Vocational Status Research Articles

Cognitive disorders in multiple sclerosis: A serious issue in patients of Multiple Sclerosis

Event Abstract Back to Event Cognitive disorders in multiple sclerosis: A serious issue in patients of Multiple Sclerosis Aamir Shahzad1* and Gottfried Kohler1 1 University of Vienna, Austria Background:Cognitive disorders are reported in about Forty to sixty percent of patients with multiple sclerosis (MS). Methods:We executed an extensive search for articles on the cognitive disorders in multiple sclerosis and reviewed their findings. Results:We found that there is shortage of articles about cognitive disorders in multiple sclerosis. There is no extensive study carried out to explore natural history of these cognitive disorders in multiple sclerosis (MS). Cognitive dysfunction can be detected in every stage of multiple sclerosis (MS). The most frequent Cognitive dysfunctions are related to information processing speed, memory and attention. Dementia is also not uncommon in multiple sclerosis (MS). Main factor which may be responsible for these cognitive dysfunction in MS include diffuse cerebral injury, as shown by magnetic resonance imaging technique. Diffuse cerebral injury, probably, interrupts connecting fibers between neuronal networks involved in these cognitive functions. Risk factors which exacerbate the cognition dysfunctions include: Fatigue, sleep problems, stress, heat and External distractions etc. Also some drugs like e.g. Gabapentin and Amitryptilene which are taken for pain or spasms treatment, impair cognitive functions. These Cognitive disorders are in part responsible for a reduced quality of life and a decreased vocational status. Recommendations: There is great need for active research in exploring cognitive disorders in multiple sclerosis patients and also to explore for alternative remedies to cure the Cognitive disorders in multiple sclerosis patients. Conference: 41st European Brain and Behaviour Society Meeting, Rhodes Island, Greece, 13 Sep - 18 Sep, 2009. Presentation Type: Poster Presentation Topic: Poster presentations Citation: Shahzad A and Kohler G (2009). Cognitive disorders in multiple sclerosis: A serious issue in patients of Multiple Sclerosis. Conference Abstract: 41st European Brain and Behaviour Society Meeting. doi: 10.3389/conf.neuro.08.2009.09.298 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 15 Jun 2009; Published Online: 15 Jun 2009. * Correspondence: Aamir Shahzad, University of Vienna, Vienna, Austria, aamir.shahzad@univie.ac.at Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Aamir Shahzad Gottfried Kohler Google Aamir Shahzad Gottfried Kohler Google Scholar Aamir Shahzad Gottfried Kohler PubMed Aamir Shahzad Gottfried Kohler Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

The outcome of a functional restoration programme for chronic low back pain

Multidisciplinary rehabilitation programmes have been successfully advocated for chronic low back pain. The aim of the study was to establish the functional and vocational outcome of a 3-week functional restoration programme. IV, Uncontrolled clinical series. One hundred and eighteen chronic low back pain patients underwent a 100-h programme consisting of back exercises, hydrotherapy, gymnasium work education and cognitive behavioural therapy. Oswestry Disability Index (ODI), Roland Morris (RM), 'patient global assessment tool' and work status scores were completed pre-programme and at least 1 year post programme. The ODI score improved by 15.6% (95% CI 11.8-19.4) and RM score by 4.6 points (95% CI 3.6-5.6). The proportion of patients who were seriously affected in the workplace had dropped from 59 to 22%. More than 85% of patients were satisfied with the outcome. Functional restoration programme improves the functional activity and vocational status of patients with chronic low back pain.

Making the Male Home-Maker: The Home Economics Imbalance in the Southern States of Nigeria

Equal educational opportunities for both male and female citizens remain one of the cardinals of Nigeria National Policy on Education with the aim of achieving high vocational and technical status. However, the scenario presents a gross imbalance in male enrolment in Home economics a major vocation course in the education system. This paper projects the aim of the course, the cause of enrolment imbalance, the consequences of the imbalance and recommends among others the reservation of a percentage of admission quota for male students, the organization of remedial courses for male students and employment of Guidance Counsellors in the school system.

