The J-curve in HIV: low and moderate alcohol intake predicts mortality but not the occurrence of major cardiovascular events.

OBJECTIVES In HIV-negative populations light to moderate alcohol consumption is associated with a lower cardiovascular morbidity and mortality than alcohol abstention. Whether the same holds true for HIV-infected individuals has not been evaluated in detail. DESIGN Cohort study METHODS:: Adults on antiretroviral therapy in the Swiss HIV Cohort Study with follow-up after August 2005 were included. We categorized alcohol consumption into: abstention, low (1-9 g/d), moderate (10-29 g/d in females and 10-39g/d in men) and high alcohol intake. Cox proportional hazards models were used to describe the association between alcohol consumption and cardiovascular disease free survival (combined endpoint) as well as cardiovascular disease events (CADE) and overall survival. Baseline and time-updated risk factors for CADE were included in the models. RESULTS Among 9,741 individuals included, there were 788 events of major CADE or death during 46,719 years of follow-up, corresponding to an incidence of 1.69 events/100 person-years. Follow-up according to alcohol consumption level was 51% abstention, 20% low, 23% moderate and 6% high intake. As compared to abstention, low (hazard ratio 0.79, 95% confidence interval 0.63-0.98) and moderate alcohol intake (0.78, 0.64-0.95) were associated with a lower incidence of the combined endpoint. There was no significant association between alcohol consumption and CADE. CONCLUSIONS Compared to abstention, low and moderate alcohol intake were associated with a better CADE-free survival. However, this result was mainly driven by mortality and the specific impact of drinking patterns and type of alcoholic beverage on this outcome remains to be determined.

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. ^

Comparing the factorial structure, invariance, and predictive validity of transtheoretical model constructs for alcohol use across restricted and unrestricted settings

With substance abuse treatment expanding in prisons and jails, understanding how behavior change interacts with a restricted setting becomes more essential. The Transtheoretical Model (TTM) has been used to understand intentional behavior change in unrestricted settings, however, evidence indicates restrictive settings can affect the measurement and structure of the TTM constructs. The present study examined data from problem drinkers at baseline and end-of-treatment from three studies: (1) Project CARE (n = 187) recruited inmates from a large county jail; (2) Project Check-In (n = 116) recruited inmates from a state prison; (3) Project MATCH, a large multi-site alcohol study had two recruitment arms, aftercare (n = 724 pre-treatment and 650 post-treatment) and outpatient (n = 912 pre-treatment and 844 post-treatment). The analyses were conducted using cross-sectional data to test for non-invariance of measures of the TTM constructs: readiness, confidence, temptation, and processes of change (Structural Equation Modeling, SEM) across restricted and unrestricted settings. Two restricted (jail and aftercare) and one unrestricted group (outpatient) entering treatment and one restricted (prison) and two unrestricted groups (aftercare and outpatient) at end-of-treatment were contrasted. In addition TTM end-of-treatment profiles were tested as predictors of 12 month drinking outcomes (Profile Analysis). Although SEM did not indicate structural differences in the overall TTM construct model across setting types, there were factor structure differences on the confidence and temptation constructs at pre-treatment and in the factor structure of the behavioral processes at the end-of-treatment. For pre-treatment temptation and confidence, differences were found in the social situations factor loadings and in the variance for the confidence and temptation latent factors. For the end-of-treatment behavioral processes, differences across the restricted and unrestricted settings were identified in the counter-conditioning and stimulus control factor loadings. The TTM end-of-treatment profiles were not predictive of drinking outcomes in the prison sample. Both pre and post-treatment differences in structure across setting types involved constructs operationalized with behaviors that are limited for those in restricted settings. These studies suggest the TTM is a viable model for explicating addictive behavior change in restricted settings but calls for modification of subscale items that refer to specific behaviors and caution in interpreting the mean differences across setting types for problem drinkers. ^

Does parental monitoring influence the use of alcohol and drugs among inner city 7th grade students?

Objective. To examine associations between parental monitoring and adolescent alcohol/drug use. ^ Methods. 981 7th grade students from 10 inner-city middle schools were surveyed at the 3 month follow-up of an HIV, STD, and pregnancy prevention program. Data from 549 control subjects were used for analyses. Multinomial logistic regression was used to examine associations between five parental monitoring variables and substance use, coded as: low risk [never drank alcohol or used drugs (0)], moderate risk [drank alcohol, no drug use (1)], and high risk [both drank alcohol and used drugs or just used drugs (2)]. ^ Results. Participants were 58.3% female, 39.6% African American, 43.8% Hispanic, mean age 13.3 years. Lifetime alcohol use was 47.9%. Lifetime drug use was 14.9%. Adjusted for gender, age, race, and family structure, each individual parental monitoring variable (perceived parental monitoring, less permissive parental monitoring, greater supervision (public places), greater supervision (teen clubs), and less time spent with older teens) was significant and protective for the moderate and high risk groups. When all 5 variables were entered into a single model, only perceived parental monitoring was significantly associated (OR=0.40, 95% CI 0.29-0.55) for the moderate risk group. For the high risk group, 3 variables were significantly protective (perceived parental monitoring OR=0.28, CI 0.18-0.42, less time spent with older teens OR=0.75, CI 0.60-0.93, and greater supervision (public places) OR=0.79, CI 0.64-0.99). ^ Conclusion. The association between parental monitoring and substance abuse is complex and varied for different risk levels. Implications for intervention development are addressed. ^

