Will more education work?

Clinicians practicing occupational medicine are increasingly confronted with patients who have complex illnesses with chronic nonspecific symptoms. Most clinicians use the traditional tools of biomedicine to diagnose and treat the illness, determine etiology, and assess disability. This article argues that the biomedical approach is inadequate to effectively evaluate and treat occupational illness. After reviewing several critiques of biomedicine, including biopsychosocial, feminist, class, and critical theory/postmodern perspectives, the author offers an alternative approach that builds on aspects of these perspectives as well as the “popular education” work of Paulo Freire. Constraints on, and possibilities for, the development of an alternative approach that attempts to build patients' capacities for transformative action are explored.

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Mieleltään haavoittuneet

Kuntoutus ◽

10.37451/kuntoutus.111700 ◽

2021 ◽

Vol 44 (3) ◽

pp. 36-48

Author(s):

Johanna Vilppola ◽

Markku Vanttaja

Keyword(s):

Mental Health ◽

Life Stories ◽

Life Story ◽

Rehabilitation Process ◽

Societal Factors ◽

Health Related ◽

Health Rehabilitation ◽

Mental Health Rehabilitation ◽

Intentions To Participate ◽

Education Work

Mielenterveyssyistä johtuvat sairauspoissaolot ja työkyvyttömyyseläkkeet ovat lisääntyneet Suomessa viime vuosikymmeninä. Sen vuoksi on tarpeen tutkia mielenterveyskuntoutujien yksilöllisiä elämäntilanteita sekä heidän kuntoutumistaan ja kiinnittymistään yhteiskuntaan. Tässä artikkelissa tarkastellaan mielenterveyskuntoutujien kuntoutusprosessia erityisesti koulutus- ja työtoimijuuden näkökulmasta. Tutkimusaineistona käytetään aikuisten mielenterveyskuntoutujien kirjoittamia elämänkerrontoja (n = 42). Elämänkerrontojen teema-analyysin ja tyypittelyn perusteella kirjoittajat jaettiin kolmeen erilaiseen ryhmään, jotka nimettiin toimijoiksi (9), taistelijoiksi (18) ja tipahtaneiksi (15). Toimijat olivat aktiivisia oman kuntoutumisensa, koulutuksensa, työnsä sekä kokonaiselämänsä suhteen. Heillä oli vahva pyrkimys hakeutua koulutukseen, palata takaisin työelämään tai ylläpitää nykyinen koulutus- ja työtilanteensa. Taistelijat olivat puolestaan omassa kuntoutusprosessissaan matkalaisia, jotka halusivat olla yhteiskunnan tarpeellisia jäseniä. Myös heillä oli koulutukseen ja työhön liittyviä haaveita, mutta keinot oman elämän hallitsemiseksi olivat toisten ihmisten tuen varassa. Tipahtaneet olivat luovuttaneet sekä oman kuntoutumisensa että koulutus- ja työtoimijuutensa suhteen. Heillä ei ollut enää koulutukseen tai työhön liittyviä tavoitteita. Abstract Mentally wounded. Research of Education and Work Agency of Mental Health Rehabilitees Mental health related sick leaves and early pensions have increased enormously in our society in the last decades. That is why it is important to study the life narratives of mental health rehabilitees, especially focusing on individual and societal factors connected to rehabilitation, education and work agency. The data of this research consisted of 42 self-written life stories of adult mental health rehabilitees. Based on theme analysis and typification, life stories were divided into three groups: agentic actors (9), warriors (18) and dropouts (15). Agentic actors were described as active agents of their own rehabilitation, education, work and life. They had strong intentions to participate in education and work. Warriors seemed to be more like passengers in their own rehabilitation process, yet they had intentions to be a necessary part of society. They had hopes and dreams towards education and work, but they seemed to be lacking concrete means to lead their independent lives. The dropouts had given up on their agency in rehabilitation, education and work. They had no more goals or intentions concerning education and work. Keywords: mental health rehabilitation, life story, education, work, agency

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Abstract 90: Socioeconomic Status Is Associated With Disability Following Acute Ischemic Stroke: Findings From The Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) Registry

Stroke ◽

10.1161/str.43.suppl_1.a90 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Janet Prvu Bettger ◽

Xin Zhao ◽

Cheryl Bushnell ◽

Louise Zimmer ◽

Ying Xian ◽

...

Keyword(s):

Socioeconomic Status ◽

Ischemic Stroke ◽

Household Income ◽

Work Status ◽

Stroke Patients ◽

Level Of Education ◽

Post Stroke ◽

Relationship Of ◽

The Relationship ◽

Education Work

Background: Socioeconomic status (SES) is widely recognized as an area of inequity that affects health outcomes. However, social determinants of health are less frequently measured in longitudinal studies of acute stroke patients. The relationship of SES on disability 3-months post-stroke is unknown. Methods: We analyzed ischemic stroke patients in the AVAIL registry who were enrolled at 98 hospitals participating in Get With The Guidelines-Stroke. Patients who died (n=64) or did not complete a modified Rankin Scale (mRS) at 3-months (n=154) were excluded. Multivariable logistic regression was used to examine the relationship of SES (defined by level of education, work status, and perceived adequacy of household income to meet needs) and disability (mRS scores 3-5). Results: Among the 2092 stroke patients who met eligibility criteria, the mean age was 65.5 ± 13.7, 44.2% were female, and 82.7% were White. Fifty seven percent had a high school or less education, 11.4% were not working post-stroke and were home not by choice, and 25.7% were without an adequate household income. A third of the sample had some level of disability at 3-months (34.6% mRS 3-5). Those with disability were more likely to be older, non-White, female, single, less educated, have inadequate income, and were home not by choice. In the multivariable analysis, lower education, inadequate income, and being home but not by choice (compared with those who returned to work) were independently associated with disability (p<0.01; Table ). Conclusion: In this national cohort of stroke survivors, socioeconomic status as measured by level of education, work status, and income were independently associated with post-stroke disability.

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