The Vocational Continuum: How to Make Sense of Vocational Outcomes After Group Cognitive Behavioural Therapy for Chronic Pain Sufferers

Vocational outcomes following group CBT programmes for patients with chronic pain are scarcely reported within the literature, despite their importance as measures of function. This study reports vocational, physical and psychological outcomes following a group CBT programme for patients suffering chronic pain. The study aimed to examine the vocational situation of chronic pain patients who completed a group CBT programme, using a scale known as the vocational continuum. The scale was developed to measure changes in RTW intention and work status, in an effort to reconceptualise vocational outcomes for this population with respect to the RTW process. A group of patients referred to a hospital pain clinic that went on to complete a group CBT programme were retrospectively surveyed about their vocational status at various time points. Physical outcomes measured included the 12-min walk test, 2-min sit to stand test, 2-min stair climb test and timed 20-m walk test. Psychological outcomes measured included pain intensity, self-efficacy, psychological distress (depression, anxiety and stress), catastrophising and disability. Responses to vocational items including work status, hours of work, intention to RTW and barriers to RTW were incorporated into the vocational continuum. Two hundred and nine (58%) of the 360 patients who completed the group CBT programme between 1998 and 2005 completed the vocational survey. Ninety percent of participants reported that their chronic pain was a barrier to RTW or increasing hours of work pre-CBT. According to the vocational continuum, fifty per cent of the study population advanced toward working full-time (chi(2)(2, N = 163) = 28.87, P < 0.01) and this result was associated with a significant reduction in pain as a reported barrier to RTW or increasing participation in work post-CBT. Significant improvements were seen across all physical and psychological measures for study participants at 1, 6 and 12 month intervals post-CBT. The study demonstrates improvements across physical and psychological measures post-CBT, indicating that participants benefited from reduced levels of pain-related distress and disability. Although retrospective, the study also suggests improvements were made across vocational outcomes. By doing so, the study adds to scant literature reporting on vocational outcomes of group CBT programmes for patients with chronic pain and offers a new scale for measuring and interpreting vocational outcomes for this population.

Quantification of the Probability of Reaching Mobility Independence at Discharge from a Rehabilitation Hospital in Nonwalking Early Ischemic Stroke Patients: A Multivariate Study

Background: This study was designed to quantify the probability of recovery of mobility in admission nonwalking stroke survivors. Methods: We evaluated 437 of 500 consecutive patients admitted for sequelae of first ischemic stroke within the first month. We performed several logistic regressions using mobility status at discharge (independence in stair climbing; walking outside and inside, without aid or supervision; walking with cane or other aid, or need for wheelchair) as dependent variable, and several independent variables, including stratification of patients according to their Barthel Index (BI) score into 6 classes (≤10; 11–20; 21–30; 31–40; 41–50; 51–60). Results: At discharge, 4.58% of patients were independent in stair climbing, 8.70% were able to walk outside, 14.41% to walk inside, and 27.46% to walk with cane or other aid, while 44.85% remained in wheelchair. Very low BI scores at admission were associated with a high risk of need for wheelchair, whereas patients with BI score 51–60 showed a high probability to reach independence in stair climbing (OR = 5.60). Age, severity of neurological impairment, global aphasia, unilateral spatial neglect, male gender and vocational status also played a prognostic role. Conclusions: The probability of potential mobility recovery can be quantified at admission with better accuracy for independence in stair climbing and walking outside without any aid (percentages correctly predicted 95.4 and 91.8%, respectively). Stratification of BI score may be useful to better quantify the risk for each patient.