Air Force web-based preventive health assessement alcohol screening effectiveness using the Alcohol Use Disorders Identification Tool (AUDIT)

Alcohol consumption has a long-standing tradition in the United States Air Force (USAF). From squadron bars to officers and enlisted clubs, alcohol has been used in social settings to increase morale and also as a way to help decrease the stress of military operations. Surveys have demonstrated that the USAF has more than double the percentage of heavy drinkers than the US population. More than one-third of the Air Force reports binge drinking in the last month while only six percent of the nation reports the same consumption pattern.^ However, alcohol has a significant harmful health effect if consumed in excess. As part of an overall prevention and treatment program aimed at curbing the harmful effects of alcohol consumption, the USAF uses the Alcohol Use Disorder Identification Test (AUDIT) to screen for high-risk alcohol consumption patterns before alcohol disorder and disability occur. All Air Force active-duty members are required to complete a yearly Preventive Health Assessment questionnaire. Various health topics are included in this questionnaire including nutrition, exercise, tobacco use, family history, mental health and alcohol use. While this questionnaire has been available in a web-based format for several years, mandatory use was not implemented until 2009.^ Although the AUDIT was selected due to its effectiveness in assessing high-risk alcohol consumption in other populations, its effectiveness in the Air Force population had not been studied previously. In order to assess the sensitivity, specificity, and positive predictive value of this screening tool, the Air Force Web-based Preventive Health Assessment alcohol screening results were compared to whether any alcohol-related diagnosis was made from January 1, 2009 to March 31, 2010.^ While the AUDIT has previously been shown to have a high sensitivity and specificity, the Air Force screening values were 27.9% and 93.0% respectively. Positive predictive value was only 4.9%. With the screening statistics found, less than one-third of those having an alcohol disorder will be found with this screening tool and only 1 out of 20 Airmen who require further evaluation actually have an alcohol-related diagnosis.^

Process evaluation of intervention program for prevention of early sexual activity and alcohol use among Hispanic teenagers

Hispanic teens are a high-risk population for initiation of early sexual activity and alcohol use which in turn has numerous social and health consequences. One strategy to address prevention of these behaviors is to implement a capacity building intervention that promotes parent child communication, encompasses their cultural values and community participation. This study describes the process evaluation of a pilot intervention program amongst Hispanic teens and their families living along the Texas-Mexico border. “Girls Lets Talk” is a small group intervention with 10-14 year old teens and their female adult family members that involves education regarding effects of alcohol use and sexual activity as well as activities for monitoring and refusal skills to prevent risky behaviors. Two waves of the program each consisting of at least seven mother daughter dyads were conducted. During the designing process, community advisory board meetings and focus groups were held to review course materials and ensure they were appropriate to the Mexican American culture. Parent and adolescent surveys were administered at the beginning and end of the intervention to assess for psychosocial outcome variables. All sessions received high mean satisfactory scores (mean of 4.00 or better on a five point scale) for both adult and adolescent participants. Qualitative feedback was obtained via debriefing sessions to evaluate experience as well as alter recruitment strategies. A Wilcoxon Sign Rank analysis of the pre and post intervention surveys was done that showed significant changes in some outcome variables such as intentions and confidence for monitoring behaviors for adults and beliefs regarding sexual activity. “Girls Lets Talk” is a promising example of how a process evaluation plan can help develop a theory based health promotion program using the community based participatory research approach. The intervention may also be effective in altering intentions and enhancing self-efficacy among parents and teens in order to decrease risky behaviors such as early sexual activity and alcohol use.^

Posttraumatic stress disorder among veterans of the Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) wars: Psychological comorbidities, postdeployment social support and unit support

