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PubMedDate not supplied

[People's participation in local health committees: showing lives, telling fights].

This study aimed at analysing people's participation in Local Health Committees and understanding the participatory action of its members by identifying potentialities and limits in the process. We used the qualitative research approach, with interviews and observation as data collection methods. By applying Habermas's theoretical referential, we visualised the people's participation as a social and historical phenomenon marked by many fights. We found a communication that is very focused on strategic actions. However, we visualised possibilities to build an autonomous public space. We concluded that the people's participation can potentially act in the transformation of healthcare practices and, as such, it should be included by municipal administrators as a tool to elaborate and implement healthcare policies.

Community Networks↗
PubMed2005

The trouble with "MSM" and "WSW": erasure of the sexual-minority person in public health discourse.

Men who have sex with men (MSM) and women who have sex with women (WSW) are purportedly neutral terms commonly used in public health discourse. However, they are problematic because they obscure social dimensions of sexuality; undermine the self-labeling of lesbian, gay, and bisexual people; and do not sufficiently describe variations in sexual behavior.MSM and WSW often imply a lack of lesbian or gay identity and an absence of community, networks, and relationships in which same-gender pairings mean more than merely sexual behavior. Overuse of the terms MSM and WSW adds to a history of scientific labeling of sexual minorities that reflects, and inadvertently advances, heterosexist notions. Public health professionals should adopt more nuanced and culturally relevant language in discussing members of sexual-minority groups.

Female↗
PubMed2006

Exploring the ethics of clinical research in an urban community.

OBJECTIVES: We consulted with representatives of an urban community in Washington, DC, about the ethics of clinical research involving residents of the community with limited access to health care. METHODS: A semistructured community consultation was conducted with core members of the Health Partnership Program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Three research case examples were discussed; questions and probes (a predetermined question or series of questions used to further investigate or follow-up a response) guided the discussion. RESULTS: The community representatives who took part in the consultation were supportive of research and appreciated the opportunity to be heard. They noted the importance of respecting the circumstances, values, needs, and welfare of research participants; supported widely representative recruitment strategies; and cited the positive benefits of providing care or treatment to participants. Monitoring participants' welfare and ensuring care at a study's end were emphasized. Trust was a central theme; participants suggested several trust-enhancing strategies, including full disclosure of information and the involvement of advocates, physicians, and trusted church members. CONCLUSIONS: Several important strategies emerged for conducting ethical research in urban communities whose residents have limited access to health care.

Black or African American↗
PubMed2004

Hurling alone? How social capital failed to save the Irish from cardiovascular disease in the United States.

OBJECTIVES: We performed a historical review of cardiovascular risk profiles of Irish immigrants to the United States, 1850-1970, in regard to lifestyle, socio-economic circumstances, and social capital. METHODS: We analyzed US Census data from 1850-1970, area-based social and epidemiological data from Boston, data from Ireland's National Nutrition Surveillance Centre, and literature on Irish migration. RESULTS: The Irish were consistently at increased risk of cardiovascular diseases, a risk that related initially to material deprivation, across the life course of at least 2 generations. CONCLUSIONS: The principal difference between the Irish and other disadvantaged immigrant groups, such as the Italians, was dietary habits influenced by experiences during the Irish famine. Although there was a psychosocial component to the disadvantage and discrimination they experienced as an ethnic group, the Irish also exhibited strong community networks and support structures that might have been expected to counteract discrimination's negative effects. However, the Irish's high levels of social capital were not protective for cardiovascular disease.

Boston↗
PubMed2004

Suicide prevention program for the elderly: the experience in Japan.

