Community-based Case Research Articles

Policies and practicalities of shipping in arctic waters: Inuit perspectives from Cape Dorset, Nunavut

Under changing climatic conditions, political and economic interest in accessing arctic waters and shipping potential is increasing, bringing forward opportunities and challenges that need to be addressed. To explore the practical implications of this from Inuit perspectives, we undertook a community-based case study in Cape Dorset, Nunavut, conducting 20 interviews between 2008 and 2009. We also examined three Nunavut Acts and Agreements, three Canadian Federal Acts, and one International Agreement to better understand the regulations and policy positions. For each we sought to understand characterizations of: community uses of the marine environment; impacts of shipping; and monitoring of ship travel. Our objective was to investigate how well (or not) Inuit experiences and observations of arctic shipping were incorporated into policy provisions governing shipping in arctic waters. A comparative analysis of Inuit and policy positions shows shared and unique priorities as well as areas of apparent disconnect related to shipping in arctic waters. Therefore, this article highlights key considerations for arctic shipping from both practical and policy perspectives. We conclude with recommendations relating to undertaking community consultations, establishing the Marine Council, improving emergency response measures, and updating existing Acts and Agreements in an effort to contribute to ameliorate the situation for mutual benefit.

Cultural uses of non-timber forest products among the Sts'ailes, British Columbia, Canada

We have identified cultural uses of non-timber forest products (NTFPs) in the Sts'ailes, a group within the central Coast Salish First Nation in British Columbia, Canada. The non-timber forest products are culturally important and often accessible to local people. We undertook a community-based participatory case study of the cultural uses of non-timber forest products within the Sts'ailes traditional territory. We used semi-structured interviews, ethnography, and secondary documents (e.g. maps and supporting documents) to provide in-depth understanding of the NTFP uses. Sts'ailes people use NTFPs by (1) gathering plants for food and medicine, (2) making materials from the plants, (3) making spiritual regalia and paints for winter ceremonials, and (4) brushing with cedar branches as spiritual practices. Forest environments and NTFPs provide secured environment for spiritual bathing and other spiritual practices and cedar branches are essential to use for purification. Because of these uses, Canadian governments need to consult and accommodate the Sts'ailes people when undertaking forestry operations. In addition, Sts'ailes use of the land demonstrates their continued possession of it.

Measuring community sustainability: exploring the intersection of the built environment & social capital with a participatory case study

Municipalities all over the globe seek to evaluate the sustainability of their communities and this process requires an interdisciplinary perspective. Walkability and social capital are important measures of sustainable communities that are not necessarily considered together in measurement schemes. Through a community-based case study, the following article examines the relationship between select measures of social capital and self-perceived walkability. Descriptive statistics demonstrated that higher levels of social capital existed in more walkable communities. More sophisticated analysis further supported this association. A community index was created from responses to questions about participating in civic engagement activities such as donating blood, attending a committee meeting or public hearing, interacting with individuals in various neighborhoods, and contributing to a community project. A trust index was also created with answers to survey questions about general trust and trust of neighbors and other members of communities. Multilevel models demonstrated that higher levels of walkability were associated with higher levels of participation in community activities, even after controlling for socio-demographic factors. Similar patterns were found for the trust index where higher levels of walkability were positively associated with positive responses to a variety of trust questions. Implications for sustainable communities policy and management are suggested.

Community-Based Case Management for the Prevention of Suicide Reattempts in Kaohsiung, Taiwan

Although a previous suicide attempt constitutes a major risk factor for an eventual completed suicide, few interventions specifically designed to prevent suicide reattempt shave been evaluated. The aim of this study was to determine the effectiveness of case management for the prevention of suicide reattempts. A total of 4,765 subjects with a recent suicide attempt referred from medical and non-medical organizations were consecutively recruited from July 2006 to June 2008. The suicide prevention program of Kaohsiung Suicide Prevention Center (KSPC)provided case management and followed up suicide attempt cases for 6 months. Survival analysis showed that the risk of suicide reattempt was significantly lower in the case management group than in the non-contact group throughout a six-month follow-up period (hazard ratio =2.93; 95% CI = 2.47–3.47). The hazard ratio (HR) of the Cox proportional hazard model for sex was 0.77 (95%CI = 0.65–0.91). Case management appears to be effective in preventing suicide reattempts in patients with a recent prior attempt. In addition, case management appeared to be more beneficial in preventing suicide reattempts in male subjects.

