Functional and work disability and treatment received by patients with major depressive disorder

This study is one part of a collaborative depression research project, the Vantaa Depression Study (VDS), involving the Department of Mental and Alcohol Research of the National Public Health Institute, Helsinki, and the Department of Psychiatry of the Peijas Medical Care District (PMCD), Vantaa, Finland. The VDS includes two parts, a record-based study consisting of 803 patients, and a prospective, naturalistic cohort study of 269 patients. Both studies include secondary-level care psychiatric out- and inpatients with a new episode of major depressive disorder (MDD). Data for the record-based part of the study came from a computerised patient database incorporating all outpatient visits as well as treatment periods at the inpatient unit. We included all patients aged 20 to 59 years old who had been assigned a clinical diagnosis of depressive episode or recurrent depressive disorder according to the International Classification of Diseases, 10th edition (ICD-10) criteria and who had at least one outpatient visit or day as an inpatient in the PMCD during the study period January 1, 1996, to December 31, 1996. All those with an earlier diagnosis of schizophrenia, other non-affective psychosis, or bipolar disorder were excluded. Patients treated in the somatic departments of Peijas Hospital and those who had consulted but not received treatment from the psychiatric consultation services were excluded. The study sample comprised 290 male and 513 female patients. All their psychiatric records were reviewed and each patient completed a structured form with 57 items. The treatment provided was reviewed up to the end of the depression episode or to the end of 1997. Most (84%) of the patients received antidepressants, including a minority (11%) on treatment with clearly subtherapeutic low doses. During the treatment period the depressed patients investigated averaged only a few visits to psychiatrists (median two visits), but more to other health professionals (median seven). One-fifth of both genders were inpatients, with a mean of nearly two inpatient treatment periods during the overall treatment period investigated. The median length of a hospital stay was 2 weeks. Use of antidepressants was quite conservative: The first antidepressant had been switched to another compound in only about one-fifth (22%) of patients, and only two patients had received up to five antidepressant trials. Only 7% of those prescribed any antidepressant received two antidepressants simultaneously. None of the patients was prescribed any other augmentation medication. Refusing antidepressant treatment was the most common explanation for receiving no antidepressants. During the treatment period, 19% of those not already receiving a disability pension were granted one due to psychiatric illness. These patients were nearly nine years older than those not pensioned. They were also more severely ill, made significantly more visits to professionals and received significantly more concomitant medications (hypnotics, anxiolytics, and neuroleptics) than did those receiving no pension. In the prospective part of the VDS, 806 adult patients were screened (aged 20-59 years) in the PMCD for a possible new episode of DSM-IV MDD. Of these, 542 patients were interviewed face-to-face with the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN), Version 2.0. Exclusion criteria were the same as in the record-based part of the VDS. Of these, 542 269 patients fulfiled the criteria of DSM-IV MDE. This study investigated factors associated with patients' functional disability, social adjustment, and work disability (being on sick-leave or being granted a disability pension). In the beginning of the treatment the most important single factor associated with overall social and functional disability was found to be severity of depression, but older age and personality disorders also significantly contributed. Total duration and severity of depression, phobic disorders, alcoholism, and personality disorders all independently contributed to poor social adjustment. Of those who were employed, almost half (43%) were on sick-leave. Besides severity and number of episodes of depression, female gender and age over 50 years strongly and independently predicted being on sick-leave. Factors influencing social and occupational disability and social adjustment among patients with MDD were studied prospectively during an 18-month follow-up period. Patients' functional disability and social adjustment were alleviated during the follow-up concurrently with recovery from depression. The current level of functioning and social adjustment of a patient with depression was predicted by severity of depression, recurrence before baseline and during follow-up, lack of full remission, and time spent depressed. Comorbid psychiatric disorders, personality traits (neuroticism), and perceived social support also had a significant influence. During the 18-month follow-up period, of the 269, 13 (5%) patients switched to bipolar disorder, and 58 (20%) dropped out. Of the 198, 186 (94%) patients were at baseline not pensioned, and they were investigated. Of them, 21 were granted a disability pension during the follow-up. Those who received a pension were significantly older, more seldom had vocational education, and were more often on sick-leave than those not pensioned, but did not differ with regard to any other sociodemographic or clinical factors. Patients with MDD received mostly adequate antidepressant treatment, but problems existed in treatment intensity and monitoring. It is challenging to find those at greatest risk for disability and to provide them adequate and efficacious treatment. This includes great challenges to the whole society to provide sufficient resources.

