Vocational Functioning Research Articles

Vocational functioning in young people accessing services for first-episode psychosis and ultra-high risk of psychosis: A longitudinal naturalistic cohort study.

Young people with first-episode psychosis (FEP) or at ultra-high risk (UHR) of psychosis often have lower vocational engagement than their peers. This study examines the effect of treatment in early intervention for psychosis services in Australia on engagement in education and employment. This is a naturalistic sample of young people aged 12-25 with FEP (n = 1574) and UHR (n = 1515), accessing treatment in the headspace Early Psychosis (hEP) programme. Engagement in education and employment was assessed at baseline and every 90 days in treatment. Mixed effects logistic regression were used to analyse changes over time. On entering the hEP programme, approximately 49% of the young people with FEP and 28% of the young people at UHR status identified as Not in Education, Employment or Training (NEET). The odds of being NEET were reduced by 27% (95% confidence interval = [14, 39]) for every 6 months treatment for the FEP group, but no change in NEET status was observed in the UHR group. In both groups, absence from daily activities was significantly reduced during time in treatment. While there are methodological challenges analysing real-world non-control group cohort data, the findings indicate positive effects of the hEP programme on vocational and daily activity engagement for young people with FEP and at UHR status. A large proportion of the young people still identified as NEET after receiving treatment services, suggesting further refinement to ensure targeted and consistent vocational support throughout care.

Assessing the Effectiveness of Voice Therapy Techniques in Treating Dysphonia: An Otolaryngological Review.

Dysphonia is a prevalent condition that can impact individuals across all age groups. It occurs when normal voice quality is altered, caused by structural and/or functional issues. Evaluation and assessment from clinicians are warranted if dysphonia persists for more than four weeks and/or is coupled with risk factors or other concerning clinical manifestations. Additionally, voice disorders can increase the risk of depression and anxiety disorders, as well as raise stress levels and lower self-reported health indicators. Dysphonia can have a substantial influence on interpersonal interactions and lower overall quality of life since effective communication relies significantly on spoken language. Hence, managing dysphonia is essential for enhancing communication abilities, improving quality of life, maintaining vocational functioning, promoting psychological well-being, and addressing underlying health concerns. Speech and language therapy, medical management, surgery, or a combination of the aforementioned are all possible treatments for dysphonia. Speech and language therapy is often the first-line treatment option for dysphonia patients who do not meet the criteria for surgical intervention. Voice therapy is often beneficial and remains the first line of treatment, even when patients approach with benign vocal fold nodules. A well-designed voice therapy program improves both the quality of life and vocal performance. The majority of the studies in the existing literature advocate for and report beneficial outcomes associated with voice therapy; however, more research is needed to provide evidence-based findings to guide clinical practice and achieve optimal outcomes. This comprehensive review elaborately highlights the utilization and efficacy of various voice therapeutic modalities utilized for the management of dysphonia in light of current literature.

Single arketamine in treatment resistant depression: Presentation of 3 cases with regard to sick-leave duration

BackgroundKetamine is the prototypal rapid-acting antidepressant (RAAD) for TRD with approved indication for esketamine-nasal spray (ESK-NS). Distinctly, arketamine (R-KET) demonstrates enhanced antidepressant effects and neuroplasticity changes compared to esketamine, with fewer dissociative side effects and abuse potential. This study focuses on R-ketamine's therapeutic implications, safety, and tolerability in TRD treatment. MethodsWe report on a year-long follow-up of three TRD patients post-single IV R-KET administration. The study, conducted under the clinical trial PCN-101 (NCT05414422), observed these subjects for healthcare resource utilization and social support system impact. Participants, adults diagnosed with recurrent major depressive disorder without psychotic features, were observed in a year-long follow-up period for safety. ResultsCase analyses revealed significant symptom reduction and improved social and vocational functioning, with reduced sick leaves and hospitalizations post-treatment. However, one case developed a substance use disorder, underscoring the need for vigilant monitoring. The study highlights R-KET's transformative potential in managing depression, indicating a shift in TRD treatment strategies towards early, aggressive interventions. ConclusionsDespite promising findings, the study faces limitations due to its small sample size, lack of randomization, and potential observational design biases. The results, while aligning with existing ketamine research, require cautious interpretation and warrant further investigation with larger, more robust studies. This exploration of R-KET's role in home-based TRD treatment opens avenues for future research, particularly focusing on its long-term effectiveness and safety in diverse patient populations. This study is registered in clinicaltrials.gov: NCT06232291.

Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Maladaptive Daydreaming Scale (BMDS-16)

Introduction and objective: Daydreaming is a common mental experience in which one gets immersed in stories, narratives, images, and fantasies, imagining them as they were real, although knowing they are unreal. Maladaptive daydreaming is characterised by an excessive and compulsive involvement on fantasy which in severe cases replaces human interaction and impairs academic, interpersonal, or vocational functioning. It can be measured using the 16-item Maladaptive Daydreaming Scale (MDS-16) which has been translated into 39 languages but validated only in eight. This study investigates the psychometric properties of the Brazilian version of this instrument (BMDS-16). Materials and methods: A total of 2,682 Brazilian adults (78% women; Mage = 26.6 years, standard deviation, SD = 7.0) participated in the study. Exploratory and confirmatory factor analyses provided support for a three-factor structure of BMDS-16 with satisfactory reliability indices. Results: Maladaptive daydreaming had positive but weak correlations with attention deficit hyperactivity disorder symptoms and dissociative experiences. As a result of the latent profile analysis, a cut-off score of 63 for maladaptive daydreaming was suggested. Based on this cut-off score, 18.6% of our sample could be considered maladaptive daydreamers. The general reliability of the scale was good (McDonald’s ω = 0.93; Cronbach’s α = 0.90). Conclusions: Overall, BMDS-16 demonstrated sound psychometric properties and applicability for general use to assess maladaptive daydreaming. The daydreaming tendency should be carefully examined in people with scores above 63, who may use fantasy in a maladaptive way, causing impairment in daily functioning and potentially conflicting with treatment.

‘It’s like an opportunity for me to have freedom and to move forward with my life’: Experiences of youth engaging in education and employment after a first episode of psychosis

ABSTRACT Background Many youth experiencing first-episode psychosis face more academic and vocational challenges than their peers. Yet few studies have explored the perspectives of youth who are not in education, employment or training (NEET) following psychosis and contrasted these with those of their counterparts engaged in education and/or employment. To address this gap, this study explored personal journeys of (re-)engaging in education and employment after psychosis. Methods Using a descriptive qualitative design, grounded in self-determination theory, in-depth interviews were conducted with individuals receiving services at an early intervention program for psychosis. Eight youth who were NEET and six who were working/in education participated. Results The analysis produced three themes that were salient to both youth with psychosis who were NEET and those in work/school: relatedness or the importance of belonging and being cared for; perceived competence; and a desire for a sense of autonomy. The themes, aligned with the self-determination theory, showed youths negotiating their decision to (re-)engage in education and employment. Discussion Engaging in education and employment seems part of a larger process that draws on significant past experiences and the envisioned future self. Efforts targeting vocational functioning are best situated in understandings of identity, recovery, and psychological needs.

CE Workshop 07: Cognitive Effects of Cancer and Treatment: “Chemobrain” and Beyond

Abstract & Learning Objectives:Improvements in treatment for non-CNS cancer have greatly improved survivorship, allowing increased attention to cancer- and treatment-related sequelae. Cognitive symptoms (cancer-related cognitive impairment, or CRCI) are reported by a large percentage of cancer survivors, and can have a clinically meaningful impact on educational, vocational, and social functioning, and thus overall quality of life. Better understanding of these concerns is therefore of critical importance, and is needed to guide treatment and potential prevention strategies. Neuropsychological studies over the past 40 years have demonstrated cognitive domains commonly affected in cancer patients treated with chemotherapy, but have also shown cognitive differences in patients not treated with systemic therapy and those receiving other types of treatment (e.g., hormonal therapies) relative to non-cancer control groups. More recently, structural and functional neuroimaging research has added to our understanding of the neural substrate of these cognitive symptoms. This course will describe various neuroimaging modalities used to investigate CRCI, including examination of grey and white matter volume and structural integrity, blood flow, brain activation during cognitive processing and at rest, and structural and functional connectivity. The presentation will also review how neuroimaging findings relate to objective and self-reported cognition and clinical and treatment factors, and discuss potential approaches currently being investigated to treat CRCI. Upon conclusion of this course, learners will be able to:1.Explain commonly affected cognitive domains after non-CNS cancer and treatment2.Discuss structural and functional brain changes related to cancer, chemotherapy, and other treatments3.Describe treatment interventions being investigated to treat cancer- and treatment-related cognitive symptoms.

