Walking with the illness and life: Experience of the community life of people previously under the services of an integrated community mental health service.

WHAT IS KNOWN ON THE SUBJECT?: There have been some studies on the experience and community life of mental health clients receiving integrated community mental health service (ICMHS). Evaluation of ICMHS suggests that the service could have positive clinical and social outcomes, but the results are inconclusive. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Research studies have focused on clients and/or staff of the ICMHS, while in this study, the experiences and perspectives of family members are also explored. More comprehensive knowledge about the work for, and community life of, people previously under the services of ICMHS is added to the existing knowledge. This study found that with "timely support" and "family presence," people who had received the services of ICMHS continued to engage in more social activities ("expanding social networks"), had "better family relationships," were "letting go" of thinking too much and more able to relax, and had "better self-efficacy and self-caring" in the community. Professional contact after ICMHS through continuous conversations (e.g. home visits and follow-up calls) and social activities are essential for both clients and their families to carry on living with the illness. Timely support, family presence, support to family members in the community and better social networks are key experiences of ICMHS clients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Although the ICMHS' resources are limited, better promotion is urgently needed for the public to realize the services and to support mental health clients. Mental health professionals may develop practice models through exploratory and confirmatory factors analyses of the themes identified from this study as the outcome measures. The cost-effectiveness of services and relapse rates over time should also be evaluated for future practice development. Further studies for practice on the difference that family support can make to the community life of former ICMHS clients are warranted. This may be achieved through research designs that compare people with, and without, family members. ABSTRACT: Introduction More comprehensive understanding, from the experiences and multiple perspectives of the clients, families and staff, about the community life of former clients of the integrated community mental health service (ICMHS) is scarce. Aim To explore the community life experiences of people after their discharge from the ICMHS. Method A qualitative approach with an interpretative phenomenological analysis was utilized for this study. Data were collected through individual semi-structured interviews of 37 participants, including people discharged from an Integrated Community Centre of Mental Wellness, their family members and staff members. Results Six themes emerged from the analysis: "timely support," "family presence," "better family relationships," "expanding social networks," "letting go" and "better self-efficacy and self-care," under the main theme of "walking with the illness and life." Discussion Over and after the ICHMS, with timely support and family presence, there was a positive trend in the experiences of clients in expanding social networks, having better family relationships, letting go of thinking too much and being more able to relax, and improving self-efficacy and self-caring. Implications for practice The study provides a more comprehensive understanding of the experiences of clients, family and staff about the community life of people post-ICMHS, providing insights and clearer directions for research and practice development.

Animal Assisted Therapy for Children and Adolescents with Autism Spectrum Disorder: Parent perspectives.

Animal-Assisted Therapy (AAT) is an intervention for children with Autism Spectrum Disorder (ASD). This study explores parent perspectives of the impact of five AAT sessions involving trained dogs with their children with ASD. A phenomenological qualitative approach was used to explore first-hand perspectives of parents. In-depth, semi-structured interviews were conducted. Data were analyzed using thematic analysis. Seventeen parents reported that the presence of the dogs facilitated their children's engagement, enjoyment, and motivation. Parents also reported that this contributed to gains in the child's communication with others and the dog (n = 11, 64.7%), behavioral regulation (n = 12, 70.6%), and community participation (n = 14, 82.3%). These findings indicate that parents supported the use of AAT and that dogs facilitated therapeutic gains.

Applying community resilience theory to engagement with residents facing cumulative environmental exposure risks: lessons from Louisiana's industrial corridor.

