"I think they do not know how to lie:" The perceptions of legal support staff about person with intellectual disabilities/autism in Turkish legal system.

BACKGROUND: Increased social integration of individuals with intellectual disabilities or autism could may raise their likelihood of interacting with justice system and legal staff. AIMS: The present article aimed to determine the perceptions of the legal support staff about the individuals with intellectual disabilities or autism. MATERIALS AND METHODS: In the study, conducted with the phenomenological method, the views of 15 legal support staff were obtained. The study reported what participants perceived and examined whether participants had an accurate understanding of the experiences/support needs of people with intellectual disabilities/autism. The data were analysed with content analysis. RESULTS: Three themes were determined: (1) Experience of interview with an individual with intellectual disabilities/autism, (2) attitudes of judges, lawyers and other staff, and (3) abuse/trauma. DISCUSSION: Findings are consistent with literature. Individuals with intellectual disabilities/autism have problems in expressing themselves, also staff do not know them, do not know their features. Studies show that staff often do not know what to do in these interviews. CONCLUSION: Based on the participant perspectives, it was determined that individuals with intellectual disabilities/autism experienced self-expression problems, interviewees did not understand children/individuals with intellectual disabilities or autism and could exhibit negative attitudes, the children could be abused and traumatised during judicial processes, they were more prone to abuse when compared to their peers, they could be involved in certain events more frequently and could be pushed to crime.

Diversity and Inclusion in the American Legal Profession: Discrimination and Bias Reported by Lawyers with Disabilities and Lawyers Who Identify as LGBTQ.

PURPOSE: This article is part of an ongoing body of investigation examining the experiences of lawyers with diverse and multiple minority identities, with particular focus on lawyers with disabilities; lawyers who identify as lesbian, gay, bisexual, transgender, and queer ("LGBTQ+" as an overarching term); and lawyers with minority identities associated with race and ethnicity, gender, and age. The focus of this article is on discrimination and bias in their workplaces as reported by the lawyers experiencing it. METHODS: We employ survey data from the first phase of this investigation, gathered from the survey responses of 3590 lawyers located across all states in the United States and working in most types and sizes of legal venues. The data were collected between 2018 and 2019, before the 2020 pandemic. We estimate differences across three categories of discrimination reported-subtle-only discrimination, overt-only discrimination, and both subtle and overt discrimination. We estimate the nature and magnitude of associations among individual and organizational variables, and we use multinomial logistic regression to illustrate relative risks of reports of discrimination for intersecting identities. RESULTS: As compared to non-disabled lawyers, lawyers with disabilities show a higher likelihood of reporting both subtle and overt discrimination versus no discrimination. Similarly, lawyers who identify as lesbian, gay, bisexual, and queer ("LGBQ") show a higher likelihood of reporting both subtle and overtdiscrimination, and subtle-only discrimination, as compared to lawyers who identify as straight/heterosexual. Women lawyers and lawyers of color are more likely to report all three types of discrimination. In general, younger lawyers are more likely to report subtle-only discrimination when compared to older lawyers. Lawyers working at a private firm are less likely to report all types of discrimination, while working for a larger organization is associated with a higher relative risk of reporting subtle-only discrimination versus no discrimination. CONCLUSIONS: The current study represents a next, incremental step for better understanding non-monochromatic and intersectional aspects of individual identity in the legal profession. The findings illustrate that primary individual and multiple minority identities, as identified by disability, sexual orientation, gender, race/ethnicity, and age, are associated with reports of discrimination and bias in the legal workplace.

Stress, drink, leave: An examination of gender-specific risk factors for mental health problems and attrition among licensed attorneys.