The association of cancer-related fatigue on the social, vocational and healthcare-related dimensions of cancer survivorship.

Cancer-related fatigue (CRF) is well documented in cancer survivors, but little is known about the personal and societal impact of CRF. This study aimed to examine the impact of CRF in relation to social and vocational functioning and health care utilization in a large sample of post-treatment cancer survivors. We conducted a cross-sectional descriptive study of early stage breast and colorectal cancer survivors (n = 454) who were within 5 years from treatment completion. Social difficulties (SDI-21), work status, absenteeism and presenteeism (WHO-HPQ) and healthcare utilization (HSUQ) were compared in those with (CFR +) and without (CRF -) clinically significant fatigue (FACT-F ≤ 34). A total of 32% met the cut-off criteria for CRF (≤ 34). Participants with CRF + had significantly higher scores on the SDI-21 across all domains and 55% of CRF + vs. 11% in CRF - was above the SDI cut-off (> 10) for significant social difficulties. Participants with CRF + were 2.74 times more likely to be unemployed or on leave (95% CI 1.62, 4.61, p < 0.001). In the subgroup of participants who were currently working (n = 249), those with CRF + reported working on average 27.4 fewer hours in the previous 4 weeks compared to CRF - (p = 0.05), and absolute presenteeism was on average 13% lower in the CRF + group (95% CI 8.0, 18.2, p < 0.001). Finally, individuals with CRF + reported significantly more physician (p < 0.001), other health care professional (p = 0.03) and psychosocial visits (p = 0.002) in the past month. CRF is associated with substantial disruption in social and work role functioning in the early transitional phase of cancer survivorship. Better management of persistent CRF and funding for the implementation of existing guidelines and recommended evidence-based interventions are urgently needed.

Clozapine dosing patterns and clinical outcomes in patients with treatment resistant schizophrenia

Clozapine is the only medication found to be effective for patients with treatment resistant schizophrenia-spectrum disorders (TRS) and its prescription patterns may impact on their outcomes. The study aims to explore the impact of clozapine dosing frequency, dose level and presence of pharmacological augmentation on the clinical, social and cognitive outcomes in patients with TRS. Patients with TRS and on clozapine were interviewed. Daily defined dose (DDD) and anticholinergic burden were calculated. Patients were categorized in three ways: the single daily dose (SDD) and multiple daily dose (MDD), ≤300 mg/day (LD) and >300 mg/day (HD) of clozapine, and clozapine monotherapy (MT) and augmentation therapy (AT). The impact of these clozapine prescription patterns and their interaction on patient outcomes were examined with ANOVA. Of 124 patients on clozapine, 98 patients (79%) had SDD, 59 patients (47.6%) received LD, and 58 patients (46.8%) had MT. Patients in the LD group had significantly better cognitive functions. Though no significant effect of clozapine dosing frequency on outcomes, among patients on LD, those on MDD had better processing speed, short-term and visual memory. Patients with MT had better motivation. Among patients on HD, those with MT had better motivation and vocational functioning. These results provide guidance to the clozapine prescription in a naturalistic setting to achieve optimizing outcomes for patients with TRS in social and cognitive functions. Further longitudinal studies are needed to verify the results.