Much attention has been given to treating Operation Iraqi Freedom/Operation Enduring (OIF/OEF) Veterans with posttraumatic stress disorder (PTSD). However, little attention is given to those Veterans who do not meet diagnostic criteria for PTSD but who may still benefit from intervention. Research is needed to investigate the impact of how different racial/ethnic backgrounds, different levels of social support and comorbid mental health disorders impact OIF/OEF Veterans with varying levels of PTSD. The purpose of this dissertation is to examine the association of comorbid Axis I disorders, race/ethnicity, different levels of postdeployment social support and unit support on OIF/OEF Veterans with varying levels of PTSD. Data for this dissertation were from postdeployment screenings of OIF/OEF Veterans from a large Veterans Affairs hospital in southeast Texas. To examine the study hypotheses, we conducted multinomial logistic regressions of the clinician reported data. ^ The first article examined the prevalence of subthreshold and full levels of PTSD and compared Axis I and alcohol use comorbidity rates among 1,362 OIF/OEF Veterans with varying levels of PTSD. Results suggest that OIF/OEF Veterans with subthreshold PTSD experience similar levels of psychological distress as those with full PTSD and highlight the need to provide timely and appropriate mental health services to individuals who may not meet the diagnostic criteria for full PTSD. ^ These results suggest that OIF/OEF Veterans of all race/ethnicities can benefit from strong social support systems. Postdeployment social support was found to be a protective factor against the development of PTSD among White, Black and Hispanic veterans while deployment unit support was a protective factor only among Black Veterans. The second article investigated the association between postdeployment social support and unit support with varying levels of PTSD by race/ethnicity among 1,115 OIF/OEF Veterans. ^ The results of this study can help to formulate treatment and interventions for OIF/OEF Veterans with varying levels of PTSD and social support systems.^

Social integration, health behaviors and health status among Mexican-American women in the *southwestern United States

Using the Hispanic Health and Nutrition Examination Survey (HHANES), this research examined several health behaviors and the health status of Mexican American women. This study focused on determining the relative impact of social contextual factors: age, socioeconomic status, quality of life indicators, and urban/rural residence on (a) health behaviors (smoking, obesity and alcohol use) and (b) health status (physician's assessment of health status, subject's assessment of health status and blood pressure levels). In addition, social integration was analyzed. The social integration indicators relate to an individual's degree of integration within his/her social group: marital status, level of acculturation (a continuum of traditional Mexican ways to dominant U.S. cultural ways), status congruency, and employment status. Lastly, the social contextual factors and social integration indicators were examined to identify those factors that contribute most to understanding health behaviors and health status among Mexican American women.^ The study found that the social contextual factors and social integration indicators proved to be important concepts in understanding the health behaviors. Social integration, however, did not predict health status except in the case of the subject's assessment of health status. Age and obesity were the strongest predictors of blood pressure. The social contextual factors and obesity were significant predictors of the physician's assessment of health status while acculturation, education, alcohol use and obesity were significant predictors of the subject's assessment of health status. ^

Marketing público y marketing universitario : la orientación de las universidades hacia la satisfacción de demandas de conocimiento de la sociedad

La idea del marketing público se genera durante el siglo XX estableciendo un intercambio entre Estado y Sociedad. La Administración Pública diseña programas, bienes y servicios, como contraparte, los ciudadanos ofrecen apoyos mediante impuestos y costos de desplazamiento, tiempo y oportunidad. El marketing universitario, propone un intercambio entre las universidades y los alumnos para satisfacer las demandas de conocimiento y formación técnica-profesional. La problemática abordada en esta propuesta es la satisfacción de necesidades públicas a través del marketing público y, en este contexto, el marketing universitario y las demandas de conocimiento de la sociedad.

La estrategia de valorización de una multinacional de cosméticos : Explotación sexuada del trabajo y Responsabilidad Social Empresaria (RSE)

Este artículo se propone analizar el modo a través del cual en la empresa de cosméticos Avon se articulan explotación sexuada del trabajo con responsabilidad social empresaria, para configurar una estrategia de valorización singular. Adentrándose en los mundos de las revendedoras y las operarias de Avon -la mayor empresa multinacional dedicada a la producción y venta de cosméticos a través del sistema de "venta directa"- se indaga cómo la empresa capitaliza en su beneficio las ventajas de la utilización de fuerza de trabajo femenina. Si bien las políticas empresarias de Avon se presentan como inconexas entre sí, pueden ser leídas como una estrategia de valorización particular, pasible de ser desagregada analíticamente en dos elementos que se encuentran articulados. El primero, que denominamos explotación sexuada del trabajo, consiste en la utilización intensiva de fuerza de trabajo femenina tanto para la producción (en la fábrica) como para la comercialización de los productos (a través del sistema de venta directa). El segundo se basa en la implementación de políticas de RSE como elemento crucial de la valorización, tanto en la esfera productiva como en la esfera de la comercialización.

