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As a practitioner involved in the planning and development of educational activities in the field of public health, I have worked within many pedagogical traditions and program parameters. Through this work, I have experienced both subtle and radical shifts in the range of skills, knowledge and relationships required to collaboratively plan and evaluate educational work. In this professional and community-based landscape, competing and often overlapping models of education and evaluation have led to much conceptual confusion and ambiguity around narrowly defined notions of best practice, evidence and knowledge legitimacy. Drawing from Dorothy Smith’s (1999) standpoint theory from which my inquiry was developed as a result of my participation with colleagues in the field, I explore how three professional practice networks of learning and development practitioners speak of the skills, knowledge, relationships and worker identities in a changing field. This research seeks to explicate the kinds of informal and largely unarticulated knowledge that is produced through the changing contexts of work. This research maps the changing conditions of educational work through my own case stories of educational practice and uses these as a springboard for discussion among three diverse professional practice networks. The Story/Dialogue Method (S/D-M) developed by Labonte and Feather (1996), is a constructivist methodological approach that, in this application, structures group dialogue into reflective insights and theories about how educational work occurs in varied settings among different professional and community-based groups. A strong reliance on interpersonal skills was articulated by all three networks to build trust, assess individual and organisational learning needs, to build partnerships and to motivate learners. Skills were often described vaguely and summarised as a series of situational specific attributes. A valuing of reflexive, working knowledge as opposed to professional or discipline-based expertise was raised as an important aspect of partnership building and in negotiating program parameters. The need to build individual and organisational relationships through formal and informal encounters was cited as a series of legitimate yet often ‘behind the scenes’ professional practices. Aligning with the notion of worker identity described by Chappell, Rhodes, Solomon, Tennant and Yates (2003) as process, practitioners spoke of their identities as constructed and temporary, negotiated through newly emerging roles and changing relationships with peers and learners. This study suggests that evidence-based practice is a contested term drawing its meanings from multiple theoretical and pedagogical traditions including that of intuition. Perhaps unsurprisingly then, evidence guiding educational approaches is viewed as a pragmatic and eclectic mix of tools stored to be adapted for use in new ways. Additionally, this study concludes that all participants (including myself) regard educational practice as a collaborative and continually negotiated endeavour.

Socioeconomic Factors Affecting Infant Sleep-Related Deaths

INTRODUCTION: Canada’s Aboriginal population is growing at a faster rate than the rest of Canada. While Aboriginal health has improved in the last few decades, life expectancy of First Nations, Inuit and Métis continues to be lower compared to the rest of the Canadian population. Furthermore, current Aboriginal health research tends to focus on those living onreserves while more than half of the Aboriginal population currently resides in urban areas. Despite the importance of neighbourhood factors for understanding health in urban areas, the importance of neighbourhood characteristic for urban Aboriginal health has yet to be examined. OBJECTIVE: The objective of the research was, to determine both individual-level predictors and neighbourhood-level predictors of self-rated health and diagnosis of chronic conditions, amongst Aboriginal populations living in the City of Toronto; and to determine whether and how neighbourhood-level predictors influence individual-level predictors of self-rated health and diagnosis of a chronic conditions in Toronto neighbourhoods with Aboriginal populations living in them. METHODS: This study was a secondary analysis of two samples from the 2006 Aboriginal people Survey, consisting of 1080 and 500 Aboriginal individuals in the Toronto Census Metropolitan Area. A series of logistic regressions models were created to identify individual and neighbourhood predictors of “poor” self-rated health and having one or more diagnosed chronic condition(s). RESULTS: A best fitting model was derived from the individual-level variables to include the demographic variables age, gender and Aboriginal status; and the socio-economic variables average household income, education level and employment status. While neighbourhood-level variables had no significant influence in predicting either health outcome, there was some evidence to suggest influence over individual-level predictors. To further examine this relation, neighbourhoods were stratified based on income inequality, average household income and availability of Aboriginal specific services. This analysis yielded some different effects of individual-level variables for different neighbourhood types, suggesting that some effects of neighbourhood characteristics may interact with individual characteristics to influence health. CONCLUSION: While contextual factors have some effect on self-rated health, individual factors serve as stronger predictors of individual health. However, more neighbourhood level studies should be considered in order to better understand the growing urban Aboriginal population and potential ecological effects on health.

The personnel policy program for the employees in studied municipality includes guidelines for the working environment, saying that health promoting activities is offered to all employees.                              Objective: To investigate how these activities were used and how the staff perceived the activities offered. The aim was also to find out how well the information about current health promotion efforts reached the staff.Method: A qualitative approach was used in the form of interviews. The sample consisted of municipal employees from seven different work sites.  A total of 12 women aged 32-52 years participated. The interviews were recorded and a hermeneutic theory was used to interpret the results.Results: The results showed that most informants used some form of fitness activity. In most cases health care-time was used for anything from walking to organized workouts. The great barrier was lack of information and lack of trained and dedicated health motivators. In several cases, informants had no knowledge about what a health motivator is supposed to do. The informants own suggestions for health promotion interventions included stress management and foot care.Conclusion: The survey showed that respondents were poorly informed about which wellness activities the municipality offered. The result could also be interpreted as a communication gap between the local authority, health motivators and the employees. A request for group activities was detected.

Thesis (Ph.D.)--University of California, San Francisco, 2009. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3402. Adviser: Mary C. White.

The purpose of this study was to begin to fill the void regarding nutriologic status in patients with Congestive Heart Failure (CHF) and or Chronic Obstructive Pulmonary Disease (COPD) receiving palliative care, and to bring the quality of palliative care to a more appropriate level as related to nutritional injury. Objectives: The objectives were: 1) to determine the prevalence of patients with a stage of nutritional injury at or above the clinical horizon; 2) to determine the response, specifically changes in biochemical parameters and physical manifestations of nutrient based lesions, after micronutrient intervention; 3) to determine if there is a relationship between micronutrient intervention and macronutrient intake; 4) to determine if there is a positive relationship between micronutrient intervention and stage of nutritional injury regardless of the percent of estimated non-protein calorie and protein needs consumed and 5) to ascertain what characteristics identify patients without resiliency / response to treatment. Design: The design was a prospective theory-based effectiveness trial exploring nutriologic status and response to micronutrient intervention utilizing a quasi-experimental design. Twenty-six Veterans with CHF / COPD admitted to the Nursing Home Care Unit for palliative care or designated as Advanced Disease were enrolled; nineteen completed the study. Subjects were recruited consecutively and comparisons were made between baseline and post-treatment values. Methods: A Minimum Data Set structured nine-step nutritional care process including evidence, diagnoses, etiologies, goals / predicted outcomes, interventions and actual outcomes was utilized. Results: All subjects presented at or above the clinical horizon of nutritional injury at baseline representing acquired nutritional loss; 84% had lesions suggestive of nutrient imbalance. Prevalence of pyridoxine, thiamin and zinc deficits were 63%, 11% and 21% respectively. Pyridoxine status following treatment improved significantly, p = .000. Fifty-three percent of subjects had improved outcomes indicating nutritional resiliency, and change within stage of injury. Factors observed in suboptimal nutritional resiliency included drug-nutrient interactions and acute infection. Conclusions: The nutritional cost from lack of responsible nutrition therapy is likely to be significant in veterans with CHF/COPD receiving palliative care. Drug-nutrient interactions and acute infections are most likely the offending factors interacting with the resiliency state.