Clustering of multiple health-risk factors among vocational education students: a latent class analysis.

Physical and mental health risks often commence during young adulthood. Vocational education institutions are an ideal setting for understanding how health-risks cluster together in students to develop holistic multiple health-risk interventions. This is the first study to examine clustering of tobacco smoking, fruit intake, vegetable intake, alcohol consumption, physical inactivity, overweight/obesity, depression, and anxiety in vocational education students and the socio-demographic characteristics associated with cluster membership. A cross-sectional survey with vocational education students (n = 1134, mean age = 24.3 years) in New South Wales, Australia. Latent class analysis identified clusters and latent class regression examined characteristics associated with clusters. Four clusters were identified. All clusters had moderate inadequate fruit intake and moderate overweight/obesity. Cluster 1 (13% of sample) had "high anxiety, high inadequate vegetable intake, low tobacco, and low alcohol use." Cluster 2 (16% of sample) had "high tobacco smoking, high alcohol use, high anxiety, high depression, and high inadequate vegetable intake." Cluster 3 (52% of sample) had "high risky alcohol use, high inadequate vegetable intake, low depression, low anxiety, low tobacco smoking, and low physical inactivity." Cluster 4 (19% of sample) was a "lower risk cluster with high inadequate vegetable intake." Compared to cluster 4, 16-25-year-olds and those experiencing financial stress were more likely to belong to clusters 1, 2, and 3. Interventions for vocational education students should address fruit and vegetable intake and overweight/obesity and recognize that tobacco use and risky alcohol use sometimes occurs in the context of mental health issues.

A Horticultural Therapy Program Focused on Succulent Cultivation for the Vocational Rehabilitation Training of Individuals with Intellectual Disabilities.

We aimed to develop a horticultural therapy program for the vocational rehabilitation of individuals with intellectual disabilities and examine its effects. Individuals with intellectual disabilities (n = 28, average age: 33.23 ± 4.9 years) were recruited from a welfare center in Jecheon, South Korea. They participated in eight weekly sessions of a horticultural therapy program consisting of common succulent cultivation techniques at a specialized succulent cultivation farm located in Jecheon, South Korea. Before and after the program, we assessed hand function (grip strength, pinch force, and hand dexterity, evaluated using a hand dynamometer, Jamar hydraulic pinch gauge, and grooved pegboard, respectively), emotional behavioral strategies (evaluated using the emotional behavioral checklist), and social skills (evaluated using the social skill rating system-teacher form). After participation in the horticultural therapy program, individuals with intellectual disabilities displayed significantly improved hand function, emotional behavior, and social skills (all p < 0.05). This study demonstrates the potential of horticultural therapy focused on succulent cultivation for the vocational training of individuals with intellectual disabilities. Future studies should investigate the effects of the program in a larger cohort.

Midwifery in Iceland: From vocational training to university education.

Midwifery education is a foundation for health professionals' competence in providing quality healthcare for the benefit of women, their families and society. This paper describes midwifery and the development of midwifery education in Iceland. It examines policy and extensive reforms, from hospital-based vocational training in midwifery to an academic university education, and the impact on the scope of midwifery practice in Iceland. The university-based programme, with its emphasis on autonomy of the midwife, seems to have affected the context of home birth and strengthened midwives' role in primary healthcare. Education reform with a focus on evidence-based practice and midwife-led continuity of care has had limited influence within the hospital system, where the structure of care is fragmented and childbirth is under threat of increasing interventions. Research is needed on the role of education in supporting evidence-based practice, normal childbirth and reproductive health in the Icelandic context.

Analysis of Time in Rehabilitation and Incidence of Successful Rehabilitation Within Individuals with Disabilities Receiving Occupational/Vocational Training.

