Using Theory to Understand the Multiple Determinants of Low Participation in Worksite Health Promotion Programs

Low participation at the employee or worksite level limits the potential public health impact of worksite-based interventions. Ecological models suggest that multiple levels of influence operate to determine participation patterns in worksite health promotion programs. Most investigations into the determinants of low participation study the intrapersonal, interpersonal, and institutional influences on employee participation. Community- and policy-level influences have not received attention, nor has consideration been given to worksite-level participation issues. The purpose of this article is to discuss one macrosocial theoretical perspective—political economy of health—that may guide practitioners and researchers interested in addressing the community- and policy-level determinants of participation in worksite health promotion programs. The authors argue that using theory to investigate the full spectrum of determinants offers a more complete range of intervention and research options for maximizing employee and worksite levels of participation.

Treatment of lupus nephritis: art or science? [Editorial]

No Abstract

Adherence with naltrexone prescription advice in hospital outpatient alcohol rehabilitation programme

Background: The anti-craving drug, naltrexone, is used as a pharmacotherapeutic adjunct in the treatment of alcohol dependence. In addictive disorders, compliance issues remain central. There are limited data on compliance with naltrexone treatment regimens within formalized rehabilitation programs and even less data that identifies factors that have an impact on this. Objective: To study patient adherence to naltrexone medication regimens and examine whether patients' reported pre-treatment alcohol use, dependence severity and measures of psychological health are predictive of medication compliance. Method: Fifty outpatients meeting DSM IV criteria for alcohol dependence enrolled in 12-week rehabilitation programme. This included cognitive behavioural therapy (CBT) and naltrexone, 50 mg orally daily. Measures included: pharmacy prescription pick-up including number of tablets dispensed, programme attendance and patient pre-treatment alcohol use variables. Measures of psychological health included somatic symptoms, anxiety, social dysfunction and depression as measured by the General Health Questionnaire (GHQ-28). Results: Classifying the sample into compliant (greater than or equal to 90% medication pick-up) and less compliant groups, 66% of subjects were naltrexone-compliant. Pre-treatment alcohol use variables were not predictive of compliance. Although social dysfunction and depression tended towards poorer prescription filling, measures of psychological distress (GHQ-28) did not identify factors predictive of medication non-compliance. One patient withdrew from treatment because of naltrexone-induced dysphoria. Conclusion: Patients with alcohol dependence demonstrated high levels of anti-craving medication compliance, good rehabilitation programme participation and favourable outcomes. Naltrexone was well tolerated. Medication compliance in this study group compared well with those of other hospital populations with chronic disorders. Factors predictive of anti-craving medication compliance in alcohol dependence require further study.

Outpatient cognitive behavioural therapy programme for alcohol dependence impact of naltrexone use on outcome

Objective: Cognitive-behavioural therapy (CBT) has been effectively used in the treatment of alcohol dependence. Clinical studies report that the anticraving drug naltrexone, is a useful adjunct to treatment. Currently, few data are available on the impact of adding this medication to programmes in more typical, outpatient, and rehabilitation settings. The objective of this study was to examine the impact on outcome of adding naltrexone to an established outpatient alcohol rehabilitation program which employed CBT. Method: Fifty patients participated in an established 12-week, outpatient, 'contract'-based alcohol abstinence programme which employed CBT. They also received naltrexone 50 mg orally daily (CBT + naltrexone). Outcomes were compared with 50 historical, matched controls, all of whom participated in the same programme without an anticraving medication (CBT alone). All patients met DSM-IV criteria for alcohol dependence. Results: Programme attendance across the eight treatment sessions was lower in the CBT alone group (p < 0.001). Relapse to alcohol use occurred sooner and more frequently in the CBT alone group (p < 0.001). Rehabilitation programme completion at 12 weeks was 88% (CBT + naltrexone) compared with 36% for (CBT alone) (p < 0.001). Alcohol abstinence at 12 weeks was 76% (CBT + naltrexone) compared with 18% (CBT alone) (p < 0.001). Conclusion: When employing the same outpatient rehabilitation programme and comparing outcomes using matched historical controls, the addition of naltrexone substantially improves programme attendance, programme completion and reported alcohol abstinence. In a typical outpatient programme, naltrexone addition was associated with significantly improved programme participation, better outcomes and was well tolerated.