Looking out of the void : Scaffolds to assist drama higher research degree students on the path to artist–scholar

In recent years, a number of Australian and international universities have offered the ability to complete postgraduate qualifications using the research frame known as creative practice as research. This has been particularly prevalent in the Drama discipline in the Creative Industries Faculty at Queensland University of Technology (QUT). There has been a noticeable shift away from students undertaking a traditional research Master of Arts (Research) or Doctor of Philosophy to a higher proportion of research higher degree students undertaking research through their creative work. The somewhat ephemeral nature of the theatre and performance practice can generate anxieties for students about how to best represent, analyse and discuss the creative practice within a theoretical frame. The argument in this paper is situated in the experience of two artist-scholars who undertook their studies at QUT while under principal supervision of the author and explores the research scaffolds that supervisors in Drama at QUT have developed to assist research higher degree students to navigate the tricky persona of artist–scholar.

Combinatorial Design of Secure Lightweight Data Dispersal Schemes (Work in Progress)

Dispersing a data object into a set of data shares is an elemental stage in distributed communication and storage systems. In comparison to data replication, data dispersal with redundancy saves space and bandwidth. Moreover, dispersing a data object to distinct communication links or storage sites limits adversarial access to whole data and tolerates loss of a part of data shares. Existing data dispersal schemes have been proposed mostly based on various mathematical transformations on the data which induce high computation overhead. This paper presents a novel data dispersal scheme where each part of a data object is replicated, without encoding, into a subset of data shares according to combinatorial design theory. Particularly, data parts are mapped to points and data shares are mapped to lines of a projective plane. Data parts are then distributed to data shares using the point and line incidence relations in the plane so that certain subsets of data shares collectively possess all data parts. The presented scheme incorporates combinatorial design theory with inseparability transformation to achieve secure data dispersal at reduced computation, communication and storage costs. Rigorous formal analysis and experimental study demonstrate significant cost-benefits of the presented scheme in comparison to existing methods.

A Combinatorial Construct for Keyless Message Dispersal (Work in Progress)

We propose a keyless and lightweight message transformation scheme based on the combinatorial design theory for the confidentiality of a message transmitted in multiple parts through a network with multiple independent paths, or for data stored in multiple parts by a set of independent storage services such as the cloud providers. Our combinatorial scheme disperses a message into v output parts so that (k-1) or less parts do not reveal any information about any message part, and the message can only be recovered by the party who possesses all v output parts. Combinatorial scheme generates an xor transformation structure to disperse the message into v output parts. Inversion is done by applying the same xor transformation structure on output parts. The structure is generated using generalized quadrangles from design theory which represents symmetric point and line incidence relations in a projective plane. We randomize our solution by adding a random salt value and dispersing it together with the message. We show that a passive adversary with capability of accessing (k-1) communication links or storage services has no advantage so that the scheme is indistinguishable under adaptive chosen ciphertext attack (IND-CCA2).

This is not the work

The exhibition THIS IS NOT THE WORK surveyed a selection of community-engaged artist projects from different locations around the world, and followed the pathways of women-centred social networks in order to initiate further collaboration and conversation. The projects documented in this exhibition were examples of artists working with women and community in challenging and unpredictable ways, demonstrating feminist sensibilities and a commitment to non-hierarchical and collective structures. Co-curated by the feminist art collective LEVEL, this exhibition project uses the gallery as a conceptual base-camp or frontline rather than a just site of display. The exhibition was developed and presented at The Block, Creative Industries Precinct, Queensland University of Technology in 2014. A co-authored paper about the project 'THIS IS NOT THE WORK – Feminist Collectives, Collaboration and Curating‘ was presented by members of LEVEL at the 'Feminist Curating: Contemporary Art and Feminism Symposium', Sydney College of the Arts, Sydney in October 2014.