Rates of mental illness and heavy alcohol use are exceedingly high in the legal profession, while attrition among women has also been a longstanding problem. Work overcommitment, work-family conflict, permissiveness toward alcohol in the workplace, and the likelihood of promotion are all implicated but have yet to be systematically investigated. Data were collected from 2,863 lawyers randomly sampled from the California Lawyers Association and D.C. Bar to address this knowledge gap. Findings indicated that the prevalence and severity of depression, anxiety, stress, and risky/hazardous drinking were significantly higher among women. Further, one-quarter of all women contemplated leaving the profession due to mental health concerns, compared to 17% of men. Logistic models were conducted to identify workplace factors predictive of stress, risky drinking, and contemplating leaving the profession. Overcommitment and permissiveness toward alcohol at work were associated with the highest likelihood of stress and risky drinking (relative to all other predictors) for both men and women. However, women and men differed with respect to predictors of leaving the profession due to stress or mental health. For women, work-family conflict was associated with the highest likelihood of leaving, while overcommitment was the number one predictor of leaving for men. Mental health and gender disparities are significant problems in the legal profession, clearly requiring considerable and sustained attention.

Assessment of the relationship between stress and performance in candidates for the Brazilian Bar Association examination.

OBJECTIVE: This study investigated stress and performance levels in candidates for the Brazilian Bar Association examination (Exame da Ordem dos Advogados do Brasil) in Rio Grande do Sul, Southern Brazil. METHODS: The following instruments were used: A sociodemographic data sheet, Lipp's Stress Symptom Inventory for Adults, the Ways of Coping Scale, the Adult Self-Report Scale, and the Self-Report Questionnaire. The final sample comprised 117 candidates, aged from 18 to 59 years (mean = 29.7, standard deviation = 7.8), 76 women (65%) and 41 men (35%). RESULTS: In the first phase of the examination, 67 candidates were approved (57.3%), but there was no significant difference in terms of stress: stress symptoms were present in 76.1% of the successful candidates and 62% of the unsuccessful candidates; (χ2 (1) = 2.09; p = 0.148). In terms of stress phases, 70.6% of the successful candidates (n = 36) were in the resistance phase and 78.4% of these had psychological symptoms. The mean age of successful candidates (28.2 years) was lower than that of unsuccessful candidates (31.7 years); (t (115) = -2.48; p = 0.015). Attention deficit/hyperactivity disorder symptoms were detected in 18 successful candidates (26.9%) and 6 unsuccessful candidates (12.2%); (χ2 (1) = 2.85; p = 0.091). CONCLUSIONS: Candidates who were successful in the first phase of the Brazilian Bar Association examination tended to be younger and scored higher for attention deficit/hyperactivity disorder symptoms, but their stress levels did not differ from those of unsuccessful candidates.

Assessment of the relationship between stress and performance in candidates for the Brazilian Bar Association examination

Abstract Objective: This study investigated stress and performance levels in candidates for the Brazilian Bar Association examination (Exame da Ordem dos Advogados do Brasil) in Rio Grande do Sul, Southern Brazil. Methods: The following instruments were used: A sociodemographic data sheet, Lipp's Stress Symptom Inventory for Adults, the Ways of Coping Scale, the Adult Self-Report Scale, and the Self-Report Questionnaire. The final sample comprised 117 candidates, aged from 18 to 59 years (mean = 29.7, standard deviation = 7.8), 76 women (65%) and 41 men (35%). Results: In the first phase of the examination, 67 candidates were approved (57.3%), but there was no significant difference in terms of stress: stress symptoms were present in 76.1% of the successful candidates and 62% of the unsuccessful candidates; (χ2 (1) = 2.09; p = 0.148). In terms of stress phases, 70.6% of the successful candidates (n = 36) were in the resistance phase and 78.4% of these had psychological symptoms. The mean age of successful candidates (28.2 years) was lower than that of unsuccessful candidates (31.7 years); (t (115) = −2.48; p = 0.015). Attention deficit/hyperactivity disorder symptoms were detected in 18 successful candidates (26.9%) and 6 unsuccessful candidates (12.2%); (χ2 (1) = 2.85; p = 0.091). Conclusions: Candidates who were successful in the first phase of the Brazilian Bar Association examination tended to be younger and scored higher for attention deficit/hyperactivity disorder symptoms, but their stress levels did not differ from those of unsuccessful candidates.

Rural Legal Deserts Are a Critical Health Determinant.