The presence of legacy pollutants, on-going chemical manufacturing activities, and population shifts have introduced complex, cumulative exposure risks to residents of many highly industrialized communities. These "industrial corridors" present unique challenges to environmental health science professionals, public and private sector decision makers, and residents seeking to make their communities safer and healthier. Social-ecological resilience theory offers a useful framework for the design and implementation of community engagement efforts to help stakeholders take action to reduce their exposure risks. A resilience framework views the human community as a coupled social-ecological system, wherein disturbances to the equilibrium of the system - acute and/or chronic - are common rather than rare events. It recognizes three key capacities of more resilient communities. These are the abilities of community members to self-organize to address changing threat levels, to hold scientifically sound understandings of the risks, and to learn from past experiences and take action - individually or collectively - to adapt to or mitigate the hazards in their local environment. We apply this resilience theory framework to a case study from Camp Minden, Louisiana, conducted through the Louisiana State University (LSU) Superfund Research Center's Community Engagement program and supported by the National Institute of Environmental Health Sciences (NIEHS). The case illuminates a critical path by which resilience theory can be applied to guide bi-directional communication and information-gathering, and co-development of risk-reducing strategies at the community level. These are central elements of community engagement within a contentious, real-world setting. The three components of the resilience framework were supported by specific program mechanisms and activities. The capacity for self-organization among community stakeholders was furthered through the convening of a Dialogue Committee which brought together representatives of concerned residents, regulatory agencies, research scientists, and others. This collaborative problem-solving approach supported a more holistic and scientifically sound understanding of the problem through a series of interactive meetings in which members discussed site-remediation options with thermal-treatment experts and regulators, and shared how recent explosions and concerns about air quality affected them. The members co-developed selection criteria and reached consensus on two types of disposal methods that would best reduce the significant threats to public health and the local environment. We also include a brief summary of our recent randomized survey of over 550 residents of Louisiana's industrialized communities to determine the influences on household-level adaptive behaviors to reduce acute and chronic environmental exposure risks. The results of the logistic regression analysis indicate that residents with more concern and knowledge about environmental hazards, along with confidence in their ability to implement risk-reduction measures - such as checking air-quality forecasts and then limiting outside activities - were much more likely to adopt the exposure-reducing behaviors, even when controlling for socioeconomic and demographic differences among respondents. These findings shed light on the conditions under which residents of these types of communities may be more likely to take action to reduce potential environmental exposure risks, and may help in the design of public education efforts. These "lessons learned" from Louisiana communities facing cumulative environmental exposure risks suggest that application of resilience theory to the design and implementation of community engagement programs may support the longer-term effectiveness of the efforts and enhance overall environmental health resilience. In addition, they provide practical insights about how to operationalize and apply these theoretical concepts to real-world environmental health challenges faced by residents of industrialized communities throughout the world.

Martial Arts as a Form of Undertaking Physical Activity in Leisure Time Analysis of Factors Determining Participation of Poles.

BACKGROUND: The aim of this paper was to analyze selected sociodemographic and economic factors that determine practicing martial arts (MA) in Poland. Our hypothesis states that MA constitute a niche sport, which is a result of conditions shaping the decision to undertake them: perception through the lens of the media/entertainment business (rather than primary values), insufficient space for practicing, as well as high costs. METHODS: The study was based on a survey conducted on a representative sample of Poles (n = 12,183). Results for 470 participants declaring some level of proficiency in MA were presented (including 124 declaring active participation). In order to verify statistically significant differences, a Chi-Square test, single-agent logistic regression analysis, and adds ratio were applied. RESULTS: 3.0% of respondents declared basic skills in MA, while advanced skills were declared by 0.9% participants. Only 1% were active practitioners. The leading motivation was "pleasure" (62.1%), followed by "keeping fit and maintaining healthy body shape" (21.8%) and "health" (7.3%). The probability of participation in MA decreased with age (40 years of age being the turning point). As for young people, there is a 15 times lower chance of married individuals undertaking MA, while possessing advanced skills doubles the probability. School provides a place to practice MA during school years, but there is a problem with continuation at a later age (18.8% declaring classes organized at school vs. 5.4% organized at work). CONCLUSIONS: Reversing the trend of decreasing popularity of MA requires promotion on each level of education and creating opportunities to continue participation after graduation. There is a need to increase the availability of cheap sport facilities in the vicinity of the place of residence or work. In case of adults, it is important to build platforms facilitating contact with MA centers.

Footprints of Fascination: Digital Traces of Public Engagement with Particle Physics on CERN's Social Media Platforms.