Multidimensional Family Therapy for Justice-Involved Young Adults with Substance Use Disorders

The present study explored the acceptability, feasibility, fidelity, and outcomes of a young adult adaptation of multidimensional family therapy (MDFT), an evidence-based family treatment originally developed for adolescents. Participants included 22 individuals between the ages of 19 to 25 who were enrolled in a criminal drug court program. MDFT was found to be feasible and was delivered with strong fidelity to young adults and their families. Participants reported high satisfaction with MDFT, and 95% completed treatment. Analyses revealed statistically significant decreases in substance use on all indicators from baseline to the 6-month follow-up. Significant improvements were also noted in vocational functioning, including a 73% increase in full-time employment from baseline to 6-month follow-up. Criminal justice outcomes included a significant decrease in legal risk, and 86% of study participants had no rearrests from baseline through the 18-month follow-up period. The article concludes with recommendations for implementing family-based interventions with young adults, as well as future research directions in this important area.

A long-term follow-up study of labor market marginalization in psychiatric patients with and without personality disorder.

Personality disorders (PDs) in adulthood are considered stable over time and are likely to have lasting psychosocial impact on the affected individual, including in areas like vocational functioning. The aim of this study was to study labor market marginalization (LMM) and receipt of social welfare benefits during 13 years from age 18 to 25 years in a sample of former psychiatric patients with and without PD. This study followed-up 186 former psychiatric patients who were thoroughly assessed in 2002-2004, including for PD, and compared them with controls. Participants were divided into three groups: former patients with PD, without PD, and a matched control group from the general population. Register data on employment, sick leave absence, disability pensioning, education, days of psychiatric care, income, and receipt of social welfare benefits in 2003-2016 were collected. Former patients had more days of unemployment, sick leave absence, and disability pensioning and received more social welfare benefits than controls during the study period. Differences between patients with and without PD were smaller than expected, but significant as regards receipt of social welfare benefits. PD also had an effect on income at age 30 years. Early onset of psychiatric disorders impairs vocational functioning up to 13 years after diagnosis, and most in those with PD.

The relationship between negative symptoms and MATRICS neurocognitive domains: A meta-analysis and systematic review

BackgroundNegative symptoms (NS) are a core symptom domain in schizophrenia spectrum disorders and are associated with poorer social and vocational functioning, and with increased likelihood and durations of hospital admission. NS are not well understood, limiting available interventions. However, numerous studies have reported associations between neurocognitive domains and NS severity. Thus, one promising area in understanding NS is in relation to neurocognition. Currently, the specificity of the relationship between NS and neurocognition is unknown, meaning that there is no consensus regarding which neurocognitive domain is most strongly associated with NS. There is a need to systematically examine the relationship between NS and various neurocognitive domains within study samples. MethodsA systematic search of Ovid PsycINFO, Ovid MEDLINE and Web of Science was performed for articles published since 2004 (year of MATRICS Consensus publication). Inclusion criteria were: 1) individuals with schizophrenia spectrum disorders, first episode psychosis or clinical high risk 2) assessed all six MATRICS neurocognitive domains (processing speed, attention, working memory, verbal learning & memory, visual learning & memory, reasoning & problem solving), 3) reported correlations between all six MATRICS neurocognitive domains and global NS. A three-level random effects hierarchical meta-analysis was performed to assess the relationship between NS (global, expressive, and experiential dimensions) and the six MATRICS neurocognitive domains. Results21 studies were included in the review (n = 3619). All MATRICS neurocognitive domains had small significant correlations with global NS (r = −0.16 to −0.20, p < 0.0001). This relationship was significantly moderated by diagnosis and the moderating effect of sex/ gender trended on significance. Analysis of a subset of the studies revealed that MATRICS neurocognitive domains also had small significant correlations with the two NS dimensions, expressive and experiential. Correlations were stronger with the expressive NS dimension. ConclusionsThis review is novel in assessing the relationship between multiple neurocognitive domains and NS within the same sample, by synthesizing close to two decades of research. Our results suggest that there is a non-specific relationship between neurocognition and NS, and that expressive NS may have a stronger relationship with neurocognitive functioning-based on the MATRICS classification of neurocognition and the neurocognitive assessments used in the included studies. This has implications on our understanding of NS and neurocognition, as well as their treatments. As we gain better understanding of the directionality of the NS-cognition relationship, it could suggest that NS, particularly in the expressive domain, could be improved by targeting cognition globally or that neurocognitive treatments could be more effective if NS are addressed first. Further implications of these results are discussed.