8-Year Follow-Up of Patients Treated for Borderline Personality Disorder: Mentalization-Based Treatment Versus Treatment as Usual

This study evaluated the effect of mentalization-based treatment by partial hospitalization compared to treatment as usual for borderline personality disorder 8 years after entry into a randomized, controlled trial and 5 years after all mentalization-based treatment was complete. Interviewing was by research psychologists blind to original group allocation and structured review of medical notes of 41 patients from the original trial. Multivariate analysis of variance, chi-square, univariate analysis of variance, and nonparametric Mann-Whitney statistics were used to contrast the two groups depending on the distribution of the data. Five years after discharge from mentalization-based treatment, the mentalization-based treatment by partial hospitalization group continued to show clinical and statistical superiority to treatment as usual on suicidality (23% versus 74%), diagnostic status (13% versus 87%), service use (2 years versus 3.5 years of psychiatric outpatient treatment), use of medication (0.02 versus 1.90 years taking three or more medications), global function above 60 (45% versus 10%), and vocational status (employed or in education 3.2 years versus 1.2 years). Patients with 18 months of mentalization-based treatment by partial hospitalization followed by 18 months of maintenance mentalizing group therapy remain better than those receiving treatment as usual, but their general social function remains impaired.

Association between psychiatric state and outcome following traumatic brain injury

This study aimed to explore the relationship between current post-traumatic brain injury psychiatric disorders and psychosocial outcome. A total of 100 participants and 87 significant others were interviewed using the Structured Clinical Interview for DSM-IV Diagnosis. Participants with mild to very severe traumatic brain injury up to 5.5 years post-injury. The Sydney Psychosocial Reintegration Scale assessed changes in vocational status, relationship status and independent living status. The vocational domain of the Sydney Psychosocial Reintegration Scale revealed the greatest degree of change. Current depression and/or anxiety contributed significantly more variance to the regression models than did any other variables. Pre-injury psychiatric disorders and substance use disorders were not predictive of any outcome variables. Longer post-traumatic amnesia duration, fewer years of education, male gender and greater time post-injury were predictive of certain outcome domains. There were no significant differences between traumatic brain injury participants' self-report and the reports of their significant others regarding psychiatric symptoms or outcome measures. The presence of current depression and anxiety are strongly related to poor outcome in terms of vocational status, relationship status and independence. The causative direction of these relationships is unclear. Using a 3-domain outcome measure has shed some light on the factors that contribute to different aspects of outcome following traumatic brain injury.

A Multisite Study of Implementing Supported Employment in the Netherlands

A Multisite Study of Implementing Supported Employment in the Netherlands

Effect of PACT on Inpatient Psychiatric Treatment for Adolescents With Severe Mental Illness: A Preliminary Analysis

Effect of PACT on Inpatient Psychiatric Treatment for Adolescents With Severe Mental Illness: A Preliminary Analysis

Effect of PACT on Inpatient Psychiatric Treatment for Adolescents With Severe Mental Illness: A Preliminary Analysis

This study examined whether inpatient psychiatric treatment and forensic treatment and incarceration were reduced among adolescents and young adults with severe and persistent mental illness after they received services in the Program of Assertive Community Treatment (PACT). The pre-post evaluation compared length of inpatient treatment and forensic treatment or incarceration for the year before and after PACT enrollment. Participants (N=15) were their own controls. Annual psychiatric hospitalization fell from 66.2 days before enrollment to 8.7 days in the first year of PACT (p=.025, Cohen's d=.54). Similarly, combined days of inpatient psychiatric treatment and forensic treatment or incarceration fell from 104.1 in the year before enrollment to 24.1 days in the year after (p=.015, Cohen's d=.61). PACT services significantly reduced time in inpatient psychiatric treatment. These preliminary results may have implications for long-term treatment, service delivery, and cost of care for adolescents and young adults with severe and persistent mental illness.