Although the scientific community increasingly recognizes that its communication with the public may shape civic engagement with science, few studies have characterized how this communication occurs online. Social media plays a growing role in this engagement, yet it is not known if or how different platforms support different types of engagement. This study sets out to explore how users engage with science communication items on different platforms of social media, and what are the characteristics of the items that tend to attract large numbers of user interactions. Here, user interactions with almost identical items on five of CERN's social media platforms were quantitatively compared over an eight-week period, including likes, comments, shares, click-throughs, and time spent on CERN's site. The most popular items were qualitatively analyzed for content features. Findings indicate that as audience size of a social media platform grows, the total rate of engagement with content tends to grow as well. However, per user, engagement tends to decline with audience size. Across all platforms, similar topics tend to consistently receive high engagement. In particular, awe-inspiring imagery tends to frequently attract high engagement across platforms, independent of newsworthiness. To our knowledge, this study provides the first cross-platform characterization of public engagement with science on social media. Findings, although focused on particle physics, have a multidisciplinary nature; they may serve to benchmark social media analytics for assessing science communication activities in various domains. Evidence-based suggestions for practitioners are also offered.

Moving toward reconciliation in indigenous child welfare.

The Touchstones of Hope reconciliation movement consists of principles (culture and language, self-determination, structural interventions, non discrimination, and holistic approach) that guide a reconciliation process of truth-telling, acknowledging, restoring and relating to reshape indigenous child welfare led by indigenous peoples and supported by their non-indigenous counterparts. This article describes a reconciliation movement in Canada grounded in Touchstones of Hope principles, involving a reconciliation process between indigenous and non-indigenous individuals, which has enabled culturally relevant concepts of child welfare and plans for child safety to emerge.

Does practice make perfect? A randomized control trial of behavioral rehearsal on suicide prevention gatekeeper skills.

Suicide is the third leading cause of death among 10-24-year-olds and the target of school-based prevention efforts. Gatekeeper training, a broadly disseminated prevention strategy, has been found to enhance participant knowledge and attitudes about intervening with distressed youth. Although the goal of training is the development of gatekeeper skills to intervene with at-risk youth, the impact on skills and use of training is less known. Brief gatekeeper training programs are largely educational and do not employ active learning strategies such as behavioral rehearsal through role play practice to assist skill development. In this study, we compare gatekeeper training as usual with training plus brief behavioral rehearsal (i.e., role play practice) on a variety of learning outcomes after training and at follow-up for 91 school staff and 56 parents in a school community. We found few differences between school staff and parent participants. Both training conditions resulted in enhanced knowledge and attitudes, and almost all participants spread gatekeeper training information to others in their network. Rigorous standardized patient and observational methods showed behavioral rehearsal with role play practice resulted in higher total gatekeeper skill scores immediately after training and at follow-up. Both conditions, however, showed decrements at follow-up. Strategies to strengthen and maintain gatekeeper skills over time are discussed.

'He's the dad isn't he?' Gender, race and the politics of prenatal screening.

BACKGROUND: Men's involvement in prenatal screening is becoming increasingly important. However, despite the potentially significant role of fathers in haemoglobinopathy screening, their participation is under researched. Furthermore, the portrayal of Black and minority ethnic (BME) fathers tends to be based on persisting stereotypes of men as either absentee parents with limited roles in screening or as controlling decision-makers. OBJECTIVE: To describe the influence of ethnicity and gender on the process of participation of men in antenatal screening for sickle cell and thalassaemia. DESIGN: A qualitative study, using in-depth interviews and focus groups with 22 pregnant women from a range of socio-economic and ethnic backgrounds, 16 male partners and 15 midwives in a northern city in the UK. RESULTS: Men from BME groups take a pragmatic and equitable role in screening with their partners. White British men on the other hand, while willing to participate in screening, take a more casual view of their own direct participation. Accounts from hospital midwives supported these findings. CONCLUSIONS: While acknowledging the importance of material connections between certain BME groups and blood disorders, two key issues are raised. First, BME men's involvement contribute a challenge towards existing assumptions often made about BME fathers. Second, White British men's participation can be useful in determining the genetic status of the foetus and therefore their role should not be neglected. Screening research and practice need to broaden out their focus on issues of gender, ethnicity and screening.

