drug and alcohol problems who access community based disability employment services

Purpose: This study identified functioning, health, and social needs in jobseekers with mental disorders independently assessed as having capacity to work and referred to disability employment services. Differences in function between jobseekers with mental illness alone and with additional drug and alcohol problems were examined with view to identifying interventions for vocational rehabilitation.

Method: A convenience sample of 116 jobseekers completed BASIS-32, CANSAS, AUDIT, DAST-10 and 6 items from the EXIT interview and were divided into two groups: mental illness only, and additional drug and alcohol issues (AUDIT total score >8 and/or DAST total score >3). Analysis of variance was used to determine group differences. Results: Jobseekers reported low-moderate problems with function. Over 40% of the sample reported unresolved psychological distress, physical health needs, and social/daytime activity needs. Thirty-five jobseekers (30%) had additional drug and alcohol problems and reported significantly greater difficulty with impulsive/addictive behavior and poorer memory and executive function than the mental illness only group. No significant differences were identified in past work functioning.

Conclusions: Screening all job seekers for psychological, physical, and social needs to identify suitable treatment and rehabilitation strategies and providing interventions that improve emotional regulation and executive function for job seekers with additional drug and alcohol problems may improve employability of job seekers accessing disability employment services.

Implications for Rehabilitation

• Many job seekers with co-existing mental illness and drug and alcohol problems who have been assessed as having the capacity to work report unresolved psychological distress, physical health needs, and social activity requirements.

• Early screening for psychological, health and social needs using a general needs measure, such as the CANSAS, will help to identify potential barriers to employment, including drug and alcohol problems.

• Vocational rehabilitation interventions that improve executive function and emotional regulation may improve employability of job seekers with additional drug and alcohol issues.

     

Health problems of lesbian women.

Lesbians are visible to society, health care providers, and researchers as women, not as an identified sub-group of women. Lesbian invisibility contributes to their collective increased vulnerability, as evidenced by decreased societal and environmental resource availability, threats to social connectedness, and barriers in accessing health care. The factors that have led to increased vulnerability have shown up in risks of violence, cancer, HIV/AIDS, and chemical dependency among lesbians.     

早期干预对正常独生子女行为问题的影响

目的：通过实施独生子女健全人格培养方案，探讨早期干预对正常独生子女行为发育的影响。方法：全部样本选自北京市西城区，随机抽取知情同意的67名健康独生子女家庭，1995／2002为实验阶段。分为干预组30例，对照组37例，干预组按健全人格培养方案连续进行干预指导6年，对照组不予干预。至2003-05完成第一阶段实验数据的处理和统计，分别给予Achenbach儿童行为量表测评儿童行为问题状况，男孩上界是21分，女孩为19分。应用儿童社会适应行为量表（采用适应行为离差智商，均数100，标准差为150）测定儿童社会适应能力，应用中国比内智商测验（共51题，通过一个计1分，连续5题不通过即停止，测得的总分根据离差智商计分法查出对应的智商，平均数为100，标准差为16）测定幼儿智商。结果：纳入儿童67人，均进入结果分析，无脱落者。①行为量表测定结果：干预组儿童行为问题中体诉、社交退缩和攻击因子分明显低于对照组（1．47&;#177;1．45，3．72&;#177;1．89；2．56&;#177;2．22，3．72&;#177;1.89；4．06&;#177;2．36，5．37&;#177;2．40．P〈0．05，P〈0．01）。②社会适应量表测定结果：干预组儿童适应行为评定量表的认知、社会自制因子分和适应商总分高于对照组（29．83&;#177;7．43．25．43&;#177;4．06；54．87&;#177;7．57，49．49&;#177;8.42；118．03&;#177;11．65，109．29&;#177;14．47，P〈0．05）。③比奈幼儿智商测定结果：干预组高于对照组（96．93&;#177;7．37．91．22&;#177;5．21，P〈0．01）。结论：通过对正常独生子女的早期健全人格培养可以减少行为问题检出率，提高儿童的适应行为和智商。     

早期干预对正常独生子女行为问题的影响

目的:通过实施独生子女健全人格培养方案,探讨早期干预对正常独生子女行为发育的影响。方法:全部样本选自北京市西城区,随机抽取知情同意的67名健康独生子女家庭,1995/2002为实验阶段。分为干预组30例,对照组37例,干预组按健全人格培养方案连续进行干预指导6年,对照组不予干预。至2003-05完成第一阶段实验数据的处理和统计,分别给予Achenbach儿童行为量表测评儿童行为问题状况,男孩上界是21分,女孩为19分。应用儿童社会适应行为量表(采用适应行为离差智商,均数100,标准差为150)测定儿童社会适应能力,应用中国比内智商测验(共51题,通过一个计1分,连续5题不通过即停止,测得的总分根据离差智商计分法查出对应的智商,平均数为100,标准差为16)测定幼儿智商。结果:纳入儿童67人,均进入结果分析,无脱落者。①行为量表测定结果:干预组儿童行为问题中体诉、社交退缩和攻击因子分明显低于对照组(1.47±1.45,3.72±1.89;2.56±2.22,3.72±1.89;4.06±2.36,5.37±2.40,P<0.05,P<0.01)。②社会适应量表测定结果:干预组儿童适应行为评定量表的认知、社会自制因子分和适应商总分高于对照组(29.83±7.43,25.43±4.06;54.87±7.57,49.49±8.42;118.03±11.65,109.29±14.47,P<0.05)。③比奈幼儿智商测定结果:干预组高于对照组(96.93±7.37,91.22±5.21,P<0.01)。结论:通过对正常独生子女的早期健全人格培养可以减少行为问题检出率,提高儿童的适应行为和智商。     

Health issues in men: Part II. Common psychosocial disorders

During screening examinations and, when appropriate, other health-related visits, family physicians should be alert for signs and symptoms of common psychosocial disorders in men. Health issues of concern include alcohol and substance abuse, domestic violence, midlife crisis and depression. Alcohol remains the most abused drug in America. The highest rates of alcohol abuse are in men 25 to 39 years of age, although alcoholism is also a considerable problem after 65 years of age. Disulfiram and the opioid antagonist naltrexone are the two medications currently labeled by the U.S. Food and Drug Administration for the treatment of chronic alcohol dependence. Like alcohol abuse, domestic violence is a sign of psychosocial distress in men. Domestic violence may be a problem in up to 16 percent of marriages. Most men move through the midlife period without difficulty. Major depressive illness occurs in about 1 percent of elderly men, whereas minor depression or subsyndromal depression affects 13 to 27 percent of older men. Selective serotonin reuptake inhibitors have become first-line therapy for depression.