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PubMed2003

Developing a virtual interdisciplinary research community in higher education.

As multidisciplinary collaboration in both clinical and research settings is becoming a key aspect of contemporary health care, strategies to enhance interprofessional interaction in postgraduate research programmes can offer important experiences to facilitate ongoing interprofessional relationships. This paper provides a retrospective appraisal of a strategy which used computer-mediated communication to develop a virtual community network, known as'health_voice' accessed through a web page. The rationale for developing the network is presented, and the process of designing and establishing the web-site through an action research approach is described The outcome of the strategy is reviewed with regard to the relationships between the real' and 'virtual' community. Reflections on the developmental process contextualise the initiative within a concept of a community-of-practice. It is acknowledged that the use of a virtual arena for communication within a research community involves a cultural change in the dynamics of higher degree teaching and learning. Future plans to further embed the virtual environment within a postgraduate research culture are given.

Cooperative Behavior↗

PubMedDate not supplied

Protecting patient privacy and data quality in a community health information network.

The healthcare industry is under mounting pressure to cut costs without reducing the quality and quantity of healthcare services. One method to streamline operations is to implement community health information networks (CHINs). This article describes ways in which CHINs can offer subscribers improved efficiency, decreased costs, and improved patient care. It also addresses the fact that membership in a CHIN, if not controlled, greatly increases legal risks. Details on how many of these risks can be minimized or avoided are provided.

Antitrust Laws↗

PubMed1983

Ideologies and intervention strategies in an urban sample of drug-abuse agencies.

The study assessed the usefulness of a "levels of analysis" criterion for distinguishing ideological orientations in an urban sample of agencies working with drug-abuse clients: 39 directors reported on their programs' goals, and on their personal philosophies about the causes of drug-abuse problems. The authors used Frank and Atkins' procedures to classify goals and philosophies based on individual, family/group, or social systems levels of analysis. As predicted, agency goals better accounted for program and organizational differences than directors' philosophies: Agencies with social systems level goals characteristically combined advocacy strategies with community networking and outreach activities. However, an unexpected finding was that agencies with individual level goals were most likely to work with poor and minority clients. The discussion emphasizes the importance of an ideological/organizational/community context for evaluating intervention strategies in community-based agencies.

Community Mental Health Services↗

PubMed2006

Understanding the experiences of lesbian, bisexual and trans survivors of domestic violence: a qualitative study.

OBJECTIVES: Using a participatory approach, our objectives were to understand community perspectives on domestic violence (DV) in lesbian, bisexual and trans (LBT) communities, and to assess access to and cultural appropriateness ofDVservices for LBT survivors. METHODS: We used qualitative methods and conducted focus groups and semi-structured interviews with LBT survivors of DV. RESULTS: Nearly all participants reported that the level of awareness regarding DV in their communities was limited. Survivors reported difficulty identifying their partners' behavior as abusive. Isolation was described as central to experiences of abuse, and respondents discussed a variety of isolation tactics specific to LBT communities. Isolation also contributed to difficulty seeking help. Respondents reported that they often did not access mainstream DV services due to concerns about homophobia and transphobia. To address DV in LBT communities respondents pointed to the importance of friendship and community networks, sharing information about queer DV, and holding batterers accountable for their behavior. CONCLUSIONS: LBT people face challenges identifying and responding to DV that are specific to their cultural context. Services for LBT DV survivors must be culturally appropriate and accessible. Community based solutions for addressing and preventing DV should be encouraged.

Adult↗

PubMed1995

Initial experience with asynchronous transfer mode for use in a medical imaging network.

Picture archiving and communication Systems (PACS) for medical imaging have always suffered from band-width limitations, throughput, and proprietary protocols. Commercially available local area networks have been hard pressed to meet the requirements of image transfer in a time consistent with patient-care needs. Recent technologic advances provide potential solutions to these constraints. Asynchronous transfer mode (ATM) provides the aggregate bandwidth and throughput that may be sufficient to satisfy the medical imaging community. Networks using prototype ATM technology have been available and commercial hardware is now becoming available. This report presents initial performance results of an ATM network and its suitability for use in a digital imaging network. Throughput of 10 Mbytes/sec was attained with Transmission Control Protocol/Internet Protocol using commercially available hardware.

Computer Communication Networks↗

PubMed2004

The rise and fall of a networked society: a formal model.

