Background
There is a priority need to make community-based care widely available for people living with schizophrenia (PLwS) in low- and middle-income countries. An innovative approach for ...increasing access could be to integrate clinical services available in tertiary care hospitals with community-based care through a task-sharing approach. We describe such an integrated intervention that was implemented at Tezpur in northeast India in collaboration with the Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH).
Method
The objectives of the study were to illustrate the feasibility of integrating and implementing the intervention and to describe its individual, systemic, and public health impacts. Due to the limited resources available, we conducted a pragmatic single-arm longitudinal evaluation of the intervention cohort over 24 months.
Results
Of the 239 PLwS enrolled in the intervention, 198 (83%) were followed up for 24 months, with nearly three-quarters reporting a >70% reduction in disabilities, most notably between 6 and 18 months. There was a marked reduction in unmet needs across multiple domains, and at 24 months, 62% of the cohort was engaged in individual jobs or other market-linked livelihood opportunities. There was greater uptake and retention with outpatient contacts at the LGBRIMH, and PLwS experienced a marked (82%) reduction in inpatient admissions rates, as compared to before enrolment. Over a period of 24 months, primary caregivers reported that their families experienced significantly fewer social difficulties such as unemployment, interpersonal conflicts, and social isolation. The intervention had a significant public health impact, with an estimated 51.8% effective treatment coverage rate for the integrated intervention.
Conclusion
Our findings provide preliminary evidence of the feasibility of implementing the integrated intervention and its effectiveness. We believe that there is merit in further in-depth refinement and exploration of this implementation-related research and cost analysis while replicating the intervention in other tertiary care institutions.
Plain Language Summary
In low- and middle-income countries such as India, integrating clinical services available at tertiary mental health hospitals with community-based care through a task-sharing approach is an innovative way to make community-based care widely available for people living with schizophrenia (PLwS). The purpose of our study was to investigate the feasibility of implementing such an intervention in a community in Tezpur, northeastern India, in collaboration with a Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH), and to describe the individual, systemic, and public health effects of the intervention. Our findings suggest that integrating the intervention is feasible, has significant impacts on individuals and public health, and is an effective way to expand access to community-based care for PLwS through partnerships with existing tertiary care institutions.
The discipline of American studies was established in the early days of World War II and drew on the myth of American exceptionalism. Now that the so-called American Century has come to an end, what ...would a truly globalized version of American studies look like? Brian T. Edwards and Dilip Parameshwar Gaonkar offer a new standard for the field’s transnational aspiration with Globalizing American Studies. The essays here offer a comparative, multilingual, or multisited approach to ideas and representations of America. The contributors explore unexpected perspectives on the international circulation of American culture: the traffic of American movies within the British Empire, the reception of the film Gone with the Wind in the Arab world, the parallels between Japanese and American styles of nativism, and new incarnations of American studies itself in the Middle East and South Asia. The essays elicit a forgotten multilateralism long inherent in American history and provide vivid accounts of post–Revolutionary science communities, late-nineteenth century Mexican border crossings, African American internationalism, Cold War womanhood in the United States and Soviet Russia, and the neo-Orientalism of the new obsession with Iran, among others. Bringing together established scholars already associated with the global turn in American studies with contributors who specialize in African studies, East Asian studies, Latin American studies, media studies, anthropology, and other areas, Globalizing American Studies is an original response to an important disciplinary shift in academia.