In this article, the author describes a suicide prevention program for the elderly in Japan carried out in a small town, Nagawamachi, Aomori. Because of the recent sharp increase in this town in the rate of suicides, we started to develop a suicide prevention program with the goal of trying to detect depression in its early stages. At first we adopted various questionnaires and used structured interviews, and then developed a screener for depression. Screening is an important part of our suicide prevention program, because elderly who are suicidal often do not recognize their distress is a treatable medical condition, partly due to a negative image of mental illness, and most of them do not seek medical help. The author underscores the importance of educational programs to address how to recognize the symptoms of depression and to develop a community network for the elderly to communicate with locals and support each other. It is also important to focus on a social schema to produce a society that respects "being" and not just "doing".

Aged↗
PubMedDate not supplied

[Neocodion misuse: evolution between 1992 and 2002].

Neocodion, a codeine antitussive preparation (codeine camphosulfonate + Grindelia + sulfogaiacol) is known to be misused by opiate addicts. This study aimed to examine the evolution in Neocodion use between 1992 and 2002. Since 1992, three surveys (1992, 1997 and 2002) investigating Neocodion misuse were performed via several community networks of pharmacists. During the same time, data on Neocodion use were extracted from the French drug-dependence monitoring programme (OPPIDUM [Observation des Produits Psychotropes Illicites ou Détournés de leur Utilisation Médicamenteuse]). A marked and continuous decrease in Neocodion consumption was observed. The number of requests for Neocodion per pharmacy and per week largely decreased from 9.9 to 2.1 between 1992 and 2002. OPPIDUM data also showed a reduction in the rate of Neocodion consumption (from 8% in 1992 to 0.4% in 2002). Patients were older (30.4 years in 1992 and 33.7 years in 2002) and their socioeconomic conditions were better. Eighty-six percent of the subjects studied were poly-drug consumers. In fact, Neocodion was less sought after for opiate maintenance than for its psychoactive effects. Despite the reduction in the consumption of Neocodion, the changes observed in the consumption patterns for this medication suggest that vigilance is still required.

Adult↗
PubMed2005

Collaboration with city agencies: a winning approach to community assessment.

Five graduate nursing students made a difference in the health of San Antonio citizens by conducting a community assessment as part of a standard clinical activity in their community health nursing course. The students and their professor were able to effect city-wide change for health protection and promotion through collaboration with the City of San Antonio Planning Department (CSAPD). By compiling information, linking organizations, and speaking before community groups about the importance of a fluoridated water supply, the students generated public interest and momentum, which resulted in a successful vote to add fluoride to the water supply. In addition, they were able to add to the assessment compiled by the Planning Department employees and increase the CSAPD's awareness of health concerns as an important area to assess within a community. The resulting assessment was more comprehensive than it would have been without the students' input. This use of collaboration provides a model other faculty may adopt for community assessment.

California↗
PubMedDate not supplied

The impact of organizational characteristics on smoking policy restrictions in midwestern hospitals.

Purpose. The relationship between hospitals' organizational characteristics and adoption of restrictive smoking policies was examined. Design. Self-administered questionnaires and telephone interviews were conducted prior to and following the target date for policy implementation. Setting. The Director of Regional Medical Services of a community network of hospitals requested in the summer of 1989 that the 57 member hospitals voluntarily implement a policy prohibiting all smoking in hospital buildings as of January 1, 1990. Subjects. Subjects were the 49 hospital CEOs (86%) who provided data at both time points. Intervention. The Director of Regional Medical Services made a personal request of the CEO during a routine visit at each hospital. Measures. Measures included structural aspects of the hospitals (e.g., number of employees, number of beds, presence of chemical dependency and psychiatric units); orientation toward employee health; support for smoking restrictions among various groups; and extent of CEO authority to set smoking policy. Results. Fifty-one percent of hospitals increased the restrictiveness of their smoking policy; 35% adopted a complete indoor smoking ban. Stepwise multiple regression analysis demonstrated that adoption of additional smoking restrictions was related to CEOs' and perceived board of directors' support of smoking restrictions, absence of a chemical dependency unit, and experience of financial difficulties in the previous two years. Conclusions. It is important to educate top decision makers as to the necessity of restrictive smoking policies. Barriers to smoking restrictions in organizations with chemical dependency units deserve particular attention from health promotion practitioners and researchers.

