We live in a watershed moment for the planet and for the church. A threatening planetary water crisis asks now for a strong church response. Ascension Lutheran Church of South Burlington, Vermont, engaged in water-focused activities, education, and worship to respond faithfully to God’s call to care for Earth and its water. In so doing, the church developed a potential model for watershed stewardship that enhances a congregation’s discipleship, spreads the vision of creation care through watershed stewardship, and offers practical guidance for churches and judicatories. This project, and other national and international water stewardship projects, offer insight into Christian leadership and education for water care. Relevant Christian theological resources and transformational educational and leadership studies grounded the project. Among recent Christian calls for action is the Evangelical Lutheran Church in America (ELCA) Resolution Urging Stewardship of the Gift of Water, passed at the 2016 Churchwide Assembly (Appendix IX). Further, Lutheran theologians, among other Christian theologians, have proposed insights into the sacredness of creation that undergird effective congregational watershed action. Their reformulated theology, plus transformational leadership and education theories, helpfully ground planning for congregational learning and action and were applied to Ascension’s watershed project. Caring for water orients a congregation in a new and deep way to its social, cultural, and ecological community, while also positioning it to develop supportive ties to other congregations and groups in the area to foster watershed health. When a congregation cares for its local watershed, it potentially promotes awareness and action to ameliorate worldwide water justice issues, including climate change and the feminization of poverty, both of which reflect and create water justice issues. A watershed discipleship church faithfully responds in our time to Jesus’ timeless words, “I was thirsty and you gave me something to drink [Matt.25:35].”

Background: There is little information on how the quality of oral health services in long-term care (LTC) facilities is conceptualized or assessed. Objectives: This study aims to develop a model for assessing the quality of oral healthcare services in LTC facilities. Methods: This study is divided into four main steps. Firstly, I examined literature for existing concepts relating to program evaluation and quality assessment in healthcare to build a theoretical framework appropriate to dental geriatrics. Secondly, I explored as an ethnographic case study a comprehensive oral healthcare program within a single administrative group of 5 LTC facilities in a large metropolis by interviewing 33 participants, including residents and their families, nursing staff, administrators and dental personnel. I also examined policy documents and made site visits to identify other attributes influencing the quality of the program. Thirdly, I drafted the assessment model combining a theoretical framework with empirical information from the case study. And lastly, I tested the feasibility and usability of the model in another dental geriatric program in northern British Columbia. I applied the assessment model by conducting 15 interviews with participants in the program, made site-visits to the 5 facilities, and reviewed documents on the development and operation of the program. Results: A combination of theory-based evaluation and quality assurance provided six sequential and iterative steps for quality assessment of oral health services in LTC. The empirical information supported the theoretical framework that a program of oral healthcare in a LTC context should be assessed for quality from multiple perspectives; it should be comprehensive; and it should include the three main attributes of quality - capacity, performance, and outcomes. Participants revealed 20 quality indicators along with suggested program objectives which encompass eight quality dimensions such as effectiveness, efficiency, and patient-centered. Conclusion: The model provides a unique system for assessing the quality of dental services in LTC facilities that seems to meet the needs of dental and non-dental personnel in LTC. / Dentistry, Faculty of / Graduate

