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Competition between community health information networks already is brewing in several cities. Some say that competition could speed network development and keep costs in check. But others worry that competition could dilute anticipated CHIN benefits.
OBJECTIVE: To develop a conceptualization of perimenopause experienced by Filipina-American women. DESIGN: Grounded theory methods of interviews and constant comparative analysis. SETTING: Participants were interviewed in their homes or other location of their choosing. PARTICIPANTS: Sixteen Filipina-American women who had not menstruated in the past 6 months or who identified themselves as perimenopausal. MAIN OUTCOME MEASURES: Changing womanhood was the core category and was related to three major categories living in my changing body changing family relationships and changing community networks. RESULTS: The women experienced changes such as hot flashes and irritability as well as role conflicts and broadening community involvement. The perimenopause is also a time to focus on oneself and to seek activities of a personal, familial, and community nature that are fulfilling in a different way than previous child-rearing activities. CONCLUSION: Filipina-American women experience perimenopause as a normal process of aging rather than as symptomatic of disease, thus providing a health-oriented model of perimenopause.
BACKGROUND: As downsizing of institutional care continues, patients discharged are likely to have more severe mental illnesses, and to have experienced longer tenures within institutions than patients who have been discharged in the past. As greater numbers of patients are removed from mental hospitals, the objective burden experienced by informal care-givers may increase, particularly if formal care levels are inadequate. AIMS OF THE STUDY: This paper documents who assumes informal care-giver roles, and the form such care-giving takes for patients discharged from a state hospital. Specifically, this paper identifies (i) what factors affect a person's decision to assume a care-giver role, including the participation of other network members in care-giving, (ii) what factors influence whether care-giving is provided in time or in direct purchase of care and (iii) how the patient's treatment location affects the decision of the network member to assume any care-giving role. DATA AND ANALYTICAL METHODS: Data for this paper are taken from a longitudinal study of the closure of a state mental hospital in central Indiana. Seventy-seven patients were asked to identify their community networks. Ninety-eight network members were surveyed about the informal care, both in time or through direct expenditures, they provided to these patients one year after discharge. Care-giving relationships were estimated using a multivariate probit model. Such a model estimates the extent to which the decision to provide care in either form depends on the care-giving activities assumed by other network members associated with a given patient, as well as the characteristics of individual patients and network members. RESULTS: Forty-one per cent of network members provided some level of informal care, with 13.3% providing some care in time, and 35.7% providing some care through direct expenditures. A positive relationship was found between participation in informal care-giving and the perception by the network member that patient needs were not being met by professionals. The decision to provide informal care was also found to be sensitive to the level of informal and formal care received by the patient. Care-giving in expense was found to be positively related to the care-giving decisions of other informal care-givers, but care-giving in time was not. Network members were more likely to provide care in time for patients who had been recently discharged to the community than for patients who remained in institutional settings. CONCLUSIONS: These results suggest the transfer of persons with severe mental illnesses from state hospitals to the community may shift the care burden between formal and informal providers. If this is the case, discharge criteria should include such factors as the community resources available to the patient. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The responsiveness of network members to perceived unmet need bespeaks the importance of informal care when the continuity of formal care cannot be assured. Findings also suggest there may be some substitution of formal and informal care when patients are discharged from institutions. Further analysis is required to determine whether network members' perceptions of unmet need are accurate, and means by which network members can be made better attuned to unmet needs actually experienced by patients.
INTRODUCTION: During 1998-2000, an international team of five researchers described nine innovative health professions education programmes as selected by The Network: Community Partnerships for Health through Innovative Education, Service, and Research. Each researcher visited one or two schools. Criteria for selection of these nine schools included commitment to multidisciplinary and community-based education, longitudinal community placements, formal linkages with government entities and a structured approach to community participation. The purpose of these descriptions was to identify key issues in designing and implementing community-based education. METHODOLOGY: Programmes in Chile, Cuba, Egypt, India, the Philippines, South Africa, Sudan, Sweden and the United States were visited. Before site visits were conducted, the researchers as a group agreed upon the elements to be described. Elements included overall institutional characteristics, curriculum, admissions practices, evaluation systems, research, service, community involvement, faculty development, postgraduate programmes and the school's relationship with government entities. Here I describe the common features of each of the nine programmes, their shared dilemmas and how each went about balancing the teaching of clinical competence and population perspectives. LESSONS LEARNED: Based upon an analysis of the cases, I present seven "lessons learned" as well as a discussion of programme development, institutionalization of reform and long-term implications for health professions education. The seven lessons are: (1) PBL and CBE are not seen as independent curricular reforms; (2) student activities are determined based upon sensitivity to locale; (3) health professionals need to work collaboratively; (4) there is a connection between personal health and population health issues; (5) population health interventions and treatment strategies need to be appropriate to local conditions; (6) graduates need to advocate for patients and the community in the public policy arena; and (7) organizational change takes a long time. CONCLUSIONS: Despite their differences, all nine exemplars are engaged in processes of organizational change. Schools are becoming more community-oriented and socially accountable, and all of these programmes have accepted two fundamental tenets: "take public money, give to the public" and "place matters".