Evaluation of collaborative assessment of work integrated learning

The international trend towards an increasingly standards-based approach to higher education and the resultant focus on the assurance of learning in tertiary programs have generated a strong emphasis on the assessment of outcomes across the higher education sector. In legal education, curriculum reform is highly prevalent internationally as a result of various reviews of legal education. As legal education focuses more on the attainment of a broader set of outcomes encompassing soft skills, capabilities and attributes, more authentic assessment will need to be developed appropriate to this new environment, meaning that modes of assessment with strong application in real-life settings should be preferred.

Corporate America And The New Luminous Environment: Kelly’s work with Johnson, Mies, and Noyes

[book] The potential of electric light as a new building “material” was recognized in the 1920s and became a useful design tool by the mid-century. Skillful lighting allowed for theatricality, narrative, and a new emphasis on structure and space. The Structure of Light tells the story of the career of Richard Kelly, the field’s most influential figure. Six historians, architects, and practitioners explore Kelly’s unparalleled influence on modern architecture and his lighting designs for some of the 20th century’s most iconic buildings: Philip Johnson’s Glass House; Louis Kahn’s Kimbell Art Museum; Eero Saarinen’s GM Technical Center; and Mies van der Rohe’s Seagram Building, among many others. This beautifully illustrated history demonstrates the range of applications, building types, and artistic solutions he employed to achieve a “nocturnal modernity” that would render buildings evocatively different at night. The survival of Kelly’s rich correspondence and extensive diaries allows an in-depth look at the triumphs and uncertainties of a young profession in the making. The first book to focus on the contributions of a master in the field of architectural lighting, this fascinating volume celebrates the practice’s significance in modern design.

The hard work of leisure: Healthy life, activewear and Lorna Jane

Since the 2000s activewear has grown as a fashion category, and the tropes of gym wear – leggings, leotards and block colours – have become fashionable attire for both men and women outside the gym. This article examines the rise of activewear in the context of an on-going dialogue between fashion and sport since the beginning of the twentieth century. Through an analysis of the Australian activewear label, Lorna Jane, we consider the fashionable female body as both the object and subject of a consumer culture that increasingly overlays leisure with fashion. Activewear can be seen as the embodiment of an active and fashionable lifestyle that is achieved through a regime of self-discipline, and that symbolizes the pleasure in attaining and displaying the healthy and fit body.

The selection, optimization, and compensation model in the work context: A systematic review and meta-analysis of two decades of research

Over the past two decades, the selection, optimization, and compensation (SOC) model has been applied in the work context to investigate antecedents and outcomes of employees' use of action regulation strategies. We systematically review, meta-analyze, and critically discuss the literature on SOC strategy use at work and outline directions for future research and practice. The systematic review illustrates the breadth of constructs that have been studied in relation to SOC strategy use, and that SOC strategy use can mediate and moderate relationships of person and contextual antecedents with work outcomes. Results of the meta-analysis show that SOC strategy use is positively related to age (rc = .04), job autonomy (rc = .17), self-reported job performance (rc = .23), non-self-reported job performance (rc = .21), job satisfaction (rc = .25), and job engagement (rc = .38), whereas SOC strategy use is not significantly related to job tenure, job demands, and job strain. Overall, our findings underline the importance of the SOC model for the work context, and they also suggest that its measurement and reporting standards need to be improved to become a reliable guide for future research and organizational practice.

Social work in a hospital emergency department

This paper describes how a Hospital Social Work Department's Emergency Team has attempted to provide a crisis and out-of-hours service to its Emergency Department. Through a staffing commitment to extensive evening and weekend cover, the Emergency Team's social worker is able to provide an immediate intervention and assessment service to problems. This has resulted in early detection and treatment of the non-medical aspects of a patient's problem and appropriate referral to other agencies for longer-term follow-up.

