A focused ethnographic study of women in recovery from alcohol abuse

Alcohol abuse and its related problems are among the most pervasive health and social concerns in the United States (U.S.) today. Women are especially vulnerable to the physical and social devastation of alcohol abuse. Yet, although there is extensive research about alcohol drinking patterns, treatment strategies, and early recovery, there is little information about the factors that facilitate successfully sustained abstinence in women. The purpose of this study was to examine and describe the common factors to successful recovery from alcohol abuse among women and to place these factors within both the context of their social networks and the larger social environment. This study draws from the population of New Mexico, where alcohol-related deaths are the highest of any state in the U.S. and the leading cause of death for individuals under the age of 65 years. The study was a focused ethnography of women who had successfully maintained long-term recovery from alcohol abuse. As an ethnographic study, data collection included participant observation, in-depth interviews with 21 women, and the collection of historical and current culturally relevant data. A purposive sampling plan was used to maximize the selection of participants who had used traditional and non-traditional approaches to recovery. As such, the analysis of the success narratives revealed two distinct findings: the first that women used several different trajectories to achieve long-term recovery. Three trajectory typologies were identified from the success narratives and labeled, A.A. as ceremony, A.A. as grounding, and Recovery as self-management. ^ However, within each of these trajectories, variations in successful recovery were seen. The second major finding was that all women articulated an overarching theme of connections as an indispensable aspect of sustained recovery. The success narratives demonstrated the powerful role that connections played in their long-term recovery and the analysis distinguished two unifying concepts of connections—those that focused beyond self (spirituality, social support, and pets) and those that focused toward self (self-nurturance, agency, and identity). This discussion will focus on the implications for clinical practice related to both women who are still actively abusing alcohol and for those who are successfully maintaining long-term recovery. ^

The role of workplace absence as an organizational mechanism in predicting employee alcohol and drug disorders

