Introduction: Eating disorders were previously regarded as a Western culture-bound syndrome affecting only young Western women. However they have been described in the UK and in across the world. Research has highlighted the prevalence of disordered eating among South Asian females. However little is known about the process of how this comes about, and little qualitative research has been conducted in this area. This research aimed to understand the issues relating to the development and maintenance of eating disorders among South Asian females and their help seeking behavior, as well as the barriers to accessing treatment. Methods: Three main studies were carried out; two systematic reviews, a review of prevalence (study 1), a qualitative review (study 2) and a qualitative study (study 3). For study 1, the review was planned and reported with reference to MOOSE guidelines (Stroup et al 2000) for systematic reviews of observational studies. For study 2, the quality of the studies was appraised in accordance with Critical Appraisal Skills Programme Criteria (CASP 2013), qualitative research check list. For both reviews, a systematic literature search was conducted across four data basis, Psychinfo, Medline, CINAL and EMBASE. All articles were screened against inclusion/exclusion criteria. The data extracted from the selected studies was tabulated in a way that demonstrated the methodological robustness and cultural quality of each study was also reported. For the qualitative study (study 3), semi-structured interviews were carried out with three groups of participants, ten South Asian females with eating disorders, seven parents and siblings and eighteen health care professionals. Results: For study 1, thirteen studies were initially selected. Overall, these studies reported higher prevalence of Bulimia among Asian females in the UK compared to Caucasian females. Studies conducted in Pakistan and India reported a lower prevalence rate of diagnosable eating disorders than reported in Western countries. In study 2, three studies were selected. They identified important themes; cultural conflict and controlling families. In study 3, two overarching themes were identified with corresponding sub-themes; development and maintenance of eating disorders in the context of family and cultural conflict; barriers and facilitators to accessing treatment. Conclusions: Reviewed prevalence study findings highlighted a need to consider the adaptation of measuring tools, as eating disorders may present differently in different cultures, and diagnostic criteria based on Western norms may not always be appropriate. There was a lack of qualitative studies and those available were of poor quality. The main aetiology and maintenance of Eating Disorders reported by South Asian females were focused on conflict with family and culture. Seeking treatment was difficult for these women due to stigma, shame, issues of confidentiality and lack of training and understanding in cultural competence among health care professionals.

Approximately 46.6 million adults in the United States live with a mental illness as of 2017. Therefore, managed care being the system that facilitates access to mental health treatment needs to be addressed. Managed care (such as healthcare plans) seeks to facilitate healthcare service delivery by providing direction and guidance to utilization and prevention of services. The purpose of this qualitative study is to explore social work perspectives on the constraints of managed care as it impacts access to mental health treatment. This study conducted qualitative interviews through a non-random sample of professional colleagues of social workers in the in the manage care field. This study found five emerging themes including long wait times, lack of providers (to provide timely, effective mental health treatment), over diagnosing to justify services, profit-driven service delivery, and managed care not aligning with social work values. The implications of this study urge the need for accountability and consistency through policy change and reform.

Master of Public Health - MPH / The number of street children, in the Democratic Republic of Congo (DRC), is estimated at 70,000 and it increases each year. The President's Emergency Plan for AIDS Relief reported a 75.1% of street boys and 81.1% of street girls report multiple sex partners in DRC, thereby increasing their risk for transmission. Access to HIV treatment remains one of the challenges for the street children with HIV/AIDS. A study conducted in Lubumbashi and Kipushi in the Province of Haut Katanga, found that 78.2% of street children have no access to health care The District of Katuba as in other local districts in the province, has seen a growing number of street children in recent years. T

Opioid use disorder (OUD) is a type of substance use disorder characterized by repeated use of opioid drugs. These drugs are known to be rapidly addictive with severe withdrawal symptoms, making death due to overdose a rising concern. In this study, we took a closer look at a specific population of women, all of whom had children and were incarcerated for opioid use. Our goal was to better understand the factors that would impact success among this group seeking medication-assisted treatment for OUD. We developed a set of questions focused on a variety of factors including stigma surrounding the disorder, influence of the disorder of parenting, approaches and barriers to treatment, and potential motivation for seeking treatment. We then virtually interviewed women participating in the Orange County Corrections Medication for Opioid Use Disorder Program, specifically in the Methadone Clinic, to better understand their experiences with OUD and methadone treatment. The purpose of this study is to give better insight into existing treatment options in order to suggest revisions to current policies. By doing so, we hope to increase rates of recovery from OUD and to provide better future outcomes.

