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Difficult Circumstances (difficult + circumstance)

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Humanities and Social Sciences50%

Selected Abstracts

Maternal Distress and Parenting in the Context of Cumulative Disadvantage

FAMILY PROCESS, Issue 2 2010
JOYCE ARDITTI PH.D.
To read this article's abstract in both Spanish and Mandarin Chinese, please visit the article's full-text page on Wiley InterScience (http://interscience.wiley.com/journal/famp). This article presents an emergent conceptual model of the features and links between cumulative disadvantage, maternal distress, and parenting practices in low-income families in which parental incarceration has occurred. The model emerged from the integration of extant conceptual and empirical research with grounded theory analysis of longitudinal ethnographic data from Welfare, Children, and Families: A Three-City Study. Fourteen exemplar family cases were used in the analysis. Results indicated that mothers in these families experienced life in the context of cumulative disadvantage, reporting a cascade of difficulties characterized by neighborhood worries, provider concerns, bureaucratic difficulties, violent intimate relationships, and the inability to meet children's needs. Mothers, however, also had an intense desire to protect their children, and to make up for past mistakes. Although, in response to high levels of maternal distress and disadvantage, most mothers exhibited harsh discipline of their children, some mothers transformed their distress by advocating for their children under difficult circumstances. Women's use of harsh discipline and advocacy was not necessarily an "either/or" phenomenon as half of the mothers included in our analysis exhibited both harsh discipline and care/advocacy behaviors. Maternal distress characterized by substance use, while connected to harsh disciplinary behavior, did not preclude mothers engaging in positive parenting behaviors. RESUMEN Este artículo presenta un modelo conceptual emergente de las características y las conexiones entre la desventaja acumulada, la angustia materna, y las prácticas de crianza de los hijos en familias de bajos recursos donde uno de los padres ha estado encarcelado. El modelo surgió de la integración de investigaciones conceptuales y empíricas existentes con un análisis de muestreo teórico de datos etnográficos longitudinales tomados de Welfare, Children, and Families: A Three-City Study ("Bienestar, Niños y Familias: Un estudio en tres ciudades"). En el análisis se usaron catorce casos ejemplares de familias. Los resultados indicaron que las madres de estas familias vivían la vida en el contexto de desventaja acumulada, ya que describieron una cascada de dificultades caracterizadas por preocupaciones con respecto al barrio donde viven, preocupaciones por el sustento económico, dificultades burocráticas, relaciones íntimas violentas y la incapacidad de satisfacer las necesidades de sus hijos. Sin embargo, las madres también tenían un profundo deseo de proteger a sus hijos y de subsanar errores del pasado. Aunque, en respuesta a los niveles altos de angustia materna y desventaja, la mayoría de las madres demostraron una disciplina severa hacia sus hijos, algunas madres transformaron su angustia apoyando a sus hijos en circunstancias difíciles. El uso de disciplina severa y apoyo por parte de las mujeres no fue necesariamente un fenómeno excluyente, ya que la mitad de las madres analizadas demostraron tanto el uso de una disciplina severa como comportamientos de cuidado y apoyo. Si bien la angustia materna caracterizada por el abuso de sustancias estuvo conectada con el uso de una disciplina severa, no excluyó que las madres tuvieran comportamientos positivos en relación con la crianza de sus hijos Palabras clave: desventaja acumulada, angustia materna, crianza de los hijos, encarcelamiento de uno de los padres, disciplina [source]

Balancing Acts: Dynamics of a Union Coalition in a Labor Management Partnership

INDUSTRIAL RELATIONS, Issue 1 2008
ADRIENNE E. EATON
This paper analyzes the experience of a set of unions that formed a coalition to engage in coordinated bargaining and to build and sustain a labor management partnership with Kaiser Permanente, a large healthcare provider and insurer. We use qualitative and quantitative data, including member and leader surveys, to explore the experience of the coalition in confronting five key challenges identified through theory and prior research on such partnerships. We find that the coalition has been remarkably successful, under difficult circumstances, in achieving institutional growth for its member unions and in balancing traditional and new union roles and communicating with members. The unions have been less successful in increasing member involvement. [source]

On the Way to a Better Future: Belgium as Transit Country for Trafficking and Smuggling of Unaccompanied Minors1

