Biomedical subjects
R Belville
Publications and source records attributed to R Belville.
Linking frontline work and state-of-the-art knowledge: a community exchange system.
When challenged by complex medical and social conditions, local providers must participate in information exchanges, resource sharing, continuing education, and service coordination. A community exchange system, flexible enough to share and adapt new knowledge, and able to provide continuing multidisciplinary training and education across different practice settings, was established for the prevention and treatment of HIV/AIDS in East Harlem, New York City. The HIV/AIDS community exchange system supports linkages among disciplines within a medical center, communication among the local community-based organizations, and networks between the two settings. The system, as a model, is applicable to complex socio-medical problems such as diabetes, substance abuse, violence, tuberculosis, or geriatrics.
Occupational injuries among working adolescents in New York State.
OBJECTIVE: To determine the number, distribution, determinants, and health consequences of occupational injuries among working adolescents in New York State. DESIGN: A retrospective, population-based analysis of New York State workers' compensation award data and the Annual Demographic File, a supplement to the US Bureau of the Census Current Population Survey. PARTICIPANTS: Adolescents, aged 14 through 17 years, who received workers' compensation awards for occupational injury from 1980 through 1987. MAIN OUTCOME MEASURES: (1) Numbers, types, and rates of occupational injuries in working adolescents by age, sex, industry, and occupation; (2) health consequences of injury, especially disability and death; and (3) secular trends in injury award rates. RESULTS: A total of 9656 adolescents were compensated for occupational injuries; 4201 compensated adolescents (43.5%) suffered permanent disability; 31 working adolescents died. The annual mean rate of compensated occupational injury was 28.2 per 10,000 adolescent workers. Rates were higher in males than in females and ranged from 8.2 per 10,000 in 14-year-old male workers to 46.8 per 10,000 in 17-year-old male workers. Highest rates by industry were seen in manufacturing (49.0/10,000 adolescent workers) and agriculture (46.2/10,000). Unskilled labor was the most dangerous occupation (52.3/10,000). CONCLUSION: Occupational injuries are a substantial and underrecognized contributor to the continuing epidemic of injury among adolescents.
The dangers of illegal child labor.
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A community-based approach to HIV case management: systematizing the unmanageable.
This article presents an analysis and typology of community-based care for a young Hispanic mother with acquired immune deficiency syndrome (AIDS). It develops a conceptual framework that examines retrospectively the needs generated by AIDS over time, the appropriateness of the services, and an assessment of the interventions. Community-based case management can effectively address some of the diverse and changing needs of AIDS patients and their families, such as bridging service gaps and fortifying patient and system strengths while minimizing their weaknesses. Community-based case managers may also be better equipped than hospital case managers to work with difficult patients and coordinate community- and hospital-based care. Conclusions are presented regarding the definition and implementation of community-based, culturally sensitive, family-centered human immunodeficiency virus case management, as well as the importance and difficulty of developing relationships among the family, health care providers, and institutions within the community.
Community medicine: its contribution to the social science of medicine.
The Division of Behavioral Sciences operates today in a social climate different from that in its formative years. The federal agencies created specifically to stimulate and support social research have been cut back severely over the past two decades, and in some instances have been eliminated. The official policy of the National Institute of Mental Health, once the main source of support for both training and research in social science in medicine, has changed to a much narrower biomedical focus. On the other hand, there are more social scientists engaged in integral roles both locally at Mount Sinai, at medical institutions nationally, and internationally (25-26). Further, reassertion of the importance for medical education of social science specifically, and of behavioral sciences more broadly defined, has been endorsed in the strongest terms by both the Association of American Medical Colleges and the National Board of Medical Examiners (27). Also, the published literature now incorporates what we in the Division of Behavioral Sciences judge to be a richer intellectual contribution to the field than ever before (28). Perhaps most important, funding for health services research and epidemiological studies has been increased in recent federal budgets. Therefore, the division is planning for expansion of both its research and education, perceiving the future as a challenge continuous with challenges of the past: finding new ways to understand the relation between social factors and the problems of health and illness.
Child labor in the United States: historical background and current crisis.
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The community as a strategic site for refining high perinatal risk assessments and interventions.
This paper describes a community-based agency's approach to reducing perinatal risk among populations at high medical, familial and environmental risk. Following a descriptive analysis of 96 families enrolled in a maternal outreach program, a case study illustrates how client-sensitive strategies are applied to successfully engage a traumatized population. The intensity and duration of the interventions, the extensive outreach efforts to the family and the dedication and commitment of the staff are not easily replicated but invaluable in helping providers and researchers understand to what extent the impact of severe deprivations and risk can be mediated and potential damage to the newborn prevented. The paper concludes that community-based agencies in partnership with social and clinical researchers from a tertiary care setting provide the key for developing more effective, integrated perinatal care by virtue of the critical density of hard-to-reach patients who can be followed by providers and clinical researchers.
Health services research for hospital policy.
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Health services research in action: explaining a decrease in patient visits at a diabetes clinic.
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The role of social scientists in planning and implementing change in a medical center.
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Influence of experience on major clinical decisions. Training implications.
We studied 779 walk-in psychiatric patients presenting to 32 first- or second-year residents and 772 patients presenting to 25 third-year residents or attending physicians as to the decision to admit to the hospital or to administer medication to those not admitted. There were no significant demographic or clinical differences between patients presenting to the two groups. The more experienced staff admitted half as many patients and treated serious depression with tricyclics twice as frequently. Inexperienced psychiatrists used hospitalization more frequently when these patients suffered from suicidal ideation, hallucinations, delusions, and inability to cope. When the training procedure was modified and second-year residents were introduced into a more structured setting, their decision-making quickly approached that of third-year residents and attending physicians. We suggest that specific training can modify decision-making, where general clinical experience may not. Implications for resident and medical student training are discussed.
A random sample for management and planning: social research at the Mount Sinai Hospital.
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