Standardised measures of needs,stigma and informal care in schizophrenia using a bottom-up,cross-cultural approach

Background There is a lack of instruments to measure the needs, stigma and informal care of people with schizophrenia that take account of sociocultural variation and patients'' and formal and informal carers'' opinions and experiences.Aims To develop questionnaires to measure stigma, needs and informal (non-professional) care for people with schizophrenia.Method We undertook the study in seven countries and in English, Spanish and Portuguese. We first held focus group discussions with patients, formal carers (professionals) and informal carers (family and friends) in Spain, the UK, Argentina, Brazil, Chile and Venezuela to elicit the main dimensions of needs, stigma and informal care. We then held nominal group discussions about these dimensions with patients, family members and professionals in Spain, Portugal and the UK, to develop the instruments.Results Three hundred and three people participated in 46 focus groups and results were discussed in three nominal groups, each involving eight participants. Three instruments were developed in this iterative process: needs for care (46 items), stigma (38 items) and informal care (20 items).Conclusions These instruments are based on service users'' and carers'' views and experiences and have cross-cultural validity. They will have application in assessment of outcomes for people with schizophrenia and their families.     

Transnational cyberpublics: new political spaces for labour migrants in Asia

This article offers a cultural interpretation of transnational solidarities that Asian political activists are generating through electronic telecommunications networks. Its focus is on the experiences of the Migrant Forum in Asia [MFA], a network of non-government organizations that question issues of human rights, citizenship and working conditions of labour migrants in the Asian region. MFA's networking activities are being transformed as email enables daily conversations across multiple national borders, and new 'imagined' communities of political action have emerged. English has been chosen as the language of solidarity, and photographs have become important in communicating activities and ideas. These media are innovative modes of transnational communication and shape political spaces that exist in symbiotic relation to the 'real'. Attention to these practices, spaces and the symbolic meanings activists attach to these communities helps to illuminate a cultural politics of transnational activism in this region.     

The impact of informal care-giving networks on adult children's care-giver burden

Previous research on the care-giver burden experienced by adult children has typically focused on the adult child and parent dyad. This study uses information on multiple informal care-givers and examines how characteristics of the informal care-giving network affect the adult child's care-giver burden. In 2007, 602 Dutch care-givers who were assisting their older parents reported on parental and personal characteristics, care activities, experienced burden and characteristics of other informal care-givers. A path model was applied to assess the relative impact of the informal care-giving network characteristics on the care-giver burden. An adult child experienced lower care-giver burden when the informal care-giving network size was larger, when more types of tasks were shared across the network, when care was shared for a longer period, and when the adult child had no disagreements with the other members of the network. Considering that the need for care of older parents is growing, being in an informal care-giving network will be of increasing benefit for adult children involved in long-term care. More care-givers will turn into managers of care, as they increasingly have to organise the sharing of care among informal helpers and cope with disagreements among the members of the network.     

Informal complaints procedure in general practice: first year's experience.

OBJECTIVE--To evaluate the first year''s experience of an informal patient complaints system that encourages extensive patient participation. DESIGN--Audit of an informal complaints procedure. SETTING--The Marylebone Health Centre, London. SUBJECTS--39 complaints received over the audit period. MAIN OUTCOME MEASURES--Types of complaints (administrative, about doctors or medical care or both, staff about patients, mixed, other) and resolution of complaints (how complaints were dealt with and their resolution). RESULTS--37 of the 39 complaints were resolved within two weeks. Two complaints sent direct to the family health services authority were resolved (with patients'' agreement) by the informal complaints procedure. CONCLUSIONS--The informal complaints procedure was more cost effective than the family health services authority system and was comparatively straightforward to implement within the practice without major organisational restructuring. The two way process of the procedure ensured patients received a quick response to complaints and helped morale of health centre staff.     

Dual equipoise shared decision making: definitions for decision and behaviour support interventions

Background

In the experience of health professionals, it appears that interacting with peers in the workplace fosters learning and information sharing. Informal groups and networks present good opportunities for information exchange. Communities of practice (CoPs), which have been described by Wenger and others as a type of informal learning organization, have received increasing attention in the health care sector; however, the lack of uniform operating definitions of CoPs has resulted in considerable variation in the structure and function of these groups, making it difficult to evaluate their effectiveness.

Objective

To critique the evolution of the CoP concept as based on the germinal work by Wenger and colleagues published between 1991 and 2002.