The proposed national mental health law in China: a landmark document for the protection of psychiatric patients' civil rights.

The proposed national mental health law in China: a landmark document for the protection of psychiatric patients' civil rights.

A Case Control Study on School Dropouts in Children of Alcohol-Dependent Males Versus that in Abstainers/Social Drinkers' Children.

Objective:To study and compare in the children of alcohol-dependent males versus those in a socio-demographically similar control group, the occurrence of school dropouts, and to examine the link between certain factors like parental education and socioeconomic status on school dropout.Materials and Methods:This was a community-based case control study. The participants were 107 family units in both study group (alcohol-dependent male, wife, at least one child less than 14 years of age) and control group (abstainer/social drinker, wife, at least one child less than 14 years of age). It was conducted in an urban slum community in Mumbai. Interview technique was used for data collection. The study was conducted for a period of 1 year.Statistical Analysis:Using software SPSS version 17.0, percentages, Chi-square test.Results and Conclusion:The number of school dropouts was significantly higher (45.31%, P < 0.001) in the children of alcohol-dependent males as compared to 22.47% in the abstainers/social drinkers’ children. In the study group, there was higher number of school dropouts among boys (52.73%, P < 0.05) as compared to girls (35.37%). There was a statistically significant association between parental illiteracy and school dropout in children in both the groups. In the control group, significantly higher number of school dropouts of socioeconomic class IV and V had dropped out as compared to those of socioeconomic class III and II.

Triaging Jobs in a Community-Based Case–Control Study to Increase Efficiency of the Expert Occupational Assessment Method

Expert assessment is useful to assess occupational exposures in cases where measured exposure data are not available. However, the process may be inefficient in a community-based study with low prevalence of exposure. This study aimed to determine if formally triaging the jobs as to likelihood of exposure before the experts review those jobs could improve study efficiency. One thousand nine hundred and sixty-one jobs from a case-control study were triaged by study staff (non-occupational health professionals) into four groups depending on the likelihood of exposure to solvents. For jobs in one group, we had additional information available in the form of job-specific modules and automatic exposure assignments for solvents based on rules pre-programmed into the job-specific module. After the automatic assignment, two experts reviewed the jobs to assign exposure to solvents in order to evaluate the process. The prevalence of exposure and the agreement between the two raters and between the raters' and the automatic assignments were compared for the four triage groups. The majority of jobs (76%) were triaged as unexposed by study staff and very few of these jobs were assigned as exposed by the raters (1%). For jobs with automatic assignment (18% of total), the raters tended to agree with the automatic assignment if that assignment was unexposed or probably exposed. There was less agreement for jobs in which the automatic assignment was possible exposure. For jobs triaged as ones with potential exposure based only on job title but with no further information available, the level of disagreement between the raters tended to be higher. Formal triaging of jobs can improve the efficiency of the expert assessment process. Of the 75% of jobs initially triaged as unexposed, virtually no exposures were found, and omitting manual review of this group would save considerable time.

Co-morbidity of epilepsy in Tanzanian children: A community-based case–control study

PurposeTo define the prevalence and associations of co-morbidity and school attendance in older children with epilepsy (CWE) from a rural district of Tanzania by conducting a community-based case–control study. MethodsChildren aged 6–14 years old with active epilepsy (at least two unprovoked seizures in the last five years) were identified in a cross-sectional survey in Tanzania. Co-morbidities were assessed and cases were compared with age-matched controls. ResultsCo-morbidity was very common amongst cases (95/112, 85%), with 62/112 (55%) having multiple co-morbidities. Co-morbidities consisted of cognitive impairment (72/112, 64%), behaviour disorder 68/112 (61%), motor difficulties 29/112 (26%), burns and other previous injuries (29/112, 26%). These complications were significantly more common in cases than in controls (odds ratio 14.8, 95%CI 7.6–28.6, p<0.001). Co-morbidity in CWE was associated with structural cause, abnormal electroencephalogram and early onset seizures. Cognitive impairment was very common in CWE (64%) and was not associated with Phenobarbital use but was associated with motor difficulties, early onset and recurrent seizures. Poor school attendance was found in 56/112 (50%) of CWE, but not in the controls: it was associated with the presence of multiple co-morbidities, especially with motor difficulties in CWE. ConclusionChildren with epilepsy in a rural area of sub-Saharan Africa had a high level of co-morbidity. Cognitive impairment and poor school attendance were very common. These associated difficulties in CWE in the region need to be addressed to reduce the negative impact of epilepsy on these children.

