Occupational Difficulties Research Articles

국내 대학병원 신생아중환자실 작업치료의 현황

Purpose : The purpose of this study was to provide some basic information about current status of occupational therapy in Korean University Hospital NICUs. Method : This study was conducted by mail and by analyzing 61 survey questionnaires sent out pediatric occupational therapist in 39 university hospitals. Result : 23 people of the current pediatric occupational therapists worked in NICU under many constraints. Some reasons for not providing occupational therapy services in the NICU were lack of pediatric occupational therapists(55.3%), funding difficulties(42.1%) and problem in the hospital system(42.1%). Conclusion : The results of this study can be used as a basis to increase the provision of occupational therapy in the NICU. Further research is needed to improve the role of occupational therapy in the NICU.

Mental health and general wellness in the aftermath of Hurricane Ike

Exposure to natural disasters has been linked to a range of adverse outcomes, including mental health problems (e.g., posttraumatic stress symptoms [PTSS], depression), declines in role functioning (e.g., occupational difficulties), and physical health problems (e.g., somatic complaints). However, prior research and theory suggest that the modal postdisaster response in each of these domains is resilience, defined as low levels of symptoms or problems in a given outcome over time, with minimal elevations that are limited to the time period during the disaster and its immediate aftermath. However, the extent to which disaster survivors exhibit mental health wellness (resilience across multiple mental health conditions) or general wellness (resilience across mental health, physical health, and role functioning domains) remains unexplored. The purpose of this study was to quantify mental health and general wellness, and to examine predictors of each form of wellness, in a three-wave population-based study of Hurricane Ike survivors (N = 658). Latent class growth analysis was used to determine the frequency of resilience on four outcomes (PTSS: 74.9%; depression: 57.9%; functional impairment: 45.1%; days of poor health: 52.6%), and cross-tabulations were used to determine the frequency of mental health wellness (51.2%) and general wellness (26.1%). Significant predictors of both mental health and general wellness included lower peri-event emotional reactions and higher community-level collective efficacy; loss of sentimental possessions or pets and disaster-related financial loss were negative predictors of mental health wellness, and loss of personal property was a negative predictor of general wellness. The results suggest that studies focusing on a single postdisaster outcome may have overestimated the prevalence of mental health and general wellness, and that peri-event responses, personal property loss and collective efficacy have a cross-cutting influence across multiple domains of postdisaster functioning.

Use and Results of MOHO Global Assessments in Community Mental Health: A Practice Analysis

This practice analysis reports an evaluation of occupational therapists' utilization of assessments derived from the Model of Human Occupation (MOHO) within adult community mental health settings. An audit of all documented assessments recorded details of (1) the number of assessments completed by each of the occupational therapists, and (2) the specific occupational difficulties identified across all assessments. Thirty-eight assessments had been completed, with a total of 35 service users. Results show variation in practice among occupational therapists in their application of MOHO assessments and, further, that the range of occupational difficulties identified for the client cohort is diverse.

Attention Deficit Hyperactivity Disorder and N-methyl-D-aspartate (NMDA) Dysregulation

Attention deficit hyperactivity disorder (ADHD) is a long recognized and common childhood disorder. ADHD adolescents tend to encounter more difficulties in school and peer relationships, whereas ADHD adults have more occupational and interpersonal difficulties. However, with the treatment of central nervous system (CNS) stimulants, 10-20 % of the patients still remain poor responders to treatment. Among hypotheses for ADHD, dysfunction of N-methyl-D-aspartate (NMDA)-type glutamate receptors has recently been suggested by accumulating genetic and animal studies. This article systemically reviews evidence supporting NMDA dysfunction as a potential ADHD pathogenesis from perspectives of neurodevelopment, attentional circuitry, and impulse inhibition. The review also addresses the development of novel treatments for ADHD via modulation of glutamatergic system, particularly the NMDA/glycine site. These so-called NMDA enhancers may provide a new treatment option for patients with ADHD.

