Community participation in bureaucratic organizations: Principles and strategies

The present paper points out that there are tasks that primary groups perform better than bureaucracies and those that bureaucracies perform better than primary groups. Both types of tasks are very interdependent so that sometimes primary group tasks must be performed within the boundaries of the bureaucratic organization. The argument is made that when primary groups intervene in bureaucracies, they can do so directly in non-expert tasks without lowering the effectiveness of the bureaucratic organization. When they intervene in expert aspects, they should do so indirectly through an expert advocate. However, in all intervention the primary group must take into account that its structure is contradictory to that of the bureaucracy and, therefore, it must keep as much distance as possible—consistent with its ability to intervene. From this analysis we derive a series of hypotheses suggesting when the community might ideally use the bureaucracy's own experts, when the community must hire its own experts, when the community should use mass media, strikes, indigenous workers, etc. It is suggested that the multitudinous possibilities for linkages can all be derived from a few basic underlying dimensions of the situation. Cet article montre qu'il existe certaines tâches que les groupes primaires accomplissent mieux que les bureaucraties, et certaines autres qu'accomplissent mieux les bureaucraties. Les deux sortes de tâches sont interdépendentes; donc parfois les tâches des groupes primaires doivent s'accomplir parmi les organisations bureaucratiques. Les auteurs soutiennent que les groupes primaires peuvent intervenir dans les bureaucraties en complétant les tâches non-expertes sans réduire l'efficacité de l'organisation bureaucratique. Quands ils participent à certains sujets experts, ils devraient se munir d'un agent expert. Mais dans toute intervention le groupe primaire doit se rendre compte que sa structure contredit celle de la bureaucratie et que, par conséquent, il doit se tenir autant à distance que possible par rapport à sa compétence d'intervention. De cette analyse proviennent des hypothèses qui indiquent quand une communauté peut se servir le mieux du personnel expert d'une bureaucratie, quand la communauté doit engager des experts, quand la communauté doit se servir des mass média, des grèves, des ouvriers indigènes, etc. Les nombreuses possibilités de liaisons proviennent toutes de quelques dimensions fondamentales de la situation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42934/1/10780_2005_Article_BF02214879.pd

Community Mental Health Centers as Human Service Organizations

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67333/2/10.1177_000276428502800506.pd

Humanity’s Best Friend: A Dog-Centric Approach to Addressing Global Challenges

No other animal has a closer mutualistic relationship with humans than the dog (Canis familiaris). Domesticated from the Eurasian grey wolf (Canis lupus), dogs have evolved alongside humans over millennia in a relationship that has transformed dogs and the environments in which humans and dogs have co-inhabited. The story of the dog is the story of recent humanity, in all its biological and cultural complexity. By exploring human-dog-environment interactions throughout time and space, it is possible not only to understand vital elements of global history, but also to critically assess our present-day relationship with the natural world, and to begin to mitigate future global challenges. In this paper, co-authored by researchers from across the natural and social sciences, arts and humanities, we argue that a dog-centric approach provides a new model for future academic enquiry and engagement with both the public and the global environmental agenda