Background. EAP programs for airline pilots in companies with a well developed recovery management program are known to reduce pilot absenteeism following treatment. Given the costs and safety consequences to society, it is important to identify pilots who may be experiencing an AOD disorder to get them into treatment. ^ Hypotheses. This study investigated the predictive power of workplace absenteeism in identifying alcohol or drug disorders (AOD). The first hypothesis was that higher absenteeism in a 12-month period is associated with higher risk that an employee is experiencing AOD. The second hypothesis was that AOD treatment would reduce subsequent absence rates and the costs of replacing pilots on missed flights. ^ Methods. A case control design using eight years (time period) of monthly archival absence data (53,000 pay records) was conducted with a sample of (N = 76) employees having an AOD diagnosis (cases) matched 1:4 with (N = 304) non-diagnosed employees (controls) of the same profession and company (male commercial airline pilots). Cases and controls were matched on the variables age, rank and date of hire. Absence rate was defined as sick time hours used over the sum of the minimum guarantee pay hours annualized using the months the pilot worked for the year. Conditional logistic regression was used to determine if absence predicts employees experiencing an AOD disorder, starting 3 years prior to the cases receiving the AOD diagnosis. A repeated measures ANOVA, t tests and rate ratios (with 95% confidence intervals) were conducted to determine differences between cases and controls in absence usage for 3 years pre and 5 years post treatment. Mean replacement costs were calculated for sick leave usage 3 years pre and 5 years post treatment to estimate the cost of sick leave from the perspective of the company. ^ Results. Sick leave, as measured by absence rate, predicted the risk of being diagnosed with an AOD disorder (OR 1.10, 95% CI = 1.06, 1.15) during the 12 months prior to receiving the diagnosis. Mean absence rates for diagnosed employees increased over the three years before treatment, particularly in the year before treatment, whereas the controls’ did not (three years, x = 6.80 vs. 5.52; two years, x = 7.81 vs. 6.30, and one year, x = 11.00cases vs. 5.51controls. In the first year post treatment compared to the year prior to treatment, rate ratios indicated a significant (60%) post treatment reduction in absence rates (OR = 0.40, CI = 0.28, 0.57). Absence rates for cases remained lower than controls for the first three years after completion of treatment. Upon discharge from the FAA and company’s three year AOD monitoring program, case’s absence rates increased slightly during the fourth year (controls, x = 0.09, SD = 0.14, cases, x = 0.12, SD = 0.21). However, the following year, their mean absence rates were again below those of the controls (controls, x = 0.08, SD = 0.12, cases, x¯ = 0.06, SD = 0.07). Significant reductions in costs associated with replacing pilots calling in sick, were found to be 60% less, between the year of diagnosis for the cases and the first year after returning to work. A reduction in replacement costs continued over the next two years for the treated employees. ^ Conclusions. This research demonstrates the potential for workplace absences as an active organizational surveillance mechanism to assist managers and supervisors in identifying employees who may be experiencing or at risk of experiencing an alcohol/drug disorder. Currently, many workplaces use only performance problems and ignore the employee’s absence record. A referral to an EAP or alcohol/drug evaluation based on the employee’s absence/sick leave record as incorporated into company policy can provide another useful indicator that may also carry less stigma, thus reducing barriers to seeking help. This research also confirms two conclusions heretofore based only on cross-sectional studies: (1) higher absence rates are associated with employees experiencing an AOD disorder; (2) treatment is associated with lower costs for replacing absent pilots. Due to the uniqueness of the employee population studied (commercial airline pilots) and the organizational documentation of absence, the generalizability of this study to other professions and occupations should be considered limited. ^ Transition to Practice. The odds ratios for the relationship between absence rates and an AOD diagnosis are precise; the OR for year of diagnosis indicates the likelihood of being diagnosed increases 10% for every hour change in sick leave taken. In practice, however, a pilot uses approximately 20 hours of sick leave for one trip, because the replacement will have to be paid the guaranteed minimum of 20 hour. Thus, the rate based on hourly changes is precise but not practical. ^ To provide the organization with practical recommendations the yearly mean absence rates were used. A pilot flies on average, 90 hours a month, 1080 annually. Cases used almost twice the mean rate of sick time the year prior to diagnosis (T-1) compared to controls (cases, x = .11, controls, x = .06). Cases are expected to use on average 119 hours annually (total annual hours*mean annual absence rate), while controls will use 60 hours. The cases’ 60 hours could translate to 3 trips of 20 hours each. Management could use a standard of 80 hours or more of sick time claimed in a year as the threshold for unacceptable absence, a 25% increase over the controls (a cost to the company of approximately of $4000). At the 80-hour mark, the Chief Pilot would be able to call the pilot in for a routine check as to the nature of the pilot’s excessive absence. This management action would be based on a company standard, rather than a behavioral or performance issue. Using absence data in this fashion would make it an active surveillance mechanism. ^

Pediatric obesity: Managed care collaborating with providers to improve diagnosis and treatment

Child overweight and obesity reaches across ethnic, cultural, socioeconomic and regional barriers. It must be assessed, diagnosed and treated to help families make sustainable behavior changes. Treatment recommendations have been made to address pediatric overweight and obesity. They include screening for risk factors, monitoring BMI trends and educating patients and families to make small sustainable changes. Health insurance companies can play a meaningful role in supporting and facilitating provider education and behavior change to diagnose, treat and prevent pediatric overweight and obesity.^ The aims of this thesis were: (1) Describe a disease management program that uses evidence-based practices to create provider behavior change related to pediatric obesity screening, diagnosis and treatment. (2) Identify ways to improve the implementation of the program based on the perceptions of participating clinicians.^ A literature review was completed to evaluate current recommendations for screening and treating pediatric obesity using the Ovid data base. The evidenced-based recommendations were compared against the practices of the Healthy Lifestyles Program (HeLP). The literature confirmed that HeLP is following evidence-based recommendations for assessment, diagnosis and treatment of pediatric obesity.^ A Children’s Mercy Family Health Partners focus group was convened to create a provider survey. The goals of the survey were to assess providers’ perception of the Healthy Lifestyles Program (HeLP). The survey was sent out through email using Survey Monkey. All survey responses were anonymous. The survey was sent to a total of 80 providers who had completed HeLP. Twenty-five percent responded. The survey results were evaluated to make recommendations for HeLP.^ Results of the survey included motivating factors for participation in HeLP. Concern about the increasing prevalence of pediatric obesity was a frequent motivator for participation. Provider barriers to obesity diagnosis were evaluated. Lack of time during clinic visits a frequent barrier to obesity diagnosis. ^ In conclusion several recommendations for the HeLP were made based on survey results. It is recommended that the program evaluate methods and tools for facilitating effective weight management follow up visits. Promotional materials should highlight the increasing prevalence of pediatric obesity when advertising HeLP. These recommendations will be used to refine the current Healthy Lifestyles Program.^