Thesis (MSD) -- Boston University, Henry M. Goldman School of Dental Medicine, 2010 (Department of Health Policy and Health Services Research). / Includes bibliographic references: leaves 73-75. / Objectives: To describe the oral health of Rhode Island Seniors and to evaluate gender differences in oral health. Methods: This is a cross-sectional study of individuals who underwent oral screening at the HeathLink Wellness Health Fair, RI, in June, 2008. Data was collected using a self-administered questionnaire on self-reported general and oral health, and a dental examination for those who attended the HealthLink Wellness Progran’s health fair. Data was coded and entered into Epi-Info version 3.4.1, then analyzed using SAS version 9.1. The clinical oral health outcome variables studied were: number of teeth, edentulousness, root tips, untreated caries, dentures, and DMFT. The self-perceived oral health outcome variables were: difficulty relaxing, avoided going out or feeling nervous or self-conscious, felt pain or distress due to teeth, gums or denture, and overall poor self-perceived oral health. The main predictor variable was gender. Other predictor variables included age, self-reported chronic diseases (diabetes, hypertension, heart disease, and dry mouth), smoking history and current smoking status, self-perceived oral health, number of teeth, dentures, and DMFT. Descriptive statistics, bivariate analyses, and multivariate logistic and linear regression analyses were performed. Results: The study sample consisted of 166 subjects with a mean age of 72.3[plus or minus]7.8 years (range=42-89 years). Descriptive analyses of the study sample’s oral health showed that the subjects had overall good oral health, with 47% having good oral hygiene, 19% had untreated caries, 8% had root tips, 46% had at least one denture (upper or lower, complete or partial), and 12% were completely edentulous. On average, study subjects retained at least half of their natural dentition (mean=16.8[plus or minus]0.8 teeth). The mean DMFT score was 18.5[plus or minus]0.5 teeth. The mean number of teeth with untreated caries was 0.4[plus or minus]0.1 teeth. Multiple logistic regression models and linear regression models were performed after controlling for potential confounders and statistically significant associations were found between the main predictor, gender; and the outcome variables, self-perceived oral health, and clinical oral health. Females were 3.3 times more likely to feel difficulty relaxing due to their teeth, gums or denture (95% CI=1.5-7.6, p=0.002), were 10 times more likely to avoid going out or felt nervous or self-conscious due to their teeth, gums or denture (95%CI=2.1- 48.2, p=0.004), were 5.9 times more likely to have felt pain or distress due to their teeth, gums or denture (95% CI=1.8-19.8, p=0.005), and were 3.2 times more likely to avoid eating some foods due to their teeth gums or denture (95% CI=1.0-10.1, p=0.03). When a new variable was constructed, that reflected an overall score for self-perceived oral health, a multiple linear regression model showed that females had overall poorer self-perceived oral health (p=[less than]0.0001) than males. When clinical oral health outcome variables and gender was analyzed, females were less likely to have decayed teeth (p=0.005), had lower DMFT (p=0.02), and had a greater number of teeth (p=0.03) than males. Conclusion: In this study sample, there is an association between clinical oral health and self-perceived oral health and gender compared to the national data. Also, despite the fact that males had poorer clinical oral health than females, females reported poorer self-perceived oral health than males.

Made available in DSpace on 2015-03-04T21:02:09Z (GMT). No. of bitstreams: 0 Previous issue date: 25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Em suas primeiras obras, Michel Foucault afirma que vivemos uma sociedade de controle, onde a subjetividade é moldada e produzida pelo sistema vigente. Por meio da relação entre discurso, verdade e poder percebe-se que a subjetividade na sociedade contemporânea é produzida por discursos enunciadores de verdades que nem sempre são as nossas, isto é, há uma constante produção de modos de ser que nem sempre é desejado, mas sim, induzido. Será estudado, portanto, em um primeiro momento, que o tipo de ethos que a sociedade contemporânea construiu está preso a uma norma de existência e, num segundo momento, como se pode resgatar o poder do sujeito enquanto criador de si, analisando a noção de ética e estética da existência. A hipótese levantada é pensar a formação da subjetividade a partir de uma constituição criativa/criadora que se dá por meio de uma práxis, da realização das virtudes. Para tanto, Foucault realiza uma volta aos gregos, buscando conceitos como epimeloû heautoû (cuidado de si), e resgatando a práti / In his first works, Michel Foucault claims we live in a society of control, where subjectivity is shaped and produced by the current system. The relation between discourse, truth and power allows us to realize that the subjectivity in modern society is produced by discourses which enunciate truths that are not always everyone’s truths, that is to say there is a constant production of ways of thinking that are not always wished for, but rather induced. In a first moment the present work studies that the kind of ethos that modern society has built is attached to a model of existence, and in a second moment how we can recuperate the subject’s power while creator, analyzing the notions of ethics and aesthetics of existence. The hypothesis proposes to think the formation of subjectivity from a creative/creating constitution that takes place through certain praxis, namely the realization of virtues. In order to achieve that, Foucault goes back to the Greeks, searching for concepts such as epimeloû heautoû (the care