Prevención primaria de diabetes tipo 2. Estado actual del conocimiento

La prevalencia de diabetes ti po 2 aumenta conti nuamente a nivel mundial y su control defi ciente genera complicaciones graves que reducen la calidad de vida de quienes la padecen y elevan sus costos de atención. Sería entonces razonable pensar que para disminuir su impacto socioeconómico deberíamos mejorar la calidad de atención de las personas con diabetes y simultáneamente prevenir el desarrollo de la enfermedad en personas con alto riesgo de padecerla. Para identi fi car personas en riesgo de desarrollar diabetes se han desarrollado cuesti onarios de probada sensibilidad y especifi cidad diagnósti ca. Existe acuerdo en que identi fi cación de estas personas no produce impactos psicológicos importantes o duraderos en la población encuestada. Existen además estrategias no farmacológicas y farmacológicas capaces de prevenir/retrasar el desarrollo de diabetes en las personas en riesgo. Las primeras, consistentes en adopción de un plan de alimentación saludable y prácti ca regular de acti vidad fí sica, logran hasta un 58% de prevención y han demostrado ser efecti vas en disti ntas poblaciones (Suecia, China, Finlandia, Norteamérica e India). Su efecto preventi vo se manti ene hasta 10 años después de la intervención. Dentro de las intervenciones farmacológicas, la metf ormina, inhibidores de la α-glucosidasa (acarbosa) y las ti azolidinedionas han demostrado su efi cacia preventi va, que en general es menor que la de los cambios de esti lo de vida. Los estudios económicos concuerdan que tanto la detección por encuestas como las intervenciones preventi vas son costo-efecti vas.The prevalence of type 2 diabetes (T2DM) is conti - nuously increasing worldwide, and its poor control causes serious complicati ons that reduce the quality of life of people suff ering the disease and increase medical care costs. To decrease diabetes socio-economic impact, we should improve treatment effi cacy and simultaneously prevent its development in people at high risk. Questi onnaires with proven diagnosti c sensiti vity and specifi city have been set up to identi fy people at risk of developing diabetes, without producing important or long-lasti ng psychological impact on the surveyed populati on. Also, non-pharmacological and pharmacological strategies can be used to prevent/delay the development of diabetes in people at risk. The former, consisti ng in the adopti on of a healthy dietary plan and the practi ce of regular physical acti vity, result in up to 58% of preventi on, have been eff ecti ve in diff erent populati ons (Sweden, China, Finland, North America and India), and their preventi ve eff ect persists up to 10 years aft er the interventi on. Among pharmacological interventi ons, metf ormin, α-glucosidase inhibitors (acarbose) and thiazolidinediones have preventi ve eff ecti veness, which in general is lower than that of lifestyle changes. Economic studies agree that both, diabetes detecti on by means of surveys as well as preventi ve interventi ons are cost-eff ecti ve.Fil: Álvarez, A.. Hospital Italiano; ArgentinaFil: Basile, R.. Sociedad Argentina de Nutrición; ArgentinaFil: Bertaina, V.. Ministerio de Salud. Administración Nacional de Medicamentos, Alimentos y Tecnología Médica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Cs.médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Caporale, Ana Julia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Cs.médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Castelli, Maria Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Confederaciones de Farmacias; ArgentinaFil: Giménez, L.. International Assistance Group; FranciaFil: Guntsche, Enrique Manuel. Universidad Nacional de Cuyo; ArgentinaFil: Litwak, L.. Sociedad Argentina de Diabetes; ArgentinaFil: Lijteroff, G.. Federación Argentina de Entidades de Lucha Contra la Diabetes; ArgentinaFil: Masciottra, Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Cs.médicas. Centro de Endocrinología Experimental y Aplicada; Argentina. Ministerio de Salud. Administración Nacional de Medicamentos, Alimentos y Tecnología Médica; ArgentinaFil: Sinay, I.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Cs.médicas. Centro de Endocrinología Experimental y Aplicada; Argentina. Ministerio de Salud. Administración Nacional de Medicamentos, Alimentos y Tecnología Médica; ArgentinaFil: Gagliardino, Juan Jose. Ministerio de Salud. Administración Nacional de Medicamentos, Alimentos y Tecnología Médica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Cs.médicas. Centro de Endocrinología Experimental y Aplicada; Argentin

Cardiorenal outcomes with dapagliflozin by baseline glucose-lowering agents: Post hoc analyses fromDECLARE-TIMI58

Aim To assess the associations between baseline glucose-lowering agents (GLAs) and cardiorenal outcomes with dapagliflozin versus placebo in the DECLARE-TIMI 58 study. Materials and methods DECLARE-TIMI 58 assessed the cardiorenal outcomes of dapagliflozin versus placebo in patients with type 2 diabetes. This post hoc analysis elaborates the efficacy and safety outcomes by baseline GLA for treatment effect and GLA-based treatment interaction. Results At baseline, 14 068 patients (82.0%) used metformin, 7322 (42.7%) sulphonylureas, 2888 (16.8%) dipeptidyl peptidase-4 inhibitors, 750 (4.4%) glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and 7013 (40.9%) insulin. Dapagliflozin reduced the composite of cardiovascular death (CVD) and hospitalization for heart failure (HHF) versus placebo regardless of baseline GLA, with greater benefit in the small group of patients with baseline use of GLP-1 RAs (HR [95% CI] 0.37 [0.18, 0.78] vs. 0.86 [0.75, 0.98] in GLP-1 RA users vs. non-users,P-interaction= .03). The overall HR for major adverse cardiovascular events (CVD, myocardial infarction or ischaemic stroke) was 0.93 (95% CI 0.84, 1.03) with dapagliflozin versus placebo, with no interaction by baseline GLA (P-interaction> .05). The renal-specific outcome was reduced with dapagliflozin versus placebo in the overall cohort (HR [95%CI] 0.53[0.43-0.66]), with no interaction by baseline GLA (P-interaction> .05). All of these outcomes were similar in those with versus those without baseline metformin use. Conclusions The effects of dapagliflozin on cardiorenal outcomes were generally consistent regardless of baseline GLA, with consistent benefits regardless of baseline metformin use. The potential clinical benefit of combining sodium-glucose co-transporter-2 inhibitors with GLP-1 RAs, given some evidence of cardiovascular risk reduction with both classes, should be explored further

Parental health limitations, caregiving and loneliness among women with widowed parents: longitudinal eveidence from France

We investigate how daughters’ feelings of loneliness are impacted when widowed parents develop health limitations, and when daughters take on personal care tasks in response. Using longitudinal data from daughters of widowed parents drawn from the French Family and Intergenerational Relationships Study (ERFI, 1485 observations nested in 557 daughters), we assess (a) whether health limitations of widowed parents are associated with daughters’ feelings of loneliness regardless of whether or not daughters provide personal care and (b) whether there is an effect of care provision on loneliness that cannot be explained by parental health limitations. Fixed effect regression analyses show that widowed parents’ health limitations were associated with raised feelings of loneliness among their daughters. No significant additional effect of providing personal care to a widowed parent was found. Prior research on the impact of health limitations of older parents on the lives of their adult–children has focused mostly on issues related to informal caregiving. Our findings suggest that more attention to the psychosocial impact of parental health limitations—net of actual caregiving—on adult children’s lives is warranted