We introduce "rural legal deserts," or rural areas experiencing attorney shortages, as a meaningful health determinant. We demonstrate that the absence of rural attorneys has significant impacts on public health-impacts that are rapidly exacerbated by COVID-19.Our work builds on recent scholarship that underscores the public health relevance of attorneys in civil and criminal contexts. It recognizes attorneys as crucial to interprofessional health care teams and to establishing equitable health-related laws and policies. Attorney interventions transform institutional practices and help facilitate the stability necessary for health maintenance and recovery. Yet, critically, many rural residents cannot access legal supports.As more individuals experience unemployment, eviction, and insecure benefits amid the COVID-19 pandemic, there is a need for attorneys to address these social determinants of health as legal needs. Accordingly, the growing absence of attorneys in the rural United States proves particularly consequential-because of this pandemic context but also because of rural health disparities. We argue that unless a collaborative understanding of these interrelated phenomena is adopted, justice gaps will continue to compound rural health inequities.

Trends in lawyer use in road traffic injury compensation claims.

Injury compensation claimants use legal services to help them navigate compensation schemes, including accessing benefits and resolving disputes. Little is known, however, about the extent of lawyer use by compensation claimants, including changes over time. This paper presents findings from one of the largest empirical investigations of lawyer use in an injury compensation setting to date. Using evidence from more than 275,000 claims in the road traffic injury scheme in the state of Victoria, Australia, this study examines the prevalence of, and changes in, lawyer use between 2000 and 2015. The analysis identifies a significant increase in the use of lawyers in the scheme, and explores possible explanations. This study provides critical insights into lawyer use in compensation settings: the steep increase in lawyer involvement has both access to justice and financial implications for compensation schemes, given the associations between lawyer use, claimant outcomes, and long-term scheme viability.

Attorneys' Attitudes Toward Coaching Forensic Clients on the MMPI-2: Replication and Extension of Attorney Survey by Wetter and Corrigan (1995).

In this study we replicated and extended Wetter and Corrigan's (1995) commonly cited convenience survey of attorneys and law students regarding their attitudes toward coaching litigants prior to forensic psychological testing. We conducted a target survey of attorneys practicing in specialty areas of law where it is common to enlist psychological testing as part of legal proceedings (family law, juvenile law, personal injury, criminal law, social security/disability, workman's compensation). The estimated prevalence of attorneys who endorse providing their clients with information about the presence of MMPI-2 validity scales is 53%, with a 95% confidence interval of ±7%. Compared with Wetter and Corrigan's results of 63%, this represents a slightly lower estimate of attorneys who indicate a positive attitude toward coaching their clients on the presence and purpose of validity scales. More than 70% of attorneys, in both surveys, believe they should provide general advice and preparation for psychological testing to their clients. Survey results were further analyzed as a function of attorney age, years in practice, and specialty area. Implications are discussed in relation to future research and the practice of forensic psychological evaluations.

Interdisciplinary collaboration needed in obtaining high-quality medical information in child abuse investigations.

BACKGROUND: Despite reporting legislation, healthcare providers (HCPs) do not always report and collaborate in cases of suspected child abuse. Recognizing this leaves children at risk, the Wisconsin Child Abuse Network (WI CAN) sought to understand barriers to mandated reporting and collaboration with child abuse investigators. OBJECTIVE: The purpose of the study was to investigate barriers for professionals in providing and obtaining high-quality medical information in child abuse investigations. PARTICIPANTS AND SETTING: Participants included five discipline-specific focus groups: HCPs, child protective services (CPS), law enforcement, lawyers, and judges. All professionals had been directly involved in Wisconsin child abuse cases. METHODS: This qualitative study consisted of discipline-specific focus groups, directed by open-ended interview questions. Data analysis was completed through the narrative inquiry methodology. RESULTS: Barriers to providing and obtaining high-quality medical information in child abuse investigations were both discipline-specific and universal amongst all groups. Discipline-specific barriers included: HCPs' discomfort with uncertainty; CPS' perception of disrespect and mistrust by HCPs; law enforcement's concerns with HCPs' overstepping professional boundaries; lawyers' concern of HCPs' discomfort with court proceedings; and judges' perception of a lack of understanding between all disciplines. Universal barriers included: value of high-quality medical information in child abuse investigations, burden of time and money; unequal resources between counties; a need for protocols, and a need for interdisciplinary collaboration. CONCLUSION: Findings from this study suggest several ways to address identified barriers. Possible interventions include equalizing resources between urban and rural counties (specifically financial resources and access to child abuse experts); protocolizing reporting and investigations; and, increasing interprofessional education.

