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Purpose: The Dementia Care Networks' Study examined the effectiveness of four community-based, not-for-profit dementia networks. The study involved assessing the relationship between the types of administrative and service-delivery exchanges that occurred among the networked agencies and the network members' perception of the effectiveness of these exchanges. Design and Methods: With the use of a case-study method, the evolution, structure, and processes of each network were documented. Social network analysis using a standardized questionnaire completed by member agencies identified patterns of administrative and clinical exchanges among networked agencies. Results: Differences were found between the four networks in terms of their perceptions of service-delivery effectiveness; perceptions of administrative effectiveness did not factor significantly. Exchanges between groups of agencies (cliques) within each of the four networks were found to be more critical than those between individual agencies within each network. Implications: Integration-measured by the types of exchanges within as opposed to across networks-differentiated the four networks studied. This research contributes to our understanding of the use of multiple measures to evaluate the inner workings of service delivery and their impact on elder health and elder health care.

In industrialized countries where HIV infection is becoming a chronic, episodic condition, rehabilitation services have the potential to play an expanded role for people living with HIV/AIDS (PLHAs). However, little is known about rehabilitation in the context of HIV. This paper documents the development of an enhanced, multidisciplinary conceptual framework of rehabilitation in the context of HIV, using the perceptions of PLHAs and rehabilitation professionals. Rehabilitation, broadly defined, is a dynamic process that includes all prevention and/or treatment activities and/or services that address body impairments, activity limitations and participation restrictions for an individual. The framework was developed through broad consultation and interviews with thirteen key informants. Themes that emerged from analysis of interviews related to concepts of rehabilitation in the context of HIV, rehabilitation professionals' roles in the context of HIV, and barriers to access and delivery of rehabilitation services. While there was some variation, key informants generally viewed rehabilitation as a goal-oriented and client-centered process with the potential to impact a range of life domains. Themes were presented to members of a national advisory committee (including PLHAs and health care providers), who produced the foundation of the HIV rehabilitation framework. The framework uses the perspective of the person living with HIV/AIDS, and includes individual life domains that may be affected by HIV, drawing and expanding upon the World Health Organization's (WHO's) International Classification of Functioning, Disability and Health.

Objective: This article describes the self-reported use of substances, participation in unprotected intercourse and differences in sexual risk-taking behavior with state of inebriation among a group of aboriginal (First Nations) people in Ontario. And, in so doing, attempts to answer some of the questions about the association between the use of alcohol and sexual risk taking in this population. Method: The project was developed in a partnership between an aboriginal steering committee and university researchers. Data were collected via interview from 658 randomly selected status First Nations people living within 11 reserve communities in the province. Results: Of the 426 individuals included in the within subject analysis 9.6% reported variation in their participation in sex, 13.8% variation in their participation in intercourse and 10.3% variation in their participation in unprotected intercourse with inebriation. An examination of individual behavior across 'sober' and 'drunk or high' states showed that there were almost equal proportions of respondents who only participated in unsafe sex when sober and respondents who only participated in unsafe sex when drunk or high. Where significant differences occurred, individuals were more likely to report a shift towards no sex or no intercourse with inebriation, not towards unprotected intercourse. Conclusions: Since a large proportion of individuals in this study engage in unprotected intercourse, the small proportion of individuals reporting different sexual behavior were more likely to report participation in a safe activity rather than an unsafe activity while 'drunk or high.' Stereotypes and assumptions may lead educators and researchers to feel the need to focus their messages on the relationship between drug and alcohol consumption and unsafe sex; however, the amount of unsafe sexual intercourse that occurs only while individuals are inebriated suggests that this focus is not of principal concern. (J. Stud. Alcohol 58: 312-322, 1997), Interviews with 426 Native American men and women reveal that their level of inebriation from alcohol has no significant effect upon their willingness to engage in unprotected sexual intercourse. The data gathered shows that more than 66% of the subject population either never uses condoms during sexual intercourse or uses them inconsistently. This indicates a very high level of risky sexual behavior existing in this population regardless of sobriety level. Those who varied their sexual behavior when inebriated were actually more likely to avoid sex at that time than attempt it., SLIGHTLY MORE than 1 million of Canada's 27 million people identified themselves as aboriginal (First Nations) people in the 1991 national census and 24% of these individuals live within the [...]

A survey of community pharmacies in Canada reveals that they use a harm reduction approach to deal with the AIDS epidemic. Study of the role of policy and practices of these pharmacies indicates that they promote safer sex practices, counsel, and provide safer-drug-use equipment and site for the disposal of used needles. The support from the federal government, regulatory bodies and professional associations enhances the effectiveness of the role of these pharmacies.

The physical, emotional, and financial costs of the caregiver of a chronically ill individual have been well documented. Much attention has been focused on caregivers of Alzheimer's disease patients. These caregivers suffer higher rates of depression, poorer health, and impairment in normal social activities. However, most caregivers of other chronically ill patients have not been examined in any detail. Over a two-year period the caregivers of patients with chronic multiple sclerosis (MS) were examined to identify their needs and to document their experience. Both the patient and the caregiver completed questionnaires. Of the total group of 235 participants, a 49 percent response rate was obtained from MS patients who identified a primary caregiver. Most of the caregivers (84 percent) provided personal care on a daily basis; 35 percent reported that this required more than 90 minutes each day. Differences in the perceptions of the patient and caregiver were noted; patients reported needing assistance from the primary caregiver less often than the caregiver did. The results also reinforced previous research findings that the caregivers were restricted in their normal activities. Few caregivers took advantage of available resources or options. Fifty-two percent were willing to hire an assistant; only 19 percent felt that institutionalization was acceptable. Fifty-five percent of caregivers reported that they never received any form of respite from the job. Respite periods and education on the availability of supportive alternatives are needed for these caregivers. (Consumer Summary produced by Reliance Medical Information, Inc.), Support for caregivers is currently an important concern of health professionals; however, while the physical, emotional, and financial costs of providing care have been documented, there has been less attention spent on the respite options available for caregivers. This study examined the experiences and needs of caregivers of individuals with multiple sclerosis and concluded that caregivers are underutilizing available respite services and feel uncomfortable with the options available to them. Further research needs to explore the reasons for underutilization of respite services and, with this information, develop ways of ensuring caregivers know about these options and feel comfortable using them., In the past ten years, there has been a growing appreciation of the role which family members play in providing care to their chronically ill relatives. Health and social science [...]

A study of 463 pharmacists in Ontario has found a gender gap in terms of earnings at different occupational levels. The gap exists even when hours worked, absences from the work force, hours spent on childcare are taken into account. Women tend to earn less than men mainly because they tend to be employees during their careers. Women pharmacists tend to have fewer children than do men in the profession. This could be seen as an issue of choice for the women, though the men do not have to make such choices.