Objective To investigate the incidence of successful rehabilitation, defined as 90 successive days in employment, within individuals with disabilities receiving occupational/vocational training (OVT) service. Method The follow-up records between January 1, 2004 and December 31, 2012 of 5313 individuals aged 15-55 who obtained OVT in the vocational rehabilitation (VR) program of the State of Illinois were examined. Cox regression models were used to analyze the effect of study factors on VR outcomes. Results After controlling for the other factors, males (incidence ratio [IR] 1.11, 95% CI 1.03-1.20), individuals with learning disability (IR 1.14, 95% CI 1.03-1.26), had existing employment (IR 1.40, 95% CI 1.26-1.56), and persons who were referred from educational institutions (IR 1.17, 95% CI 1.01-1.36) or community agencies (IR 1.30, 95% CI 1.14-1.48) appeared to have a relatively high incidence of successful rehabilitation. In contrast, those who lived in densely populated areas (IR ranged from 0.56 to 0.89), had physical disability (IR 0.77, 95% CI 0.68-0.88), had disability of most significant degree (IR 0.85, 95% CI 0.79-0.93), and persons with Supplemental Security Income/Social Security Disability Insurance supports (IR 0.84, 95% CI 0.76-0.94), tended to have a lower incidence of rehabilitation than their counterparts. Conclusion The incidence of successful rehabilitation seems to be related to the demographic, disability, and pre-service characteristics, but not necessarily the provider factors.

Effects of Peer Helper Training Program on Existential Spiritual Well-being, Peer Relationship, and Depression for Students Attending a Specialized Girls Vocational High School / 정신간호학회지

PURPOSE: The aim of this study was to investigate the effects of a peer helper training program on existential spiritual well-being, peer relationship, and depression for students attending a specialized girls vocational high school. METHODS: The participants were forty-two students attending a specialized girls vocational high school in D city. Data were collected form october 23 to December 24, 2013. To test the effects of the peer helper training program, the participants were divided into two mached groups, an experimental group (21) and a control group (21). Data were analyzed using chi2-test, Fisher exact probability test, and t-test with the SPSS/WIN 12.0 program. RESULTS: After attending the peer helper training program, significant differences between the experimental group and the control group were found for existential spiritual well-being (t=3.35, p=.002) and peer relationship (t=2.29, p=.028). However, there was no significant differences in depression between the two groups. CONCLUSION: The results indicate that the peer helper training program enhances existential spiritual well-being and peer relationship for students attending a specialized girls vocational high school. Therefore, this program is a good strategy that teachers and community mental health nurses can use to increase existential spiritual well-being and peer relationship of these high school girls.

[Health coaching as a part of integration into the job market--evaluation of a qualification concept]. / Gesundheits-Coaching in der Arbeitsmarktintegration--Evaluation eines Qualifizierungskonzepts.

OBJECTIVES: The aim of this study is to develop, implement and evaluate an education programme enabling the pedagogic staff of employment promotion agencies to integrate health promotion approaches und activities in vocational training programmes. METHODS: The evaluation of the education programme is based on Kirkpatrick's 4 levels training evaluation model. Besides the participants' verbal end of session feedback, a standardised questionnaire was used at the end of the education programme and after 3 months practical experience. Process evaluation included the implementation level of the methods learned. RESULTS: From a total of 71 participants, 56 completed the first and 31 the second questionnaire (return rate 79% and 44%, respectively). The participants' mean age was 42 years, 80% were female. Only 22% of them integrated health topics systematically into their daily work. A 3-day basic training followed by case conferences during practical work was developed to transfer knowledge and practical competence in person-to-person talks and group activities (so called FIT-counselling and FIT-group). For 96% of participants, their expectations regarding the education programme were met completely or predominantly. 91% indicated a rise in motivation to work as health coach. When rating the training material, 96% judged it helpful for implementation/transfer. Many participants marked the education programme as being too short and wished more time for the topic of "mental health" and exchange of experiences. The follow-up after 3 months on-the-job training revealed that 84 and 97%, respectively, found FIT-counselling and FIT-groups helpful for their daily work. In all employment promotion agencies FIT-counselling and FIT-groups were implemented. CONCLUSION: Our results affirm the need for and prove the acceptance of education programmes enabling the pedagogic staff of job-training programmes to deliver health coaching. Periodic case conferences take into account the participants' request for more exchange of experiences, facilitate implementation and contribute to quality and sustainability. Further development of the education programme is ongoing.