Privileges and penalties in the legal profession: an intersectional analysis of career progression.

Intersectionality theory is concerned with integrating social characteristics to better understanding complex human relations and inequalities in organizations and societies (McCall 2005). Recently, intersectionality research has taken a categorical and quantitative turn as scholars critically adopt but retain existing social categories to explain differences in labour market outcomes. A key contention is that social categories carry penalties or privileges and their intersection promotes or hinders the life chances of particular groups and individuals. An emergent debate is whether the intersection of disadvantaged characteristics (such as female gender or minority ethnic status) produce penalties that are additive, multiplicative or ameliorative. Research is inconclusive and as yet pays little attention to moderating factors such as employer type, size, geographic location or work profile. Drawing on administrative records for individuals qualified as solicitors in England and Wales, collected by the Solicitors Regulation Authority (SRA), combined with aggregated workforce data and firm characteristics of their law firms, we undertake a statistical analysis of the intersection of gender and ethnicity in the profession with a degree of precision and nuance not previously possible. In response to calls to broaden studies of inequalities and intersectionality beyond their effect on pay or income (Castilla 2008) we focus on career progression to partnership as our key measure of success. The original contribution of our study is twofold. First, we establish statistically different profiles of law firms, showing how the solicitors' profession is stratified by gender, ethnicity and socio-economic background, as well as the type of legal work undertaken by developing a model of socio-economic stratification in the profession. Second, we demonstrate that while penalties tend to be additive (i.e. the sum of the individual ethnic and gender penalties) this varies significantly by law firm profile and in some situations the effect is ameliorative.

Perception of District Judges and Lawyers Towards Medico-legal Reports, Medical Certificates and Medical Expert Opinion.

INTRODUCTION: The medico legal reports and certificates prepared by doctors can be used as valuable documentary evidence in the court of law. The study was designed with objectives to explore the perception of judges and lawyers about the quality of medico legal reports prepared by the doctors and their competence in providing the expert evidence in the court. METHODS: It is a questionnaire based cross sectional study conducted among the district judges and government attorneys of 75 districts of Nepal from March to May 2016. The data obtained was analysed by SPSS version 16.0. RESULTS: Among a total of 78 participants who responded the questionnaire, 40 (51.3%) were district judges and 38 (48.7%) district attorneys. Most of them graded that the reports prepared by the doctors were just average. Among them, 49 (63.6%) strongly agreed and 28 (36.4%) partially agreed that the reports were useful in deciding the cases. A total of 44 (56.4%) respondents strongly agreed and 34 (43.6%) partially agreed that expert opinion of the doctors in the courts were useful to decide the cases. Seventy one (92.2%) of them rated general doctors as moderately competent. CONCLUSIONS: The medical reports prepared by the Nepalese doctors were just average as perceived by judges and lawyers and the competency in presenting the evidence in courts was moderate as rated by them.

Alcohol and other substance use among medical and law students at a UK university: a cross-sectional questionnaire survey.

PURPOSE OF THE STUDY: To examine the use of alcohol and other substances among medical and law students at a UK university. STUDY DESIGN: Anonymous cross-sectional questionnaire survey of first, second and final year medical and law students at a single UK university. RESULTS: 1242 of 1577 (78.8%) eligible students completed the questionnaire. Over half of first and second year medical students (first year 53.1%, second year 59.7%, final year 35.9%) had an Alcohol Use Disorders Identification Test (AUDIT) score suggestive of an alcohol use disorder (AUDIT≥8), compared with over two-thirds of first and second year law students (first year 67.2%, second year 69.5%, final year 47.3%). Approximately one-quarter of medical students (first year 26.4%, second year 28.4%, final year 23.7%) and over one-third of first and second year law students (first year 39.1%, second year 42.4%, final year 18.9%) reported other substance use within the past year. Over one-third of medical students (first year 34.4%, second year 35.6%, final year 46.3%) and approximately half or more of law students (first year 47.2%, second year 52.7%, final year 59.5%) had a Hospital Anxiety and Depression Scale anxiety score suggestive of a possible anxiety disorder. CONCLUSIONS: Study participants had high levels of substance misuse and anxiety. Some students' fitness to practice may be impaired as a result of their substance misuse or symptoms of psychological distress. Further efforts are needed to reduce substance misuse and to improve the mental well-being of students.