L'épidémie de VIH a introduit la question du risque et de la maladie dans les rapports entre les femmes et les hommes. Parmi les stratégies mises en place du niveau individuel au niveau collectif, différentes selon les situations et inscrites dans des représentations infléchies par le contexte culturel, celles relatives aux personnes atteintes par le VIH sont primordiales. Ce « traitement social » est marqué par des différences et des similitudes entre les hommes et les femmes, qui induisent certaines recompositions des rapports entre hommes et femmes. Cette recherche, qui relève simultanément de l'anthropologie médicale et de l'anthropologie du genre, décrit et analyse la dimension du genre dans le traitement social de l'infection à VIH dans le système de soin au Cameroun. L'analyse des représentations de la maladie à travers les messages sanitaires des années 1980 à 2000 révèle les stéréotypes de genre prévalent dans la société camerounaise et leurs usages dans la prévention. L'expérience d'hommes et de femmes vivant avec le VIH dans le système de soin montre ensuite des différences entre leurs perceptions et conduites, qu'ils soient patients ou professionnels de santé, de l'annonce du statut jusqu'à sa révélation au partenaire. Puis c'est à travers l'expérience du traitement antirétroviral que des différences entre les hommes et les femmes apparaissent dans le système de soin. Enfin, l'étude de la gestion de la sexualité, de la procréation et de l'allaitement montre comment les rôles sociaux des hommes et des femmes se construisent de manière particulière pour des personnes vivant avec le VIH, dévoilant un aspect du genre dans la société camerounaise / The HIV epidemic has brought the issue of risk and disease into relations between women and men. Among the strategies set up from the individual to the collective level, varied in different situations and shaped by culturally framed representations, those relating to people living with HIV are crucial. This "social treatment" is marked by differences and similarities between men and women, which induce some reconstructions of the relationships between men and women. This research, which belongs simultaneously to the fields of medical anthropology and anthropology of gender, describes and analyzes the gender dimension of the social treatment of HIV infection in the health care system in Cameroon. The analysis of disease representations through health messages from 1980 to 2000 reveals the gender stereotypes prevalent in the Cameroonian society and their use in prevention. The experience of men and women living with HIV in the health care system then shows the differences between their perceptions and behavior, whether patients or health professionals, from announcement of HIV status by health professionnals to disclosure to partner. Then men and women’s experience of antiretroviral therapy reveal gender dimensions in the health care system. Finally, the study of the management of sexuality, pregnancy and infant feeding shows how the social roles of men and women are built in a special way for people living with HIV, as a window an aspect of gender in Cameroonian society

Submitted by Carlos Vinícius Jenezi Santos (carlosjenezi@hotmail.com) on 2018-06-14T01:26:32Z No. of bitstreams: 1 TA FINAL CARLOS JENEZI_FINAL.pdf: 643498 bytes, checksum: 5e5b5637c7f7928188cf615e7b3c73da (MD5) / Rejected by Simone de Andrade Lopes Pires (simone.lopes@fgv.br), reason: Prezada Carlos, Recebemos a postagem do seu trabalho na biblioteca digital e para ser aprovado serão necessários alguns ajustes: 1º CAPA: correção do nome da escola. FUNDAÇÃO GETULIO VARGAS, não tem acento no "U". Atenciosamente, SRA on 2018-06-14T16:50:14Z (GMT) / Submitted by Carlos Vinícius Jenezi Santos (carlosjenezi@hotmail.com) on 2018-06-14T19:13:59Z No. of bitstreams: 1 TA FINAL CARLOS JENEZI_FINAL.pdf: 641921 bytes, checksum: 7faadbc4b9f5d7002cf03cd791f5615d (MD5) / Approved for entry into archive by Simone de Andrade Lopes Pires (simone.lopes@fgv.br) on 2018-06-15T16:47:48Z (GMT) No. of bitstreams: 1 TA FINAL CARLOS JENEZI_FINAL.pdf: 641921 bytes, checksum: 7faadbc4b9f5d7002cf03cd791f5615d (MD5) / Approved for entry into archive by Isabele Garcia (isabele.garcia@fgv.br) on 2018-06-15T19:08:54Z (GMT) No. of bitstreams: 1 TA FINAL CARLOS JENEZI_FINAL.pdf: 641921 bytes, checksum: 7faadbc4b9f5d7002cf03cd791f5615d (MD5) / Made available in DSpace on 2018-06-15T19:08:54Z (GMT). No. of bitstreams: 1 TA FINAL CARLOS JENEZI_FINAL.pdf: 641921 bytes, checksum: 7faadbc4b9f5d7002cf03cd791f5615d (MD5) Previous issue date: 2018-06-13 / Este estudo analisa a questão da viabilidade socioeconômica do tratamento de câncer de pulmão, umas das neoplasias com maior incidência e mais alta taxa de mortalidade, através de imunoterapia. Este tipo de tratamento, a maior inovação no combate ao câncer nas última décadas, traz importantes desafios de acesso em função do alto custo de tratamento. Alternativas que possam eventualmente garantir o acesso à essas terapias foram aprofundadas através da análise sobre estudos já realizados sobre o tema e também através de pesquisas em profundidade com profissionais que atuam na área, sejam eles da assistência ou da gestão. O estudo se baseou em três hipóteses, que foram aprofundadas e ampliadas após a etapa de pesquisas, trazendo nossos fatores ao tema discutido. A primeira hipótese debateu sobre a garantia constitucional brasileira de acesso universal e integral da saúde pela população e o papel do Estado na promoção de saúde. A segunda discutiu critérios socioeconômicos para decisão de protocolos de tratamento. A terceira discorreu sobre metodologias de maior precisão diagnóstica, garantindo a utilização de medicamentos de alto custo somente em situações de comprovado ganho terapêutico. Ao fim, o estudo procura apontar alternativas que possam garantir o acesso populacional à tratamentos inovadores dentro da realidade socioeconômica brasileira. / This study analyzes the question of the socioeconomic viability of the treatment of lung cancer, one of the neoplasias with higher incidence and higher mortality rate, through immunotherapy. This type of treatment, the greatest innovation in the fight against cancer in the last decades, brings important challenges of access due to the high cost of treatment. Alternatives that could possibly guarantee access to these therapies were deepened through the analysis of studies already done about this subject and also through in-depth research with professionals working in the area, whether in the cancer care or management. The study was based on three hypotheses, which were deepened and expanded after the research stage, bringing new factors to the topic discussed. The first hypothesis discussed the Brazilian Constitution, that guarantee the universal and comprehensive access to health by the Brazilian population and the role of the State in health promotion. The second discussed socioeconomic criteria for definition of treatment guidelines. The third one debates about methodologies with greater diagnostic precision, guaranteeing the use of high cost drugs only in situations of proven therapeutic gain. Finally, the study seeks to identify alternatives that can guarantee the population access to innovative treatments within the Brazilian socioeconomic reality.