In a well networked community, there is intense social interaction, and information disseminates briskly and broadly. This is important if the environment is volatile (i.e., keeps changing) and individuals never stop searching for fresh opportunities. Here, we present a simple model that attributes the rise of a dynamic society to the emergence of some key features in its social network. We also explain the apparently paradoxical observation that although such features do not necessarily materialize even under favorable conditions they display a significant resilience to deteriorating conditions. We interpret these findings as a discontinuous phase transition in the network formation process.

Journal Article↗

PubMed2001

Developing principles for health impact assessment.

BACKGROUND: Policies and practice in many sectors affect health. Health impact assessment (HIA) is a way to predict these health impacts, in order to recommend improvements in policies to improve health. There has been debate about appropriate methods for this work. The Scottish Executive funded the Scottish Needs Assessment Programme to conduct two pilot HIAs and from these to develop guidance on HIA. METHODS: Case study 1 compared three possible future scenarios for developing transport in Edinburgh, based on funding levels. It used a literature review, analysis of local data and the knowledge and opinions of key informants. Impacts borne by different population groups.were compared using grids. Case study 2 assessed the health impacts of housing investment in a disadvantaged part of Edinburgh, using published literature, focus groups with community groups and interviews with professionals. RESULTS: Disadvantaged communities bore more detrimental effects from the low transport investment scenario, in the areas of: accidents; pollution; access to amenities, jobs and social contacts; physical activity; and impacts on community networks. The housing investment had greatest impact on residents' mental health, by reducing overcrowding, noise pollution, stigma and fear of crime. CONCLUSION: Although there is no single 'blueprint' for HIA that will be appropriate for all circumstances, key principles to inform future HIA were defined. HIA should be systematic; involve decision-makers and affected communities; take into account local factors; use evidence and methods appropriate to the impacts identified and the importance and scope of the policy; and make practical recommendations.

Adolescent↗

PubMed2001

Achieving better health through health impact assessment.

OBJECTIVE: Health Impact Assessment (HIA) provides a method of predicting the health impacts of policies and activities, in order to recommend changes that would improve health. We piloted approaches to health impact assessment and made recommendations for its use as part of the planning and policy making processes in Scotland. DESIGN: Two Health Impact Assessments were done as case studies. One assessed the City of Edinburgh Council's Local Transport Strategy. The other assessed North Edinburgh Area Renewal Housing Strategy. Both were done in partnership with the professionals responsible for developing the strategies. RESULTS: The main health impacts of transport strategy were in the areas of: accidents, pollution, access to amenities, jobs and social contacts, opportunities for physical activity in walking and cycling and impacts on community networks. Overall, housing strategy impacted most on mental health, especially stress and depression. The recommendations of both HIAs are being used in developing the strategies further. CONCLUSIONS: Health impact assessment can make explicit the health consequences of decisions in different sectors, including impacts on health inequalities. Health Impact Assessment should be done as part of community planning and other partnership activities. Consideration of health impacts should become part of routine decision making.

Community Participation↗

PubMedDate not supplied

Building a virtual network in a community health research training program.

OBJECTIVE: To describe the experiences, lessons, and implications of building a virtual network as part of a two-year community health research training program in a Canadian province. DESIGN: An action research field study in which 25 health professionals from 17 health regions participated in a seven-week training course on health policy, management, economics, research methods, data analysis, and computer technology. The participants then returned to their regions to apply the knowledge in different community health research projects. Ongoing faculty consultations and support were provided as needed. Each participant was given a notebook computer with the necessary software, Internet access, and technical support for two years, to access information resources, engage in group problem solving, share ideas and knowledge, and collaborate on projects. MEASUREMENTS: Data collected over two years consisted of program documents, records of interviews with participants and staff, meeting notes, computer usage statistics, automated online surveys, computer conference postings, program Web site, and course feedback. The analysis consisted of detailed review and comparison of the data from different sources. NUD*IST was then used to validate earlier study findings. RESULTS: The ten key lessons are that role clarity, technology vision, implementation staging, protected time, just-in-time training, ongoing facilitation, work integration, participatory design, relationship building, and the demonstration of results are essential ingredients for building a successful network. CONCLUSION: This study provides a descriptive model of the processes involved in developing, in the community health setting, virtual networks that can be used as the basis for future research and as a practical guide for managers.

Canada↗

PubMed1995

The trouble with CHINS (community health information networks).

If one had to choose a single acronym that captures both the vision and folly of today's health care industry, it would be "CHIN." The term--which stands for "community health information network"--combines the idealism of community-based health care with the promise of computer automation. Ironically, the acronym may come to be synonymous with "sticking your neck out"; these costly computer networks presuppose a quixotic collaboration among hospitals and health systems long at one another's competitive throats. For CHINs to succeed, they must overcome barriers that many industry insiders say are insurmountable.

