Manual Redefining Social Problems

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We have visited many government, nongovernment, and private schools and teacher training programs in Asia, Latin America, and Africa, and we have talked extensively with teachers, students, headmasters, school owners, and government officials. We have implemented training for illiterate adults in developing countries and have tested that training effectively over the last few years, applying the best of our experience to improving organizations like Opportunity International, a large microfinance institution.

These experiences have convinced us that the time is right to redefine quality education in the developing world.

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We have developed a robust educational model that combines traditional content with critically important financial, health, and administrative skills, which can be delivered via existing school systems and teachers. The model requires significant changes in both content and pedagogy. First, entrepreneurship and health modules are mandatory curriculum components for all primary grade students. Second, student-centered learning methods are used that require students to work in groups to solve complex problems and manage projects on their own.

This approach is inspired by models of adult education in developing countries that focus on self-efficacy as a critical foundation of positive livelihood and health-seeking behaviors, along with active-learning pedagogies used in progressive schools throughout the world. The health curriculum draws on the work of the World Health Organization and focuses on preventing disease, caring for sick children, and obtaining medical care.

The entrepreneurship curriculum is informed by our work with adult entrepreneurs in developing countries, and it draws ideas from a broad range of financial and entrepreneurial programs developed by organizations like the International Labour Organization, Junior Achievement, and Aflatoun. Conceptual knowledge is put into practice at school through activities that empower children to use what they have learned.

For example, students practice routine health behaviors, such as hand washing and wearing shoes near latrines—and, to the extent feasible, gain exposure to other important behaviors, such as boiling drinking water and using malaria nets. They practice routine market-like transactions by earning points for schoolwork and budgeting those points to obtain valuable prizes, such as sitting in a favorite chair or being first in line.

Students also develop higher order skills as they work in committees to develop and execute complex projects. Health-related projects can range from planning and carrying out an athletic activity to be played during recess, to practicing diagnostic skills when classmates are ill—helping to decide, for example, when a cold has turned into a respiratory infection that requires antibiotics. Entrepreneurship projects include identifying and exploiting market opportunities through business ideas like school gardens or community recycling that create real value.

Students learn and practice workplace skills and attitudes like delegation, negotiation, collaboration, and planning—opportunities that are rarely available to them outside their families. Some school systems, especially at the secondary level, have begun to include entrepreneurship and health topics in their curricular requirements. But including information in basic lectures is not enough.

The Cronbach's alpha value was 0. All phenomenological variables identified from psychiatric assessment were entered into a principal component factor analysis. A total of nine factors were identified, with a clear break in the scree plot at the sixth principal component, indicating a six-factor model of disorder. The varimax-rotated factors, which cumulatively accounted for Eigenvalues for the six factors ranged from 1.

For validation purposes, items that loaded on factors 7 to 9 were removed, the analysis repeated, and another sixfactor model identified. The sixth component of this new model was altered and the resulting six-factor solution improved, accounting for Eigenvalues for these six factors ranged from 1. The pattern of factors in the second factor analysis after rotation is shown in Table 3. The clinical interpretation of the sixfactor solution was assessed by the current study's research team and the following factor titles were assigned: psychosis Factor I ; conflict management problems Factor II ; control issues Factor III ; psychosexual problems Factor IV ; major depression Factor V ; and physiological dependency Factor VI.

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The items comprised by each factor were summed to create continuous variables that were named as outlined above. Because there was some overlap in the variables comprised by Factors II and III, and all of the comprised variables were conceptualized as being representative of problems with interpersonal power management, the items on these two factors were clustered and summed to form one continuous variable "power management problems".

Associations between factors and personality disorder. Among those diagnosed with an Axis II personality disorder, The factors of major depression and psychosexual problems were not significant. The proportion of patients with symptoms within the major depression factor was about equal for persons diagnosed with an Axis II personality disorder versus those diagnosed with an Axis I clinical disorder Due to the distribution of features of psychosexual problems and major depression within the sample, these factors are likely to be positively related to cluster diagnosis.