Highlights of drought policy and related science in Australia and the USA

Patterns of water supply and use in Australia and the U.S.A. differ in many ways. This results in different perceptions concerning the nature of drought and policy approaches to its management. This paper discusses the differences and similarities and explores lessons that policy makers in both countries can learn from one another. A key difference between the two countries is that whereas drought is perceived in Australia essentially in terms of its impact on agriculture, in the U.S. both perceptions and policy are also heavily influenced by the impact of drought on urban communities. This has led to different policy emphases. In 1992 Australia established its National Drought Policy; the U.S. is presently considering the adoption of a national drought policy. These policies highlight drought being accepted as part of natural climate variability, rather than as a natural disaster. They also emphasize the protection of the natural resource base.

Modern scientific methods and their potential in wastewater science and technology

Application of novel analytical and investigative methods such as fluorescence in situ hybridization, confocal laser scanning microscopy (CLSM), microelectrodes and advanced numerical simulation has led to new insights into micro-and macroscopic processes in bioreactors. However, the question is still open whether or not these new findings and the subsequent gain of knowledge are of significant practical relevance and if so, where and how. To find suitable answers it is necessary for engineers to know what can be expected by applying these modern analytical tools. Similarly, scientists could benefit significantly from an intensive dialogue with engineers in order to find out about practical problems and conditions existing in wastewater treatment systems. In this paper, an attempt is made to help bridge the gap between science and engineering in biological wastewater treatment. We provide an overview of recently developed methods in microbiology and in mathematical modeling and numerical simulation. A questionnaire is presented which may help generate a platform from which further technical and scientific developments can be accomplished. Both the paper and the questionnaire are aimed at encouraging scientists and engineers to enter into an intensive, mutually beneficial dialogue. (C) 2002 Elsevier Science Ltd. All rights reserved.

Energy intake and energy expenditure in elite lightweight female rowers

Purpose: The training program undertaken by many athletes will affect directly the total, habitual energy requirements of that individual. Unless that energy requirement is met via the diet and or supplementation, chronic negative energy balance will ensue, which will have both short-term and long-term effects not only on performance but also on general health. The aim of this research was therefore to determine the energy expenditure (EE) and hence energy requirements of lightweight female rowers and, further, to compare this with their self-reported energy intake (EI). Methods: The El of seven lightweight female rowers was measured using a self-reported 4-d weighed dietary record. EE was determined using the doubly labeled water (DLW) technique over a 14-d period. Results: The mean (+/-SD) age, height, and weight of the subjects was 20 (+/-1.1) yr, 168.8 (+/-4.7) cm, and 60.9 (+/-23) kg, respectively. The rowers self-reported El was 2214 (+/-313) kcal.d(-1) and their total EE was 3957 (+/-1219) kcal.d(-1). After adjusting total EE for changes in body weight (mean (+/-SD) - 1.2 (+/-1.2) kg), the comparison between adjusted El and reported showed a bias to underreporting of 1133 (+/-1539) kcal.d(-1) or 34%. The bias was not consistent across adjusted El, and two of the seven subjects overreported their intake. Conclusions: Due to the underreporting of EI, diet recording may not be an appropriate way of assessing energy requirements in lightweight female rowers. A benefit of accurately determining energy requirements, as with DLW, is that female lightweight rowers will be able to successfully manipulate their EI and achieve the set weight cut-off for participation without compromising their health or performance.

Planning for institutional capacity building in war-torn areas: the case of Jaffna, Sri Lanka

This paper examines an attempt to build capacity and empower local institutions in war-torn Jaffna,, on the northern tip of Sri Lanka. A participatory approach that is aimed at social empowerment is seen to be possible even under the most restrictive of political environments. However, whether or not the development intervention provides a foundation for longer-term improvement depends on the extent to which institutional capacity is built. Through an examination of the Jaffna Reconstruction Project, it is argued that if any of the ingredients of this institutional capacity are missing, not only will the 'islands of participation and empowerment' that are built by the development initiative be short-lived, but there may also be a negligible contribution to building a foundation for longer-term improvement in quality of life. (C) 2001 Elsevier Science Ltd. All rights reserved.

Beyond participation, hierarchies, management and markets: 'New' governance and place policies

This paper argues that a 'new local governance' discourse offers some promise as a policy framework that can re-conceptualise the state-community (and market) relationship and deliver improved community outcomes, particularly in the context of place based or spatial policies and programs.

Participation and older people: Meaning, theory and practice

Increasing older people's participation in society is important in ageing policies worldwide. There is a need to understand the challenges for health professionals of transforming policy on participation into liberating social change practices on the ground. This paper explores the meaning, theory and practice of participation. It uses the example of a work in progress project that has attempted to address structural barriers to older people's participation within an Australian aged care facility, to illustrate theoretical and practice principles surrounding participation.