On Cultures of Democracy Gaonkar, Dilip Parameshwar
Public culture,
01/2007, Letnik:
19, Številka:
1
Journal Article
Recenzirano
Odprti dostop
In this introduction to the special issue on "Cultures of Democracy" the editor establishes the focus on the second and third wave countries of Samuel Huntington's "three waves of democratization" to ...argue that after nearly a century of incessant experimentation, democracy remains on trial in a variety of national/cultural sites. A comparative discussion of the second & third waves of democracy delineates the retreat & collapse of many second wave democracies, & the supreme paradox of optimism and despair of the third wave. Comparative political science addresses the question of what is to be done with a rich body of recommendations that unfortunately take their orientation from work toward a particular conception of democracy. In response, the essays in this issue offer culturally inflected accounts of people's practices & the associational forms that sustain those practices in a variety of national/cultural sites on issues of pre-existing cultural repertoires, city centered democratic institutions, the evolving character of crowd action, traditional definitions of democracy, coordination & trust across ideological divide, & solidarity. Despite its many travails & failings, democracy is the inescapable horizon of political lives & imaginings. Its future & flourishing will depend on our capacity to imagine a more capacious rather than constricted view of its possibilities & fragilities. References. J. Harwell
In introducing the essays in this special issue, the idea of "new imaginaries" is outlined. The thoughts of Cornelius Castoriadis & those generated by the Center for Transcultural Studies working ...group are called upon. The five key ideas of the "new imaginaries" are outlined. The concepts of the social imaginary, symbolism, & social-historical multiplicity -- concepts promoted by Castoriadis -- are presented. Finally, the essays in this special issue are briefly summarized. Each works together to produce a diverse approach to new imaginaries, raising both new hopes & new challenges for a globalized, modern world. 17 References. K. Larsen
If the proliferation of new social movements thematized in Hegemony and Socialist Strategy was the key conjectural feature on the horizon of radical democratic politics in Euro-America in 1980s, the ...eruptions of the people in the streets and slums all over the world, and especially in the global south, is hauntingly present in the background of On Populist Reason. With the democratic imaginary now gone global, Laclau's positing of the people as the political subject par excellence and populism as the paradigmatic logic of the political acquires new pertinence. This double privileging is accompanied by a series of shifts in emphasis in the conceptual architecture of Laclau's theory of hegemony. Aside from the further radicalization two pivotal terms in Laclau's social ontology - heterogeneity and contingency - one can observe three other noticeable shifts in emphasis: First, on the plane of discursivity (or in the differential field of the meaningful) the articulatory practices are increasingly characterized in terms of their rhetoricity (i.e. the mode of braiding the rhetorical form with its function); and, furthermore, the tropological characterization of the articulatory practices progressively yields to an analysis of their performative emergence by way of 'naming'. Second, there is a corresponding shift in the analytic interest from the discursive production of the nodal points (such as 'free market' or 'law and order') to the discursive production of empty signifiers (especially, of the 'people'). Third, the conflictual social field is configured not only in terms of antagonisms but also in terms of dislocations.
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6.
On Alternative Modernities Gaonkar, Dilip Parameshwar
Public culture,
1999, Letnik:
11, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Introduces a special journal issue exploring the many alternative narratives of modernity that might be created in the contemporary world. Western modernity emerged in the 19th century in terms of a ...narrative opposition. On the one side stood an apparently good form of modernity associated with secularism, scientism, progress, & instrumental rationality. On the other side stood a form of cultural modernity that stressed the cultivation & care of the self over & against the homogeneity & complacency of the prior form. The conflict between these narratives has defined the dilemma of modernity in the West to which writers & scholars have responded ever since. However, if modernity is best described as an attitude of questioning the present, then it is possible to imagine many other narratives not captured by this basic dualism. These narratives are possible because cultures & nations have creatively adapted to the modern world. D. Ryfe
If the proliferation of new social movements thematized in Hegemony and Socialist Strategy was the key conjectural feature on the horizon of radical democratic politics in Euro-America in 1980s, the ...eruptions of the people in the streets and slums all over the world, and especially in the global south, is hauntingly present in the background of On Populist Reason. With the democratic imaginary now gone global, Laclau's positing of the people as the political subject par excellence and populism as the paradigmatic logic of the political acquires new pertinence. This double privileging is accompanied by a series of shifts in emphasis in the conceptual architecture of Laclau's theory of hegemony. Aside from the further radicalization two pivotal terms in Laclau's social ontology - heterogeneity and contingency - one can observe three other noticeable shifts in emphasis: First, on the plane of discursivity (or in the differential field of the meaningful) the articulatory practices are increasingly characterized in terms of their rhetoricity (i.e. the mode of braiding the rhetorical form with its function); and, furthermore, the tropological characterization of the articulatory practices progressively yields to an analysis of their performative emergence by way of 'naming'. Second, there is a corresponding shift in the analytic interest from the discursive production of the nodal points (such as 'free market' or 'law and order') to the discursive production of empty signifiers (especially, of the 'people'). Third, the conflictual social field is configured not only in terms of antagonisms but also in terms of dislocations. (Author abstract)
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