Individual and neighborhood social factors of hypertension management in a low-socioeconomic status population: a community-based case–control study in Singapore

The aim of this study was to determine hypertension awareness, treatment and control, as well as to carry out regular blood pressure (BP) screening and monitoring, in a multi-ethnic urban low-socioeconomic status (SES) Asian community; and to compare these estimates with those of a higher-SES community in the same geographic location. We studied a neighborhood of three blocks of rented public flats (lower-SES community) and three adjacent blocks of owner-occupied public flats (higher-SES community) in Taman Jurong, Singapore. BP was measured, and demographic details and reasons for irregular BP screening, monitoring and treatment were collected from 2009 to 2010. Logistic regression was used to determine predictors of hypertension management. Participation was 90.0% (359/400) for the rental flat community and 70.2% (351/500) for the owner-occupied flats. Prevalence, awareness, treatment and control in the low-SES community (rental flats) were 63.9% (228/357), 61.8% (141/228), 69.5% (98/141) and 43.9% (43/98), respectively, whereas in the neighboring community these were 65.0% (228/351), 83.3% (190/228), 85.3% (162/190) and 66.0% (107/162), respectively. Adjusting for other sociodemographic variables, awareness, treatment and control were poorer in the low-SES community. In the low-SES community, awareness was higher among diabetics, dyslipidemics, those ≥60 years and those with regular access to doctors. Treatment was more likely among those ≥60 years, but less likely among those needing financial aid. Control was less likely in the employed. High cost of screening and treatment, if diagnosed, was the most frequently cited barrier among the low-SES group. Hypertension management in those of lower SES is poorer than in those of higher SES. For the lower-SES population, financial barriers need to be addressed.

Professional and Personal Factors Associated with Gerontological Practice: Implications for Training and Education

Professional practice with older adults is performed in a variety of settings and across a broad range of areas. Planning for care throughout the end of life represents an increasingly important aspect of work with older adults as a result of the nation's aging demographic and concomitant health care needs. Community-based geriatric case managers represent a growing cadre of professionals encountering frail older adults with future care needs that can be anticipated in advance; however, little is known regarding specific professional and personal factors associated with greater practice in this area. This article presents the findings from a study of 148 community-based case managers' advance care planning practices, conducted in the Southeastern United States. Correlational analyses revealed specific gerontological skills, educational activities, and personal experiences in advance care planning that was highly correlated with practice. Implications for training are discussed.

Case Managers and the Useof Medicare, Part D

The purpose of this study was to examine the experiences and opinions of community-based mental health case managers with the Medicare prescription drug benefit. A qualitative approach, consisting of analysis of data from 3 case manager focus groups, was used to achieve an understanding of the role that case managers played in beneficiaries' access to and use of prescription medicines. Two urban nonprofit community-based mental health agencies. Adults who are disabled by mental illness depend on case managers for information about their prescription drug insurance, help with formulary and plan switching information, and assistance with tasks related to medication adherence in the community. Common themes in the case managers' discussion were managing beneficiary problems, stress for beneficiaries, information and paperwork issues, and cynicism regarding health care reform. The critical role of case managers in the use of Medicare Part D is not well understood or appreciated. Case managers need to be informed about Medicare Part D and ready to advocate for their clients in the community. In addition, it is important for case managers to understand how Medicare Part D affects not only older adults, but also adults living with serious and persistent mental illness.

Risk factors for mortality in smear-negative tuberculosis suspects: a cohort study in Harare, Zimbabwe.