Background: While there has been a dramatic increase in the prevalence of diabetes in developing countries, such as Mexico, there is a critical need to better understand how the challenges that arise in shifting the focus from acute care to care for chronic conditions manifest at the level of patient care provision in the health care organization and community, especially in rural resource-poor communities. One step in this direction is the exploration of the potential that social capital may provide in improving our understanding of the relationships that exists among patients, health care providers and the broader community. Objectives: To examine the provision of health care for diabetes, as well as the beliefs, resources and relationships that exist among patients and families, health care teams and community partners that affect treatment for diabetes in a rural resource-poor community in Mexico. Methods: This study incorporated a qualitative action-research approach and data was collected via community asset mapping, surveys, semi-structured interviews and group discussions. Utilizing an action research model, the study procedures were iterative, whereby results from selected data collection techniques were used to inform subsequent iterations of data collection. Community resources were identified with key informant input and via community exploration, to record existing and potential diabetes-related resources. Surveys were administered to health care providers, patients and general community members. Semi-structured interviews and group discussion topics were informed by the Innovative Care for Chronic Conditions Framework as well as by prior data collection procedures such as the surveys and preceding interviews. The interviews and group discussions were conducted with health care providers, diabetic patients, and community leaders. Results: Community asset mapping revealed limited existence of health care resources available to the rural community in Mexico. Three salient themes emerged across health care providers, diabetic patients, and community leaders: (1) Cultural eating behaviors are important drivers in preventing and managing diabetes mellitus; (2) Diabetic patients are currently ill-prepared to adequately manage chronic conditions, such as chronic conditions; (3) Trust is an important facilitator and/or barrier for both patients and health care providers when searching for ways to enhance management of diabetes outside of the health care organization. Conclusion: An evidence-based understanding of the diabetes-related beliefs, current perceived performance of diabetes care provision, the availability of community resources and social capital can be used to leverage the health care in low-income communities where primary health services are limited in their availability and/or capacity. The informed construction of community-derived initiatives and interventions that integrate community resources and improve the social capital within the community can enhance the care for patients with diabetes by offering both alternative and complementary avenues of accessing care that supports long-term disease management.

El negocio presentado consiste en la elaboración de una lonchera desplegable con su complemento que son envases de material biodegradable, son productos que cumplen los estándares de calidad y contribuyen al medio ambiente, que brindan la facilidad de transportar los alimentos de un lugar a otro, sin llevar tantas cosas en las manos y puedan continuar con la rutina diaria con satisfacción. Estos productos serán mostrados a través de nuestra página web, radio y redes sociales. Toda esta gestión será supervisada por los perfiles de puestos idóneos para cada actividad dentro de la empresa, que fueron seleccionados a gran detalle para evitar falencias y/o incidentes a futuro en los procesos internos de la empresa. La inversión estimada para iniciar las operaciones en la empresa será S/ 444,814.38 soles, esto permitirá implementar la creación de la página Web y cubrir los gastos de marketing, iniciando de esta manera la elaboración y comercialización de los productos y con esto obtener una proyección de ventas favorable durante los 05 