Community Health Planning↗

PubMed2006

Modularity and community structure in networks.

Many networks of interest in the sciences, including social networks, computer networks, and metabolic and regulatory networks, are found to divide naturally into communities or modules. The problem of detecting and characterizing this community structure is one of the outstanding issues in the study of networked systems. One highly effective approach is the optimization of the quality function known as "modularity" over the possible divisions of a network. Here I show that the modularity can be expressed in terms of the eigenvectors of a characteristic matrix for the network, which I call the modularity matrix, and that this expression leads to a spectral algorithm for community detection that returns results of demonstrably higher quality than competing methods in shorter running times. I illustrate the method with applications to several published network data sets.

Journal Article↗

PubMed1999

Deinstitutionalization and psychiatric reform in Spain.

The transformation of psychiatric care which has been carried out in Spain since the 1980s, under the name of "Psychiatric Reform", had produced as it most significant achievements: (i) the development of a new organizational structure for mental health care, (ii) the integration of psychiatric patients in the general health care system, (iii) the creation of an extensive community network of mental health centers, and (iv) the adoption by the general public of more positive attitudes towards mental illness and its treatment and the passing of legislative measures aimed at improving the civil rights of these patients. However, the application of the Psychiatric Reform has followed an uneven course in Spain as a whole, with marked differences between the different autonomous communities. The main deficiency has been in the development of intermediate community services and programs to rehabilitate and resettle patients in the community. With regard to deinstitutionalization, the results have also been insufficient and it is still possible to observe a strong tendency, within the system, to maintain the old mental hospitals for both long-term and short-term illness care. Finally, the analysis of the Spanish experience has revealed that (i) many of the criticisms leveled at deinstitutionalization are not aimed at its "conceptual core" but stem from its inadequate implementation, and (ii) it is wrong to equate deinstitutionalization and psychiatric reform with closure of psychiatric hospitals, without the awareness that this process is far more complex.

Deinstitutionalization↗

PubMedDate not supplied

[Deinstitutionalization and psychiatric reform in Spain].

The transformation of psychiatric care which has been carried out in Spain since the 1980s, under the name of < >, had produced as it most significant achievements: i) the development of a new organizational structure for mental health care, ii) the integration of psychiatric patients in the general health care system, iii) the creation of an extensive community network of mental health centers, and iv) the adoption by the general public of more positive attitudes towards mental illness and its treatment and the passing of legislative measures aimed at improving the civil rights of these patients. However, the application of the Psychiatric Reform has followed an uneven course in Spain as a whole, with marked differences between the different autonomous communities. The main deficiency has been in the development of intermediate community services and programs to rehabilitate and resettle patients in the community. With regard to deinstitutionalization, the results have also been insufficient and it is still possible to observe a strong tendency, within the system, to maintain the old mental hospitals for both long-term and short-term illness care. Finally, the analysis of the Spanish experience has revealed that, i) many of the criticisms leveled at deinstitutionalization are not aimed at its < > but stem from its inadequate implementation, and ii) it is wrong to equate deinstitutionalization and psychiatric reform with closure of psychiatric hospitals, without the awareness that this process is far more complex.

Deinstitutionalization↗

PubMed2001

Spanish psychiatric reform: what can be learned from two decades of experience?

OBJECTIVE: The objective of the paper is to describe the impact of Spanish psychiatric reform on the organization and functioning of mental health services. METHOD: This paper is based on official administrative reports and on relevant related publications. RESULTS: The most significant achievements of Spanish psychiatric reform have been: (i) the development of a new organization of mental health care, decentralized in character and territorially based; (ii) the integration of psychiatric patients in general health care; (iii) the creation of an extensive community network of health centres; and (iv) the development of more positive attitudes towards mental illness. However, our analysis also reveals the existence of significant deficiencies. CONCLUSION: Analysis of the Spanish experience shows that the process of psychiatric reform depends basically on long-term commitments, which in a system such as Spain's must come from central administration and also from the autonomous communities.

Health Care Reform↗

PubMed1982

The healing process in African psychotherapy.

Some orientations in African psychotherapy were examined. The holistic concept in a therapeutic context and the community network approach to treatment are discussed. The paper presents the individual in African psychotherapy as one whose disease causality and healing process are inextricably linked with the supernatural.

Ceremonial Behavior↗

PubMed1998

Mental health issues of abused women: the perceptions of shelter workers.