Predictors and course of vocational status, income, and quality of life in people with severe mental illness: A naturalistic study

Due to high unemployment rates, people with mental illness are at risk of poverty and are deprived of the social and psychological functions of work, such as the provision of social support, structuring of time, and self-esteem, with a negative effect on their perceived quality of life (QoL). Two distinct processes are held responsible for the low work force participation of people with mental illness: ‘Social underachievement’ and ‘social decline’. Social underachievement signifies that, due to early illness onset, the educational attainment of people with mental illness is low and entry to the labor market fails. Social decline, on the other hand, describes the loss of competitive employment after illness onset, followed by prolonged periods of unemployment and difficulties to re-enter the labor market. This study examines how social underachievement and decline are reflected in the course of vocational status, income, and QoL of people with severe mental illness in the years after a psychiatric admission in a naturalistic longitudinal design. A total of 176 participants diagnosed with schizophrenia or affective disorders were interviewed during an index hospitalization in two large psychiatric hospitals in Zurich. Follow-up interviews were conducted 12 and 30 months after. Random coefficient models (multilevel models) were used to examine simultaneously the predictors and course of the variables of interest. A low number of psychiatric hospitalizations, a higher educational degree, a diagnosis of schizophrenia, and years of work experience predicted a higher vocational status. Vocational status decreased in first-admission participants with prolonged hospitalizations during the follow-up period. Income did not change over time and was positively influenced by a higher age of illness onset, competitive employment, higher education, and not having had a longer hospitalization recently. Subjective QoL significantly improved and was rated higher by people with any kind of employment than by participants without a job. Participants with an affective disorder, those with few hospitalizations but a recent inpatient stay of longer duration, showed lower QoL. Including employment issues early in treatment is especially important for people with an early illness onset and those with more severe forms of psychiatric disorder. A life course perspective enhances the understanding of patients’ vocational potential and needs for support.

Is Vocational Rehabilitation a Transition to Recovery?

This study explored the recovery experiences from being on a vocational rehabilitation scheme for service users with severe and enduring mental health problems. This was the first phase of a vocational rehabilitation service review and development. Two associate researchers/service users were integral to the study and increased its validity. A qualitative research method was taken, using a semi-structured interview. Two main themes emerged: moving on and being on the scheme. The findings were that transitional vocational rehabilitation schemes could have a positive effect on the vocational status, quality of life and mental health of service users with severe and enduring mental health problems given the right environment. It was recommended that the vocational rehabilitation scheme should continue, whilst the support for service users and interagency working alongside the scheme warranted further investigation. Following the study, the scheme expanded to become an employment service that extends from the public to the independent sector and offers a wider range of vocational rehabilitation schemes within it.

Relations Among Sociodemographic, Neurologic, Clinical, and Neuropsychologic Variables, and Vocational Status Following Mild Traumatic Brain Injury

To explore the long-term relations among sociodemographic, neurologic, clinical, and neuropsychologic variables, and vocational status in persons with mild traumatic brain injury (MTBI), and to identify the symptoms that determine whether or not these individuals return to work. Longitudinal quasi-experimental between-groups design. Eighty-five MTBI subjects aged between 16 and 65 years. The emergency ward of the Trois-Rivieres Regional Hospital Centre in Quebec, Canada. Age, gender, Glasgow Coma Scale score, duration of posttraumatic amnesia, duration of retrograde amnesia, total of symptoms at emergency, time elapsed since the trauma, Paced Auditory Serial Addition Task, Stroop Color Word Test, California Verbal Learning Test, and the number of symptoms at follow-up (12 to 36 months posttrauma). Only the total number of symptoms reported at follow-up was related to vocational status. The majority of individuals had returned to work 1 year or more post-MTBI. Individuals who had not returned to work reported the greatest number of symptoms, which could be linked to their affective status. Six affective symptoms, 5 cognitive symptoms, 6 physical symptoms, and 8 symptoms relating to social and daily life activities differentiated the participants who had returned to work from those who had not. Patient characteristics, injury severity indicators, and cognitive functions were not associated with vocational status. To better understand post-MTBI vocational status, it is important to focus on subjective complaints that arise following the injury.

