Energy Balance,Eating Disorder Risk,and Pathogenic Behaviors Among Athletic Trainers

ContextResearch exists on energy balances (EBs) and eating disorder (ED) risks in physically active populations and occupations by settings, but the EB and ED risk in athletic trainers (ATs) have not been investigated.ObjectiveTo assess ATs'' energy needs, including the macronutrient profile, and examine ED risk and pathogenic behavioral differences between sexes (men, women) and job statuses (part time or full time) and among settings (college or university, high school, nontraditional).DesignCross-sectional study.SettingFree living in job settings.Patients or Other ParticipantsAthletic trainers (n = 46; male part-time graduate assistant ATs = 12, male full-time ATs = 11, female part-time graduate assistant ATs = 11, female full-time ATs = 12) in the southeastern United States.Main Outcome Measure(s)Anthropometric measures (sex, age, height, weight, body composition), demographic characteristics (job status [full- or part-time AT], job setting [college/university, high school, nontraditional], years of AT experience, exercise background, alcohol use), resting metabolic rate, energy intake (EI), total daily energy expenditure (TDEE), EB, exercise energy expenditure, macronutrients (carbohydrates, protein, fats), the Eating Disorder Inventory-3, and the Eating Disorder Inventory-3 Symptom Checklist.ResultsThe majority of participants (84.8%, n = 39) had an ED risk, with 26.1% (n = 12) engaging in at least 1 pathogenic behavior, 50% (n = 23) in 2 pathogenic behaviors, and 10.8% (n = 5) in >2 pathogenic behaviors. Also, 82.6% of ATs (n = 38) presented in negative EB (EI < TDEE). Differences were found in resting metabolic rate for sex and job status (F_1,45 = 16.48, P = .001), EI (F_1,45 = 12.01, P = .001), TDEE (F_1,45 = 40.36, P < .001), and exercise energy expenditure (F_1,38 = 5.353, P = .026). No differences were present in EB for sex and job status (F_1,45 = 1.751, P = .193); χ² analysis revealed no significant relationship between ATs'' sex and EB (= 0.0, P = 1.00) and job status and EB ( = 2.42, P = .120). No significant relationship existed between Daily Reference Intakes recommendations for all macronutrients and sex or job status.ConclusionsThese athletic trainers experienced negative EB, similar to other professionals in high-demand occupations. Regardless of sex or job status, ATs had a high ED risk and participated in unhealthy pathogenic behaviors. The physical and mental concerns associated with these findings indicate a need for interventions targeted at ATs'' health behaviors.     

Modifying a social problem‐solving program with the input of individuals with intellectual disabilities and their staff

Social problem‐solving programs have shown success in reducing aggressive/challenging behaviors among individuals with intellectual disabilities in clinical settings, but have not been adapted for health promotion in community settings. We modified a social problem‐solving program for the community setting of the group home. Multiple sequential methods were used to seek advice from community members on making materials understandable and on intervention delivery. A committee of group home supervisory staff gave advice on content and delivery. Cognitive interviews with individuals with intellectual disabilities and residential staff provided input on content wording and examples. Piloting the program provided experience with content and delivery. The process provides lessons on partnering with vulnerable populations and community stakeholders to develop health programs. © 2012 Wiley Periodicals, Inc. Res Nurs Health 35:610–623, 2012     

Participatory Workplace Wellness Programs: Reward,Penalty, and Regulatory Conflict

Context

In keeping with the Patient Protection and Affordable Care Act, Congress revised the law related to workplace wellness programs. In June 2013, the Departments of Treasury, Labor, and Health and Human Services passed the final regulations, updating their 2006 regulatory framework. Participatory programs that reward the completion of a health risk assessment are now the most common type of wellness program in the United States. However, legal and ethical concerns emerge when employers utilize incentives that raise questions about the voluntariness of such programs. At issue is that under the Americans with Disabilities Act (ADA) of 1990, employers cannot require health-related inquiries and exams.

Methods

To analyze the current interpretation of the ADA, I conducted research on both LexisNexis and federal agency websites. The resulting article evaluates the differences in the language of Congress''s enabling legislation and the federal departments’ regulations and how they may conflict with the ADA. It also reviews the federal government''s authority to address both the legal conflict and ethical concerns related to nonvoluntary participatory programs.

Findings

Employers’ practices and the federal departments’ regulations conflict with the current interpretation of the ADA by permitting employers to penalize employees who do not complete a health risk assessment. The departments’ regulations may be interpreted as conflicting with Congress''s legislation, which mentions penalties only for health-contingent wellness programs. Furthermore, the regulatory protections for employees applicable to health-contingent wellness programs do not apply to participatory programs.

