Perspectives on paid work among men and women with schizophrenia: The results of a two study comparison in Ireland.

BACKGROUND: While research indicates that people with serious mental health conditions want to work, few studies have examined motivation and concerns associated with employment. OBJECTIVES: This study examined the work attitudes among two samples of Irish people with psychotic conditions, primarily schizophrenia. METHODS: Data gathered through two work related research projects was used. A self-report instrument, the work motivation scale (WMS), gathered data in two separate studies. It was possible to examine participants' motives and concerns due to the two factor structure, positive and negative, of this scale. Descriptive statistical analysis was conducted for each of the two samples individually. A sub-analysis by gender was also conducted. RESULTS: Across the two samples, analysis showed the consistent motivators were increased coping ability, improved self-identity, and enhanced self-worth. Men particularly wanted others to see them as good workers. On the other hand, women regarded a job as a means to forget about having a mental illness. A sizeable minority in both samples expressed apprehensions such as work being boring and an expectation from others that they should work rather than them being personally motivated to do so. CONCLUSIONS: While caution must be exercised in interpreting the results due to the small sample size, this study has extended our understanding in this under-researched but important topic.

An exploratory study of the extent of social inclusion among people with psychosis and psychotic-related conditions.

BACKGROUND: Understanding social inclusion among at-risk populations will deepen our understanding of their specific needs. AIM: This study explored the level of social inclusion among people with psychotic-related conditions using a standardised interview. METHOD: The Social Inclusion Interview Schedule was used in two research projects. People with psychosis participated in both studies and had been recruited as part of an Irish programme of research on psychotic conditions. Descriptive statistics were used to quantify participants' level of social exclusion. RESULTS: Data from 71 participants were available, 38 in one cohort and 33 in the other. The smaller cohort had a shorter mean duration of illness. Participants' mean age was 40. The majority lived in the community and were satisfied with their living arrangements. In each cohort, the same two areas of community integration emerged as problematic - having something productive to do and being close to someone in the community. There was a higher level of perceived stigma among the cohort with the longer duration of illness. DISCUSSION/CONCLUSION: While evidence of social inclusion was found among participants, there were areas of concern particularly with regard to integration into work and social connectedness.

Physically Disabled Adults' Perceptions of Personal Autonomy: Impact on Occupational Engagement.

Despite the prominence of the concept of autonomy in the UN Convention on the Rights of Persons With Disabilities and within disability theory, the relevance of autonomy to occupational engagement is unclear. Using a qualitative, narrative approach, eight adults with significant physical disabilities engaged in iterative interviews exploring their life history and perception of autonomy in daily life. Interviews were transcribed verbatim and themed. Key themes that emerged were that participants valued autonomy differently; their perception of their own personal autonomy influenced both occupational choices and the meaning derived from occupational engagement. While some participants actively sought occupations in which they could make decisions, others preferred more supportive environments, yet all participants avoided situations in which their autonomy was undermined. Awareness of an individual's values regarding autonomy could assist occupational therapists to both select appropriate occupations for intervention and discuss the meaning derived from occupations, thereby enhancing client-centered practice.

Work life after psychosis: A detailed examination.

BACKGROUND: Conducting research on the work outcomes of first episode psychosis (FEP) samples may extend our understanding of the factors associated with the work outcome of people with schizophrenia and other psychotic illnesses. OBJECTIVE: To conduct a detailed study of the work outcome of an FEP sample. METHODS: Members of a FEP cohort, who had completed a 12-year clinical outcome assessment, were invited to participate in an adjunctive work outcome study. Engagement in paid and non-paid work was first established and the relationship with potentially influential baseline characteristics investigated. Subsequently the influence of work outcome to participants' level of quality of life, mental health, recovery, and social inclusion were examined. RESULTS: Among the 38 participants the mean percentage of time spent in work was 62% of which 50% was in paid work and 12% was in non-paid work. Being employed at inception was the only independent predictor of the duration of the follow-up period spent in work. Relationships between work outcome and all measures of wellbeing were found. CONCLUSION: The paid and non-paid work attained by people affected by a psychotic illness played an important role in the extent of their wellbeing, recovery, and social inclusion.

Interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function for children with hemiplegic cerebral palsy.

OBJECTIVE: We examined the interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function. METHOD: Three occupational therapists independently scored 34 videotaped assessments of children with hemiplegic cerebral palsy aged 6 yr, 1 mo, to 14 yr, 5 mo. Intraclass correlation coefficients (ICCs) at a 95% confidence interval were calculated for total scores, category scores, and item scores. RESULTS: The correlation between raters' total scores was high (ICC = .961). The highest correlation for test components between raters was found for fluency (ICC = .902), followed by range of movement (ICC = .866), and the lowest correlation was found for quality of movement (ICC = .683). The ICCs for individual test item scores varied and ranged from .368 to .899. CONCLUSION: This study demonstrated high interrater reliability for total scores, with scoring of some individual components and items requiring further consideration from both a clinical and a research perspective.

Akinetic mutism--not coma.