Is Fly in/Fly out (FIFO) a viable interim solution to address remote medical workforce shortages?

Geographically remote regions of Australia experience a higher degree of socioeconomic inequality and health inequity, amid poor resourcing and extreme climatic conditions, when compared with their more urban counterparts. Doctors with the knowledge, skills and interest in remote work remain a scarce resource, with only 58 practitioners per 100,000 people versus 196/100,000 in metropolitan areas. Pending the arrival of the full complement of long-term remote medical workforce, an alternative solution that has so far received little attention but could provide near equivalence to resident doctors is the 'fly in/fly out' (FIFO) model. Specifically, where one doctor has a continuous relationship with one town or community, albeit spending their rostered time off away from this location, rather than continuity of service with different doctors each time. In this model, doctors spend a fixed number of days at work geographically remote from their home and families, with logistical support (eg housing, transport) provided, followed by a fixed number of days back at home not working. This provides a the doctor with the benefits of remote clinical work plus guaranteed time off at home, a more acceptable roster than in many remote locations at present. This also avoids the complex issue of experienced doctors having to leave remote areas mid-career for the well-documented reasons of spouse employment and children's education, as well as providing easier access to professional development activities. The author followed this path and remains a FIFO doctor after 7 years of continuous service. For FIFO to be effective, there needs to be a commitment from the sponsoring organisation for short, balanced, flexible, family friendly rosters and a positive organizational structure with effective communication between management and front line staff. Evidence shows that families and children with healthy family functioning, who are able to balance separateness and togetherness and are able to readily adjust when circumstances move from stability through change, and have strong communication skills, cope well with FIFO work. The author's employer actively supports his FIFO work arrangements. Although FIFO presents challenges and is not for everyone, it may be time for organisations providing medical care to remote Australia to further consider this option. Allowing mid-career doctors experienced in remote medicine to continue remote clinical practice when they move to the city for family reasons would provide an immediate benefit to remote communities. Notwithstanding the challenges, perhaps it is time to consider the option of FIFO to address ongoing workforce shortages?

Merging the fields of mental health and social enterprise: lessons from abroad and cumulative findings from research with homeless youths.

Despite the growing integration of supported employment within the mental health system in the United States as well as the widespread use of social enterprises abroad, the fields of mental health and social enterprises remain largely separate in the USA. The mental health field currently lacks a response that strengthens homeless youths' existing human and social capital, provides them with marketable job skills and employment, and impacts their mental health. To address this gap, this paper establishes a case for using social enterprises with homeless youths, drawing on both global precedents and findings from a mixed-methods study of a social enterprise intervention with homeless youths. Recommendations are offered for how to integrate social enterprises with mental health treatment as well as how to evaluate their impact on mental health outcomes.

Experiences of attendance at a neuromuscular centre: perceptions of adults with neuromuscular disorders.

PURPOSE: The aim of this research is to gain an insight into adults with neuromuscular disorders' experiences of attendance at a specialised, voluntary sector, Neuromuscular Centre and explore its value to these adults who attend for treatment, education or employment. METHOD: This study was qualitative in design. In-depth interviews were conducted with nine self-selected participants, recruited from the population of adults with neuromuscular disorders who attended the Neuromuscular Centre. Interviews were transcribed verbatim and thematically analysed. Thematic networks were utilised to aid interpretation. RESULTS: Participants saw the benefit of specialist input to remain mobile and independent for longer. The Centre created a culture of understanding and empathy which facilitated mutual support and self-acceptance. Opportunities for employment and education offered a sense of purpose. Sharing experiences developed self-knowledge and the ability to self-manage their condition. CONCLUSION: Attendance at this voluntary sector Neuromuscular Centre provided physical, psychosocial and economic benefits. The Neuromuscular Centre through its holistic approach offers a unique model for rehabilitation of adults with neuromuscular disorders. As an enterprise, satellite centres adopting the ethos of the Centre could be created, which could potentially help to redress the inequalities in health care for adults with neuromuscular disorders.