To investigate mortality rates and risk factors for death among smear-negative tuberculosis (TB) suspects. Cohort study nested within a cluster-randomised trial of community-based active case finding. Smear-negative TB suspects were followed for 12 months, with home tracing where necessary. We calculated mortality rates and used regression analysis to investigate the relationship between clinical characteristics and death. Between February 2006 and June 2007, 1195 smear-negative TB suspects were followed for 1136.8 person-years. Human immunodeficiency virus (HIV) prevalence was 63.3%. During follow-up, 139 participants died (11.6%) and mortality rates remained high throughout; 119 (16.5%) HIV-positive individuals and 13 (3.1%) HIV-negative individuals died (HR = 5.8, 95%CI 3.3-10.4, P < 0.001). Advanced immunosuppression was the main risk factor for death among HIV-positive participants, with CD4 count < 50 cells/μ l associated with a 13-fold increased risk of death. Antiretroviral treatment (ART) was initiated by only 106 (14.7%), with long delays in accessing care. HIV-positive smear-negative TB suspects are at high and sustained risk of death. Current guidelines for the management of HIV-infected TB suspects are limited, and this study adds to evidence that specific policies are required to promote earlier HIV and TB diagnosis and reduce delays in ART initiation.

Reflective Practice

The role of a nurse case manager (NCM) incorporates practice that is built upon knowledge gained in other roles as well as components unique to case management. The concept of reflective practice was used in creating a framework to recognize the developmental stages that occur within community based case management practice. The formation of this framework and its uses are described in this article. The practice setting is a community based case management department in a large midwestern metropolitan health care system with Magnet recognition. Advanced practice nurses provide care for clients with chronic health conditions. Twenty-four narratives were used to identify behaviors of community based case managers and to distinguish stages of practice. The behaviors of advanced practice found within the narratives were labeled and analyzed for similarities. Related behaviors were grouped and descriptor statements were written. These statements grouped into 3 domains of practice: relationship/partnership, coordination/collaboration, and clinical knowledge/decision making. The statements in each domain showed practice variations from competent to expert, and 3 stages were determined. Reliability and validity of the framework involved analysis of additional narratives. The reflective practice process, used for monthly case review presentations, provides opportunity for professional development and group learning focused on improving case manager practice. The framework is also being used in orientation as new case managers acclimate to the role. Reflective writing has unveiled the richness and depth of nurse case manager practice. The depth of knowledge and skills involved in community-based case management is captured within this reflective practice framework. This framework provides a format for describing community based case manager practice development over the course of time and has been used as a tool for orientation and peer review.

Factors associated with community-based case managers' advance care planning practices

Community-based geriatric case managers work with an increasingly frail older population in need of advance care planning (ACP) throughout the end of life; however little is known regarding factors that...

Longitudinal study of symptom control and quality of life indicators with patients receiving community-based case management services

A longitudinal study examined seven outcomes of chronically ill patients receiving community-based case management services. A repeated-measures analysis showed that these patients reported greater satisfaction with quality of life and personal well-being and controlled their symptoms better, but declined in self-care activities of daily living and in self-care instrumental activities of daily living.

Variability in selecting patients to manage in the community: a service evaluation of community matron's case-finding strategies

Community-based case management of high-frequency health service users, also termed 'high-intensity users' may reduce the demand on secondary care. In the UK, experienced senior nurses 'community matrons' have been appointed to provide more care in the community and to case manage high-intensity users and prevent unnecessary hospital admission. Computerized scoring systems have been developed to help with case finding. To evaluate how community matrons select their caseload, in particular the impact of a case finding tool, and access to computer-based systems. We used direct observation and the think aloud protocol during case selection and a series of workshops. Analysis was based on the Framework Approach (familiarization, coding, charting, mapping and interpretation) using verbatim transcripts analysed by N-Vivo software. Community matrons within the same locality have different and sub-optimal caseloads. Although common elements exist in case selection, processes are modified by individuals depending on the influence of their interpersonal relationships, accessibility of computer systems and personal experience and expertise. The supporting IT system often produced data too late and while predicting admission did not identify cases amenable to community intervention. Inter-professional networks, personal experience and training influence the patients identified for case management. The combination of an improved case finding tool and a better defined role for community matrons could lead to more standardized and equitable case selection.