Comparison of factor scores by diagnosis. There were no significant differences between the two groups for the major depression factor. One-way ANOVA was used to assess differences in power management problems, psychosexual problems, and physiological dependency for the three levels of disorder severity mild, moderate, and severe. Because the assumption of homogeneity of variance was violated, the Brown-Forsythe F-ratio is also reported.

Results indicated the three severity groups differed significantly for power management problems F 3 There were no significant differences between the moderate and severe groups on this measure. For psychosexual problems, there were no significant mean differences between the three severity groups see Table 4. The proposed re-conceptualization of personality disorder in the upcoming DSM-V has faced major scrutiny due to its confusing, inconsistent, and incoherent criteria 5. The purpose of the current case-control study of a Jamaican sample was to determine whether the individual phenomenological features of personality disorder would cluster into patterns similar to those for traditional personality disorder features and categories.

When the phenomenological features of personality disorder are disaggregated and analyzed, the resulting clusters do not resemble the conventional categories of personality disorder as specified by the DSM-IV-TR.

Instead, they cluster into three distinct categories of factors that seem to represent problems of psychoemotional nature, indicating a singular, completely separate concept, stemming from problems with impulse control and authority and conflict management, to replace the current iteration of personality disorder classification.

The components of the factors representing power management problems, psychosexual problems, and physio - logical dependency are features of dysfunction that are variable and not representative of personality traits typically assessed by other [traditional] measures of personality disorder. The authors of the current study theorize that the underlying basis of these factors may be a neurobiological dysfunction, the presentation of which is colored by the personality traits that an individual possesses.

In this way the dysfunction may be similar to an Axis I disorder. It has been previously suggested that features of personality disorder are no different from the symptomology of mental disorders as both are "caused by biological and psychosocial factors and, like those of other disorders, they wax and wane over time" 3.

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The authors of the current study suggest a conceptual shift be made, reconfiguring the classification systems by remerging "personality disorder" with Axis I disorders as suggested by Livesley et al. Axis II would serve as the location for listing important personality indicators that could help clinicians understand how the dysfunction is manifested and how various personality traits may be at work in ways both beneficial and harmful for an individual's functioning and treatment outcome.

Axis II classification of the personality traits of patients with or without a personality disorder diagnosis would help clinicians select the most appropriate intervention for each case 9. Together this suggests that the disaggregated phenomenology of patients with personality disorder do not match the conventional DSM diagnostic categories.

Depression and personality disorder. The association between depression and personality disorder has long been established: a lengthy history of depression can predispose individuals to the condition, and stressful life events common among those with personality disorders can lead to depressive episodes Several patients in the study sample had either undergone treatment for depression Furthermore, of all the co-morbid Axis I diagnoses, persons diagnosed with personality disorder were significantly more likely to also have a didiagnosis of major depression than any of the other Axis I disorders that were diagnosed.

Although individuals with features of personality disorder were not significantly more likely than those without these features to be depressed, the high rate of depression If this is the case, treatment of this underlying pathology will resolve the symptoms of the depression. Further research is required to explore the possible relationship between these two conditions.

There are several challenges inherent in measuring personality disorder severity based on current diagnostic guidelines. The use of nonstandard nomenclature in the diagnostic process has significantly impaired psychiatrists' ability to adequately ascribe severity, and has been criticized for limitations in its logical basis and clinical application Like Walton et al. Concurrence of the current findings with Walton et al. In a recent article in New York Times Magazine , author Ethan Watters 17 states that the United States has "for many years been busily engaged in a grand project of Americanizing the world's understanding of mental health and illness," and bemoans the world's steady adoption of European and American values of mental illness.

Elsewhere, the editor of the British Journal of Psychia try acknowledged that his journal was "bound to see the panorama of psychiatry through British spectacles" The present study attempts to address this problem by investigating personality disorder in another culture, using the case-control method. In their research, the authors grapple with the difficulty of applying European and American concepts to classify personality disorder in a Jamaican sample. Based on their results, the authors propose a complete reframing of personality disorder conceptualization.

While many of the phenomenological features of personality disorder identified in the Jamaican study sample are similar to the dimensions postulated by Widiger et al. The authors propose this new phenomenon, which appears to be associated with problems with impulse control and authority and conflict management, as a replacement for traditional DSM criteria in the reclassification of personality dysfunction, and suggest the term Shakatani as a possible name for the condition.