Hospital Administration↗
PubMed1992

Managing chronic illness: an immigrant woman's acquisition and use of health care knowledge.

As occupational therapists increasingly encounter a multicultural clientele, there is growing interest in the influence of a person's culture on his or her interactions with the environment. This paper presents a case study of a Chinese-Canadian immigrant woman with rheumatoid arthritis. The case study illustrates how the subject's family, community networks, and workplace, coupled with the occupational therapy clinical setting, intermingled to shape the daily management of her illness. The case material focuses on the subject's acquisition and use of different types of health care knowledge as she responds to her illness. It shows that the subject's experiences and management decisions about her health are closely linked to the material and social conditions of her life as a working-class immigrant woman. This article suggests that attention needs to be paid to the broader systems of the environment in understanding the responses of immigrant women to occupational therapy, rather than on the cultural distinctiveness of the clients.

Adaptation, Psychological↗
PubMedDate not supplied

Raising families: urban women's experiences of requiring support.

Rapid social changes and the pressures of contemporary living have put families under increasing stress. Nurses have the potential to offer support for families experiencing stress. Therefore, it behoves nurses to develop a greater understanding of the stressors affecting families in contemporary Australia. This paper reports an exploratory descriptive study of urban women's experiences of dealing with difficult and demanding situations in their lives as mothers and family carers in contemporary Australian society, and explores women's experiences of seeking support for family issues. Participants' insights about the nature and availability of support for themselves and their families when in these stressful situations are revealed. Participants sought support from various personal networks, community and self help groups, and professional helpers. However, adequate support was not always available. Nurses have the potential to further develop their role in relation to providing support to women raising families.

Adaptation, Psychological↗
PubMed1991

Entry of human immunodeficiency virus infection into a population of injecting drug users, Victoria, 1990.

OBJECTIVE: To investigate the pathway by which the human immunodeficiency virus (HIV) is entering populations of injecting drug users (IDUs) in Victoria. DESIGN: A retrospective case-control study comparing the prevalence of self reported risk behaviour in HIV-infected and uninfected Victorian IDUs. SETTING: Subjects were recruited by trained peer outreach workers from their personal networks, community agencies and Fairfield Hospital outpatients, and by a research worker from the major metropolitan prison. PARTICIPANTS: People who had been resident in Victoria for the past 12 months and had injected an illicit drug more than once in the previous three years were eligible to participate. Sixty-two such people (28 HIV-infected, 34 not infected) were included in the study. MAIN OUTCOME MEASURES: The two main hypothesised portals of entry were from the non-IDU homosexual population in Victoria, and from HIV-infected IDUs elsewhere. RESULTS: male homosexual contact was the most consistent risk factor identified by this study (odds ratio [OR], 6.2; 95% confidence interval [CI], 1.7-23.8). Having lived in or visited Sydney before 1986 was also associated with being infected with HIV (OR, 13.2; 95% CI, 1.5-603), and this was associated with homosexuality. Infected IDUs reported more sharing of injecting equipment than controls (OR, 9.0; 95% CI, 1.5-92.5), particularly with sexual partners; when this was the case, they were more likely to always use the injecting equipment after their partner (61% of cases, 0% of controls; OR, greater than or equal to 4.1; P = 0.0006). CONCLUSION: Men who have a history of both homosexual contact and injecting drug use represent the group of IDUs at highest risk of HIV infection in Victoria. Although heterosexual and homosexual IDUs may have limited contact only, a larger epidemic of HIV infection in heterosexual IDUs could spread from homosexual IDUs through the sharing of injecting equipment.

Adult↗
PubMed2005

Sustainable chronic disease management in remote Australia.