Goals, plans, and behavior changes: A relevant part of the post-treatment cancer experience

Background. Colorectal cancer (CRC) survivors have to manage treatment side effects, psychosocial issues, and co-morbidities, as well as modify their lifestyles to decrease risk of recurrence and prolong life. Identifying survivors’ goals and key factors that influence their goals will highlight the issues cancer survivors face post-treatment and the resources needed to help them engage in health-promoting behaviors.^ Objectives and methods. This dissertation examines the health-related goals of post-treatment CRC survivors using two studies: (1) a qualitative study to identify and describe the health goals of CRC survivors during the transition from active treatment to post-treatment survivorship and follow-up care; and (2) a cross-sectional survey to identify CRC survivors’ goals, and key factors that influence their goals.^ Results. (1) The 41 qualitative interviews indicated participants’ health-related goals were to be healthy, get back to normal, and not have a cancer recurrence. Most of the CRC survivors reported they maintained healthy behaviors, made healthy behavior changes, or had goals to change their behavior. Respondents were empowered to improve their health by maintaining follow-up care and regular health screenings, and many were managing treatment side effects in an effort to improve functional abilities. (2) The cross-sectional study found that CRC survivors’ most prevalent goals were related to healthy behaviors (i.e., eat a healthy diet and engage in physical activity), and cancer care or disease management (i.e., keep up with health screenings and monitor symptoms). Goals that survivors identified as important were similar to goals they perceived were important to their providers (i.e., goals related to cancer care, disease management). Certain goals were statistically associated with age, barriers to achieving goals, social support and health-related quality of life.^ Conclusions. CRC survivors have health-promoting goals post-treatment and are interested in making health behavior changes. Goals ranged from cancer care/surveillance and disease management to healthy lifestyle modifications. Patients may need help resolving or managing treatment side effects or co-morbidities prior to implementing health promoting behaviors. Healthcare providers’ recommendations may be a powerful resource to encourage survivors to engage in health-promoting behaviors. Self-management and goal setting support could be an appropriate strategy to assist patients with achieving their post-treatment health goals.^

Nonpurging binge eaters versus nonbinge eaters and treatment retention for adult obesity