Healthy start program participation: the consumers' perspective.

In 1991, the federal Maternal and Child Health Bureau developed the Healthy Start Initiative as a comprehensive community-based program to eliminate the high rates of poor pregnancy outcomes among women of color. To date, few studies of the programmatic outcomes of this Initiative have examined the views of Healthy Start consumers. To understand the benefits of Healthy Start from their consumers' perspective, the Pittsburgh Allegheny County Healthy Start project conducted a survey of 202 of their Healthy Start participants in 2003. The participants completing the survey reported benefits of participating in the program including stress reduction, receiving resources and referrals, and consistent social support of program staff. According to the project's annual statistics, Healthy Start has improved pregnancy outcomes among African American women participants in the Pittsburgh community. However, and according to these participants, the quality of staff and consumer connectedness, availability and consistency of material resources, and social support are as critical as more traditional health interventions to their satisfaction, motivation to participate, and willingness to refer others to the program. Women of color will often forego health services perceived as intimidating and/or culturally insensitive, but programs such as the Healthy Start Initiative offer a critical link that encourages participation and, as a result, improves maternal and child health status.

Wheelchair propulsion biomechanics and wheelers' quality of life: an exploratory review.

PURPOSE. To provide an overview of associations between wheelchair propulsion biomechanics for both everyday and racing wheelchairs, wheeling-related upper limb injuries, and quality of life of manual wheelchair users through a synthesis of the available information. METHODS. A search of publications was carried out in PubMed and SportsDiscus databases. Studies on wheelchair propulsion biomechanics, upper limb injuries associated with wheelchair propulsion and quality of life of wheelchair users were identified. Relevant articles cited in identified articles but not cited in PubMed or SportsDiscus were also included. RESULTS. Wheelchair sports participation has positive impact on quality of life and research in racing wheelchair biomechanics can indirectly promote the visibility of wheelchair sports. The impact of pushrim-activated power-assisted wheelchairs (a hybrid between manual and battery-powered wheelchairs) and geared manual wheels on wheelers' everyday life were discussed. CONCLUSIONS. The study of wheelchair propulsion biomechanics focuses on how a wheelchair user imparts power to the wheels to achieve mobility and the accumulated knowledge can help to improve wheelchair users' mobility, reduce physical stress associated with wheelchair propulsion, and as a result, enhance quality of life.

Cancer control planners' perceptions and use of evidence-based programs.

The Cancer Prevention and Control Research Network surveyed 282 cancer control planners to inform its efforts to increase the use of evidence-based cancer control programs (EBPs; programs that have been scientifically tested and have successfully changed behavior). Respondents included planners from organizations in state Comprehensive Cancer Control coalitions as well as other governmental and nongovernmental organizations and community-based coalitions. Respondents provided information about personal and organizational characteristics, their cancer control programs, their attitudes toward EBPs, and their awareness and use of Web-based resources for EBPs. Although findings showed strong preferences for cancer control programs that have been shown to work, less than half of respondents (48%) had ever used EBP resources. Regardless of whether they had used EBP resources, almost all respondents (97%) indicated that further training would help them and their organizations adopt and adapt EBPs for use in their communities. The most frequently endorsed training needs were finding and securing additional resources (such as funding and technical assistance), followed by adapting EBPs for cultural appropriateness. The Cancer Prevention and Control Research Network consortium is using these findings to develop a Web-based interactive training and decision support tool that is responsive to the needs identified by the survey respondents.

Facilitating participatory multilevel decision-making by using interactive mental maps.