Feasibility of a Career Development Intervention for Veterans in Vocational Rehabilitation: Protocol for a Pilot Randomized Controlled Trial

Background Veterans with psychiatric disorders want additional career development services to support their recovery and pursuit of meaningful employment. However, no career counseling programs have been designed for this specific population. We developed the Purposeful Pathways intervention to fill this need. Objective This study protocol aims to (1) evaluate the feasibility and acceptability of the Purposeful Pathways intervention for veterans living with psychiatric disorders and (2) explore preliminary clinical outcome data. Methods A total of 50 veterans who are participating in transitional work vocational rehabilitation services at a Veterans Affairs hospital will be randomized to either treatment as usual or the augmented treatment condition (treatment as usual plus Purposeful Pathways). Feasibility will be assessed via recruitment rates, clinician fidelity to treatment, retention rates, and acceptability of randomization procedures. Acceptability will be assessed via client satisfaction at treatment termination using quantitative and qualitative data collection. Preliminary clinical and vocational outcomes will be assessed at baseline, 6 weeks, 12 weeks (treatment termination), and a 3-month follow-up via quantitative measures assessing vocational functioning, vocational process, and mental and physical functioning. Results This pilot randomized controlled trial is beginning recruitment in June 2023 and is expected to continue through November 2025. Data collection is expected to be completed by February 2026, with full data analysis completed by March 2026. Conclusions Findings from this study will provide information on the feasibility and acceptability of the Purposeful Pathways intervention, as well as secondary outcomes related to vocational functioning, vocational process, and mental and physical functioning. Trial Registration ClinicalTrials.gov NCT04698967; https://clinicaltrials.gov/ct2/show/NCT04698967 International Registered Report Identifier (IRRID) PRR1-10.2196/47986

The diagnosis that should speak its name: why it is ethically right to diagnose and treat personality disorder during adolescence.

Although national guidelines explicitly state that personality disorder can be diagnosed and treated in young people aged 12 to 18 years (adolescents), most clinicians remain hesitant. This creates a gap between science and practice, which we argue is largely motivated by moral reasons and, therefore, is best challenged by ethical arguments. We provide seven arguments in support of the notion that it is ethically right to diagnose and treat personality disorder when it occurs in adolescents. Central to these arguments is the scientific evidence that features of personality disorder are among the best predictors of a complex cluster of psychopathology leading to impairments in many areas of current and future mental, social and vocational functioning. We argue that intervention during adolescence and young adulthood is not only humane, but also critical for efforts to avert the longstanding psychosocial and health problems that seem refractory to treatment in adults with personality disorder. Moreover, we argue that regular services are often inadequately equipped to meet the needs of young people with personality disorder and that the common 'stepped-care' approach should be replaced by a 'staged-care' approach. Finally, we argue that early detection and intervention might have anti-stigmatizing effects, similar to other areas of healthcare in which stigmatizing labels have changed meaning when the conditions to which they refer have become more amenable to treatment.

Association between childhood maltreatment and social functioning in individuals with affective disorders: A systematic review and meta-analysis.

Childhood maltreatment has been linked to impairments in social functioning and social cognition in adults with affective disorders. However, conclusions have been limited by inconsistent findings across different maltreatment subtypes and social domains. We conducted a systematic review and meta-analysis to quantify associations between childhood maltreatment (overall and subtypes - physical, emotional and/or sexual abuse, and/or physical and/or emotional neglect) and different domains of social functioning and social cognition in adults with affective disorders (bipolar disorder or major depressive disorder). We also examined effect moderators and mediators of these associations. A systematic search was performed on 12.12.2022 which identified 29 studies included in qualitative synthesis (n = 3022 individuals with affective disorders), of which 27 (n = 2957) were pooled in meta-analyses. Across studies, five social functioning and five social cognition domains were examined, of which four domains of social functioning and two domains of social cognition had sufficient data for meta-analysis (PROSPERO CRD42022288976). Social functioning: childhood maltreatment was associated with lower global social functioning (r = -0.11 to -0.20), poorer interpersonal relations (r = -0.18 to -0.33), and with aggressive behaviour (r = 0.20-0.29) but was unrelated to vocational functioning. Emotional abuse and emotional neglect showed the largest magnitudes of effect. Social cognition: there was no meta-analytic evidence of associations between maltreatment and social cognition domains. Exploratory moderation analyses did not identify any consistent moderators. Narrative synthesis identified attachment style as possible moderator, and sensory patterns, anxiety, and depressive symptoms as possible mediators between childhood maltreatment and social outcomes. Overall, the available evidence was limited, particularly in relation to social cognition. Adults with affective disorders are at risk of social functioning difficulties after childhood maltreatment exposure, an effect observed across multiple maltreatment subtypes, social functioning domains, and diagnoses. Addressing social functioning problems may benefit maltreated adults with both bipolar disorder and major depressive disorder.