Dropout from obesity treatment has been a major factor associated with weight control failure, with few reliable predictors of dropouts or completers. Previous studies have tended to treat obese people as a homogeneous group with standard behavior modification-based interventions. Current research indicates there may be subgroups within the obese population, binge eaters and nonbinge eaters, who have different dropout rates. Current studies also recommend focusing on the subset of this subgroup that does not engage in purging (vomiting, laxative abuse, or excessive exercise) to compensate for binge eating. This research uses a secondary dataset (N = 156) from a prospective study in which participants were randomized to a Food Dependency (FD) and a Behavioral Self-Management (BSM) group for weight reduction. Criteria for subjects in the original study included (1) scoring higher on the existing Binge Eating Scale (BES) in order to ensure enrollment of more binge eaters and (2) no compensatory purging behavior for binge eating. Subjects were then reclassified in this study as binge eaters or nonbinge eaters using the more stringent proposed 1994 DSM-IV criteria for Binge Eating Disorder (BED). Subjects were followed for dropout. Variables studied were binge status, age at obesity onset, age at study baseline, class instructor, number of previous weight loss attempts, race, marital status, body mass index (BMI kg/m$\sp2$), type of intervention, work status, educational level, and social support. Stepwise backward regression Cox survival analysis indicated binge status had a consistent, statistically significant protective effect on dropout in which binge eaters were half as likely to dropout versus nonbinge eaters (p = 0.04). Cox proportional hazards analysis indicated no statistical difference in dropout by type of intervention (FD, p = 0.13; BSM, p = 0.80) when controlling for binge status. All other variables did not reach significance, which is consistent with the literature. Implications of these findings suggest that (1) the proposed 1994 DSM-IV criteria for BED is a more useful classification that the existing DSM-III-R criteria, and (2) the identification of subgroups among obese subjects is an important step in dropout and weight loss intervention research. Future research can confirm this finding. ^

Evaluation of web-based resources for HIV+ youth

Given current rates of the Human Immunodeficiency Virus (HIV) in youth ages 15–24, comprehensive care is imperative in order to manage the virus and to prevent further transmission. In the past decade, the Internet has become an immensely popular source for information, including health information. Due to the increase in Internet use for this purpose, the assessment of the quality, accuracy, and timeliness of health information on the Internet is necessary since the information delivered may not be current or accurate. The purpose of this study was to determine the quantity and quality of websites containing health information and resources directed specifically towards HIV positive youth. Three general search terms, “HIV + teens”, “HIV teens info”, and “HIV infected teens,” were searched using the current top three search engines: Google, Yahoo!, and MSN/Bing. The first hundred hits of each search were then categorized by type of website. The examination of the search results yielded 7 sites that met the inclusion criteria. These sites were consequently evaluated on functionality and content using an adapted version of a pre-existing instrument. The functionality analysis revealed that no websites that contained self management information were dedicated specifically to HIV positive youth. The content analysis showed that the sites chosen for evaluation were mostly consistent with the guidelines provided by the Department of Health and Human Services. The most discussed topics in the sites included the importance of safer sexual behavior, HIV counseling, partner notification, safer behavior choices, such as condom use, and mental health. These results highlight the need for the development of accessible websites that contain accurate information targeting youth infected with HIV. This study provides a snapshot of the available web-based resources and health information for HIV positive youth, and is relevant for health educators, care providers, researchers, and others intervening with HIV+ youth. ^

Construcción de alternativas para el desarrollo autogestionado y sustentable a partir de la investigación acción participación en el asentamiento informal 'El milagro de Dios' Armenia-Colombia

El municipio de Armenia en Colombia, se proyecta como un 'Territorio Amable y de Oportunidades para la Vida' donde aproximadamente 10 mil de sus 300 mil habitantes viven en asentamientos humanos informales, 34 de los cuales se encuentran en terrenos con riesgo cualitativo alto, lo que genera condiciones de exclusión, pobreza y marginalización. Siendo la academia un actor del desarrollo territorial, desde el enfoque metodológico de la Inteligencia Territorial invita al sector público, a los empresarios y a la comunidad para dar una nueva mirada sobre estos asentamientos con el fin de plantear alternativas que tengan en cuenta las potencialidades y recursos de estas comunidades, permitiendo que sus habitantes pasen de ser objeto a sujetos de su propio desarrollo. Dentro de los resultados alcanzados se pueden destacar el diagnóstico situacional del desarrollo y la calidad de vida en esta comunidad (Identidades); la identificación de las principales problemáticas (Necesidades) y la priorización de alternativas de solución autogestionada (Expectativas)

Economia solidária e trabalho coletivo : Um olhar sobre a Cooperativa do Riachão no Norte de Minas Gerais - Brasil