Produktivitätskosten der rheumatoiden Arthritis in Deutschland: Kostenzusammensetzung und Prädiktion der Hauptkostenkomponenten

Identification of predictors for the productivity cost components: (1) sick leave, and (2) work disability in gainfully employed and (3) impaired household productivity in unemployed patients with rheumatoid arthritis (RA) from the societal perspective. Investigation of productivity costs was linked to a multicenter, randomized, controlled trial evaluating the effectiveness of clinical quality management in 338 patients with RA. The productivity losses were assessed according to the German Guidelines on Health Economic Evaluation. By means of multivariate logistic regression analyses, predictors of sick leave, work disability (employed patients, n=96), and for days confined to bed in unemployed patient (n=242) were determined. Mean annual costs of 970 EUR arose per person taking into consideration all patients (453 EUR sick leave, 63 EUR work disability, 454 EUR impaired productivity of unemployed patients). Disease activity, disease severity, and impaired physical function were global predictors for all of the cost components investigated. Sick leave costs were predicted by prior sick leave periods and the vocational status blue collar worker, work disability costs by sociodemographic variables (marital status, schooling), and the productivity costs of unemployed patients by impaired mental health and impaired physical functions. Interventions such as reduction in disease progression and control of disease activity, early vocational rehabilitation measures and vocational retraining in patients at risk of quitting working life, and self-management programs to learn coping strategies might decrease future RA-related productivity costs.

Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS)

Cognitive impairment occurs in roughly 50% of patients with multiple sclerosis (MS). It is well known that processing speed and episodic memory deficits are the most common neuropsychological (NP) sequelae in this illness. Consensus has emerged about the specific tests that prove most helpful for routine monitoring of MS associated cognitive impairment. The purpose of this study was to examine the validity of the Minimal Assessment of Cognitive Function in MS (MACFIMS), a recommended battery based on the findings of an international conference held in 2001. We tested 291 MS patients and 56 healthy controls. Frequencies of impairment paralleled those reported in previous work for both individual cognitive domains and general impairment. All tests were impaired in the MS group, and distinguished relapsing-remitting (RR) from secondary progressive (SP) course. Principle components analysis showed a distinct episodic memory component. Most of the MACFIMS tests discriminated disabled from employed patients. However, in regression models accounting for all NP tests, those emphasizing verbal memory and executive function were most predictive of vocational status. We conclude that the MACFIMS is a valid approach to routine NP assessment of MS patients. Future work is planned to determine its psychometric properties in a longitudinal study.

Evaluation of a community-based model of rehabilitation following traumatic brain injury

In recent years there has been a growing trend towards community-based post-acute rehabilitation for individuals with traumatic brain injury (TBI), as opposed to the traditional centre-based model, based on the premise that these individuals will learn more effectively in settings where they usually have to perform. In the present study, outcomes at two years post-injury in 77 individuals with TBI, treated within the community were compared on measures of activities of daily living (ADL), vocational status, and emotional adjustment with those of 77 TBI patients individually matched for gender, age, education, occupation, post-traumatic amnesia (PTA) duration, Glasgow Coma Scale (GCS) score and time in inpatient rehabilitation, who had attended the hospital for outpatient therapy. There were no significant differences between groups in terms of employment outcomes or independence in personal or domestic ADL. However those treated in the community were less likely to be independent in shopping and financial management and reported more changes in communication and social behaviour. Due to constraints of time and resources, these patients had received fewer one-on-one therapy sessions and thus treatment costs were somewhat lower. Attendant care costs were also lower in the community treatment group. Strengths and weaknesses of community-based post-acute rehabilitation are discussed.