En 2010, l'Organisation Mondiale de la Santé (OMS) a publié de nouvelles recommandations pour le traitement contre le Vih/Sida dans le but d'améliorer la qualité des thérapies antirétrovirales (TARV) distribuées dans les pays en voie de développement (PED). Cependant, les coûts de plus en plus importants liés à l'incorporation des antirétroviraux (ARV) de nouvelle génération, associés à l'intensification de la protection des droits de la propriété intellectuelle (DPI), accentuent le déséquilibre entre les priorités d'expansion de la couverture des patients et les objectifs d'amélioration des traitements, ce qui favorise la pérennité d'un double standard de soins dans le monde. Cette thèse a pour objectif d'analyser les déterminants de l'incorporation des nouvelles technologies et de l'évolution des prix des ARV pour mieux comprendre leur impact sur la qualité et l'accessibilité financière des TARV dans les PED. La présente recherche est basée sur la politique brésilienne de TARV et les leçons qu'elle peut apporter dans la lute contre l'épidémie du Vih/Sida. La première partie de la thèse porte sur les critères utilisés pour l'incorporation des nouveaux médicaments dans les protocoles cliniques de TARV. L'étude part des méthodes de l'analyse de contenu et statistique pour examiner l'impact des prix des ARVs sur les recommandations thérapeutiques et comment celles-ci influencent la pratique médicale. / In 2010, the World Health Organization (WHO) published new HIV/AIDS treatment recommendations which aim at improving the quality of antiretroviral therapy (ART) delivered in developing countries. Nonetheless, the higher costs of incorporating new and more potent antiretrovirals (ARVs), coupled by the intensification of intellectual property rights (IPRs) protection, put in evidence a growing trade-off between patient coverage expansion priorities and treatment quality objectives, which tend to favor the perpetuation of a double standard of HIV care in the world.This thesis aims at analyzing the determinants of technology incorporation and price evolution in HIV care as the basis for discussing how these can impact both the quality and affordability of ART in low and middle-income settings. The present research takes as reference the Brazilian ART policy and the insights it may provide in the fight against the HIV/AIDS epidemic. The first part of this thesis addresses the criteria used for the incorporation of novel drugs in ART guidelines. Content and statistical analyses are used to examine the impact of ARV prices on therapeutic recommendations and how the latter have been able to influence clinical practice. They show that, although efficacy, toxicity and dosing convenience represent major determinants of ART incorporation decisions in Brazil, costs have most recently started influencing deferral in the use of new ARVs. The second part takes into account the role of patent protection on pharmaceutical innovation and pricing, further employing descriptive and econometric approaches to analyze ARV market structure and prices in Brazil.