K B Boomer

Examining the role of vocational rehabilitation on access to care and public health outcomes for people living with HIV/AIDS.

Abstract Purpose: The purpose of this study is to examine the role of vocational rehabilitation services in contributing to the goals of the National HIV/AIDS strategy. Three key research questions are addressed: (a) What is the relationship among factors associated with the use of vocational rehabilitation services for people living with HIV/AIDS? (b) Are the factors associated with use of vocational rehabilitation also associated with access to health care, supplemental employment services and reduced risk of HIV transmission? and (c) What unique role does use of vocational rehabilitation services play in access to health care and HIV prevention? Method: Survey research methods were used to collect data from a broad sample of volunteer respondents who represented diverse racial (37% Black, 37% White, 18% Latino, 7% other), gender (65% male, 34% female, 1% transgender) and sexual orientation (48% heterosexual, 44% gay, 8% bisexual) backgrounds. Results: The fit of the final structural equation model was good (root mean square error of approximation = 0.055), with 90% upper bound of 0.058, Comparative Fit Index = 0.953, TLI = 0.945). Standardized effects with bootstrap confidence intervals are reported. Conclusions: Overall, the findings support the hypothesis that vocational rehabilitation services can play an important role in health and prevention strategies outlined in the National HIV/AIDS strategy. Implications for Rehabilitation Vocational rehabilitation services can play a unique role in contributing to the goals of the National HIV/AIDS strategy by increasing access to care, increasing use of job support services and reducing health-risk behaviors. Increased job confidence and more positive health perception reduced HIV stigma, which is a key mediator to use of vocational rehabilitation services. The Behavioral Model of Vulnerable Populations is a useful framework to evaluate the impact of vocational rehabilitation services on access to health care and health-risk behaviors.

Is any job better than no job? Labor market experiences and depressive symptoms in people living with HIV

The purpose of this study is to determine the relationship between the psychosocial work environment and labor market experiences (including unemployment) on mental health among adults living with HIV. We used data provided by 538 participants at clinical and community sites across Ontario, Canada. Generalized estimating equation models showed that employment was associated with lower depressive symptoms. For employed participants, adverse psychosocial work conditions, specifically job insecurity, psychological demands, and decision authority were associated with depressive symptoms. For the entire sample, the number of adverse psychosocial work conditions was associated with higher depressive symptoms while participants working in poor quality jobs reported similar levels of depressive symptoms than those who were unemployed or not in the labor force. This study showed that poor quality employment (as assessed by having a high number of adverse psychosocial work exposures) was associated with a similar level of depressive symptoms as unemployment, suggesting that “bad jobs” may not offer the same mental health benefits as “good jobs.” Policies to improve employment outcomes should take the quality of employment into account to maximize mental health benefits as better employment may lead to better mental health.

Empirically Based Ground Truth Criteria for Seismic Events Recorded at Local Distances on Regional Networks with Application to Southern Africa

Wepresentanewapproachtoobtainingempiricallybased(EB)criteriafor estimating the epicentral location accuracy (i.e., ground truth, GT) of seismic events recorded at local distances on a regional network. The approach has been developed usinga jackknife resampling method appliedto carefully pickedPgphasearrivaltimes for GT reference events from several South African gold mines. The events were well recorded locally by Southern African Seismic Experiment (SASE) stations within the Archean Kaapvaal craton, an area of relatively simple crustal structure. The region- specific criteria obtained specify an EBGT395% level of epicentral accuracy if events are recorded on eight or more stations at distances less than the Pg=Pn crossover (215 km) when the stations have a primary azimuthal gap <202 degrees. In addition, when nine or more stations are used for event location and one of them is within 79 km of the event, we find that a focal depth accuracy of 4 km at the 95% confidence level can be obtained and that an accuracy of 6 km can be obtained if eight stations are used. This result illustrates that GT criteria commonly applied to global event catalogs can be relaxed if an accurate velocity model and carefully picked phase-arrival times are used for event locations. Consequently, it is likely that additional events can be added to GT compilations by developing EBGT criteria for other regional networks and using them to identify candidate GT events. For example, the EBGT criteria developed in this study, when applied to the SASE seismicity catalog, yields 10 new GT events.