Presencia de estrés y otros factores de riesgo de enfermedad cardiovascular entre las enfermeras y abogados de una ciudad de Minas Gerais - Brasil / Presença de estresse e outros fatores de risco para doenças cardiovasculares em enfermeiros e advogados de um município de Minas Gerais - Brasil / EPresence of stress and other risk factors for cardiovascular disease among nurses and lawyers of a city of Minas Gerais - Brazil

Las enfermedades cardiovasculares (ECV) son una causa importante de morbilidad y mortalidad en todo el mundo. Este estudio tuvo como objetivo evaluar el estrés y otros factores de riesgo de las enfermedades cardiovasculares en las enfermeras y abogados de un municipio de Minas Gerais (Brasil). La muestra estuvo conformada por 20 enfermeras de la zona hospitalaria y 26 abogados independientes. Cada voluntario respondió dos cuestionarios, uno sobre factores de riesgo de las enfermedades cardiovasculares en general y el Inventario de Síntomas de Estrés para Adultos (ISSL). Después se descubrió que el índice de masa corporal (IMC), la circunferencia abdominal (CA) y la presión sanguínea de cada voluntario. Los resultados indican que el 55% de las enfermeras y el 30,9% de los abogados presentes estrés. La etapa de agotamiento es especialmente preocupante, de ser encontrado, respectivamente, 10% y 11,6% de las enfermeras y abogados. Los hallazgos relacionados con el sobrepeso / obesidad, circunferencia de la cintura de riesgo, el sedentarismo y la ingesta de alcohol son preocupantes porque aumenta el riesgo de enfermedades cardiovasculares en la muestra. Se concluyó que existen factores de riesgo de ECV y se necesitan intervenciones para mejorar la salud y calidad de vida de estos profesionales (AU)

As doenças cardiovasculares (DCV) constituem causa importante de morbidade e mortalidade em todo o mundo. Esse estudo objetivou avaliar o estresse e outros fatores de risco para DCV em enfermeiros e advogados de um munícipio de Minas Gerais (Brasil). A amostra foi composta por 20 enfermeiros da área hospitalar e com 26 advogados autônomos. Cada voluntário respondeu a dois questionários, um sobre fatores de risco para DCV em geral e o Inventário de Sintomas de Stress para Adultos (ISSL). Após foi verificado o Índice de Massa Corporal (IMC), a Circunferência Abdominal (CA) e a pressão arterial de cada voluntário. Os resultados encontrados indicam que 55% dos enfermeiros e 30,9% dos advogados apresentam estresse. A fase de exaustão é especialmente preocupante, sendo encontrada, respectivamente, em 10% e 11,6% dos enfermeiros e advogados. Os achados referentes ao sobrepeso/obesidade, circunferência abdominal de risco, sedentarismo e ingestão de bebi-das alcóolicas são preocupantes, pois elevam os riscos de DCV na amostra. É possível concluir que há fatores de risco para DCV e que intervenções são necessárias em prol da saúde e qualidade de vida desses profissionais (AU)

Cardiovascular disease (CVD) is an impor-tant cause of morbidity and mortality world-wide. This study aimed to evaluate stress and other risk factors for CVD in nurses and law-yers of a municipality of Minas Gerais (Brazil). The sample consisted of 20 nurses from the hospital area and 26 independent lawyers. Each volunteer answered two questionnaires, one on risk factors for CVD in general and the Inventory of Stress Symptoms for Adults (ISSL). After it was found the body mass index (BMI), abdominal circumference (AC) and blood pressure of each volunteer. The results indicate that 55% of nurses and 30.9% of the lawyers present stress. The exhaustion stage is of particular concern, being found, respectively, 10% and 11.6% of nurses and lawyers. The findings relating to overweight / obesity, waist circumference of risk, sedentary life-style and intake of alcohol are worrying because increase the risk of CVD in the sample. It was concluded that there are risk factors for CVD and interventions are needed to improve health and quality of life of these profesional (AU)

Legal access to medications: a threat to Brazil's public health system?