South African Deaf education and the Deaf community.

In a special section of the american Annals of the Deaf, Deaf education and the Deaf community in South Africa are discussed. The special section is organized into 7 segments: a historical overview to establish context, the educational context, educators and learners, postgraduate education and employment, perspectives of Deaf children and their parents, sport and the arts, and spiritual lives and mental health. Throughout the entire section, however, the central focus is on the overall foundation (or lack thereof) of education for Deaf learners in South Africa.

Achieving community membership through community rehabilitation provider services: are we there yet?

Findings from an analysis of the characteristics and services of community rehabilitation providers (CRPs) in the early years of the 21st century are presented. Services provided by CRPs can be categorized along two dimensions: purpose (work, nonwork) and setting (facility-based, community). The number of individuals with disabilities present provides a third perspective for analysis. The majority of CRPs provided both work and nonwork services, and the majority of those that provide employment services offered both integrated and facility-based employment. Individuals with developmental disabilities were most likely to be supported in facility-based work (41%), followed by nonwork services (33%), and integrated employment (26%). Despite some changes in CRP characteristics, the goal of community membership has not yet been widely achieved.

Skill shortages in health: innovative solutions using vocational education and training.

INTRODUCTION: This article reports findings of a project funded by the Australian National Council for Vocational Education Research. The project explores solutions to current and projected skills shortages within the health and community services sector, from a vocational education and training perspective. Its purpose is to locate, analyse and disseminate information about innovative models of health training and service delivery that have been developed in response to skill shortages. METHODS: The article begins with a brief overview of Australian statistics and literature on the structure of the national health workforce and perceived skill shortages. The impact of location (state and rurality), demographics of the workforce, and other relevant factors, on health skill shortages is examined. Drawing on a synthesis of the Australian and international literature on innovative and effective models for addressing health skill shortages and nominations by key stakeholders within the health sector, over 70 models were identified. The models represent a mixture of innovative service delivery models and training solutions from Australia, as well as international examples that could be transposed to the Australian context. They include the skill ecosystem approach facilitated by the Australian National Training Authority Skill Ecosystem Project. Models were selected to represent diversity in terms of the nature of skill shortage addressed, barriers overcome in development of the model, healthcare specialisations, and different customer groups. RESULTS: Key barriers to the development of innovative solutions to skills shortages identified were: policy that is not sufficiently flexible to accommodate changing workplace needs; unwillingness to risk take in order to develop new models; delays in gaining endorsement/accreditation; current vocational education and training (VET) monitoring and reporting systems; issues related to working in partnership, including different cultures, ways of operating, priorities and timelines; workplace culture that is resistant to change; and organisational boundaries. For training-only models, additional barriers were: technology; low educational levels of trainees; lack of health professionals to provide training and/or supervision; and cost of training. Key enhancers for the development of models were identified as: commitment by all partners and co-location of partners; or effective communication channels. Key enhancers for model effectiveness were: first considering work tasks, competencies and job (re)design; high profile of the model within the community; community-based models; cultural fit; and evidence of direct link between skills development and employment, for example VET trained aged care workers upskilling for other health jobs. For training only models, additional enhancers were flexibility of partners in accommodating needs of trainees; low training costs; experienced clinical supervisors; and the provision of professional development to trainers. CONCLUSIONS: There needs to be a balance between short-term solutions to current skill shortages (training only), and medium to longer term solutions (job redesign, holistic approaches) that also address projected skills shortages. Models that focus on addressing skills shortages in aged care can provide a broad pathway to careers in health. Characteristics of models likely to be effective in addressing skill shortages are: responsibility for addressing skills shortage is shared between the health sector, education and training organisations and government, with employers taking a proactive role; the training component is complemented by a focus on retention of workers; models are either targeted at existing employees or identify a target group(s) who may not otherwise have considered a career in health.