Discussion

CoP was originally developed to provide a template for examining the learning that happens among practitioners in a social environment, but over the years there have been important divergences in the focus of the concept. Lave and Wenger's earliest publication (1991) centred on the interactions between novices and experts, and the process by which newcomers create a professional identity. In the 1998 book, the focus had shifted to personal growth and the trajectory of individuals' participation within a group (i.e., peripheral versus core participation). The focus then changed again in 2002 when CoP was applied as a managerial tool for improving an organization's competitiveness.

Summary

The different interpretations of CoP make it challenging to apply the concept or to take full advantage of the benefits that CoP groups may offer. The tension between satisfying individuals' needs for personal growth and empowerment versus an organization's bottom line is perhaps the most contentious of the issues that make CoPs difficult to cultivate. Since CoP is still an evolving concept, we recommend focusing on optimizing specific characteristics of the concept, such as support for members interacting with each other, sharing knowledge, and building a sense of belonging within networks/teams/groups. Interventions that facilitate relationship building among members and that promote knowledge exchange may be useful for optimizing the function of these groups.     

Devolving authority for health care in Canada's provinces: 3. Motivations,attitudes and approaches of board members

OBJECTIVE: To obtain information from the members of the boards of devolved health care authorities on their motivations, attitudes and approaches, to evaluate their relative orientations to the expectations of provincial governments, local providers and community members, and to evaluate the influence of members'' being employees in health care or social services and being willing to stand for election. DESIGN: Mail survey conducted in cooperation with the devolved authorities during the summer of 1995. SETTING: Three provinces (Alberta, Saskatchewan and Prince Edward Island) with established boards and 2 provinces (British Columbia and Nova Scotia) with immature boards. PARTICIPANTS: All 791 members of the boards of devolved authorities in the 5 provinces, of whom 514 (65%) responded. OUTCOME MEASURES: Respondents'' declared motivations, levels of confidence in board performance and attitudes toward accountability; differences between members who were willing to run for election to boards and others and differences between members who were employees in health care or social services and others. RESULTS: The main motivations of board members were an interest in health care and a desire to be part of decision-making and their main concern was inadequacy of data for decision-making. Almost all (93%) felt that they made good decisions, and 69% thought that they made better decisions than those previously made by the provincial government. Most (72%) felt that they were accountable to all of the local citizens, although nearly 30% stated that they represented the interests of a specific geographic area or group. Attitudes toward their provincial governments were polarized, with half agreeing and half disagreeing that provincial rules restrict the board members. The board members who were employed in health care and social services and those who were willing to stand for election did not differ substantially from their counterparts, although potential electoral candidates were less likely than others to feel accountable to provincial-level constituencies (such as taxpayers and the minister of health) and more likely to represent the interests of a specific geographic area or group. Only a modest number of differences were found among members from different provinces. CONCLUSIONS: Board members'' strong feelings of accountability to and representation of local citizens could counteract the structural influences leading board members to favour the interests of provincial governments and providers.     

社区微更新：北京老城公共空间的设计介入途径探讨

在北京逐渐从大规模的快速城市建设转向小规模渐进式的城市更新的背景下,文章以团队近几年的研究和实践为基础,首先探讨了公共空间的日常性,认为它是由居民的主动行为和非正规活动而创造,并成为城市活力的源泉。接着,文章指出社区营造是城市公共空间微更新的主要方式,而基于社区营造的设计介入则成为了设计师、城市管理者和居民沟通的平台,并提出了基于社区文化的引导参与、平衡利益和诉求的协作改造和共同参与下的功能嫁接设计介入途径,然后讨论了设计介入的过程性特征和相关平台的构建设想,从而可能对类似的实践提供有益的参考。     

Experimental evidence for group hunting via eavesdropping in echolocating bats

Group foraging has been suggested as an important factor for the evolution of sociality. However, visual cues are predominantly used to gain information about group members'' foraging success in diurnally foraging animals such as birds, where group foraging has been studied most intensively. By contrast, nocturnal animals, such as bats, would have to rely on other cues or signals to coordinate foraging. We investigated the role of echolocation calls as inadvertently produced cues for social foraging in the insectivorous bat Noctilio albiventris. Females of this species live in small groups, forage over water bodies for swarming insects and have an extremely short daily activity period. We predicted and confirmed that (i) free-ranging bats are attracted by playbacks of echolocation calls produced during prey capture, and that (ii) bats of the same social unit forage together to benefit from passive information transfer via the change in group members'' echolocation calls upon finding prey. Network analysis of high-resolution automated radio telemetry confirmed that group members flew within the predicted maximum hearing distance 94±6 per cent of the time. Thus, echolocation calls also serve as intraspecific communication cues. Sociality appears to allow for more effective group foraging strategies via eavesdropping on acoustical cues of group members in nocturnal mammals.     