OBJECTIVES: To evaluate the process of establishing a Safe Community project for children. DESIGN: A descriptive study. SETTING: Penarth, a town (population 20,430) Vale of Glamorgan, South Wales. SUBJECTS: 3943 children and their families in Penarth. MAIN OUTCOME MEASURES: Whether the 12 criteria for a Safe Community project (World Health Organisation) were met. Implementation of the safety agenda set by the community. RESULTS: Safe Child Penarth met 10 of the 12 criteria for the Safe Community network. All the items on the agenda were introduced in the initial two years of the project. There were difficulties, however, achieving sustained community ownership of the project. CONCLUSIONS: The Safe Community concept stimulated work to improve child safety in Penarth. Community safety initiatives should involve all local agencies to identify the problems and work with the community to set and meet the safety agenda. Partnership with the local authority is valuable to improve the safety of the environment. The experience generated from Safe Child Penarth has been used to develop a county wide, all age community safety project.
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We consider the problem of detecting communities or modules in networks, groups of vertices with a higher-than-average density of edges connecting them. Previous work indicates that a robust approach to this problem is the maximization of the benefit function known as "modularity" over possible divisions of a network. Here we show that this maximization process can be written in terms of the eigenspectrum of a matrix we call the modularity matrix, which plays a role in community detection similar to that played by the graph Laplacian in graph partitioning calculations. This result leads us to a number of possible algorithms for detecting community structure, as well as several other results, including a spectral measure of bipartite structure in networks and a centrality measure that identifies vertices that occupy central positions within the communities to which they belong. The algorithms and measures proposed are illustrated with applications to a variety of real-world complex networks.
The promotion of a partnership set up to assure care for dependent elderly people has become a popular topic amongst health care and social services planners. This paper reviews what seems to be Québec's main assumptions concerning the demands created by the demographic explosion of elderly people, limited financial resources, and the negative impact of institutionalisation. The state's five guidelines for the establishment of sensible health care services for dependent elderly people are also discussed. They include redefining the '65 years or over' criterion that labels someone in this age group as 'a person needing extra care services'; cutting and re-allocating state expenditures; soliciting all eventual partners outside the formal health care network; reformulating the roles and duties of health care professionals, stressing the efficiency of their intervention; and re-asserting the value of an elderly person's family and community networks. An interpretation of the meaning of partnership, based on information in government documents, as well as the conditions that could hinder its development are also discussed. Finally, an overview is provided of the potential effects of a partnership on the target group and the community. This analysis is based on Québec's situation although many of the angles and dilemmas could be applied to other industrialised countries.
John C. Lincoln Health Network, Phoenix, was awarded the Foster G. McGaw Prize for excellence in community service, one of the healthcare field's most prestigious honors. The network serves a broad geographic area and nearly a dozen communities. Those communities most challenged by poverty, hunger, poor housing and crime are the focus of most of the health network's efforts.
Increasingly, agencies supporting community health promotion interventions require participating communities and evaluators to specify how the intervention will be maintained once agency funding ends. The Stanford Five-City Project (FCP) implemented two different strategies to maintain its heart disease education program, with the second strategy designed to overcome the barriers to implementation that were encountered by the first. This paper provides a practice-oriented description of the initial 'community network' maintenance strategy of the FCP, the barriers that were encountered as this network strategy was implemented, the alternative 'capacity-building' strategy directed at local health educators and the successful implementation of this alternative. Also discussed are the community organization issues underlying the shift in intervention maintenance strategies and the specific components of the capacity-building strategy, including its focus on health educators, and its application of a training of trainers model and cooperative learning methods to provide professional development, technical assistance and other resources to a target group of community health educators. Our experience indicates that capacity-building is a viable method for intervention maintenance and that it may also facilitate efforts to disseminate model health promotion programs to communities lacking experience in community health promotion intervention.
It is useful to view the social handling of alcohol problems in US communities from the perspective of a whole network of human service systems that share in the burden of identifying and responding to problem drinkers. This analysis examines the management of alcohol problems in different community service systems by mapping patterns in the institutional encounters of problem drinkers across alcohol treatment, drug treatment, mental health treatment, social welfare and criminal justice systems in a single US community. Findings highlight the prominence of large bureaucratic systems for social welfare and criminal justice as sources of referrals for smaller service systems offering treatment for alcohol problems. However, large proportions of problem-drinking service recipients in the community remain exclusive clients of the welfare and criminal justice systems, making no contact with therapeutically orientated service settings. Compared with problem drinkers who obtain treatment services, problem drinkers on the case-loads of criminal justice and welfare agencies tend to be younger, of higher socio-economic status, are more likely to be male, and tend to drink less heavily and to experience fewer symptoms of alcohol dependence. Given the distinctive characteristics of problem drinkers found exclusively in criminal justice and welfare settings, it may be advisable for communities to introduce early intervention programs in these systems that target services to this particular subgroup of problem drinkers.