Insight into psychosis and quality of life

Background Insight into having a psychotic disorder is often considered to be a positive characteristic that improves quality of life. However, the evidence regarding this controversy is mixed. The present study examined the relation between insight and quality of life. Method One hundred thirty-one participants with a psychotic disorder (103 with schizophrenia, 28 with schizoaffective disorder) underwent an assessment of insight, psychotic symptoms, and quality of life. The relation between insight and quality of life was assessed using regression analyses. Results Contrary to our hypothesis, better insight into having a psychotic disorder was related to reduced emotional well-being ( β = .23, P < .01), lower vocational status ( β = .31, P < .01), and less economic satisfaction ( β = .27, P < .01). Insight into the need for taking medication was positively correlated with higher emotional well-being ( β = −.18, P < .05). No relation was found between insight and psychotic symptoms. Discussion In light of our findings, the potential importance of combining insight with mechanisms for coping is discussed.

Medical Director Responsibilities for Outpatient Cardiac Rehabilitation/Secondary Prevention Programs

Medical Director Responsibilities for Outpatient Cardiac Rehabilitation/Secondary Prevention Programs

738 POSTER Lymph node ratio as prognostic factor in digestive tumours

Subcutaneous allergen-specific immunotherapy (SCIT) is a well-documented treatment of IgE-mediated allergic disease. Little is known about potential effects of SCIT on the risk of other chronic immune-related diseases. Over the years, a few casuistic reports have caused concern that SCIT might act as a trigger of autoimmune disease.We aimed to investigate the association of SCIT with the incidence of autoimmune disease and ischemic heart disease (IHD), as well as all-cause mortality.All Danish citizens without other known diseases were linked and followed through central registries on medications and hospital admissions. Persons receiving SCIT and persons receiving conventional allergy treatment (CAT; nasal steroids or oral antihistamines) were compared with regard to mortality and development of autoimmune diseases, acute myocardial infarction (AMI), and IHD. Cox regression (survival analysis) with age as the underlying time scale was used to estimate relative risks (hazard ratios [HRs] with 95% CIs) associated with SCIT compared with CAT adjusted for age, sex, vocational status, and income.During the 10-year study period (1997-2006), a total of 18,841 and 428,484 persons were followed in the SCIT and CAT groups, respectively. Receiving SCIT was associated with lower mortality (HR, 0.71; 95% CI, 0.62-0.81) and lower incidence of AMI (HR, 0.70; 95% CI, 0.52-0.93), IHD (HR, 0.88; 95% CI, 0.73-1.05), and autoimmune disease (HR, 0.86; 95% CI, 0.74-0.99).In this registry-based observational study, receiving SCIT compared with CAT was associated with lower risk of autoimmune disease and AMI, as well as decreased all-cause mortality.

Developing Therapeutics for Schizophrenia and Other Psychotic Disorders

Although the second-generation or atypical antipsychotic drugs have been breakthrough medicines for the treatment of schizophrenia and other psychotic conditions, cognitive dysfunction and to some extent negative symptoms of the disease continue to be the main cause of poor vocational status of the patients. Thus, the majority of investigational drug development efforts today target these unmet medical needs. This review postulates that the field of schizophrenia research has advanced sufficiently to develop biochemical hypotheses of the etiopathology of the disease and target the same for revolutionary disease modifying therapy. This postulate is based on recent studies that have begun to provide a testable etiopathology model that integrates interactions between genetic vulnerability factors, neurodevelopmental anomalies, and neurotransmitter systems. This review begins with a brief overview of the nosology and etiopathology of schizophrenia and related psychotic disorders to establish a context for subsequent detailed discussions on drug discovery and development for psychotic disorders. Particular emphasis is placed on recent advances in genetic association studies of schizophrenia and how this can be integrated with evidence supporting neurodevelopmental abnormalities associated with the disease to generate a testable model of the disease etiopathology. An in-depth review of the plethora of new targets and approaches targeting the unmet medical need in the treatment of schizophrenia exemplify the challenges and opportunities in this area. We end the review by offering an approach based on emerging genetic, clinical, and neurobiological studies to discover and validate novel drug targets that could be classified as disease modifying approaches.