From Craton to Rift: Empirically Based Ground-Truth Criteria for Local Events Recorded on Regional Networks

Region‐specific empirically based ground‐truth (EBGT) criteria used to estimate the epicentral‐location accuracy of seismic events have been developed for the Main Ethiopian Rift and the Tibetan plateau. Explosions recorded during the Ethiopia–Afar Geoscientific Lithospheric Experiment (EAGLE), the International Deep Profiling of Tibet, and the Himalaya (INDEPTH III) experiment provided the necessary GT0 reference events. In each case, the local crustal structure is well known and handpicked arrival times were available, facilitating the establishment of the location accuracy criteria through the stochastic forward modeling of arrival times for epicentral locations. In the vicinity of the Main Ethiopian Rift, a seismic event is required to be recorded on at least 8 stations within the local ![Graphic][1] crossover distance and to yield a network‐quality metric of less than 0.43 in order to be classified as EBGT595% (GT5 with 95% confidence). These criteria were subsequently used to identify 10 new GT5 events with magnitudes greater than 2.1 recorded on the Ethiopian Broadband Seismic Experiment (EBSE) network and 24 events with magnitudes greater than 2.4 recorded on the EAGLE broadband network. The criteria for the Tibetan plateau are similar to the Ethiopia criteria, yet slightly less restrictive as the network‐quality metric needs to be less than 0.45. Twenty‐seven seismic events with magnitudes greater than 2.5 recorded on the INDEPTH III network were identified as GT5 based on the derived criteria. When considered in conjunction with criteria developed previously for the Kaapvaal craton in southern Africa, it is apparent that increasing restrictions on the network‐quality metric mirror increases in the complexity of geologic structure from craton to plateau to rift. [1]: /embed/inline-graphic-1.gif

Validating the client-focused considering work model for people living with HIV and quantifying phases of change of commitment to work

Abstract The primary purpose of this study was to validate the client-focused considering work model and to gain a better understanding of the nature of the relationship among the four domains purported to influence the considering work process (medical, psychosocial, financial/legal and vocational). A second goal of the study was to quantify the relationship between these four domains and the phases of considering work (contemplation, preparation, action, resolution). Structural equation modeling was used to analyze data of 1702 diverse (43% Black, 31% White, 19% Latino 7% other) unemployed respondents who were recruited from AIDS Service Organizations (ASO) and networks across the United States to complete the National Working Positive Vocational Development and Employment Needs Survey (NWPC-VDENS). Overall the results of this study supported the validity of the client-focused considering work model and helped to provide a deeper level of understanding of the relationship among the domains of influence and their contribution to the level of commitment to the considering work process. Implications for Rehabilitation This model enables rehabilitation professionals to consider interventions for clients at different phases (contemplation, preparation, action) of considering work. Rehabilitation professionals are encouraged to provide prevocational services to engage people with HIV in the considering work process. When assisting PLWH within the considering work process, it is important to assess not only medical status but also psychosocial, financial and vocational concerns.

The Impact of Psychosocial Factors on Health and Retention Outcomes for People Living With HIV: Implications for Rehabilitation Counselors and Educators

Despite medical advancements that have significantly improved the health outcomes of people living with HIV (PLWH), many do not achieve optimal health outcomes due to psychosocial barriers. This 5-year retrospective longitudinal study draws upon the International Classification of Functioning, Disability, and Health (ICF) framework to conceptualize the relationships between personal and environmental factors and health and retention outcomes among a sample of 704 PLWH in Pennsylvania. A generalized estimated equations (GEE) model was used to model retention in care outcomes (at least one medical visit every 6 months) and a general linear mixed (GLM) model was used to analyze immune system health outcomes (CD4%). This exploratory study reveals that gender, age, race, use of antiretroviral (ARV) medications, use of case management service, mental health diagnosis, and alcohol use were significantly associated with retention in care, whereas race, ethnicity, gender, mental health treatment, use of ARV medications, use of case management services, and retention in care status were significantly associated with the immune system health outcome of CD4%. The results suggest a need for rehabilitation interventions to address key psychosocial issues, as rehabilitation counselors have a unique skill set to address the medical case management needs of individuals with HIV. Implications for rehabilitation counselors and educators are discussed.