Endo Echo Improves Primary Care Provider And Community Health Worker Self-Efficacy In Complex Diabetes Management In Medically Underserved Communities

Objective: To determine whether participation in a multidisciplinary telementorship model of healthcare delivery improves primary care provider (PCP) and community health worker (CHW) confidence in managing patients with complex diabetes in medically underserved regions.Methods: We applied a well-established healthcare delivery model, Project ECHO (Extension for Community Healthcare Outcomes), to the management of complex diabetes (Endo ECHO) in medically underserved communities. A multidisciplinary team at Project ECHO connected with PCPs and CHWs at 10 health centers across New Mexico for weekly videoconferencing virtual clinics. Participating PCPs and CHWs presented de-identified patients and received best practice guidance and mentor-ship from Project ECHO specialists and network peers. A robust curriculum was developed around clinical practice guidelines and presented by weekly didactics over the ECHO network. After 2 years of participation in Endo ECHO, PCPs and CHWs completed self-efficacy surveys comparing confidence in complex diabetes management to baseline.Results: PCPs and CHWs in rural New Mexico reported significant improvement in self-efficacy in all measures of complex diabetes management, including PCP ability to serve as a local resource for other healthcare providers seeking assistance in diabetes care. Overall self-efficacy improved by 130% in CHWs (P<.0001) and by 60% in PCPs (P<.0001), with an overall large Cohen's effect size.Conclusion: Among PCPs and CHWS in rural, medically underserved communities, participation in Endo ECHO for 2 years significantly improved confidence in complex diabetes management. Application of the ECHO model to complex diabetes care may be useful in resource-poor communities with limited access to diabetes specialist services.Abbreviations: CHW = community health worker; CME = Continuing Medical Education; ECHO = Extension for Community Healthcare Outcomes; FQHC = federally qualified health center; PCP = primary care provider     

Who learns from whom? Supporting users and developers of a major biodiversity e-infrastructure

Support systems play an important role for the communication between users and developers of software. We studied two support systems, an issues tracker and an email service available for Scratchpads, a Web 2.0 social networking tool that enables communities to build, share, manage and publish biodiversity information on the Web. Our aim was to identify co-learning opportunities between users and developers of the Scratchpad system by asking which support system was used by whom and for what type of questions. Our results show that issues tracker and emails cater to different user mentalities as well as different kind of questions and suggest ways to improve the support system as part of the development under the EU funded ViBRANT programme.     

四川省内异地就医联网结算管理实践探索

四川省内基本医疗保险异地就医联网结算试点工作已全面启动。四川省肿瘤医院作为首批联网试点医院,积极顺应联网结算需求,主动创新、完善服务内涵、畅通服务流程,全面落实了实现异地就医即时结算的主要措施,极大方便了异地就医人群,取得了显著的社会效益。异地就医联网结算是一项全新工作,针对运行中存在的问题提出建议,为完善异地医保的服务与管理提供参考。     

Devolving authority for health care in Canada's provinces: 4. Emerging issues and prospects

Devolution or authority for health care is evaluated in the context of 3 objectives of provincial governments--community empowerment to garner new allies for health care restructuring, service integration to create a true "system" and conflict containment as spending is cut. Devolved authorities cannot pursue each of these objectives with equal vigour because they must balance the competing pressures from their provincial government, their providers and their local citizens. Each devolved authority accommodates these pressures in its own way, through different trade-offs. Appointed board members are generally well intentioned in representing the interests of their entire community but are unlikely to overcome formidable barriers to community empowerment in health care. Unless future board elections attract large and representative voter turnouts, they may fragment board members'' accountability (by making them more accountable to multiple interest groups) rather than solidify it (by making them more accountable to the community). Although boards have integrated and rationalized parts of the institutional sector, integration of the community sector is hampered by structural constraints such as the lack of budgetary authority for a broader scope of services, including physicians'' fees and drugs. Devolved authorities will deflect blame from provincial governments and contain conflict only while they believe that there is still slack in the system and that efficiency can be improved. When boards no longer perceive this, they are likely to add their voices to local discontent with fiscal retrenchment. Continuing evaluation and periodic meetings of authorities to share experiences and encourage cross-jurisdictional policy learning are needed.     