Developing mental imagery using a digital camera: a study of adult vocational training.

This study was undertaken to explore the use of a digital camera for mental imagery training of a vocational task with two young adult men with Down syndrome. The results indicate that these particular men benefited from the use of a collaborative training process that involved mental imagery for learning a series of photocopying operations. An outline of a mental imagery assessment method is provided along with a description of the training procedures that were used in the study. Mental imagery was taught and rehearsed by means of a Powerpoint computer presentation. Trainers and participants worked collaboratively to complete a task analysis and to take photos of each person performing the operations correctly. Through the use of self-modelling and feed forward, participants were able to learn from observing their own actions and, in particular, to learn from 'successes' that they have not yet had. On the basis of this pilot study, it is proposed that mental imagery training is an important new approach for collaborative training, especially for individuals whose language systems are not well developed. There is a need, however, for further investigation into the role of mental imagery as this relates to memory, self-regulation and metacognition.

'Brain fag' symptoms in apprentices in Nigeria.

The 'brain fag' syndrome, which was first reported from West Africa in 1960 among students, has been shown to occur very widely in African students in western educational systems south of the Sahara. This study investigated the distribution of its symptoms in a group of apprentices chosen by convenient sampling from Ile-Ife, a university town about 240 km northeast of Lagos in Nigeria. The subjects who (in contrast) were training under an indigenous form of education - the African apprenticeship system - consisted of 183 (69.8%) males, and 79 (30.2%) females, in the age range of 13-26 years (mean +/- SD 18.2 +/- 3.0 years). Questionnaires were interview-administered to collect data on the sociodemographic, economic, and family background, English language proficiency, and the degree of the presence of brain fag symptoms. Results indicated a generally low rate of brain fag symptoms among these different types of apprentices. A relationship between proficiency in English, but not socioeconomic status, with brain fag symptoms was found. In the case of the Nigerian apprentices investigated here, brain fag symptoms were not significantly associated with the method of training learning (which is dependent mainly on verbal instructions in the vernacular from their bosses, and vicarious learning by observing the boss at work). The implications of these findings for two of the theories advanced for the pathogenesis of the brain fag syndrome were discussed.

Job terminations among persons with severe mental illness participating in supported employment.

For persons with psychiatric disabilities, maintaining a job is often more difficult than acquiring a job. A large proportion of jobs end unsatisfactorily. This study explored job terminations among 63 persons with severe mental illness who participated in competitive jobs through supported employment programs. More than half of the job terminations were unsatisfactory, defined as the client quitting without having other job plans or being fired. Baseline ratings of demographic and clinical characteristics, preemployment skills training, and early ratings of job satisfaction and work environment did not predict unsatisfactory terminations. Clients with better work histories were less likely to experience unsatisfactory terminations. In addition, unsatisfactory terminations were associated retrospectively with multiple problems on the job that were related to interpersonal functioning, mental illness, dissatisfaction with jobs, quality of work, medical illnesses, dependability, and substance abuse. These results suggest that supported employment programs need to address job maintenance with interventions that identify and address different types of difficulties as they arise on the job.

[Occupational rehabilitation of psychiatric patients in the Michaelshoven/Cologne vocational training center--an integrated overall concept]. / Die berufliche Rehabilitation psychisch Behinderter im Berufsförderungswerk Michaelshoven/Köln--Ein integratives Gesamtkonzept.