Crime, neighborhood deprivation, and asthma: A GIS approach to define and assess neighborhoods

Exposure to neighborhood factors remains difficult to quantify when neighborhoods are often predefined and imprecisely measured. This study examines the association between neighborhood deprivation and participation in a community-based asthma case management (CM) program in Oakland, CA. We estimated neighborhoods by calculating walking distances of ▪, ▪ and ▪ miles around each child’s ( n = 2892) residence. The model assesses deprivation by the addition of weighted factors within a child’s neighborhood–crime rates, alcohol outlets, and eight 2000 US Census characteristics. The results illustrate that neighborhood deprivation is weakly associated with greater levels of program participation, but neighborhood education level, measured by percentage of residents with less than a high school education, is strongly associated with greater program participation (OR: 4.43, 95% CI: [1.23, 15.99]). Neighborhood deprivation factors were significantly different between neighborhoods defined by walking distances and census blockgroups (Wilcoxon-signed rank test: p < 0.05).

Demographic and clinical profile of patients with juvenile onset open angle glaucoma in southwestern Nigeria

This was a non-comparative, retrospective review of patients diagnosed with juvenile open angle glaucoma (JOAG) in the eye clinic of a tertiary hospital in southwestern Nigeria. To document the demographic characteristics, clinical features and treatment outcome of the patients diagnosed with JOAG. Data were extracted from the clinical record of patients diagnosed with JOAG in the eye clinic of the University College Hospital, Ibadan, Nigeria, between January 2001 and December 2005. Such data included the basic demographic data, the clinical characteristic of the patients and the outcome of their treatment. Twenty-nine patients were reviewed, which represents 3.4% of all newly diagnosed glaucoma patients seen in the out-patient section of the eye clinic of the University College Hospital, Ibadan, over the period reviewed. Eight (27.6%) patients were aged 20 years and below. The mean age was 25.1 ± SD 6.0 years. Eighteen (62.1%) had visual acuity of 6/18 or worse in the better eye at the time of presentation. The mean intraocular pressure (IOP) of the patients at presentation was 32.3 ± SD 15.2 mmHg. Eight (27.6%) patients defaulted within 6 months of presentation. The mean IOP for the 21 patients who were followed up on treatment for a mean period of 9.6 months was 17.0 ± SD 6.0 mmHg. Most patients with JOAG in this review presented with advanced form of the disease. Early detection through parent-driven school eye health program and community-based case detection could help in reducing the scourge arising from JOAG among our population.

Homelessness: patterns of emergency department use and risk factors for re-presentation

ObjectivesTo describe patterns of service use and to predict risk factors for re-presentation to a metropolitan emergency department (ED) among people who are homeless.MethodsA retrospective cohort analysis was undertaken over...

The Risk and Timing of Tuberculosis Diagnosed in Smear-Negative TB Suspects: A 12 Month Cohort Study in Harare, Zimbabwe

BackgroundCases of smear-negative TB have increased dramatically in high prevalence HIV settings and pose considerable diagnostic and management challenges.Methods and FindingsBetween February 2006 and July 2007, a cohort study nested within a cluster-randomised trial of community-based case finding strategies for TB in Harare, Zimbabwe was undertaken. Participants who had negative sputum smears and remained symptomatic of TB were follow-up for one year with standardised investigations including HIV testing, repeat sputum smears, TB culture and chest radiography. Defaulters were actively traced to the community. The objectives were to investigate the incidence and risk factors for TB. TB was diagnosed in 218 (18.2%) participants, of which 39.4% was bacteriologically confirmed. Most cases (84.2%) were diagnosed within 3 months, but TB incidence remained high thereafter (111.3 per 1000 person-years, 95% CI: 86.6 to 146.3). HIV prevalence was 63.3%, and HIV-infected individuals had a 3.5-fold higher risk of tuberculosis than HIV-negative individuals.ConclusionWe found that diagnosis of TB was insensitive and slow, even with early radiography and culture. Until more sensitive and rapid diagnostic tests become widely available, a much more proactive and integrated approach towards prompt initiation of ART, ideally from within TB clinics and without waiting for TB to be excluded, is needed to minimise the risk and consequences of diagnostic delay.