Factors associated with mental health service use in urban, impoverished, trauma-exposed adults.

This study utilized the Expanded Behavioral Model of Health Service Use Among Vulnerable Populations to investigate disparities in mental health care use among a community sample of urban, impoverished, trauma-exposed adults. Self-report questionnaires were completed by 135 adults with a lifetime history of traumatic stress exposure. Results suggested approximately 20% of the sample were receiving mental health services, and these individuals were primarily getting services at outpatient mental health facilities. Social support, positive attitudes toward treatment seeking, and occupational disability were significantly associated with current mental health service use. Logistic regression analyses indicated that after controlling for significant covariates, occupational disability was the only need variable that predicted current mental health service utilization (OR = 1.25, 95% CI = 1.08 to 1.45, p < .01). Improving attitudes toward treatment seeking as well as identifying occupational difficulties may be important avenues for improving willingness to seek care and decreasing disparities in care for trauma-exposed adults. Implications for mental health policy and practice are discussed.

Creating Enabling Environments at Preschool for Children with Developmental Coordination Disorder

The aim of this descriptive case study was to investigate the use of a two-part intervention in enabling the play skills of children with probable developmental coordination disorder in their preschool environments. Occupational performance coaching (OPC) was used with three teacher-child dyads in combination with a play-based intervention with the child. The intervention took place over 4 weeks and used the Canadian Occupational Performance Measure, the Revised Knox Preschool Play Scales, and the Play Observation Scale as outcome measures. Results indicated that the teachers found OPC to be useful in raising their awareness of issues surrounding occupational performance difficulties and in generating solutions to those difficulties. Improvements were noted in the children's occupational performance and in their developmental play skills. Frequency of engagement in group play increased while frequency of onlooker and unoccupied behaviour decreased. Implications for future interventions and research are described.

Plus Ça Change…

This study sought to capture the challenges facing working women in the wake of the late-2000s recession; we also studied whether and how these challenges varied by race and leadership status. Drawing on qualitative data from 4,388 women employed in 2010 across Michigan (one of the most economically depressed states), we inductively analyzed accounts of the “biggest challenge facing working women.” We found that at a time when the workforce was reeling from major economic change, women's occupational difficulties remained largely unchanged. Their top five employment concerns mirrored decades past: work-life imbalance, pay inequity, gender discrimination, childcare, and the glass ceiling. Emphases varied somewhat by race and leadership, but overall, women's chief concerns cut across these boundaries. We provide an abundance of quotes to bring life to these perspectives, letting the voices of working women be heard. Our findings suggest that the global economic crisis failed to outstrip challenges that working women have confronted for years. We conclude with a call for broad change to better support women (and men) in the workforce—during and after the Great Recession.

Donepezil-Induced Confusional State in a Patient With Autopsy-Proven Behavioral-Variant Frontotemporal Dementia

Donepezil-Induced Confusional State in a Patient With Autopsy-Proven Behavioral-Variant Frontotemporal Dementia

AB1426-HPR Evaluation of socio-demographic variables, psychiatric comorbidity, and pain in fibromyalgia patients

BackgroundFibromyalgia isa chronic pain syndrome of unknown etiology associated to emotional disorders and low levels in health related quality of life.ObjectivesTo compare socio-demographic variables, psychiatric comorbidity, and pain among fibromyalgia...

Occupational Burnout Levels of Turkish Imams

The main purpose of this study was to examine the level of occupational burnout among Turkish imams. The study was a descriptive one in which the data was gathered through the “Maslach Burnout Inventory” and the “Personal Information Form”, which were given to 124 imams working in Bursa, Turkey. For the 124 imams with the study population comprised, 11 variables were examined. These variables were, marital status, age, educational level, length of service, working district, occupational difficulty, using computer technology, occupational research, part-time job, Arabic language, and size of community. For the statistical analysis of the collected data Kruskal–Wallis, t test, ANOVA χ2, and Fisher's exact test were used. The results indicated that although there was no statistical difference between the education level, marital status, Arabic, and computer knowledge variables among imams in any of the subscales, there were significant differences on emotional exhaustion, depersonalization, and personal accomplishment subscales ( p &lt; 0.005) on age, length of service, workplace, occupational difficulty, part-time job, occupational research, and size of the community variables.