INTERNATIONAL MIGRATION, Issue 4 2005
Ilse Derluyn
ABSTRACT During the last decade, irregular border crossings emerged as a new element in international migratory flows, with smuggling and trafficking networks being an essential part. Many people are compelled to use these networks to realize their dream of a better living, and for many this "promised land" is the United Kingdom (UK). Belgium has important sea connections with the UK, and is, therefore, an important migration transit zone, although many migrants are intercepted on Belgian territory during their tempt to reach the UK. Some are unaccompanied or separated children and adolescents, minors travelling without parent(s) or a legal caregiver. This study aims to gain insight about this population of unaccompanied minors travelling to the UK. We use the situation in Zeebrugge, one of Belgium's main ports, as a case study. We analysed 1,093 data files of unaccompanied minors intercepted in Zeebrugge, and carried out participatory observation at the shipping police station. The intercepted unaccompanied minors are mainly male, between 15 and 18 years of age, and from an Asian or Eastern European country. Of the 899 unique persons found in the data files, 113 were intercepted several times. After the interception, the Aliens Office gives the majority (82.9%) an identity document without a requirement to leave Belgium, while 15.3 per cent must leave Belgium immediately or within five days. In 82.9 per cent of the cases, a child protection officer is contacted to make a decision about the situation. In 67.2 per cent of these cases, no child protection measure is taken, and the minor may leave the police station; in 32 per cent of the cases, the minor is transferred to a centre, mostly crisis reception. Almost all unaccompanied minors are convinced they want to reach the UK to create a better livelihood, join a family member, or escape a difficult political situation. Nevertheless, most travel in difficult circumstances; are scared; and lack essential information about life in the UK, their possibilities in Belgium, what will happen if they are transferred to a centre, and so forth. Most minors also do not want to be transferred to a centre, and many , although not all , disappear again from the centres. This study has several implications concerning the kind of decisions taken by the legal authorities, the necessary physical and psycho-social care and the availability of an interpreter and social worker during the interception, the number of reception places and the care in these centres, and the tasks of the legal guardian. Finally, some limitations of the study are mentioned. VERS UN AVENIR MEILLEUR : LA BELGIQUE COMME PAYS DE TRANSIT POUR LA TRAITE ET L'INTRODUCTION CLANDESTINE DE MINEURS NON ACCOMPAGNÉS Au cours de la dernière décennie, le franchissement irrégulier des frontières est apparu comme un nouvel élément des flux migratoires internationaux, dont les réseaux de traite et d'introduction clandestine sont un aspect essentiel. Beaucoup de gens sont forcés d'utiliser ces réseaux pour réaliser leur rêve d'une vie meilleure et pour beaucoup, cette « terre promise », c'est le Royaume-Uni. La Belgique ayant d'importantes liaisons maritimes avec le Royaume-Uni con-stitue de ce fait une importante zone de transit pour les migrations, bien que de nombreux migrants soient interceptés sur le territoire belge alors qu'ils tentent d'atteindre le Royaume-Uni. Certains d'entre eux sont des enfants et des adoles-cents non accompagnés, séparés, des mineurs qui voyagent sans parent(s), sans personne qui en ait la garde juridique. Cette étude vise à mieux connaître cette population de mineurs non accompagnés voyageant en direction du Royaume-Uni. Nous prenons comme cas concret la situation à Zeebrugge, l'un des principaux ports belges. Nous avons analysé 1 093 fichiers de données concernant des mineurs non accompagnés interceptés à Zeebrugge, et nous sommes livrés à une observation participative au poste de police du port. Les mineurs non accompagnés inter-ceptés sont pour la plupart des garçons âgés de quinze à dix-huit ans originaires d'un pays d'Asie ou d'Europe orientale. Sur les 899 personnes trouvées dans les fichiers, 113 ont été interceptées plusieurs fois. Après l'interception, les Ser-vices de l'immigration donnent à la majorité de ces garçons un document d'identité sans obligation de quitter la Belgique, alors que 15,3 pour cent d'entre eux doivent quitter le pays, soit immédiatement soit dans les cinq jours. Dans 