BACKGROUND: In Brazil, health is fundamental human right guaranteed by the Constitution of 1988, which created the Brazilian Universal Health System (Sistema Único de Saúde - SUS). The SUS provides medications for outpatient care via policy of pharmaceutical assistance (PA) programmes. Despite the advances in PA policies which include the improvement in access to medications, there has been a significant increase in lawsuits related to health products and services. This study aimed to characterize the medication processes filed between 2010 and 2014 against the Secretary of State for Health of São Paulo (State Health Department of São Paulo - SES/SP), in Brazil, following PA policies. METHODS: This descriptive study used secondary data on medication lawsuits filed against the SES/SP between 2010 and 2014. The data source was the S-Codes computerized system. RESULTS: In the period evaluated, the number of lawsuits filed concerning health-related products increased approximately 63%; requests for medications were predominant. Approximately 30% of the medications involved in court proceedings were supplied via PA programmes. With regard to medications supplied via specialized component, 81.3% were prescribed in disagreement with the protocols published by the Ministry of Health. Insulin glargine was the most requested medication (6.3%), followed by insulin aspart (3.3%). Because there is no scientific evidence that either of these medicines is superior for the treatment of diabetes, neither of them has been incorporated into the SUS by the National Commission for Technology Incorporation. The judicial data showed that most of the lawsuits involved normal proceedings (i.e., individual demands), were filed by private lawyers, and named the State of São Paulo as the sole defendant, demonstrating the individual nature of these claims. The data indicate inequality in the distribution between the number of cases and lawyers and the number of lawsuits and prescribers, evidencing the concentration of lawyers and physicians in filing lawsuits. CONCLUSION: The judicialization of health in the State of São Paulo with the characteristics presented herein is a threat to the SUS.

Trends in the earnings gender gap among dentists, physicians, and lawyers.

BACKGROUND: The authors examined the factors associated with sex differences in earnings for 3 professional occupations. METHODS: The authors used a multivariate Blinder-Oaxaca method to decompose the differences in mean earnings across sex. RESULTS: Although mean differences in earnings between men and women narrowed over time, there remained large, unaccountable earnings differences between men and women among all professions after multivariate adjustments. For dentists, the unexplained difference in earnings for women was approximately constant at 62% to 66%. For physicians, the unexplained difference in earnings for women ranged from 52% to 57%. For lawyers, the unexplained difference in earnings for women was the smallest of the 3 professions but also exhibited the most growth, increasing from 34% in 1990 to 45% in 2010. CONCLUSIONS: The reduction in the earnings gap is driven largely by a general convergence between men and women in some, but not all, observable characteristics over time. Nevertheless, large unexplained gender gaps in earnings remain for all 3 professions. PRACTICAL IMPLICATIONS: Policy makers must use care in efforts to alleviate earnings differences for men and women because measures could make matters worse without a clear understanding of the nature of the factors driving the differences.

Mapping French people's views regarding posthumous reproduction.