It is intended to discuss the prospect of collective work in solidarity economy, from experiences with those of the Cooperative Riachao workers, located in a rural community in the municipality of Montes Claros, Minas Gerais / Brazil, this approximately 240 farming families extractive are benefited with the generation of jobs and income through initiatives grounded in associations, cooperatives and collectives. Among the 80 to 90 years, appeared inBrazil experiences of solidarity, resulting economy of the labor market crisis and rising unemployment, and an important response to the workers in relation to changes in the world of work. It is grounded in the organization of groups of workers, by way of solidarity, community, cooperation, and self-management reactions. In this sense, we intend to present the achievements, challenges and dilemmas of workers COOPERIACHAO, around a project that aims at empowerment of social actors and social transformation of the subject

Los Problemas de las Gimnasias

Este artículo se propone sintetizar las principales ideas de las ponencias presentadas en la Mesa de Trabajo "Los problemas de las Gimnasias" que se desarrolló en el marco del 9° Congreso Argentino y 4° Latinoamericano de Educación Física y Ciencias realizado en la Universidad Nacional de La Plata en junio de 2011. Todas ellas coinciden en pensar a la Gimnasia como parte fundamental de una Educación Corporal que se proponga transmitir aquellos saberes corporales culturalmente significativos que sirvan de herramientas para el conocimiento, el cuidado y la autogestión del propio cuerpo. A partir de estos puntos de coincidencia cada ponencia se explaya en su especificidad: ya sea desde la investigación y el análisis de los textos de divulgación y académicos, de los discursos de profesores, alumnos y practicantes; desde el análisis crítico del campo gímnico actual; desde propuestas bien concretas de trabajo de las gimnasias, en este caso la gimnasia aeróbica, la gimnasia funcional, el Método Pilates, o la gimnasia en el Profesorado en Educación Física con proyección en la gimnasia escolar

Descentralización, autogestión, gestión local. Estudio de caso de un municipio en La Pampa, Argentina

Los municipios, en los últimos veinticinco años, han cambiado sus roles. En la actualidad, los gobernantes locales asumen formas de gestionar que atienden a las crecientes demandas sociales de sus vecinos, redefiniendo las políticas públicas municipales. Parte de la tarea de gestión es el ordenamiento territorial como estrategia para orientar la distribución espacial del desarrollo, de acuerdo con los recursos disponibles, con el mejor uso que a los mismos se da en términos sociales, económicos y ambientales. Concretarlo implica cambios cualitativos importantes, adecuaciones en la gestión político-administrativa. En Victorica, La Pampa, la autogestión se perfila como una de las características más sobresalientes. La dinámica gestión de su territorio es ejemplo para otros municipios que intentan imitar el estilo. Los actores sociales son la clave del cambio.

Los Problemas de las Gimnasias

Este artículo se propone sintetizar las principales ideas de las ponencias presentadas en la Mesa de Trabajo "Los problemas de las Gimnasias" que se desarrolló en el marco del 9° Congreso Argentino y 4° Latinoamericano de Educación Física y Ciencias realizado en la Universidad Nacional de La Plata en junio de 2011. Todas ellas coinciden en pensar a la Gimnasia como parte fundamental de una Educación Corporal que se proponga transmitir aquellos saberes corporales culturalmente significativos que sirvan de herramientas para el conocimiento, el cuidado y la autogestión del propio cuerpo. A partir de estos puntos de coincidencia cada ponencia se explaya en su especificidad: ya sea desde la investigación y el análisis de los textos de divulgación y académicos, de los discursos de profesores, alumnos y practicantes; desde el análisis crítico del campo gímnico actual; desde propuestas bien concretas de trabajo de las gimnasias, en este caso la gimnasia aeróbica, la gimnasia funcional, el Método Pilates, o la gimnasia en el Profesorado en Educación Física con proyección en la gimnasia escolar

Descentralización, autogestión, gestión local. Estudio de caso de un municipio en La Pampa, Argentina