82,9 pour cent des cas, un agent de protection de l'enfance est contacté pour prendre une décision quant à la situation. Dans 67,2 pour cent de ces cas, aucune mesure de protection de l'enfant n'est prise et le mineur peut quitter le poste de police. Dans 32 pour cent des cas, le mineur est transféré dans un centre, un lieu d'accueil pour les situations de crise. Presque tous les mineurs non accompagnés sont convaincus de vouloir se rendre au Royaume-Uni pour y gagner leur vie, retrouver un membre de leur famille ou échapper à une situation politique difficile. Pourtant, la plupart de ces mineurs voyagent dans des circonstances difficiles. Ils ont peur. Ils n'ont pas les informations essentielles sur la vie au Royaume-Uni, sur les possibilités qui existent pour eux en Belgique, sur ce qui se passera s'ils sont transférés dans un centre. Beaucoup , mais pas tous , disparaissent de ces centres. Cette étude a diverses implications concernant le genre de décisions que pren-nent les autorités juridiques, les nécessaires soins physiques et psychosociaux pendant l'interception ainsi que la présence d'un interprète et d'un travailleur social, le nombre de places et les soins dans les centres d'accueil, les tâches de la personne qui a la responsabilité légale du mineur. Enfin, certaines limites de cette étude sont évoquées. CON MIRAS A UN MEJOR FUTURO: BÉLGICA COMO PAÍS DE TRÁNSITO DE LA TRATA Y EL TRÁFICO DE MENORES NO ACOMPAÑADOS Durante la última década, los cruces fronterizos irregulares se han convertido en un nuevo elemento de las corrientes migratorias internacionales, siendo un componente esencial de ellas las redes de tráfico y trata de personas. Son muchas las personas que se ven obligadas a recurrir a estas redes para hacer realidad su sueño de una vida mejor y para muchos "la tierra prometida" es el Reino Unido. Bélgica tiene importantes conexiones marítimas con el Reino Unido y, por consi-guiente, es una zona de tránsito de la migración sumamente importante, aunque muchos migrantes son interceptados en territorio belga en su intento por llegar al Reino Unido. Entre las personas interceptadas se encuentran niños y adoles-centes, menores de edad que viajan solos, sin sus padres o tutor legal. Este estudio tiene por objeto comprender cómo esta población de menores no acom-pañados viaja al Reino Unido. Con ese fin, se recurre a un estudio por casos examinando la situación en Zeebrugge, uno de los principales puertos de Bélgica. Se han analizado 1.093 expedientes de menores no acompañados, interceptados en Zeebrugge, y se ha realizado una observación participativa en la estación de policía naval. Los menores no acompañados interceptados eran principalmente varones, entre 15 y 18 años de edad, provenientes de Asia y Europa oriental. De las 899 personas no acompañadas encontradas en los expedientes, 113 habían sido interceptadas varias veces. Tras la intercepción, el Servicio de Inmigración otorga a la mayoría un documento de identidad (82,9 por ciento) sin obligarles a abandonar Bélgica, mientras que el 15,3 por ciento debe salir inmediatamente de Bélgica, o bien en un plazo máximo de cinco días. En el 82,9 por ciento de los casos, se establece contacto con un oficial de la protección de la infancia para que decida en cuanto a la situación del menor. En el 67,2 por ciento de estos casos, no se adopta ninguna medida de protección del menor y éste puede abandonar la estación de policía; y en el 32 por ciento de los casos, se transfiere al menor a un centro de recepción que se ocupa de casos críticos. Prácticamente todos los menores no acompañados tienen la certeza de que llegarán al Reino Unido para tener una mejor vida, reunirse con un familiar, o escapar de la difícil situación política. No obstante, la mayoría viaja en condiciones difí-ciles, tiene miedo y carece de información esencial sobre la vida en el Reino Unido, sobre sus posibilidades en Bélgica, y sobre lo que ocurrirá si son trans-feridos a un centro, etc. La mayoría de estos menores no quiere ser transferida a un centro y muchos, aunque no todos, se escapan de los mismos. Este estudio repercutirá, sin lugar a dudas, en las decisiones que adoptan las autoridades jurídicas, en la atención física y sicosocial necesarias, en la disponi-bilidad de un intérprete o trabajador social durante la intercepción, así como en el número de plazas de acogida y de atención en estos centros, y en las tareas que incumben a todo tutor legal. Finalmente, se enumeran algunas de las limitaciones de este estudio. [source]