Occupational issues of adults with ADHD

BackgroundADHD is a common neurodevelopmental disorder that persists into adulthood. Its symptoms cause impairments in a number of social domains, one of which is employment. We wish to produce a consensus statement on how ADHD affects employment.MethodsThis consensus development conference statement was developed as a result of a joint international meeting held in July 2010. The consensus committee was international in scope (United Kingdom, mainland Europe, United Arab Emirates) and consisted of individuals from a broad range of backgrounds (Psychiatry, Occupational Medicine, Health Economists, Disability Advisors). The objectives of the conference were to discuss some of the occupational impairments adults with ADHD may face and how to address these problems from an inclusive perspective. Furthermore the conference looked at influencing policy and decision making at a political level to address impaired occupational functioning in adults with ADHD and fears around employing people with disabilities in general.ResultsThe consensus was that there were clear weaknesses in the current arrangements in the UK and internationally to address occupational difficulties. More so, Occupational Health was not wholly integrated and used as a means of making positive changes to the workplace, but rather as a superfluous last resort that employers tried to avoid. Furthermore the lack of cross professional collaboration on occupational functioning in adults with ADHD was a significant problem.ConclusionsFuture research needs to concentrate on further investigating occupational functioning in adults with ADHD and pilot exploratory initiatives and tools, leading to a better and more informed understanding of possible barriers to employment and potential schemes to put in place to address these problems.

Childhood Sexual Abuse, Adult Psychiatric Morbidity, and Criminal Outcomes in Women Assessed by Medium Secure Forensic Service

There is little literature on childhood sexual abuse in women seen by forensic services. A cohort of 225 cases of women seen by forensic services in a medium secure unit in the UK were examined, and childhood sexual abuse and non–childhood sexual abuse cases were compared. Over half the sample had a history of childhood sexual abuse, and 5.6% of this group were victims of a subsequent sexual assault in adulthood. The perpetrators were all male. The majority of intrafamilial cases resulted in victims being raised in environments outside the family home. Childhood sexual abuse was associated with later relationship, educational, and occupational difficulties. Significant associations were also seen with personality disorder, self-harm, and substance misuse. Treating services need to recognize the potential importance of childhood sexual abuse in their models of care given the complexity of the association between childhood sexual abuse and psychosocial needs and its impact on successful rehabilitation.

Behavioural and psychological management of somatic symptom disorders: An overview

The number of patients who seek help at primary and secondary care for somatic symptoms which cannot be explained by any known medical condition is enormous. It has been proposed to rename ‘somatoform disorders’ in DSM-IV as ‘somatic symptom disorders’ in DSM-5. This is supposed to include disorders such as somatization disorder, hypochondriasis, undifferentiated somatoform disorder, pain disorder and factitious disorder. The reason for the renaming and grouping is that all these disorders involve presentation of physical symptoms and/or concern about medical illness. In the literature, there is considerable variation adopted with respect to diagnosis and in the approaches adopted for intervention. However, the common feature of these disorders is the chronicity, social dysfunction, occupational difficulties and the increased healthcare use and high level of dissatisfaction for both the clinician and the patient. A number of behavioural and psychological interventions for somatic symptoms have been carried out at primary, secondary and tertiary care settings and recently there have been more attempts to involve the primary care physicians in the psychological interventions. This review aims at giving an overview of the components of the behavioural and other psychological interventions available for addressing medically unexplained somatic symptoms and to present their efficacy.

