The relationships surrounding well-being, spiritual perspective, self-transcendence, health status, and fatigue in homeless persons have not been studied from a nursing perspective. This original descriptive study explored relationships among well-being, spiritual perspective, self-transcendence, health status, and fatigue in a sample of 61 homeless men and women in two shelters. A conceptual model based upon Rogers' Science of Unitary Human Beings and Reed's Theory of Self-Transcendence was constructed and tested. Multiple significant correlations were calculated between the study variables indicating that health status and spiritually-related variables correlate positively with well-being. Additionally, sell-transcendence and health status were significant predictors of well-being in this sample. Significant differences were also found between the long-term and short-term housed participants on spiritual perspective, self-transcendence and well-being. Clinical implications and research recommendations are provided.

This study explains why, beginning in 1976 and continuing into the 1980s, unions lost power in Mexico. The recent loss of power in Mexico is consistent with a worldwide convergence towards declining union power. Few would dispute that declining union power is related to globalization. But how does globalization affect union power? This study demonstrates that the prevailing approach to globalization and union power, the market pressures approach, cannot explain why labor unions lost power in Mexico. This suggests that in countries, such as Mexico, where unions rely on political support rather than organizational resources to attain power, increased exposure to market pressures may not explain declining union power. Only unions in advanced industrial societies enjoy the market conditions that make it possible to gain power via their organizational resources. I propose that, in countries where organized labor derives its power from its relationship to the state, globalization affects union power via the domestic instantiations of globalization. The way that global economic shocks and the interests of foreign investors shape the interests of domestic economic elite constitute the domestic instantiations of globalization. My approach builds on the International Political Economy research tradition. This study shows that labor lost power in Mexico for two nested reasons. First, labor lost power because it lost access to decision-making in the state. Second, labor lost access to decision-making because global economic crisis and new foreign investment strategies created a new internationalist elite oriented towards foreign credit and global markets. Disillusioned with the existing political leadership and their "national" economic project, the internationalist elite promoted the rise to power of new political leaders that favored neoliberal economic reforms. Bureaucrats, allied with the internationalists, undermined labor along with other advocates of the "national" project, as part of a struggle for power. This study delineates the aspect of the state-labor alliance in Mexico that granted labor unions power historically and reveals the importance of globalization in determining labor's recent fate in Mexico. It contributes a new model of globalization and union power, raising questions about how sociologists conceptualize globalization and state-society relations more generally.

This paper documents the activities of the leadership team of Central United Methodist Church (CUMC) in its outreach mission to University Homes. University Homes is a public-owned housing project located in the heart of the Atlanta University Center community. The primary methodology was the corporate use of an intercessory prayer book, Forty Days for Five People by G. Ross Freeman. The thesis is that spirituality consisting of contemplation and prayer with a foundation of Christian Education are significant tools of empowerment---especially for persons with no previous history of mission outreach---which allow Christians to become committed and involved in order to undertake a coordinated effort of missions to poor and underprivileged persons living in public housing. Also, church leaders and other laity in an affluent middle class church with no previous history of mission involvement with public housing can be equipped spiritually through the vehicle of prayer to undertake a vital mission project. Therefore, the church will begin impacting its community by adhering to its mission statement to impact the community by inviting children, youth and adults to Christ. The leaders were challenged to spend time reflecting and praying for designated people of the community. After this phase, these persons voluntarily visited those for whom they had been interceding in order to openly communicate what the Spirit of Cod had revealed to the leadership, and to lay a foundation in order to build meaningful relationships. This project will focus on the dynamics and praxis of the local church's attempt to participate in vital missions in a public housing project, and the role of the associate pastor as mediator/facilitator between the public housing community and the church. The purpose of this study is to examine the reasons inner-city churches have problems engaging in missions to local public housing residents. This project will also present a model with specific alternatives for inner-city churches to become better neighbors in missions to their local communities. Chapter I outlines the overall purpose for the study, presenting the ministry setting and the associate pastor's role in developing strategies for missions praxis. Chapter II focuses on the project in action and the phases of this outreach ministry. Chapter III recounts the history of missions, highlights the relationship of the black church to its community, and reviews the literature on urban mission models for inner-city churches. Chapter IV provides insight into the implications of this project through discussions of spirituality and Christian Education. Chapter V concludes with evaluations, project summary, and reflections.