A model of social work classification in health care

The introduction of casemix funding for Australian acute health care services has challenged Social Work to demonstrate clear reporting mechanisms, demonstrate effective practice and to justify interventions provided. The term 'casemix' is used to describe the mix and type of patients treated by a hospital or other health care services. There is wide acknowledgement that the procedure-based system of Diagnosis Related Groupings (DRGs) is grounded in a medical/illness perspective and is unsatisfactory in describing and predicting the activity of Social Work and other allied health professions in health care service delivery. The National Allied Health Casemix Committee was established in 1991 as the peak body to represent allied health professions in matters related to casemix classification. This Committee has pioneered a nationally consistent, patient-centred information system for allied health. This paper describes the classification systems and codes developed for Social Work, which includes a minimum data set, a classification hierarchy, the set of activity (input) codes and 'indicator for intervention' codes. The advantages and limitations of the system are also discussed.

Asking the critical questions: An evaluation of social work students' experiences in an international placement

Preparing social work students for the demands of changing social environments and to promote student mobility and interest in overseas employment opportunities have resulted in an increasing demand for international social work placements. The literature describes numerous examples of social work programmes that offer a wide variety of international placements. However, research about the actual benefit of undertaking an overseas placement is scant with limited empirical evidence on the profile of students participating, their experience of the tasks offered, the supervisory practice and the outcomes for students' professional learning and career. This study contributes to the existing body of literature by exploring the relevance of international field placements for students and is unique in that it draws its sample from students who have graduated so provides a distinctive perspective in which to compare their international placement with their other placement/s as well as evaluating what were the benefits and drawbacks for them in terms of their careers, employment opportunities and current professional practice.

Work Stress in the Nursing Profession : An Evaluation of Organizational Causal Attribution

The goal of this study was to examine the role of organizational causal attribution in understanding the relation of work stressors (work-role overload, excessive role responsibility, and unpleasant physical environment) and personal resources (social support and cognitive coping) to such organizational-attitudinal outcomes as work engagement, turnover intention, and organizational identification. In some analyses, cognitive coping was also treated as an organizational outcome. Causal attribution was conceptualized in terms of four dimensions: internality-externality, attributing the cause of one’s successes and failures to oneself, as opposed to external factors, stability (thinking that the cause of one’s successes and failures is stable over time), globality (perceiving the cause to be operative on many areas of one’s life), and controllability (believing that one can control the causes of one’s successes and failures). Several hypotheses were derived from Karasek’s (1989) Job Demands–Control (JD-C) model and from the Job Demands–Resources (JD-R) model (Demerouti, Bakker, Nachreiner & Schaufeli, 2001). Based on the JD-C model, a number of moderation effects were predicted, stating that the strength of the association of work stressors with the outcome variables (e.g. turnover intentions) varies as a function of the causal attribution; for example, unpleasant work environment is more strongly associated with turnover intention among those with an external locus of causality than among those with an internal locuse of causality. From the JD-R model, a number of hypotheses on the mediation model were derived. They were based on two processes posited by the model: an energy-draining process in which work stressors along with a mediating effect of causal attribution for failures deplete the nurses’ energy, leading to turnover intention, and a motivational process in which personal resources along with a mediating effect of causal attribution for successes foster the nurses’ engagement in their work, leading to higher organizational identification and to decreased intention to leave the nursing job. For instance, it was expected that the relationship between work stressors and turnover intention could be explained (mediated) by a tendency to attribute one’s work failures to stable causes. The data were collected from among Finnish hospital nurses using e-questionnaires. Overall 934 nurses responded the questionnaires. Work stressors and personal resources were measured by five scales derived from the Occupational Stress Inventory-Revised (Osipow, 1998). Causal attribution was measured using the Occupational Attributional Style Questionnaire (Furnham, 2004). Work engagement was assessed through the Utrecht Work Engagement Scale (Schaufeli & al., 2002), turnover intention by the Van Veldhoven & Meijman (1994) scale, and organizational identification by the Mael & Ashforth (1992) measure. The results provided support for the function of causal attribution in the overall work stress process. Findings related to the moderation model can be divided into three main findings. First, external locus of causality along with job level moderated the relationship between work overload and cognitive coping. Hence, this interaction was evidenced only among nurses in non-supervisory positions. Second, external locus of causality and job level together moderated the relationship between physical environment and turnover intention. An opposite pattern of interaction was found for this interaction: among nurses, externality exacerbated the effect of perceived unpleasantness of the physical environment on turnover intention, whereas among supervisors internality produced the same effect. Third, job level also disclosed a moderation effect for controllability attribution over the relationship between physical environment and cognitive coping. Findings related to the mediation model for the energetic process indicated that the partial model in which work stressors have also a direct effect on turnover intention fitted the data better. In the mediation model for the motivational process, an intermediate mediation effect in which the effects of personal resources on turnover intention went through two mediators (e.g., causal dimensions and organizational identification) fitted the data better. All dimensions of causal attribution appeared to follow a somewhat unique pattern of mediation effect not only for energetic but also for motivational processes. Overall findings on mediation models partly supported the two simultaneous underlying processes proposed by the JD-R model. While in the energetic process the dimension of externality mediated the relationship between stressors and turnover partially, all the dimensions of causal attribution appeared to entail significant mediator effects in the motivational process. The general findings supported the moderation effect and the mediation effect of causal attribution in the work stress process. The study contributes to several research traditions, including the interaction approach, the JD-C, and the JD-R models. However, many potential functions of organizational causal attribution are yet to be evaluated by relevant academic and organizational research. Keywords: organizational causal attribution, optimistic / pessimistic attributional style, work stressors, organisational stress process, stressors in nursing profession, hospital nursing, JD-R model, personal resources, turnover intention, work engagement, organizational identification.