Participation of citizens in political, economic or social decisions is increasingly recognized as a precondition to foster sustainable development processes. Since spatial information is often important during planning and decision making, participatory mapping gains in popularity. However, little attention has been paid to the fact that information must be presented in a useful way to reach city planners and policy makers. Above all, the importance of visualisation tools to support collaboration, analytical reasoning, problem solving and decision-making in analysing and planning processes has been underestimated. In this paper, we describe how an interactive mental map tool has been developed in a highly interdisciplinary disaster management project in Chennai, India. We moved from a hand drawn mental maps approach to an interactive mental map tool. This was achieved by merging socio-economic and geospatial data on infrastructure, local perceptions, coping and adaptation strategies with remote sensing data and modern technology of map making. This newly developed interactive mapping tool allowed for insights into different locally-constructed realities and facilitated the communication of results to the wider public and respective policy makers. It proved to be useful in visualising information and promoting participatory decision-making processes. We argue that the tool bears potential also for health research projects. The interactive mental map can be used to spatially and temporally assess key health themes such as availability of, and accessibility to, existing health care services, breeding sites of disease vectors, collection and storage of water, waste disposal, location of public toilets or defecation sites.

Research as spiritual covenant.

Conducting research with Native American communities poses special challenges from misunderstandings that may arise from the interface of differing cultural worldviews held by the scientific and the Native communities. Although the community-based participatory research approach shows promise for conducting research that can maximize benefits and minimize the risks of harm to Native American people, there is little information related to the practical implementation of culturally appropriate research practices when working with Native American communities. Drawing on the authors' research with three Native American communities in the Northwest, this article describes culturally appropriate processes for engaging Native American communities. The first section identifies and describes the principles that provide the foundation for the authors' research activity as a spiritual covenant and guides the authors' research with the three communities. The second section describes the project phase matrix that was used to organize the approaches employed in this work.

The cycle of caring.

This article discusses areas where nurse leaders may make conscious and deliberate efforts to impact the organization's culture for caring. Leaders must first care for caregivers and have a commitment to their well-being. It is essential that we develop and engage in programs and activities that help staff with their personal struggles and propel them forward on the journey to being their best selves. We must seek to give them the skills and competencies necessary to work in a caring environment. Nurse leaders must facilitate the development and implementation of programs that foster a caring and compassionate culture. The author shares 2 programs that nourish the soul during difficult times for patients and their loved ones in the hospital setting-End-of-Life program and Massage Therapy program. Just as we care for those within our walls, we must also plan and deliver programs that promote health and well-being of our community. Such programs are an integral part of fulfilling our organization's mission of caring for the community. New and proven technologies advance our profession and contribute in invaluable ways to a healing environment; however, it is critical that we retain the art of caring, fundamental from the past and that helped to shape the profession of nursing.

Parents' decision-making preferences in pediatric oncology: the relationship to health care involvement and complementary therapy use.

This study investigated how parents' preferred level of control in treatment decision-making is related to their personal health care involvement and to their decision to use complementary therapies (CTs) for their child. One hundred-eighteen parents of pediatric oncology patients completed an anonymous CT survey. The Krantz Health Opinion Survey (KHOS) was used to determine parents' preferred involvement in personal health care, and the Control Preferences Scale for Pediatrics (CPS-P) measured preferred role in pediatric treatment decision-making. Unlike previous studies of adult cancer patients, most parents preferred active or collaborative decision-making. The KHOS and CPS-P were significantly correlated, indicating that parents' preferred role in children's treatment decisions was related to their own personal health care involvement. Forty-six percent of parents used CTs for their child, and 33% began using a new CT after diagnosis. The hypothesized relationship between CT use and parents' own health care involvement was partially supported. Preference for control in decision-making was not associated with CT use. These findings provide validation for the newly developed CPS-P and indicate that parents' decisions to use CT for their child are related in part to individual health care preferences.

Phenix: a ousadia do renascimento da subjetividade cidadã / Phoenix: boldness in the rebirth of citizen subjectivity