The Sharing Health Care Initiative (SHCI) demonstration project, which aimed to improve management of chronic diseases, was implemented in four small remote communities in the Katherine region which are serviced by the Katherine West Health Board, a remote Aboriginal-community-controlled health organisation in the Northern Territory. We reviewed the project proposal, final report, evaluation reports and transitional funding proposal, and supplemented these with in-depth interviews with key individuals. We determined factors critical to the sustainability of the SHCI project in relation to context, community engagement, systems flexibility and adaptability, the availability and effect of information systems, and the human nature of health care and policy. The project had a significant impact on community awareness of chronic disease and an improvement in clinic processes. We found that a number of interrelated factors promoted sustainability, including: An implementation strategy sufficiently flexible to take account of local conditions; A high level of community engagement; Appropriate timeframes, timing and congruence between national policy and local readiness to implement a chronic disease project; Effective communication between participating organisations; Project champions (key individuals) in participating organisations; Effective use of monitoring and evaluation data; and Adequate and ongoing funding. The absence of a number of these factors, such as poor communication, inhibited sustainability. Other factors could both promote and inhibit. For example, the impact of key individuals was important, but could be idiosyncratic and have negative effects.

Catchment Area, Health↗
PubMedDate not supplied

"Spiritlinking": a key to dynamic change. Fostering chaos enables leaders to form the networks and unity needed to fulfill their mission.

To contend with the anxiety and chaos inherent in rapid change, leaders can turn to ¿spiritlinking,¿ the deliberate and untiring act of building the high-energy networks where new ideas are born and new ways of delivering service take form. Spiritlinking leaders are able to envision and promote the paradox of disequilibrium. They seek truth, pushing the organization into a condition of imbalance where staid settledness gives way to new paradigms founded on constant transformation. Spiritlinking leaders are not bound by organizational charts. They have discovered that the greater the participation in the organization, the greater the access to vast amounts of information and insight, which will ultimately lead to profound transformation. Spiritlinking is directed toward networking, community forming, and coalition building, often across chasms of ideological differences. Leaders must have the skill to manage the vision, which entails generating courage and belief through the cloudiness of ambiguity. Spiritlinking leaders must also create synergy from conflict, gathering strong-minded, self-assured persons who perhaps hold vastly differing perspectives, yet, in working for the common good, arrive at surprising, wonderful decisions. Finally, spiritlinking leaders assist the organization in working through resistance by identifying the mode, motive, and meaning of the resistant behavior and determining the action the organization is willing to take to move beyond it.

Canada↗
PubMedDate not supplied

Being there.

Explore the source record for details and available documents.

Aged↗
PubMed1998

Medicare program: request for public comments on implementation of the Medicare+Choice program, and notice of timeframes for submission of applications for contracts--HCFA. Notice of intent to regulate; solicitation of comments.

The Balanced Budget Act of 1997 (BBA) establishes a new Medicare+Choice program. Under this program, eligible individuals may elect to receive Medicare benefits through enrollment in one of an array of private health plans that contract with us. The BBA directs the Secretary to publish by June 1, 1998, regulations establishing standards for the Medicare+Choice program. We have already received comments and inquiries from the public on a number of issues associated with the Medicare+Choice program. This document solicits further public comments on issues related to implementation of the Medicare+Choice program. We intend to consider these comments as we develop an interim final rule to implement the Medicare+Choice program. This document also includes preliminary information regarding application procedures for organizations that intend to contract with us to participate in the Medicare+Choice program. This document also informs the public of a meeting to discuss the Medicare+Choice program.

Aged↗
PubMed1998

Medicare+Choice PSO formation: a step-by-step decision process.

The introduction of the Medicare + Choice program has opened up new opportunities for healthcare providers to contract directly with Medicare through provider-sponsored organizations (PSOs). Because the time, resources, and risks inherent in forming and operating a Medicare + Choice PSO are substantial, providers should approach this new opportunity methodically. A seven-step process can take providers from assessment to contract application.

Capitation Fee↗