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

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

Helping family doctors detect vulnerable caregivers after an emergency department visit for an elderly relative: results of a longitudinal study

BACKGROUND: Family doctors have been ascribed a role in monitoring patients and their informal caregivers. Little is known about the factors that might alert physicians to changing circumstances or needs of the caregivers. The study objective was to examine changes in family caregivers' quality of life following an emergency department (ED) visit by an older community-dwelling relative that might cue doctors to subsequent caregiver distress. METHODS: A longitudinal study with follow-up at 1- and 4-months was conducted in the EDs of 4 hospitals in Montreal, Canada. Caregivers reported on demographics and quality of life (SF-36). Patients reported on demographics and functional disability. Multiple linear regression for repeated measures was used to evaluate changes in caregiver quality of life and factors related to these changes. RESULTS: 159 caregivers (60.5 yrs ± 15.8%; 73.0% female), including 68 (42.8%) spouses, 60 (37.7%) adult children, and 31 (19.5%) other relatives participated. Following an initial ED visit by older relatives, caregiver general health and physical functioning declined over time, while mental health status improved. Compared to the other relative caregiver group, spouses were at increased risk for decline in general health, mental health, and physical functioning at 1 month, while adult children were at increased risk for decline in physical health at 1 month. CONCLUSION: Spouses were most at risk for decline in quality of life. Primary care physicians who become aware of an ED visit by an elderly person may be alerted to possible subsequent deterioration in family caregivers, especially spouses

The Emergence of Hospital Federations: An Integration of Perspectives from Organizational Theory

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68464/2/10.1177_107755878704400206.pd

Nucleophilic Functionalization of the Calix[6]arene Para- and Meta-Position via p‑Bromodienone Route

It is here demonstrated that the p-bromodienone route, previously reported for calix[4]arenes, is also effective for the functionalization of the calix[6]arene macrocycle. Thus, alcoholic O-nucleophiles can be introduced at the calix[6]arene exo rim. In addition, the reaction of a calix[6]arene p-bromodienone derivative with an actived aromatic substrate, such as resorcinol, led to the first example of a meta-functionalized, inherently chiral calix[6]arene derivativ

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

Integration in primary community care networks (PCCNs): examination of governance, clinical, marketing, financial, and information infrastructures in a national demonstration project in Taiwan

Background. Taiwan's primary community care network (PCCN) demonstration project, funded by the Bureau of National Health Insurance on March 2003, was established to discourage hospital shopping behavior of people and drive the traditional fragmented health care providers into cooperate care models. Between 2003 and 2005, 268 PCCNs were established. This study profiled the individual members in the PCCNs to study the nature and extent to which their network infrastructures have been integrated among the members (clinics and hospitals) within individual PCCNs. Methods. The thorough questionnaire items, covering the network working infrastructures - governance, clinical, marketing, financial, and information integration in PCCNs, were developed with validity and reliability confirmed. One thousand five hundred and fifty-seven clinics that had belonged to PCCNs for more than one year, based on the 2003-2005 Taiwan Primary Community Care Network List, were surveyed by mail. Nine hundred and twenty-eight clinic members responded to the surveys giving a 59.6 % response rate. Results. Overall, the PCCNs' members had higher involvement in the governance infrastructure, which was usually viewed as the most important for establishment of core values in PCCNs' organization design and management at the early integration stage. In addition, it found that there existed a higher extent of integration of clinical, marketing, and information infrastructures among the hospital-clinic member relationship than those among clinic members within individual PCCNs. The financial infrastructure was shown the least integrated relative to other functional infrastructures at the early stage of PCCN formation. Conclusion. There was still room for better integrated partnerships, as evidenced by the great variety of relationships and differences in extent of integration in this study. In addition to provide how the network members have done for their initial work at the early stage of network forming in this study, the detailed surveyed items, the concepts proposed by the managerial and theoretical professionals, could be a guide for those health care providers who have willingness to turn their business into multi-organizations. © 2007 Lin; licensee BioMed Central Ltd.published_or_final_versio