Los municipios, en los últimos veinticinco años, han cambiado sus roles. En la actualidad, los gobernantes locales asumen formas de gestionar que atienden a las crecientes demandas sociales de sus vecinos, redefiniendo las políticas públicas municipales. Parte de la tarea de gestión es el ordenamiento territorial como estrategia para orientar la distribución espacial del desarrollo, de acuerdo con los recursos disponibles, con el mejor uso que a los mismos se da en términos sociales, económicos y ambientales. Concretarlo implica cambios cualitativos importantes, adecuaciones en la gestión político-administrativa. En Victorica, La Pampa, la autogestión se perfila como una de las características más sobresalientes. La dinámica gestión de su territorio es ejemplo para otros municipios que intentan imitar el estilo. Los actores sociales son la clave del cambio.

Construcción de alternativas para el desarrollo autogestionado y sustentable a partir de la investigación acción participación en el asentamiento informal 'El milagro de Dios' Armenia-Colombia

El municipio de Armenia en Colombia, se proyecta como un 'Territorio Amable y de Oportunidades para la Vida' donde aproximadamente 10 mil de sus 300 mil habitantes viven en asentamientos humanos informales, 34 de los cuales se encuentran en terrenos con riesgo cualitativo alto, lo que genera condiciones de exclusión, pobreza y marginalización. Siendo la academia un actor del desarrollo territorial, desde el enfoque metodológico de la Inteligencia Territorial invita al sector público, a los empresarios y a la comunidad para dar una nueva mirada sobre estos asentamientos con el fin de plantear alternativas que tengan en cuenta las potencialidades y recursos de estas comunidades, permitiendo que sus habitantes pasen de ser objeto a sujetos de su propio desarrollo. Dentro de los resultados alcanzados se pueden destacar el diagnóstico situacional del desarrollo y la calidad de vida en esta comunidad (Identidades); la identificación de las principales problemáticas (Necesidades) y la priorización de alternativas de solución autogestionada (Expectativas)

Economia solidária e trabalho coletivo : Um olhar sobre a Cooperativa do Riachão no Norte de Minas Gerais - Brasil

It is intended to discuss the prospect of collective work in solidarity economy, from experiences with those of the Cooperative Riachao workers, located in a rural community in the municipality of Montes Claros, Minas Gerais / Brazil, this approximately 240 farming families extractive are benefited with the generation of jobs and income through initiatives grounded in associations, cooperatives and collectives. Among the 80 to 90 years, appeared inBrazil experiences of solidarity, resulting economy of the labor market crisis and rising unemployment, and an important response to the workers in relation to changes in the world of work. It is grounded in the organization of groups of workers, by way of solidarity, community, cooperation, and self-management reactions. In this sense, we intend to present the achievements, challenges and dilemmas of workers COOPERIACHAO, around a project that aims at empowerment of social actors and social transformation of the subject

Los Problemas de las Gimnasias

Este artículo se propone sintetizar las principales ideas de las ponencias presentadas en la Mesa de Trabajo "Los problemas de las Gimnasias" que se desarrolló en el marco del 9° Congreso Argentino y 4° Latinoamericano de Educación Física y Ciencias realizado en la Universidad Nacional de La Plata en junio de 2011. Todas ellas coinciden en pensar a la Gimnasia como parte fundamental de una Educación Corporal que se proponga transmitir aquellos saberes corporales culturalmente significativos que sirvan de herramientas para el conocimiento, el cuidado y la autogestión del propio cuerpo. A partir de estos puntos de coincidencia cada ponencia se explaya en su especificidad: ya sea desde la investigación y el análisis de los textos de divulgación y académicos, de los discursos de profesores, alumnos y practicantes; desde el análisis crítico del campo gímnico actual; desde propuestas bien concretas de trabajo de las gimnasias, en este caso la gimnasia aeróbica, la gimnasia funcional, el Método Pilates, o la gimnasia en el Profesorado en Educación Física con proyección en la gimnasia escolar