More than words: Speech production in first-episode psychosis predicts later social and vocational functioning.

Several disturbances in speech are present in psychosis; however, the relationship between these disturbances during the first-episode of psychosis (FEP) and later vocational functioning is unclear. Demonstrating this relationship is critical if we expect speech and communication deficits to emerge as targets for early intervention. We analyzed three 1-min speech samples using automated speech analysis and Bayes networks in an antipsychotic-naive sample of 39 FEP patients and followed them longitudinally to determine their vocational status (engaged or not engaged in employment education or training-EET vs. NEET) after 6-12 months of treatment. Five baseline linguistic variables with prior evidence of clinical relevance (total and acausal connectives use, pronoun use, analytic thinking, and total words uttered in a limited period) were included in a Bayes network along with follow-up NEET status and Social and Occupational Functioning Assessment Scale (SOFAS) scores to determine dependencies among these variables. We also included clinical (Positive and Negative Syndrome Scale 8-item version (PANSS-8)), social (parental socioeconomic status), and cognitive features (processing speed) at the time of presentation as covariates. The Bayes network revealed that only total words spoken at the baseline assessment were directly associated with later NEET status and had an indirect association with SOFAS, with a second set of dependencies emerging among the remaining linguistic variables. The primary (speech-only) model outperformed models including parental socioeconomic status, processing speed or both as latent variables. Impoverished speech, even at subclinical levels, may hold prognostic value for functional outcomes and warrant consideration when providing measurement based care for first-episode psychosis.

Validity and reliability of the Polish Maladaptive Daydreaming Scale (PMDS-16) and its short form (PMDS-5).

Maladaptive daydreaming (MD) defines excessive use of fantasy, which replaces human interaction and/or interferes with academic, interpersonal, or vocational functioning. This study tests psychometric properties of the Polish version of the Maladaptive Daydreaming Scale (PMDS-16) and a short 5-item version derived from it (PMDS-5), and their capacity to screen for MD. The relationship between MD, resilience and the quality of life was also explored. Validity and reliability were examined in a sample of 491 participants in nonclinical (n = 315) and mixed-clinical (n = 176) groups who completed the tests online. The exploratory factor analysis with principal component analysis method of parameter estimation without rotation confirmed a one-factor solution of both instruments. Reliability of both versions was corroborated by Cronbach's alpha coefficient (PMDS-16: >.941; PMDS-5: >.931). The cutoff score maximizing sensitivity and specificity for MD was 42 in both instruments, but the short version had better discriminating properties. People who identified themselves as maladaptive daydreamers in comparison to those who did not had significantly higher scores in both instruments. Maladaptive daydreamers also had lower quality of life in the psychological and social relationships domains and poorer resilience. Both PMDS-16 and PMDS-5 proved to have satisfactory psychometric properties. They have similar psychometric properties, although PMDS-5 has better discriminating power and can be used effectively for the screening of MD.