Conclusions

Either Congress or the federal agencies should address the conflict among employers’ practices, the wellness regulations, and the ADA and also consider additional protections for employees. Employers can avoid ethical and legal complications by offering voluntary programs with positive incentives.     

Instruments for detection and screening of cognitive impairment for older adults in primary care settings: A review

The Patient Protection and Affordable Care Act requires evaluation for cognitive impairment as part of the Annual Wellness Visit (AWV). Nurses and nurse practitioners in primary care are in a good position to incorporate brief cognitive screens into the AWV. Early recognition of cognitive problems allows clinicians and patients the opportunity to discuss any new or ongoing concerns about cognition, address possible reversible causes, or refer for further evaluation. It should be noted that some patients may prefer not to explore for cognitive impairment.Numerous brief cognitive screens have been developed for primary care, with no one screen being appropriate for all patients or clinicians. This review examines the psychometric properties, usefulness, and limitations of both patient and informant brief (under five minutes) cognitive screens endorsed by the Alzheimer's, National Institute of Aging (NIA), and Gerontological Society (GSA) workgroups, plus a recently developed brief version of the standard MoCA.     

Coaching: A Primer for the Radiologist

The practice of coaching using positive psychology is an emerging and promising approach to address the radiologist burnout epidemic, with the focus on wellness even more urgent given the coronavirus disease 2019 pandemic and other recent stressful events. Coaching uses a strengths-based approach to help radiologists identify and achieve positive emotions, create meaningful relationships, increase engagement and purpose, and develop coping skills for personal and professional stressors, including communication, improving resilience, team building, and mindfulness. Health and wellness coaching promotes healthy behavior change as a means of averting or mitigating chronic lifestyle-related diseases and is a potential treatment for burnout and stress management. Coaches help clients enhance self-motivation, identify strengths, and implement a framework for change by applying psychological resources, including mindfulness, positive mind-set, resilience, self-efficacy, and self-awareness. The framework of coaching is built upon psychological safety, mindfulness, accountability, and the coach-client relationship. Coaches use the three fundamental skills of mindful listening, open-ended inquiry, and perceptive reflections to empower clients on their journeys to achieve their best selves.     

An exploration of the relevance of the concept of “flow” in art therapy

Abstract

Mihaly Csikszentmihalyi, a psychologist, conducted research into the psychological state of happiness. A result of this work is the concept of “flow” (Csikszentmihalyi, 1992 Czikszentmihalyi, M. 1992. “Flow”: The psychology of happiness, USA: Harper & Row.  [Google Scholar]). Csikszentmihalyi's work has to date not been reviewed in art therapy literature for its relevance to our clinical practice or theoretical conceptualisation. Both art therapy and the concept of “flow” are concerned with the well-being of the individual. In this paper I will explore possible intersections between them. I present a summary of the salient features of Csikszentmihalyi's findings in regard to flow and explore how I have found that an understanding of this psychological state can be relevant in my art therapy practice. A consideration of the phenomenon of “flow” may be a way of re-addressing a balance between understanding an art therapy client's areas of “wellness” and “strength” as well as possible areas of “ illness” or “difficulty”.     

A Road Map to Foster Wellness and Engagement in Our Workplace—A Report of the 2018 Summer Intersociety Meeting

The 2018 radiology Intersociety Committee reviewed the current state of stress and burnout in our workplaces and identified approaches for fostering engagement, wellness, and job satisfaction. In addition to emphasizing the importance of personal wellness (the fourth aim of health care), the major focus of the meeting was to identify strategies and themes to mitigate the frequency, manifestations, and impact of stress. Strategies include reducing the stigma of burnout, minimizing isolation through community building and fostering connectivity, utilizing data and benchmarking to guide effectiveness of improvement efforts, resourcing and training “wellness” committees, acknowledging value contributions of team members, and improving efficiency in the workplace. Four themes were identified to prioritize organizational efforts: (1) collecting, analyzing, and benchmarking data; (2) developing effective leadership; (3) building high-functioning teams; and (4) amplifying our voice to increase our influence.     

Pilot-Testing an Intervention to Enhance Wellness Policy Implementation in Schools: Wellness Champions for Change

Objective

To develop and pilot-test Wellness Champions for Change (WCC) to enhance local wellness policy (LWP) implementation by forming wellness teams.