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The concept of Shakatani - derived from the Swahili words shaka "problem" and tani "power" -stems from an early Jamaican anthropological study by Kerr 20 and sociological work by Stone 21, 22 that chronicle the tensions caused by economic oppression, racism, biased methods of education, and the economic and psychological insecurity caused by centuries of colonial domination by the British.

This study had several limitations.

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But, as can be seen in Figure Musculoskeletal disorders have spread. They now affect millions of workers and cost employers billions of euros Eurofound, These disorders result from physical factors—such as repetitive movements, heavy loads, frequent bending and twisting, exposure to cold, and insufficient time for recovery—but also from certain psychosocial factors da Costa and Viera, All other occupations are exposed to some of the most common physical hazards that, along with stress, can cause musculoskeletal disorders.

For example, about half of managers, professionals and technicians International Standard Classification of Occupations [ISCO] 1 say that they perform repetitive movements with their hands or arms for at least a quarter of their working time. In addition, more than 25 per cent of them say they have to adopt painful or tiring positions for more than a quarter of their working time. Workers in the services sector, meanwhile, have an exposure equal to or above the European average.

In some work settings where activity is particularly intense, workers are not always able to adopt the safest behaviours. These time factors can predict a poor balance between private and professional life. Atypical schedules may, however, be suitable for some people for personal reasons, and to others at certain stages of their lives. The number of people working long hours more than 48 hours per week decreased between and , from 19 per cent to 16 per cent.

Likewise, only 32 per cent of people at work said they had working days of at least 10 hours in , compared to 36 per cent in But 23 per cent said they had, at least once during the previous month, worked two days in succession separated by a break of less than 11 hours.

In addition, employees are working frequently on Saturdays—52 per cent had worked on a Saturday at least once in the month prior to the survey. Night work is practised at least once a month by 19 per cent of people at work. In all, 9 per cent of people at work 10 per cent of employees can choose from several schedules and nearly 20 per cent of them can adapt their schedules.

Only 7 per cent of employees and 16 per cent of people at work can choose their working hours freely. In seven out of ten cases, working hours do not change; 13 per cent of people at work have work schedules that change the same day or the day before; and 12 per cent of them can be called to work with very little prior notice. This figure conceals large disparities according to professional profiles: more than a third of the most highly-qualified white-collar workers see their free time encroached upon.

Employees have to work faster, carry out more demanding tasks, and have jobs that are richer in emotions: so they must reconcile a diverse set of factors regulating the pace of work, thus adding operational constraints and complicating their task.

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Especially over long periods, these new constraints have adverse consequences for the health and well-being of workers. In addition, numerous epidemiological studies have shown that workers subjected to very intense activities have an increased risk of health problems cardiovascular diseases, musculoskeletal disorders, depression, etc. Inglehart and Baker, ; Mercure and Vultur, ; Bigi et al. These expectations of development and personal fulfilment in work have become increasingly important since the s.

This relative effacement of the instrumental and painful dimension of work in favour of another dimension, more related to the activity itself and its consequences for the individual, took place in two stages. The majority of European employees report that their job gives them job satisfaction 80 per cent and have the feeling of doing useful work 84 per cent. But 16 per cent of them do not feel that they receive the recognition they deserve for their work and only 38 per cent think they have career prospects.

Thus, 71 per cent of them say that their job involves learning new things, but this is not the case for the remaining 29 per cent. Nearly half of employees 46 per cent say they perform monotonous tasks, but just as many feel they can apply their own ideas into their work 27 per cent sometimes and 25 per cent never. The survey shows that 41 per cent of employees received training paid for by their employers during the previous 12 months.

The most qualified of them have access to more and longer-term training. About 65 per cent of employees can choose or change the order of the tasks they have to perform, their working speed and the methods applied. Only a quarter of them have a say in choosing their colleagues. The participation of employees in decisions concerning the organisational aspects that concern them remains limited: 44 per cent of them are consulted prior to their objectives being set; 44 per cent are involved in improving the organisation and work processes of their department; and 41 per cent have an influence on the important decisions that concern them.