Mental Health service provision organizations have strong professional norms of cooperation, which exert pressures on organizational actors to integrate and coordinate services to better, serve clients. Pressures to integrate services sometimes run counter to the funding mechanisms employed in delivery systems. This is especially true for managed care. This study examined whether integration increased or decreased as a result of the introduction of risk-based managed care in one community. Data were collected at two points in time, 1996 and 1999, in order to assess changes in services integration over time. Survey instruments and field interviews were employed to collect the relevant data. Standard network analysis techniques and simple content analysis were used for the analysis. The theoretical portion of this dissertation sought to determine which set of literature better described what occurred in a normatively cooperative network with competitive, managed care incentives. I reviewed literature in organization theory, common pool resources, and mental health to support a cooperative view of mental healthcare delivery, and reviewed principal-agent theory and managed care to support a non-cooperative view of mental healthcare delivery. I found that despite the competitive incentives introduced into the mental health delivery network, integration increased over a three-year period. Integration was measured using network measures such as density, degree centrality, cliques, core provider analysis, and blockmodels. The network findings were further supported by the qualitative analysis performed on the interview data. The latter part of the dissertation develops a model that explains collective action in interorganizational networks. It draws upon the organizational theory literature by describing the determinants necessary for network formation and using the concepts of communication, norms, time, and context. The common pool resource literature contributes a diagnosis stage to the model that assists in explaining how networks change and develop desirable characteristics over time, while supplementing the OT literature's perspective on communication, context, and time. I also suggest ways in which this dissertation contributes to practice, focusing on the systems design of mental health delivery systems.

Food Security is defined as the condition in which an assured, sustainable supply of enough nutritionally proper food is available for people to lead healthy, productive lives. The condition in which any of these requirements is missing is known as "Food Insecurity." In this paradigm, absolute food security as enjoyed by most people in the United States is at one end of the food security continuum and Famine is at the other; different levels of food insecurity make up the rest. The above definitions mandate that any analysis of why regions or populations are vulnerable to different levels of food insecurity must consider more than just the availability of food. The "Indicator Approach" to these analyses is based on the collection and analysis of diverse types of data, from multiple sources, which address socioeconomic, agroecological, demographic, environmental, agricultural and political factors in order to come to a more comprehensive understanding of food security conditions and their underlying causes in the areas studied. The hypotheses of this research are (1) That some of these "indicators" are correlated to measures or proxies for vulnerability and food insecurity at statistically meaningful levels, and (2) That the indicators so related will, in general, vary at the subnational level. The data set for this research consists of about 70 indicator and outcome parameters from different aspects of life in the Republic of Malawi, in Southern Africa. The analysis was performed through the following sequence of steps: (1) Definition of four national level proxies for Vulnerability and Food Insecurity, (2) Decomposition of Malawi's 154 EPAs into six non-overlapping EPA clusters, and (3) Independent analysis of each EPA cluster and the nation for each proxy variable with three analytic approaches (Bivariate Correlation, Regression Trees, and Multiple Linear Regression). The results of these 84 separate "mini-analyses" confirmed the research hypotheses and led to other conclusions about vulnerability assessments in general, and conditions in Malawi in particular. These results independently confirm that very small landholdings, female heads of household, and the lack of adequate employment opportunities are among the primary correlates of vulnerability and food insecurity in Malawi.

Why was national alcohol Prohibition repealed in the United States? Prohibition's repeal is unique in several respects. Alcohol Prohibition is the only American drug prohibition to ever be repealed, and the only constitutional amendment to ever be repealed. Furthermore, the volatility of Prohibition policy serves as a useful case for political sociology, which tends to focus on stable policies and government agencies. Prohibition's repeal is important substantively because it is the only American drug prohibition to be repealed. The question of repeal requires examination of several theoretical issues. First, is the process of creating a new policy fundamentally different from the process of dismantling an existing policy? Second, what effect does an exogenous crisis (like World War I or the Great Depression) have on state actor's response to the demands of a social movement? Third, what is the role of elites in a social movement? Fourth, what effect does the implementation of a policy have on those constituencies supporting it? I examine the substantive and theoretical issues of Prohibition's repeal using a variety of primary and secondary sources. National Prohibition resulted from the combined effects of crisis and elite social movement activity. Both were necessary for passage of the 18th Amendment. Implementation of the amendment proved difficult and had a destabilizing effect on Prohibition's supporters. Repeal of Prohibition resulted from the combined effects of implementation and crisis. The passage and repeal of Prohibition were the result of very different processes, suggesting that dismantling a policy is a different kind of political project than creating a policy.

