Acceptability and use of coercive methods across differing service configurations with and without seclusion and/or psychiatric intensive care units

AIMS: To compare across different service configurations the acceptability of containment methods to acute ward staff and the speed of initiation of manual restraint. BACKGROUND: One of the primary remits of acute inpatient psychiatric care is the reduction of risks. Where risks are higher than normal, patients can be transferred to a psychiatric intensive care unit or placed in seclusion. The abolition or reduction of these two containment methods in some hospitals may trigger compensatory increases in other forms of containment which have potential risks. How staff manage risk without access to these facilities has not been systematically studied. DESIGN: The study applied a cross-sectional design. METHODS: Data were collected from 207 staff at eight hospital sites in England between 2013 - 2014. Participants completed two measures; the first assessing the acceptability of different forms of containment for disturbed behaviour and the second assessing decision making in relation to the need for manual restraint of an aggressive patient. RESULTS: In service configurations with access to seclusion, staff rated seclusion as more acceptable and reported greater use of it. Psychiatric intensive care unit acceptability and use were not associated with its provision. Where there was no access to seclusion, staff were slower to initiate restraint. There was no relationship between acceptability of manual restraint and its initiation. CONCLUSION: Tolerance of higher risk before initiating restraint was evident in wards without seclusion units. Ease of access to psychiatric intensive care units makes little difference to restraint thresholds or judgements of containment acceptability. This article is protected by copyright. All rights reserved

Work ethics and general work attitudes in adolescents are related to quality of life, sense of coherence and subjective health – a Swedish questionnaire study

BACKGROUND: Working life is an important arena in most people's lives, and the working line concept is important for the development of welfare in a society. For young people, the period before permanent establishment in working life has become longer during the last two decades. Knowledge about attitudes towards work can help us to understand young people's transition to the labour market. Adolescents are the future workforce, so it seems especially important to notice their attitudes towards work, including attitudes towards the welfare system. The aim of this study was to describe and analyse upper secondary school students' work attitudes, and to explore factors related to these attitudes. METHODS: The sample consisted of 606 upper secondary school students. They all received a questionnaire including questions about quality of life (QOL), sense of coherence (SOC), subjective health and attitudes towards work. The response rate was 91%. A factor analysis established two dimensions of work attitudes. Multivariate analyses were carried out by means of logistic regression models. RESULTS: Work ethics (WE) and general work attitudes (GWA) were found to be two separate dimensions of attitudes towards work. Concerning WE the picture was similar regardless of gender or study programme. Males in theoretical programmes appeared to have more unfavourable GWA than others. Multivariate analyses revealed that good QOL, high SOC and good health were significantly related to positive WE, and high SOC was positively related to GWA. Being female was positively connected to WE and GWA, while studying on a practical programme was positively related to GWA only. Among those who received good parental support, GWA seemed more favourable. CONCLUSION: Assuming that attitudes towards work are important to the working line concept, this study points out positive factors of importance for the future welfare of the society. Individual factors such as female gender, good QOL, high SOC and good health as well as support from both parents, positive experience of school and work contacts related positively to attitudes towards work. Further planning and supportive work have to take these factors into account

Psychosocial working conditions and the risk of depression and anxiety disorders in the Danish workforce

<p>Abstract</p> <p>Background</p> <p>To examine the risk of depressive and anxiety disorders according to psychosocial working conditions in a large population-based sample.</p> <p>Methods</p> <p>Job Exposure Matrix was applied to assess psychosocial working conditions in a population-based nested case-control study of 14,166 psychiatric patients, diagnosed with depressive or anxiety disorders during 1995–1998 selected from The Danish Psychiatric Central Research Register, compared with 58,060 controls drawn from Statistics Denmark's Integrated Database for Labour Market Research.</p> <p>Results</p> <p>Low job control was associated with an increased risk of anxiety disorders in men (IRR 1.40, 95% CI 1.24–1.58).</p> <p>In women an elevated risk of depression was related to high emotional demands (IRR 1.39, 95%CI 1.22–1.58) and to working with people (IRR 1.15, 95% CI 1.01–1.30). In both sexes high demands were associated with a decreased risk of anxiety disorders. There was a weak association between job strain and anxiety disorders in men (IRR 1.13, 95%, CI 1.02–1.25)</p> <p>Conclusion</p> <p>Psychosocial work exposures related to the risk of depressive and anxiety disorders differ as between the sexes. The pattern of risks is inconsistent. The results give rise to rethinking both study designs and possible causal links between work exposures and mental health.</p

Elevskador i ett arbetsmiljöperspektiv Vad kan vi lära av kommunbaserade skolstudier?

Examination of the research literature have been undertaken with regard to the registration and analysis of injuries to pupils at school. A frame of analysis based on a consensus within occupational-injury research is offered. The results point to potential risk groups, and also to hazardous locations and activities. The studies examined have primarily focused on the injury itself. Less attention has been paid to the causes of and circumstances underlying different kinds of injuries, and to the distinguishing features of community, school or pupil that might influence injury occurrence. Age and gender of pupils are the only exceptions. Further research should focus on the sequences of events culminating in injuries to school pupils, and to the situational and structural factors that govern these sequences.En granskning av svensk och internationell forskningslitteratur har genomförts med avseende på registrering och analys av elevskador i skolan inom en hel kommun. En analysram byggd på konsensus inom arbetsskadeforskningen bildar bas. Resultaten visar på potentiella riskgrupper, riskfyllda platser och aktiviteter. Studierna i granskningen fokuserar framförallt själva skadan; mindre uppmärksamhet riktas mot orsakerna till och omständigheterna bakom olika typer av skador och vilka utmärkande drag hos samhället, skolan och eleverna : förutom kön och ålder : som påverkar förekomsten av skador. Fortsatt forskning bör inriktas mot de händelseförlopp som ger upphov till elevskador och åt de situationella och strukturella faktorer som styr dessa förlopp

Skaderelaterade faktorer i skolmiljön Utveckling av ett instrument för registrering och analys av elevskador

The school constitutes an environment of public-health concern since it is the location of occurrence of a major proportion of injuries sustained by children. This paper reviews a total of 43 empirical studies dealing with the determinants and characteristics of injuries to school pupils. On the basis of the review, a proposal is made for a specialized instrument (SIIR) dedicated to the analysis and registration of injuries and incidents at school. It addresses the "who?", "where?" and "what?" questions usually posed in more traditional instruments for injury surveillance. The key novelty, however, lies in the fact that the SIIR places far greater emphasis on the "how?" and "why?" questions of injury. Accordingly, it allows them to be subjected to greater scrutiny, and is designed to provide support for preventive work at school level as well as for surveillance, and research and development.Skolan är ett område som är intressant ur folkhälsosynpunkt eftersom många skador som drabbar barn inträffar där. I denna artikel sammanfattas en inventering av 43 empiriska studier för att identifiera faktorer som är avgörande för och karaktäristiska hos elevskador. Med denna som grund utarbetades ett instrument (STAR) som kan användas för att registrera och analysera elevskador och tillbud i skolan. Instrumentet innehåller frågorna "vem?", "var?"- och "vad?", vilka vanligen ställs i mer traditionella instrument för skaderapportering. I STAR läggs dock större vikt vid frågorna "hur?" : och "varför?" skadan/tillbudet inträffade, vilket gör att de kan undersökas mycket noggrannare. Dessutom är det konstruerat för att stödja såväl förebyggande arbete i skolan som registrering och analys, forskning och utveckling