Vocational retraining centres, sui generis, belong to those vocational rehabilitation facilities where disabled adults are afforded an opportunity for comprehensive occupational reorientation, facilities that operate on the principle of "dual training under one roof", i.e. combine practical and theoretical contents, which documents their close linkage with the mainstream vocational education system practiced in Germany. An essential modification has for some years now been introduced at the Michaelshoven/Cologne vocational retraining centre: the traditional conveyance of skills and knowledge (i.e., acquisition of technical competence) has been replaced by attainment of occupational action competence as the focus of rehabilitative efforts. Hand in hand with this concept rooted in the principle of client-concentration, comes implementation of the principles of integration and holistic approach. Integration means that rehabilitees with mental illness participate in the rehabilitation programmes alongside rehabilitees without mental illness. The holistic approach is expressed in a number of closely coordinated elements ensuring that the specific configuration of persons with mental illness and their way of life are taken into consideration from the very beginning of their stay in the Michaelshoven/Cologne vocational retraining centre. Along with in-depth talks at entry and specific vocational guidance for individuals with mental illness, these elements inter alia include: pre-rehabilitation adjustment, pre-rehabilitation course, an extramural industrial practical, action-oriented training methods throughout, and systematic placement assistance and support--in line with the vocational retraining centre's motto of "picking up our rehabilitees right where they stand".

[The authentication of modern Japanese acupuncture].

The Meiji government that modernized Japan decided the direction which adopted western medicine positively and eliminated Oriental medicine, and carried out the policy to inhibit acupuncture (1874). However, there was no concrete system until 1885, when the Ministry of Home Affairs issued a report to entrust the permission and superintendance of acupuncture to each prefecture. On the other hand, modern education for the blind was begun in various parts of the country in 1878, and acupuncture was adopted as a vocational course. The Rakuzenkai Blind School began Anma and acupuncture in 1881, but in 1885 acupuncture was removed from the curriculum and put under the direct control of the Ministry of Education. The principal of the school, Ryokichi Yatabe, had doubts about this and sent a question to Tokyo Imperial University. The answer to it (1887) was to recognize acupuncture, and this recognition became an admission of the revival of acupuncture in the course of blind education and the basis of the thought in legislation for modern Japanese acupuncture. There is a high possibilty that the reply to Yatabe was influenced by the article of Sansaku Okumura (1864-1912), a blind man in Kanazawa City, which appeared in the 157th issue of "Iji Shimbun" (1885).

A holistic transition programme for persons with learning disabilities in Israel.

This paper describes a two year holistic transition programme for persons with a learning disability in Israel and a follow-up of the first cohort of trainees. The programme which was initiated by the National Insurance Institution and 'Nitzan' a parent voluntary organization was developed to provide these persons with the vocational, personal and social skills required for successful independent living and vocational adjustment. The training was carried out in a residential setting and included vocational training, activities of daily living, educational activities and personal adjustment counselling. The results indicated that two years after completing the programme the trainees were generally meeting the expectations of the goals of the project.

[Medical and occupational rehabilitation of psychiatric patients. Results of concomitant research of rehabilitation facilities for psychiatric and handicapped patients]. / Medizinische und berufliche Rehabilitation für psychisch Kranke. Ergebnisse der Begleitforschung von Rehabilitationseinrichtungen für psychisch Kranke und Behinderte (RPK).

The Rehabilitation facilities for mentally ill and disabled (RPK) are designed to enable clients with chronic mental illness to (re)acquire the skills needed for their reintegration in occupational and/or social respects. The peculiar feature of the RPKs is their holistic approach integrating medical-psychiatric care, vocational preparation and training services, as well as sociotherapeutic measures. Accompanying research findings clearly prove that, once they have gained a firm foothold in the RPK, the great majority of the rehabilitees will achieve successful and lasting rehabilitation. The medical phase is completed by some two thirds of the clients admitted. Drop-out usually occurs in the initial three months period. The medical phase is followed by medical-vocational services in approx. 60% of the rehabilitees, and the majority of these achieve successful reintegration, with a drop-out rate of 15-20% in this phase clearly below the rate during the medical service provision phase. RPKs operating along a cooperative model have proven their worth within a dense service provider network, while the advantages of the integrative model lie in its concentration of services under one roof. Recommendations given in particular pertain to simplification of admission procedures and to ensuring follow-up services after programme completion.