The system of human subjects' protections has recently gone through many changes. Overtly, the structural and functional changes are justified by rhetorical claims of increasing protections for research subjects. Yet, change represents an opportunity for a restructuring of the system in ways not immediately obvious. So, despite rhetorical claims of increased protections for subjects, what problems are delineated and how is the system of human subjects' protections constituted? Examination of the structure and functioning of the system, utilizing a blend of social constructivism, science and technology theories, and power theories, as well as a multi-layered, multi-dimensional examination of the system of human subjects' protections points to multiple social actors with many different interests. Many of these actors claim to speak for the subjects; however the subjects themselves do not speak in venues where policy is decided. Many problematic aspects of the system of human subjects' protections are delineated; however, few of the problematic aspects were addressed by the recent structural and functional changes made to the system. Overall, the current structural and functional aspects of the system of human subjects' protections do not necessarily support rhetorical claims of increased protections for subjects. As the system came under pressure from public scrutiny, the adjustments which followed tended to benefit institutional interests rather than human subjects.

Assimilation has long been the driving force behind the federal government's policies relating to American Indians. The termination and relocation policies of the 1950s and 1960s exemplify government actions in this area. As a direct result of these two policies there was an influx of American Indians into urban areas. Abandoned by the federal government and facing competition from other minority groups for state services, American Indians began to develop their own service organizations. Urban Indian community centers, many pan-Indian by necessity due to the numerous tribes present in each urban community, were some of the first organizations created. These organizations provided services, support, and a cultural haven. This thesis reviews the history of these policies and their impact on American Indians and concludes with an analysis of research done at the American Indian Community House, New York City, which examines the contemporary role of community centers in urban areas.

<p> Mexico's innovative health reforms have attracted scholarly attention beyond its own borders, making it a valuable case to study how countries set priorities. This dissertation examines the multifaceted topic of priority setting through a multidisciplinary approach: each of the three papers of this dissertation employs one of three disciplinary perspectives: historical, quantitative or normative. The dual focus on mental health and HIV--two highly stigmatized diseases with almost opposite histories of prioritization--further underscores the social and historical aspects of health priority setting. Paper 1, "Outrage and Evidence: Julio Frenk and the Politics of Mental Health Advocacy in Mexico, 1968-2006," examines the recent history of mental health advocacy efforts in Mexico. Tracing the career of Julio Frenk, a contemporary global health leader as well as Mexico's Minister of Health from 2000 to 2006, demonstrates that mental health advocacy moved from a focus on human rights abuses to a statistical-based advocacy that emphasized the burden of mental illness. Paper 2, "Beyond Universal Treatment Access: A Multi-level Study of Mental Health Care in Public HIV Clinics in Mexico," represents the first study of the availability and usage of mental health services among HIV+ individuals in Mexican HIV clinics. This paper uses multi-level modeling of a cross-sectional survey from Mexico's National Institute of Public Health to explore factors associated with patients receiving mental health care. The results indicate that clinic-level factors account for much of the observed variation in mental health care for HIV+ individuals. Paper 3, "'What Magic is there in the Pronoun `My'?' The Role of Patient and Disease Advocates in Public Deliberations about Priority Setting for Health Policy," analyzes the risks and benefits of recent, and often controversial, attempts by countries like Mexico to include this specific class of stakeholder in public deliberation for health. Patient participation does bring the risk of bias due to their partiality. However, by drawing on deliberative democratic theory, this paper argues that such partiality confers epistemic advantages to deliberation, such that, if certain procedural and substantive constraints are met, the benefit of their participation may offset the risks.</p>

This study examines the development, organization, and implementation process of an intersectoral work insertion program (ISWIP) that is implemented through the collaboration of six stakeholders from different sectors of the community, including health and employment. The research objective is approached by case study methodology whereby the main methods of inquiry are documentation collection, participant observation, and semi-structured interviews. An innovative program logic model is developed that illustrates key components of using an intersectoral approach: leadership, sharing resources, and serving interests. The study demonstrates the relevance of local development to the social integration of individuals with mental illness. It also provides insight into the challenging nature of collaboration; obstacles such as negotiating roles, maintaining interests, and dealing with unforeseen consequences can be sources of frustration and tension among participants. Communication, attitude, and stakeholder involvement, are mediating factors in overcoming conflicts, reducing tension, and promoting successful collaboration.