OBJECTIVE: The study mapped French people's views regarding the acceptability of posthumous reproduction. BACKGROUND: Posthumous reproduction - the use of a deceased person's gametes for procreative purposes -is a controversial procedure because it involves a series of ethical issues, namely the surviving partner's rights to procreation, the emotional feelings and financial interests of other family members, and the government's interest in maintaining orderly inheritance rules. METHODS: A convenience sample of participants aged 19-68 (104 lay people, 47 health professionals and 15 lawyers) were presented with 48 realistic stories that were composed according to a four-factor within-subject design: marital status (married for about 10 years with children, married for about three years without children, and cohabiting for three years without children) × attitude of the deceased's parents (favourable vs. unfavourable to posthumous procreation) × time elapsed since the partner's death (three months vs. nine months) × deceased's wishes (written consent, oral consent given in front of credible witnesses, unknown wishes, and unfavourable attitude). RESULTS: Through cluster analysis, four qualitatively different positions were found. They were called Never Acceptable (35% of the sample, mostly health professionals, lawyers and regular attendees to the church or temple), Tolerable in a Few Cases (28%), Depends on Deceased's Wishes (22%, mostly lay people) and Quite Acceptable (16%, mostly lay people). CONCLUSIONS: About half of French lay people view the current legislation regarding posthumous assisted reproduction in a country such as the UK as more appropriate than the French legislation.

Perspectives from Employers, Insurers, Lawyers and Healthcare Providers on Factors that Influence Workers' Return-to-Work Following Surgery for Non-Traumatic Upper Extremity Conditions.

PURPOSE: Return-to-work (RTW) stakeholders have varied roles and may therefore hold their own perspectives regarding factors that may influence outcomes. This study aimed to determine stakeholders' perspectives on factors influencing RTW following surgery for non-traumatic upper extremity conditions. METHODS: A questionnaire was distributed to RTW stakeholders via gatekeeper organizations. Stakeholders rated 50 potential prognostic factors from 'not' to 'extremely' influential. Data were dichotomized to establish stakeholders' level of agreement. Disagreements between stakeholder groups were analyzed using χ 2. The relationship between stakeholder demographic variables and rating of a factor was determined via regression analysis. RESULTS: One thousand and eleven stakeholders completed the survey: healthcare providers (77.8 %); employer representatives (12.2 %); insurer representatives (6.8 %); and lawyers (3.2 %). Factors with the highest stakeholder agreement for influencing RTW were: self-efficacy (92.2 %); post-operative psychological status (91.8 %); supportive employer/supervisor (91.4 %); employer's willingness to accommodate job modifications (90.7 %); worker's recovery expectations (88.3 %); mood disorder diagnosis (86.6 %); post-operative pain level (86.4 %); and whether the job can be modified (86.3 %). Disagreements between stakeholder groups were found for 19 (36 %) factors. The strongest disagreements were for: age; gender; obesity; doctor's RTW recommendation; and presence of a RTW coordinator. Respondents' characteristics (e.g., age, workers' compensation jurisdiction, work experience, stakeholder group) were associated with factor rating. CONCLUSION: The factors stakeholders rated as having the greatest influence on RTW were predominately psychosocial and modifiable. These variables should be the focus of future research to determine prognostic factors for RTW for workers with upper extremity conditions, and to develop effective RTW interventions.

The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys.

OBJECTIVES: Rates of substance use and other mental health concerns among attorneys are relatively unknown, despite the potential for harm that attorney impairment poses to the struggling individuals themselves, and to our communities, government, economy, and society. This study measured the prevalence of these concerns among licensed attorneys, their utilization of treatment services, and what barriers existed between them and the services they may need. METHODS: A sample of 12,825 licensed, employed attorneys completed surveys, assessing alcohol use, drug use, and symptoms of depression, anxiety, and stress. RESULTS: Substantial rates of behavioral health problems were found, with 20.6% screening positive for hazardous, harmful, and potentially alcohol-dependent drinking. Men had a higher proportion of positive screens, and also younger participants and those working in the field for a shorter duration (P < 0.001). Age group predicted Alcohol Use Disorders Identification Test scores; respondents 30 years of age or younger were more likely to have a higher score than their older peers (P < 0.001). Levels of depression, anxiety, and stress among attorneys were significant, with 28%, 19%, and 23% experiencing symptoms of depression, anxiety, and stress, respectively. CONCLUSIONS: Attorneys experience problematic drinking that is hazardous, harmful, or otherwise consistent with alcohol use disorders at a higher rate than other professional populations. Mental health distress is also significant. These data underscore the need for greater resources for lawyer assistance programs, and also the expansion of available attorney-specific prevention and treatment interventions.