La estrategia de valorización de una multinacional de cosméticos : explotación sexuada del trabajo y Responsabilidad Social Empresaria (RSE)

Este artículo se propone analizar el modo a través del cual en la empresa de cosméticos Avon se articulan explotación sexuada del trabajo con responsabilidad social empresaria, para configurar una estrategia de valorización singular. Adentrándose en los mundos de las revendedoras y las operarias de Avon -la mayor empresa multinacional dedicada a la producción y venta de cosméticos a través del sistema de "venta directa"- se indaga cómo la empresa capitaliza en su beneficio las ventajas de la utilización de fuerza de trabajo femenina. Si bien las políticas empresarias de Avon se presentan como inconexas entre sí, pueden ser leídas como una estrategia de valorización particular, pasible de ser desagregada analíticamente en dos elementos que se encuentran articulados. El primero, que denominamos explotación sexuada del trabajo, consiste en la utilización intensiva de fuerza de trabajo femenina tanto para la producción (en la fábrica) como para la comercialización de los productos (a través del sistema de venta directa). El segundo se basa en la implementación de políticas de RSE como elemento crucial de la valorización, tanto en la esfera productiva como en la esfera de la comercialización.

La estrategia de valorización de una multinacional de cosméticos : Explotación sexuada del trabajo y Responsabilidad Social Empresaria (RSE)

Este artículo se propone analizar el modo a través del cual en la empresa de cosméticos Avon se articulan explotación sexuada del trabajo con responsabilidad social empresaria, para configurar una estrategia de valorización singular. Adentrándose en los mundos de las revendedoras y las operarias de Avon -la mayor empresa multinacional dedicada a la producción y venta de cosméticos a través del sistema de "venta directa"- se indaga cómo la empresa capitaliza en su beneficio las ventajas de la utilización de fuerza de trabajo femenina. Si bien las políticas empresarias de Avon se presentan como inconexas entre sí, pueden ser leídas como una estrategia de valorización particular, pasible de ser desagregada analíticamente en dos elementos que se encuentran articulados. El primero, que denominamos explotación sexuada del trabajo, consiste en la utilización intensiva de fuerza de trabajo femenina tanto para la producción (en la fábrica) como para la comercialización de los productos (a través del sistema de venta directa). El segundo se basa en la implementación de políticas de RSE como elemento crucial de la valorización, tanto en la esfera productiva como en la esfera de la comercialización.

Culturas escolares y distinción social

La presente ponencia se inscribe en el proyecto ?Escolarización de la elites: el papel de las escuelas privadas polimodal de la provincia de Buenos Aires en la formación de los sectores altos y medios altos?, radicado en el Departamento de Ciencias de la Educación de la UNLP. Nos centramos en el análisis de los perfiles y estrategias institucionales y propuestas pedagógicas de la red de establecimientos privados del nivel medio de educación de la provincia de Buenos Aires. A fin de lograr una mejor caracterización de los componentes del ideario pedagógico escolar que animan a dichas instituciones, consideramos necesario recorrer los ?discursos de sí? que las mismas construyen. El estudio de los establecimientos que atienden a jóvenes de familias acomodadas permite una primera caracterización de los modelos de escolarización propuesto por las escuelas. Así, las políticas de marketing educativo, el ideario institucional, el proyecto institucional, el perfil de joven que se aspira formar, son elementos centrales para comprender los procesos de elección de doble vía: desde las familias hacia las instituciones y de estas a las familias, como la forma en que las elites escolares y las instituciones "de excelencia" construyen socialmente la imagen del privilegio y del éxito escolar

La estrategia de valorización de una multinacional de cosméticos : Explotación sexuada del trabajo y Responsabilidad Social Empresaria (RSE)

Este artículo se propone analizar el modo a través del cual en la empresa de cosméticos Avon se articulan explotación sexuada del trabajo con responsabilidad social empresaria, para configurar una estrategia de valorización singular. Adentrándose en los mundos de las revendedoras y las operarias de Avon -la mayor empresa multinacional dedicada a la producción y venta de cosméticos a través del sistema de "venta directa"- se indaga cómo la empresa capitaliza en su beneficio las ventajas de la utilización de fuerza de trabajo femenina. Si bien las políticas empresarias de Avon se presentan como inconexas entre sí, pueden ser leídas como una estrategia de valorización particular, pasible de ser desagregada analíticamente en dos elementos que se encuentran articulados. El primero, que denominamos explotación sexuada del trabajo, consiste en la utilización intensiva de fuerza de trabajo femenina tanto para la producción (en la fábrica) como para la comercialización de los productos (a través del sistema de venta directa). El segundo se basa en la implementación de políticas de RSE como elemento crucial de la valorización, tanto en la esfera productiva como en la esfera de la comercialización.