Latest news and product developments

PRESCRIBER, Issue 2 2008
Article first published online: 11 FEB 200
NICE should evaluate all new medicines NICE should determine the cost effectiveness of all new medicines, the Health Select Committee has concluded in its second review of the Institute. The review, prompted by criticisms from patients, health professionals and the pharmaceutical industry, found that NICE is doing ,a vital job in difficult circumstances'. The Committee called for the costs to carers and society to be included in cost effectiveness estimates (this is currently prohibited) and for cost per QALY thresholds to be aligned with NHS affordability. NICE should publish brief appraisals at the time of a product launch , these could be used to negotiate prices. GPs responsible for unlicensed co-proxamol GPs who prescribe co-proxamol are now responsible for the consequences, the MHRA warns. The Agency agrees that the drug may be needed by ,a small group of patients who are likely to find it very difficult to change from co-proxamol or where alternatives appear not to be effective or suitable'. Following the withdrawal of product licences, stock that is currently in the supply chain may be dispensed but no new stock should be released by suppliers. The Drug Tariff price of co-proxamol has now increased from £2.79 to £20.36 per 100 tablets. Vitamin D deficiency on the increase Pregnant and breastfeeding women may need vitamin D supplements, the Department of Health has warned, and GPs are seeing increasing numbers of patients with vitamin D deficiency. Endogenous synthesis may be low in some ethnic groups and dark-skinned people, and north of Birmingham there is no light of the appropriate wavelength for the synthesis of vitamin D during the winter. The Department says free vitamin supplements are available for eligible patients through its Healthy Start Scheme (www.healthystart.nhs.uk) and may also be supplied at low cost by some PCTs. Innovation and good practice recognised Innovative practice and better outcomes for patients have been recognised through awards from the NHS Alliance and Improvement Foundation presented by the Secretary of State for Health, Rt Hon Alan Johnson, at the annual NHS Alliance conference held in Manchester. The Mountwood Surgery in Northwood, Middlesex, won the CHD QOF GP Practice Award sponsored by Schering Plough for their outstanding multidisciplinary approach to tackling CHD. In addition to having a highly organised in-house cardiology team, they have produced an interactive, patient-empowering booklet for CHD. Mountwood Surgery achieved blood pressure targets of 96.79 per cent in their CHD patients. North Tees PCT wins the CHD QOF PCO Award, also sponsored by Schering Plough, for their support and encouragement to GP practices to ,own' CHD care. They provide timely feedback of performance data using funnel plots and regular communication by the CHD LIT and Cardiac Network. Even though North Tees PCT has a high CHD prevalence, 4.2 per cent vs 3.6 per cent nationally, across the 27 practices 85 per cent of patients achieved cholesterol targets and 91 per cent reached the QOF blood pressure target. The St Benedict's Hospice Day Centre Project (for the Sunderland Teaching Primary Care Trust) won the Guy Rotherham Award for its excellent multidisciplinary team improvement of the palliative care provided. This team demonstrated a thorough understanding of the use of quality improvement methods to improve patient care, and carefully measured the individual improvements they made. Through the use of a referral ,decision tree', nonattenders were reduced by 300 per cent and average waiting times halved. The Extended Primary Care (EPC) Gynaecology Service (for the Practice Based Commissioning Consortium South Manchester Hub) was highly commended for its development of an effective and innovative service offering gynaecological treatment managed within a primary care setting, allowing patients improved access closer to home. The Salford Perinatal Mental Health Project was also highly commended for effectively challenging the high levels of maternal suicides. The awards were also supported by Prescriber, the British Cardiac Patients Association and the British Cardiac Society. Anastrozole superior to tamoxifen in long term A new analysis of the ATAC trial (Lancet Oncology 2008;9:45-53) shows that the advantages of the aromatase inhibitor anastrozole (Arimidex) over tamoxifen as adjuvant therapy for breast cancer persist for at least four years after the end of treatment. After primary treatment with surgery, chemotherapy or radiotherapy, postmenopausal women with localised invasive breast cancer were randomised to five years' treatment with anastrozole or tamoxifen. Among 5216 women who were hormone-receptor positive, anastrozole increased disease-free survival by 15 per cent after 100 months. Time to recurrence and distant recurrence were also increased, though overall survival was similar; the absolute difference in time to recurrence was greater at nine years (4.8 per cent) than at five years (2.8 per cent). Joint symptoms and fractures were more frequent with anastrozole during treatment but not thereafter. Use a steroid with a LABA , MHRA reminder The MHRA has reminded clinicians that patients treated with an inhaled long-acting beta-agonist (LABA) should also use an inhaled steroid. In the latest edition of Drug Safety Update (2008;1:No.6), the Agency reviews the implications of the SMART study (Chest 2006;129:15-26), which reported an increased risk of respiratory- and asthma-related deaths among patients using salmeterol (Serevent). This is contradicted by epidemiological data suggesting that asthma-related admissions have declined since LABAs were introduced. Randomised trials also do not support such a risk, probably because inhaled steroids are used more consistently in trial settings. The latest Update notes that product licences for carisoprodol (Carisoma) have been suspended due to concerns about the risk of abuse and psychomotor effects. It also includes a comprehensive summary of drug interactions with statins, a warning that methylene blue should not be prescribed for a patient taking a drug with serotonergic activity, and a reminder that only oral formulations of desmopressin are now licensed for primary nocturnal enuresis. This issue of Update is available at www.mhra.gov.uk. Copyright © 2008 Wiley Interface Ltd [source]