Este é um projeto de Pesquisa-intervenção vinculado à Universidade Estadual de Maringá (UEM). Enquanto projeto de Pesquisa-intervenção (Thiollent, 1981 e Brandão, 1981 e 1984) pressupõe a práxis como o lócus da produção do conhecimento e critério de verdade. A população com a qual interagimos é atendida pelo Núcleo Social Papa João XXIII, localizado na periferia de Maringá/PR/Brasil. A nossa inserção neste agrupamento humano está sustentada na premissa-denúncia de Martín-Baró (1987 e 1989) de que vivemos sobre o império da desvalorização da vida humana, forjado pelo autoritarismo socioeconômico do capitalismo e da sociedade de consumo de massas por ele engendrada (Caniato, 1997; Martin & Schumann, 1999 e Beinstein, 1999). Seus reflexos excludentes são escamoteados pelos discursos demagógicos e ideológicos dos regimes políticos democráticos atuais. Partimos dos ensinamentos de Theodor Adorno (1965) em A Personalidade Autoritária de que tendências preconceituosas, nem sempre conscientizadas pelos indivíduos, dão sustentação subjetiva a formas de organização conduzentes à barbárie. Trilhando pelos estudos de Adorno, em especial agrupados em suas obras Dialética do Esclarecimento... (1985) e Educação e Emancipação (1995) – interagimos desde outubro de 2000 com a população do Núcleo Social, atravessando com eles o sofrimento psicossocial decorrente da banalização da violência (Arendt, 2000), e da injustiça (Dejours, 1999) sociais e de certas formas de inserção social marcadas pelo fatalismo e pela alienação psicossocial (Martín-Baró, 1987 e Chauí, 1993). A coordenação e os acadêmicos do Curso de Psicologia da UEM participantes deste projeto interagem, semanalmente, com a população do Núcleo Social, levantando questões-demanda que vêm estando vinculadas, principalmente, a sua situação de excluídos. Estas questões são estudadas teoricamente pelos integrantes do projeto e voltam a ser discutidas com a população, não se perdendo de vista a análise contextual e das condições concretas de vida daqueles indivíduos sob as quais estas demandas de compreensão emergiram. Nesta oportunidade é ampliado o conhecimento que nós-eles obtivéramos anteriormente e, assim, ocorre sucessivamente em novos encontros. Pudemos constatar nesta convivência com este grupo, a imersão destes indivíduos nos valores imputados pela sociedade de massa e até certa resistência em estar exercendo a verdadeira cidadania. Como a consciência do povo daqui é o medo dos homens de lá... (AU)

Folklore linked to pregnancy and birth in Nigeria.

As a part of a safe motherhood project implemented in eastern Nigeria between 1992 and 1996, in-house interviews were conducted with rural women and traditional birth attendants in the seven states of eastern Nigeria. The overall project was designed to contribute toward the reduction of maternal mortality and morbidity through the involvement of community leaders and women's organizations in women's health activities in rural Nigeria. It also focused on identifying and addressing some of the underlying cultural factors in maternal mortality and morbidity in Nigeria. Findings from the interview show that women in rural eastern Nigeria still hold many folklore beliefs about pregnancy and childbirth, and some of these beliefs lead to delay in the referral of complications to hospitals.

Community perceptions and treatment seeking for malaria in Baringo district, Kenya: implications for disease control.

BACKGROUND: Malaria is one of the leading causes of morbidity and mortality in Kenya. Its control depends on many factors, some of which have not been studied at the level of rural community. OBJECTIVE: To identify what households in a Kenyan rural community perceive to be the cause and symptoms of malaria and their treatment behaviour for malaria. SETTING: Community-based study conducted in Marigat division of Baringo district. DESIGN: Cross-sectional study utilising qualitative ethnographic and semi-quantitative methods. Multi-stage cluster stratified procedure was used to select the villages, after which screening interviews were used to identify households. Finally, interviews and informal discussions were conducted with 463 heads of households with self-reported cases of malaria. The study was conducted between April and October 1992. RESULTS: The study findings indicate that the community has multiple aetiologies for malaria. Of the 463 heads of households interviewed, 258 (58.5%) associated the cause of the disease to the mosquito. Other aetiological beliefs included: wild vegetables (13.1%), water (11%) and milk (9.8%). Many of the respondents (90%) could identify malaria by several correct symptoms. In the treatment of malaria, various health resources such as public health facilities, over-the counter medications, private clinics and herbal medicines are used. For first choice of care, many households used public health facilities. However, if the malaria illness persisted, other forms of treatment especially private clinics and medicinal plants seem to have been preferred. CONCLUSION: Understanding community perceptions of aetiology, symptom identification and treatment of malaria is an important step towards the control of the disease.