The road not taken: life experiences in monozygotic twin pairs discordant for major depression

In an effort to understand how environmental experiences contribute to risk for major depression (MD), we conducted joint autobiographical interviews with 14 pairs of monozygotic twins (mean age 51.2) rigorously discordant for a lifetime history of MD. Twelve of the pairs could be sorted into four broad categories. In two pairs, discordance was associated with a single traumatic event occurring to the affected twin. In seven pairs, the well twin had one stable, long-term, successful romantic relationship, whereas the affected co-twin had romantic reversals one or more of which precipitated depressive episodes. These pairs varied in the degree to which the romantic problems seemed to arise from bad luck or poor choices. In one pair, occupational difficulties were strongly related to discordance in experiences with MD. In two pairs, several mechanisms seemed to be at work. Discordance in the quality of intimate love relationships was the most common etiological factor revealed by interview in these discordant pairs, with single dramatic events and occupational problems being considerably rarer. Even in this best of natural experiments, the causal interrelationship between personality, environment and depressive episodes was not always clear. Many pairs illustrated the protective effects of planfulness and the malignant effect of cumulative continuity where early difficulties in relationships shaped the subsequent life course. These results speak both to the importance of environmental influences on human well-being and psychopathology, and the complexity of the causal paths underlying their effects.

Cost-effectiveness of a vocational enablement protocol for employees with hearing impairment; design of a randomized controlled trial

BackgroundHearing impairment at the workplace, and the resulting psychosocial problems are a major health problem with substantial costs for employees, companies, and society. Therefore, it is important to develop interventions to support hearing impaired employees. The objective of this article is to describe the design of a randomized controlled trial evaluating the (cost-) effectiveness of a Vocational Enablement Protocol (VEP) compared with usual care.Methods/DesignParticipants will be selected with the 'Hearing and Distress Screener'. The study population will consist of 160 hearing impaired employees. The VEP intervention group will be compared with usual care. The VEP integrated care programme consists of a multidisciplinary assessment of auditory function, work demands, and personal characteristics. The goal of the intervention is to facilitate participation in work. The primary outcome measure of the study is 'need for recovery after work'. Secondary outcome measures are coping with hearing impairment, distress, self-efficacy, psychosocial workload, job control, general health status, sick leave, work productivity, and health care use. Outcome measures will be assessed by questionnaires at baseline, and 3, 6, 9, and 12 months after baseline. The economic evaluation will be performed from both a societal and a company perspective. A process evaluation will also be performed.DiscussionInterventions addressing occupational difficulties of hearing impaired employees are rare but highly needed. If the VEP integrated care programme proves to be (cost-) effective, the intervention can have an impact on the well-being of hearing impaired employees, and thereby, on the costs for the company as well for the society.Trial registrationNetherlands Trial Register (NTR): NTR2782

Are Occupational Factors and Mental Difficulty Associated With Occupational Injury?

To evaluate the associations between biomechanical, physical, and psychological demands and occupational injury according to depressive symptoms severity. Two thousand eight hundred eighty-two French working people completed a questionnaire covering sociodemographic characteristics, smoking, alcohol consumption, obesity, job, chronic diseases, depressive symptoms, and injuries during the previous 2-year period. Data were analyzed using logistic regression. Occupational injury (9.2%) strongly related to biomechanical, physical, and psychological demands among depressive-symptoms-free workers (odds ratios ranging from 1.35 to 3.15). These relationships were stronger among the workers with depressive symptoms without medical treatment (11.9%) and among those with persistent symptoms despite a treatment (1.7%), with odds ratios up to 12. These associations were partially confounded (up to 51%) by unhealthy behaviors, health status, and chronic diseases. High-occupational demands and depressive symptoms can be early identified and monitored to prevent injury.