构建促进保护地社区资源使用与保护目标协调的社会情境分析工具——武夷山国家公园试点区实践

结合"公共池塘资源"、"环境权利"和"社会-生态系统"意义认知理论,从话语分析入手研究社会-生态系统中,制度如何作用于社区行为而最终影响生态系统,并以提供政策建议为终点,形成一个针对保护地社区资源利用的社会情境分析工具。研究以武夷山国家公园体制试点区社区为对象,从社区主体认知和研究者外部观察的知识合作入手,首先分析社区资源禀赋和环境权利的实现。研究发现,影响资源权属和使用的关键制度包括宏观层面的土地政策,中观层面的保护地规划和管理,以及微观层面的乡规民约,凸显了法律与民间规范的共同作用。影响生态产品和服务获取以及福利转化等环境权利的关键因素是中观层面的正式制度,包括市场机制和信用体系,以及非正式制度,主要是长期形成并与时俱进的社区集体行动机制等。其次,分析影响社区权利可得性的协商机制。协商需要注意程序合法,重视社区环境自主权;在内容上尊重历史和传统,提供充分信息;在实施上有明确的成本-收益分析。这样才能推动社区认知与保护管理目标相一致,以制度变迁促进生态系统服务持续。研究表明,这一社会情境分析工具以国家公园体制试点为契机,可以帮助提出改善社区的资源禀赋和完善环境权利的专门政策,促进自然生态系统和社区福利双赢。     

Feasibility assessment and implementation strategies of green care in rural Taiwan

Pursuing the rural idyll for retirement is especially a popular age-old dream for Taiwan people. Farming for health is an emerging trend, which drivers to initiate a green care service based on a combination of agriculture resources and traditional care. The purposes of this study were to assess the feasibility of green care in rural communities and to propose implementation strategies for varied rural area types in Taiwan. This study was conducted with two stags. A feasibility study comprising two aspects of political and environmental feasibilities was assessed in the first stage. The political feasibility was assessed based on social demand and government policies. Accordingly, three alternative models for senior green care participation were proposed, including green occupational therapy (for residents), rural long-stay tourism (for tourists), and agricultural working holiday (for volunteers). The environmental feasibility assessment was conducted in 102 rural communities in northern Taiwan. Five indexes, including the natural environment, rural resources, public facilities, senior care, and community capacity, were used to evaluate the potential of communities for developing green care. The results showed that green care implementing active aging in place in rural areas is feasible. Seventeen communities with plentiful or unique rural resources and high-quality community capacity were recommended as potential communities. In the second stage, a multiple case study was conducted in three communities representing different alternative models of green care. The community leader interviews, on-site investigations, vision forum, and operation workshop were adopted to propose the implementation strategies of green care for three communities, respectively, including human resource, volunteer or tourist management, revenue distribution, and marketing.

     

A Taxonomy of Continuing Medical Education Endeavour

Five basic forms of continuing educational endeavour by physicians are listed in rank order. These components constitute an indivisible unit bound together by self-learning. The scholarly habit of planned daily reading and study in a home library-sanctuary as an integral part of a physician''s workday heads the list. Day-to-day informal and formal colleague-association in patient care in the community and teaching hospital, in group practice and by consultation is the present major form of continuing educational endeavour. Emphasized is the sabbatical return every three to five years for three months at least to the teaching hospital to reinforce scholarly motivation and attitudes and to acquire new skills and knowledge. Attendance at scientific sessions of learned professional societies and short courses should be accompanied by presession and post-session guided reading to be undertaken in the physician''s home library-sanctuary.     

面向居民生态福祉的国土空间生态网络构建——以临沂市为例

构建面向居民福祉的生态安全体系,统筹考虑生态安全格局中的生态系统要素连通关系和生态系统服务供需关系,是强化国土空间生态修复规划成果,提升居民生态福祉的重要途径。研究基于"源-汇"理论,构建景观生态安全维育网络与生态系统服务亲近网络。结果显示：（1）45%的生态系统服务保护目标是实现高生态系统服务供给和低机会成本的合理阈值,基于此识别的生态供给源地面积为1230.89km²,中心城区及部分主要街道的生态系统服务供需关系呈现高需求-低供给现象;（2）共识别景观生态安全维育廊道75条,其中重要廊道1054km,次重要廊道1154km,一般廊道1366km;（3）生态系统服务亲近廊道分为10个组团,网络化程度低,西北部主要由森林构成,中东部主要由沿河湿地提供服务;（4）构建临沂市"三区两带五廊多组团"的国土空间生态安全格局,在保障景观生态安全的同时有效协调区域生态系统服务供求关系,促进生态-社会协同可持续发展。     