As part of a multi-site Centers for Disease Control and Prevention-funded initiative, a community-level HIV prevention project targeting injection drug users was implemented in the FivePoints community in Denver, Colorado. The protocol for the initiative included the use of peer networks to conduct outreach and disseminate intervention materials to injecting drug users. Since April 1993, project staff established a peer network of 119 participants who distribute approximately 3,000 materials per month.
The Los Angeles Free-Net, an interactive community information resource, was established in part to help community members become more effective consumers of health care services. By providing timely, expert answers to anonymously asked medical questions at no charge, we hope to decrease unnecessary physician-patient encounters, encourage effective preventive-health measures, and improve the overall results of health care in our community. Although it is too early to assess health care benefits from this system, the following observations may help guide the development of similar systems around the nation: (1) A small annual registration fee generates both moral and financial public support. (2) Demographic information from registered users can help direct attempts at enfranchising all members of the community. (3) Toll-free access, free public-instruction sessions, moderated forums, extensive volunteer help, and encryption security are encouraged, while Internet censorship is difficult and counterproductive. (4) Access to Internet resources is important, but the strength of a community system lies primarily in the sharing of expertise and resources among members of the community. (5) A critical mass of available physicians to answer questions must be matched with a critical level of question input for this type of interactive medical information resource to function in a time-sensitive fashion.
Obtaining feedback on data elements from national experts was crucial to the development of the core patient data set. This was accomplished, in part, through using GroupSystems electronic meeting software.
OBJECTIVE: To analyze trends and various approaches to professional development in selected community health worker (CHW) training and certification programs in the United States. We examined the expected outcomes and goals of different training and certification programs related to individual CHWs as well as the community they serve. METHOD: A national survey of CHW training and certification programs. Data collection was performed through personal interviews, phone interviews and focus groups. Data sources included public health officials, healthcare associations, CHW networks, community colleges, and service providers. Initial screening interviews resulted in in-depth interviews with participants in 19 states. We applied human capital theory concepts to the analysis of the rich qualitative data collected in each state. RESULTS: CHW programs in the U.S. seem to have been initiated mainly due to lack of access to healthcare services in culturally, economically, and geographically isolated communities. Three trends in CHW workforce development were identified from the results of the national survey: (1) schooling at the community college level - provides career advancement opportunities; (2) on-the-job training - improves standards of care, CHW income, and retention; and (3) certification at the state level - recognizes the work of CHWs, and facilitates Medicaid reimbursement for CHW services. CONCLUSION: Study findings present opportunities for CHW knowledge and skill improvement approaches that can be targeted at specific individual career, service agency, or community level goals. Trained and/or certified community health workers are a potential new and skilled healthcare workforce that could help improve healthcare access and utilization among underserved populations in the United States.
Iron supplementation is a commonly used strategy to meet the increased requirements of at-risk groups, such as women of childbearing age, especially during pregnancy. Other at-risk groups for which iron supplementation may be appropriate include infants, young children, adolescents and the elderly. There is a need to consider iron supplementation as part of a comprehensive strategy for the prevention of iron deficiency, and not just as a treatment for anemia that is stopped as soon as clinical improvement is noted. Experience in developing countries indicates that often the poorest women with the most deficient intakes are the least likely to receive iron supplements during pregnancy. Providing supplements to women during antenatal care visits is useful but often inadequate, so other delivery channels must also be explored, including private sector markets and community networks. Communication efforts must be expanded to increase understanding of the importance of taking supplements and to address any fears or misconceptions relating to supplementation. Overall, we must increase the capacity of individuals and communities to define, analyze and act to address their own health needs.
Most persons move to senior living communities because they want to regain the sense of "community" lost when they left their families, neighborhoods, and community networks. By focusing on mission, mutuality, and myth, the organization can offer residents this feeling of belonging. The mission statement must become the heart of the organization. It should represent both resident and staff expectations and goals. Community also develops around mutuality, a life-sustaining and growth-promoting matrix of care, comprising resident-staff care, staff-resident care, resident-resident care, and staff-staff care. Myth, the third component of community, is a way of making sense of what is often a senseless world and enhancing people's feeling of community. To facilitate coping with the stresses of aging, senior living community staff must sustain and promote myths, especially religious myths, images, and symbols. St. Leonard Center, Dayton, OH, is a senior living community that has incorporated these three components into its organization to make it a community in the true sense.