골덴하르 증후군(Goldenhar syndrome)아동에 대한 감각통합치료 평가와 중재: 사례연구

This case study was to examine the effect of the sensory integration therapy on the Goldenhar syndrome child with tactile defensiveness, developmental delay and occupational performance difficulties. The child was 7.10 year old boy. For intervention, four evaluations were used and the results are as follows. First, in Canadian Occupational Performance Measure showed occupational performance goal as reading and writing in upright position. Second, in Short sensory profile and sensory history, significant differences between sensory sensitivity and tactile processing. Third, in Developmental Profile-3 showed delay. Fourth, in Bruininks-Oseretsky Test of Motor Proficiency-2 showed below average. After intervention, the results of which showed a positive changes. Therefore, this case study is found that the sensory integration therapy is effective in the Goldenhar syndrome child with tactile defensiveness and developmental delay.

Behavioral Activation Therapy for Remediating Persistent Social Deficits in Medication-Responsive Chronic Depression

The purpose of this article is to explore the use of behavioral activation therapy in patients with medication-responsive chronic depression who continue to experience social and occupational deficits. The classification of chronic depression includes a variety of disorders that are both common and debilitating and that frequently leave patients socially impaired even after remission of mood symptoms. Medication is often only partially effective in remedying these social impairments. As a result, other interventions, including forms of psychotherapy, may be justified as an adjunct to medication to improve residual social impairment. Behavioral activation therapy is one such treatment that may be especially appropriate for such individuals. The authors offer a brief description of behavioral activation therapy and examine how to adapt this therapy for use in patients with medication-responsive chronic depression. Preliminary evidence suggests that the therapy can be easily implemented with few modifications to improve social and occupational difficulties.

Suicidal behaviour and psychosocial problems in veterinary surgeons: a systematic review

Rates of suicide are elevated among veterinary surgeons in several countries, yet little is known about contributory factors. We have conducted a systematic review of studies investigating suicidal behaviour and psychosocial problems in veterinary surgeons. A systematic search of the international research literature was performed in May 2008. Data from 52 studies of non-fatal suicidal behaviour, mental health difficulties, stress and burnout, occupational difficulties, and psychological characteristics of veterinary surgeons were extracted by two independent reviewers and analysed. Studies were rated for quality and greater emphasis placed on findings from higher quality studies. The majority of studies were of stress and occupational difficulties experienced by veterinary surgeons. Occupational stressors included managerial aspects of the job, long working hours, heavy workload, poor work-life balance, difficult client relations, and performing euthanasia. Few studies investigated suicidal behaviour or mental health difficulties in the profession. Some studies suggested that young and female veterinarians are at greatest risk of negative outcomes such as suicidal thoughts, mental health difficulties, and job dissatisfaction. The review highlights the difficulties faced by veterinary surgeons that may contribute to poor mental wellbeing and suicidal behaviour. Future research might include further examination of the influence of euthanasia on attitudes towards suicide and more direct examination of the impact that occupational risk factors might have on suicidal behaviour. Suggestions about the review's implications for suicide prevention in this group are also made.

Atendimento pré-hospitalar ao idoso vítima de violência em cinco capitais brasileiras

Este artigo analisa as características e a operacionalização no cotidiano da atenção pré-hospitalar aos idosos vítimas de violências e acidentes de cinco capitais (Manaus, Recife, Brasília, Rio de Janeiro e Curitiba), abordando ainda suas capacidades, seus obstáculos e potencialidades. Pautou-se na triangulação de métodos quantitativos e qualitativos. Analisaram-se dados de oitenta serviços da atenção pré-hospitalar móvel e fixa: 32 em Manaus; 18 em Recife; dez em Brasília; 12 no Rio de Janeiro e oito em Curitiba. Entre os achados estão as diferenças (de tamanho e diversidade de categorias profissionais) e dificuldades das equipes para identificar, atender e notificar os casos por falta de capacitação; pouca atuação preventiva; quase nenhum envolvimento com a família e orientação a ela; praticamente nenhum atendimento ao autor da agressão; incipiente articulação e parcerias da rede, sobretudo dos serviços pré-hospitalares com os hospitalares.