While some studies have documented the mental health symptoms of battered women, we know little of the extent to which shelter residents present with mental health and substance abuse symptoms, or the effect of these issues on other residents, staff, and children. Further, it is not clear whether shelter staff feel sufficiently trained to safely and adequately address such concerns. The current survey was an effort to document what proportion of shelter residents present with severe symptomatology and its effect on the shelter environment. The survey was completed by 158 staff from 23 of Alberta's 30 shelters. Since shelters are one aspect of a community network of services, it was of interest to identify how well mental health and substance abuse services complement each other and whether shelters have developed strategies to better connect with other agencies.

Adult↗

PubMed2026

Diversity analysis of indoor and outdoor fungal bioaerosols in UK households: a prospective, observational, longitudinal study.

BACKGROUND: Long-term exposure to indoor fungal bioaerosols is a recognised risk factor for respiratory illness, particularly in damp and poorly ventilated housing. However, the diversity and seasonal variability of these fungal communities are poorly understood. As part of the West London Healthy Home and Environment Study (WellHome), this study aimed to characterise the composition, diversity, and temporal dynamics of indoor fungal bioaerosols in urban UK homes, as compared with outdoor air, to inform future exposure baselines and policy development. METHODS: In this prospective, community-based observational study, 118 households were recruited across West London, UK, via community networks and partner organisations, prioritising families with children aged 5-17 years with asthma or allergies, from diverse socioeconomic backgrounds. Sampling occurred between Oct 3, 2022, and June 14, 2024. Participant data were collected via questionnaires completed by household members, capturing demographics, building characteristics, and respiratory health. Passive-air samplers were used in living rooms for 28 days during two seasonal campaigns, with concurrent outdoor sampling at four fixed community sites. Fungal bioaerosols were identified by ITS2 amplicon sequencing and quantified using broad-range quantitative PCR targeting the 18S rRNA gene. Diversity indexes and temporal dynamics were analysed using ecological statistics and generalised additive models. FINDINGS: 118 households were enrolled, comprising 504 residents (263 women, 237 men, and four not reported). Among 504 participants who self-identified, the largest groups comprised individuals identifying as Black African (n=47), Somali (n=46), White British (n=42), and African (n=38), with additional representation from mixed race ethnic backgrounds (n=29), Black British (n=27), White (n=22), and Black Caribbean (n=18), alongside several other ethnicities each represented at lower frequencies. Of 118 households, 104 completed both seasonal campaigns and 14 completed one, yielding 262 air samples (222 indoor and 40 outdoor). DNA was successfully recovered from all samples, identifying 2027 fungal genera. Indoor environments showed significantly higher richness (mean 646 vs 495 amplicon sequence variants; p<0·0001) and Shannon diversity (4·21 vs 3·53; p<0·0001) than outdoors. Community composition differed markedly (permutational multivariate ANOVA p<0·0001), with Penicillium, Aspergillus, and Wallemia enriched indoors. Indoor fungal communities presented stronger seasonal cycling (R2=0·203) than outdoor communities (R2=0·012). Fungal burden across all homes had a median 11 043 genomic equivalence (GE); IQR 4598-20 579 GE. The highest levels were observed in homes with visible mould; one household showed elevated Aspergillus exposure linked to repeated asthma hospitalisations in a sensitised resident. INTERPRETATION: Indoor fungal bioaerosols are more diverse and dynamic than outdoor communities in urban UK homes. These findings establish foundational exposure data and highlight the need for incorporating fungal bioaerosol monitoring into public health policy to mitigate mould-related health risks. FUNDING: UK Research and Innovation (UKRI) Strategic Priorities Fund (SPF) Clean Air Programme.

Humans↗

PubMed1993

Strategic planning. From the ground up: planting the seeds of network development.

It is critical to understand and accept the intense effort and planning needed for successful network development. No model exists that can be immediately implemented successfully. Every organization involved in network development will have to become familiar with the issues, benefits and risks, as well as involve the key stakeholders, which include administration, board and health professional providers from physicians through allied professionals. The outcome of this development can be a very successful, efficient new delivery model that will benefit the users, the payers and the providers. Although difficult and sometimes boring, the methodical and thorough movement through the process of developing a regional community network can greatly enhance outcome. The shared vision of the network should be exciting, and should make participants search for the clear image of what will be developed. All should work jointly as partners to accomplish that vision. Although there may be facilitation and assistance, it will be the providers and stakeholders who will be most affected by the network. It is their commitment, effort, energy and experience that will lead to success.

Comprehensive Health Care↗