VOCATIVE FUNCTIONS OF DIMINUTIVES IN ENGLISH PROSE LITERATURE FOR CHILDREN

The current article deals with English diminutives from the perspective of Speech Act Theory formulated by J. Searle and supplemented by other scholars (e.g. D. Wunderlich). In the focus of the research are the diminutive-related vocative speech acts which are used in addressing the participants of speech situations and contribute to establishing the addressee. In the arrangement of relations and interactions between participants of communication, there have been found only two components: the addresser and the addressee. The empirical material for the study is based on popular works by modern writers of English prose literature for children such as A. Ahlberg, R. Dahl, E. Nesbit, J. Wilson. The choice of the target texts results from their antropocentricity and childcenteredness. Vocative speech acts perform two communicative functions: a) calls are aimed at catching the addressee’s attention; b) addresses are aimed at maintaining or emphasizing the contact between speaker and addressee. Among the diminutives used in vocative functions there have been found first names, family names, terms of kinship and descriptors. First-names diminutive forms are most recurrent in the vocative speech acts. It results from the fact that the addressee in juvenile prose literature is a child. Most of the first names in the diminutive form are used to express a positive attitude to the addressee. There has been found only one example of a family-name diminutive in the vocative function, whose purpose is to express a negative attitude to the addressee. Besides, diminutives in the vocative function complement other speech acts such as directives, commissives and representatives. Diminutive vocatives either intensify or weaken the illocution of the speech act they complement, and express positive or negative attitude to the addressee.

Young Adult Pain Rehabilitation: Interdisciplinary Development and Preliminary Outcomes of a Novel Treatment Program.

Young adults with chronic pain and symptoms experience disruptions to their social, emotional, physical, and vocational functioning. Interdisciplinary pain rehabilitation programs for pediatric and adult populations are not designed specifically to address the developmental needs of young adults. This article describes the development of a novel intensive interdisciplinary outpatient rehabilitation program tailored to the unique needs of young adults with chronic pain and symptoms. Tailored content included vocational assessment and consultation, financial literacy education, and sexual health education. Outcome data demonstrate treatment gains, with reductions in pain interference, pain severity, pain catastrophizing, and depressive symptoms, as well as improvements in mental and physical quality of life, perceived performance, perceived satisfaction with performance, and objective measures of physical functioning. The article concludes with clinical recommendations for the management of chronic pain and symptoms in young adults, applicable across multiple treatment settings.

Awareness on Attention Deficit Hyperactivity Disorder among Primary School Teachers of Public Schools in Kathmandu

Introduction: Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood mental health disorders. It causes impairment in the child’s key life activities, for instance, social relations, academic, family and vocational functioning, furthermore, adherence to social regulations, norms and laws. Teachers can play a valuable informant in regard to diagnosis on ADHD as they are in regular contact with children. The objective of this study was to identify level of awareness and associated factors of awareness on ADHD among primary school teachers of public schools in Kathmandu.&#x0D; Methods: Descriptive cross sectional research design was used. Out of 274 primary level schools in Kathmandu, 14 schools were selected by lottery method. Cluster random sampling technique was used. All the available primary teachers from selected schools were included in the study. Knowledge of Attention Deficit Disorder Scale (KADDS) was used to collect data. The total sample size was 130. SPSS version 20 was used for data analysis. Bivariate and multivariate logistic regression analysis was used to find out the association between awareness on ADHD and selected study variables.&#x0D; Results: Among 130 school teachers, more than half (50.8%) had low level of awareness. In multivariate logistic regression analysis, the educational level was significantly associated with awareness on ADHD. However, in bivariate analysis the teachers’ age and duration of teaching were also significantly associated with the awareness on ADHD.&#x0D; Conclusion: More than half of primary level school teachers of public schools had low level of awareness on ADHD. Education level of the teachers was associated with level of awareness. Hence, the teachers need to be encouraged to pursue higher level education.

Cancer Rehabilitation Fact Sheet in Korea.

Cancer rehabilitation aims to enable patients to maximize their physical, social, psychological, and vocational functions within the limits that arise during the course of the disease and its treatment. According to recent domestic studies, most patients report one or more physical problems during or after cancer treatment. This review presents the latest updates on cancer-related rehabilitation issues. Cancer rehabilitation in Korea still faces various barriers, including a lack of awareness, problems with the healthcare delivery system, and high costs, and recognizing the need for rehabilitation during cancer treatment varies among patients and even physicians. Hence, an appropriate cooperative referral system for cancer rehabilitation requires improvement. We herein review the current status of and barriers to cancer rehabilitation in South Korea to resolve the issues of domestic cancer rehabilitation.