The relationships between work stressors and organizational performance in long-term care for elderly residents

This study investigates the relationships between work stressors and organizational performance in terms of the quality of care provided by the long-term care facilities. Work stressors are first examined in relation to the unit's structural factors, resident characteristics, and to the unit specialization. The study is completed by an investigation into the associations of work stressors such as job demands or time pressure, role ambiguity, resident-related stress, and procedural injustice to organizational performance. Also the moderating effect of job control in the job demands organizational performance relationship is examined. The study was carried out in the National Research and Development Centre for Welfare and Health (STAKES). Survey data were drawn from 1194 nursing employees in 107 residential-home and health-center inpatient units in 1999 and from 977 employees in 91 units in 2002. Information on the unit resident characteristics and the quality of care was provided by the Resident Assessment Instrument (RAI). The results showed that large unit size or lower staffing levels were not consistently related to work stressors, whereas the impairments in residents' physical functioning in particular initiated stressful working conditions for employees. However, unit specialization into dementia and psychiatric residents was found to buffer the effects that the resident characteristics had on employee appraisals of work stressors, in that a high proportion of behavioral problems was related to less time pressure and role conflicts for employees in specialized units. Unit specialization was also related to improved team climates and the organizational commitment of employees. Work stressors associated with problems in care quality. Time pressure explained most of the differences between units in how the employees perceived the quality of physical and psychosocial care they provide for the residents. A high level of job demands in the unit was also found to be related to some increases in all clinical quality problems. High job control buffered the effects of job demands on the quality of care in terms of the use of restraints on elderly residents. Physical restraint and especially antipsychotic drug use were less prevalent in units that combined both high job demands and high control for employees. In contrast, in high strain units where heavy job demands coincided with a lack of control for employees, quality was poor in terms of the frequent use of physical restraints. In addition, procedural injustice was related to the frequent use of antianxiety of hypnotic drugs for elderly residents. The results suggest that both job control and procedural justice may have improved employees' abilities to cope when caring for the elderly residents, resulting in better organizational performance.