We describe a case of akinetic mutism mistaken as coma. A 77-year old lady presented with apparent unresponsiveness. In fact she responded when stimulated. She subsequently developed movements typical of clonic perseveration, erroneously treated as seizures. She also had features of a frontal lobe syndrome. Initial CT scan showed no abnormality; it was only after an MRI scan that a diagnosis of bilateral paramedian thalamic infarction was made. MRI scanning should be considered early in the investigation of patients with atypical neurological presentation.

Handwriting speed: duration of testing period and relation to socio-economic disadvantage and handedness.

In the course of norm-referencing the Handwriting Speed Test (HST) for 8- to 18-year-olds in the Irish education system, the authors examined the issue of the duration of the handwriting test period, the relation of handwriting speed to socio-economic disadvantage and the comparative handwriting speed of left- and right-handed students. The literature reports some concerns about the generalizability of results from a short-duration handwriting speed test, some evidence that children from poorer backgrounds are less proficient at handwriting, and conflicting results on the relation of handedness to speed of handwriting. The results of this study suggest that the addition of a further 9-minute test to the 3-minute test of the HST would improve its ability to predict handwriting speed problems in everyday extended writing tasks, such as examinations, and would also identify some children who are wrongly classified as slow writers on the 3-minute test. The results also indicate a markedly lower-than-average handwriting speed for children attending designated disadvantaged schools. The results suggest that neither left- nor right-handed children have a consistent advantage in handwriting speed.

Perceptions of quality of life in people with ALS: effects of coping and health care.

Few qualitative studies have explored the 'meaning' of life experiences for persons with ALS. We aimed to identify the meaning of QoL in five selected individuals, and to consider how their experience of health care affected perceived well-being, using a phenomenological approach. Four of the five participants were revisited. Themes that emerged included: importance of faith, search for control, importance of dignity, desire to maintain identity, importance of family, a sense of loss, importance of altruism and support, fighting amyotrophic lateral sclerosis, and appreciation of life. All participants felt that professional services contributed to their well-being. QoL remained individual and multi-dimensional and was defined by cognitive and behavioural strategies used to cope with ALS. Our findings highlight the need to consider how persons with ALS may adapt to progressive illness.

Measurement and prediction of motor proficiency in children using Bayley infant scales and the Bruininks-Oseretsky test.

A sample of 76 Irish girls and boys of about 9 years of age, for whom neonatal (birthweight, Apgar and Neonatal Behavioural Assessment Scale) and infancy measures (Bayley Infant Scales at 18 months) were available, were administered the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). The main focus of this paper is on a longitudinal analysis of the relationships between the neonatal and infancy measures and the BOTMP administered at about 9 years. However, since the literature expresses some doubts about the basis of the division of the BOTMP subtests into fine motor and gross motor groups and about the meaningfulness of the overall battery score, an initial statistical analysis was undertaken to examine these construct validity issues with this sample of children. This analysis indicated that the division of subtests into fine motor and gross motor skills groups, as formulated by the BOTMP, is not supported. The longitudinal analysis, therefore, focused mainly on subtest scores and provided some evidence of a degree of continuity in measured motor proficiency between birth, 18 months and the prepubertal period. Continuity was more evident for female children.

Influence of guidelines on CPR decisions: an audit of clerking proforma.

We audited documentation rates and implementation of cardiopulmonary resuscitation (CPR) decisions for patients admitted under the Department of Elderly Care Medicine, Mayday University Hospital, Croydon, as new guidelines and a proforma were introduced. For the first audit, data were collected from 75 departmental discharges. Following introduction of a proforma, six point prevalence audits were performed of all elderly care inpatients. Consultant documentation improved from 27/75 (36%) to 102/109 (94%), 135/148 (91%), 133/140 (95%), 96/119 (81%), 148/157 (94%) and 167/169 (98%) in audits 2, 3, 4, 5, 6 and 7 respectively. The percentages of decisions that were Do Not Attempt Resuscitation (DNAR) were 64% 72%, 45%, 68% and 62% in audits 3 to 7 respectively. For audit 5 our guidelines required discussion with patient before making a DNAR order, whereas the guidelines applicable for the other audits did not stipulate discussion. The fall in documentation rates and proportion of CPR decisions that were DNAR in audit 5 were statistically significant. There was no significant difference in age, diagnosis, cognitive function or disability between patients in those audits (3-7) when these parameters were recorded. Introducing a proforma significantly improved CPR decision documentation. Obligatory discussion with a patient before issuing a DNAR order was associated with a fall in documentation of decisions.

The influence of new guidelines on cardiopulmonary resuscitation (CPR) decisions. Five cycles of audit of a clerk proforma which included a resuscitation decision.

Current guidelines advise discussion with patients before issuing a 'do not attempt resuscitation' (DNAR) order. We report five audit cycles of cardiopulmonary resuscitation (CPR) documentation after introducing a proforma, the last cycle following the latest guidelines. In first audit data were collected from 75 patient discharges. CPR decisions were documented in 27 (36%). Four subsequent point prevalence audits carried out on all inpatients following proforma introduction showed documentation improved to 102/109 (94%), 135/148 (91%), 131/140 (94%) and 102/119 (86%) in cycles two, three, four and five, respectively. The last three audits also revealed that consultants consistently made more DNAR orders than trainee doctors. However, following the introduction of the latest guidelines the proportion of patients in whom a decision was made, and the percentage of those decisions that were DNAR, fell.