The Wallpaper Effect: The Contact Hypothesis Fails for Minority Group Members Who Live in Areas with a High Proportion of Majority Group Members

We aim to provide one explanation for why the link between contact and prejudice is consistently less strong for minority group members than it is for majority group members. Specifically, we propose a “wallpaper effect” such that contact works to increase minority group members'' positivity towards majority groups when they live in areas densely populated with other minority group members. Conversely, we suggest that when minority group members live in neighborhoods patterned with majority group faces (as is so often the case), contact will be less transformative. We test this assumption using a large sample of both New Zealander minority (Māori; N = 925) and majority (European; N = 3805) group members. In line with predictions, Māori who lived in minority dense neighborhoods showed the traditional association between contact and increased warmth towards New Zealander Europeans. This relationship, however, was weak or non-existent when they lived in primarily European neighborhoods. Contact effects in majority group members were unaffected by neighborhood composition. The interaction held when controlling for, and was not explained by: gender, income, experiences of harm, cognitions of race-based rejection, or realistic threat. We provide the first evidence to suggest that when it comes to minority group members'' intergroup attitudes, contact with majority group members may be a relatively ineffective predictor unless the “wallpaper” of their lives is minority-dense.     

Blundering Intruders: Extraneous Impacts on Two Indigenous Food Systems

Indigenous communities commonly face a major impediment in their ongoing efforts to participate effectively in the stewardship and sustainable management of their traditional lands, waters and resources. Externally driven projects and policies can overwhelm communities' abilities to respond, severely impact in their resource base, and significantly eclipse traditional knowledge, practices and values. Such projects and policies can be devastating to small, Indigenous communities struggling to maintain their culture and economic independence in a changing world. While many examples of external impacts on small-scale resource use could be drawn upon for these communities, we illustrate this situation by examining the impact of fisheries management regimes on Indigenous coastal communities in British Columbia, Canada and Aotearoa New Zealand. We characterize the problem and identify key stressors involved. Within the context of Indigenous rights and Indigenous peoples' knowledge, perspectives and experience, we highlight the need to recognize this type of constraint on Indigenous Peoples' resource use and effective participation in resource management.     

Prevention of Falls Network Europe: a thematic network aimed at introducing good practice in effective falls prevention across Europe. Four years on

ProFaNE, Prevention of Falls Network Europe, is a four-year thematic network co-ordinated by the University of Manchester, UK, with 25 partners across Europe and funded by the European Community Framework 5. There are also Network Associates from a number of EU and non-EU countries who give their advice and experience at steering meetings, seminars and conferences. There are four main themes (taxonomy and co-ordination of trials; clinical assessment and management of falls; assessment of balance function; psychological aspects of falling). The work of ProFaNE is practical, in terms of developing the evidence base for implementation of effective interventions, standardising the health processes for people with a history of falls and encouraging best practice across Europe. Over the four years of the Network many key publications by the members have been regularly cited, the web membership has increased to over 2,000 members from 30 countries, there is an active discussion board and there are nearly 1,000 resources available to download. The success of the networking and relationship building in these four years has meant that many countries have adopted new national strategies to prevent falls and injuries.     

Recruiting medical groups for research: relationships, reputation, requirements, rewards, reciprocity, resolution, and respect

Background

In order to conduct good implementation science research, it will be necessary to recruit and obtain good cooperation and comprehensive information from complete medical practice organizations. The goal of this paper is to report an effective example of such a recruitment effort for a study of the organizational aspects of depression care quality.

Methods

There were 41 medical groups in the Minnesota region that were eligible for participation in the study because they had sufficient numbers of patients with depression. We documented the steps required to both recruit their participation in this study and obtain their completion of two questionnaire surveys and two telephone interviews.

Results

All 41 medical groups agreed to participate and consented to our use of confidential data about their care quality. In addition, all 82 medical directors and quality improvement coordinators completed the necessary questionnaires and interviews. The key factors explaining this success can be summarized as the seven R's: Relationships, Reputation, Requirements, Rewards, Reciprocity, Resolution, and Respect.

Conclusion

While all studies will not have all of these factors in such good alignment, attention to them may be important to other efforts to add to our knowledge of implementation science.