primeros años. Los emprendedores aportaran el 40% del capital, pero se necesitará de inversión externa para cubrir el otro 60%. Donde se le retribuirá al inversionista una rentabilidad de 13% anual y una participación del 2% de las ventas para el segundo año. El equipo de emprendedores está integrado por 4 futuros egresados de la Universidad Peruana de Ciencias aplicadas, todos con experiencia en diferentes campos empresariales sobre las cuales se apoya y recae este proyecto innovador y rentable que le facilitara la vida a muchas personas. / The presented business consists in the elaboration of a folding lunchbox with its complement that are containers of Eco-friendly material, they are products that meet quality standards and contribute to the environment, which provide the facility to transport food from one place to another, without carry so many things in your hands and can continue with the daily routine with satisfaction. These products will be shown through our website, radio and social networks. All this management will be supervised by the profiles of suitable positions for each activity within the company, which were selected in great detail to avoid failures and / or future incidents in the internal processes of the company. The estimated investment to start operations in the company will be S / 444,814.38 soles, this will allow the implementation of the website and cover the marketing expenses, thus initiating the preparation and marketing of the products and thus obtaining a projection of favorable sales during the first 5 years. Entrepreneurs will contribute 40% of the capital, but external investment will be needed to cover the other 60%. Where the investor will be rewarded with a 13% annual return and a 2% share of sales for the second year. The team of entrepreneurs is composed of 4 future graduates of the Universidad Peruana de Ciencias Aplicadas, all with experience in different business fields on which this innovative and profitable project is based and which will make life easier for many people. / Tesis

Bakgrund: Vården av för tidigt födda barn har utvecklats från att vara fokuserad på det sjuka barnet och personalen runt det till att vara familjecentrerat. I de flesta länder har olika vårdformer införts med fokus på hela familjen och personalen har till uppgift att stötta och hjälpa de att delta i vården av sitt barn. I hela världen föds det ungefär 15 miljoner för tidigt födda barn dit barn födda före vecka 37 räknas. Syfte: Att beskriva föräldrarnas upplevelser av att vårda sitt för tidigt födda barn på neonatalen. Metod: En litteraturöversikt över nio vetenskapliga studier utförda med kvalitativ metod. Studierna valdes ut från databaserna CINAHL Complete och Pubmed. Två studier hittades via två andra studiers referenslistor. Studierna lästes, sammanfattades och kategoriserades i olika teman och subteman. Resultat: Resultatet presenteras i två teman, Att vårda sitt barn med subteman Att vara med och få ta hand om sitt barn och Erfarenheter av känguruvård och hud-mot-hudvård och Olika vårdformers betydelse för föräldrarna. Nästa tema var Personalens betydelse med subteman Betydelsen av personalens stöd, uppmuntran och kompetens och Svårt med kommunikation och vikten av information. Denna litteraturöversikt visade att föräldrarna ville vara med och vårda sitt barn. Föräldrarna önskade att personalen stöttade dem att våga ta hand om sitt barn och visade och hjälpte dem bli den som tog hand om det mesta runt barnet. De önskade att personalen tog med dem i planeringen av vården och informerade dem fortlöpande om barnets hälsotillstånd. Diskussion: Resultatet visade att föräldrarna ville vårda sitt barn på neonatalen och hur viktigt det var att föräldrarna fick hjälp att lära sig vårda barnet. Neonatalen var en helt ny ofta skrämmande miljö för föräldrarna och barnet upplevdes som liten och känslig och föräldrarna var rädda att skada sitt barn. Resultatet visade att föräldrarna hade liknande upplevelser av att vårda sitt barn trots att de kom från många olika länder. Resultatet diskuterades utifrån konsensusbegreppet vårdandet med utgångspunkt från Katie Erikssons ansa, leka, lära. Ansandet handlar om den dagliga vården av barnet med tvätt, blöjbyten och omvårdnad. Lära syftar till att föräldrarna behöver hjälp att lära sig ta hand om barnet då det är väldigt litet och känsligt och omvårdnaden är uppbyggd på mycket forskning vad som är bäst för det för tidigt födda barnet. Leka syftar på att pröva sig fram och öva och hitta nya lösningar. Olika vårdformer har införts på många ställen i världen och dessa har som mål att hjälpa föräldrarna och personalen att vårda barnet på bästa sätt. I dessa studier har de olika vårdformernas betydelse inte undersökts specifikt utan bara nämnts övergripande. God kommunikation är viktig för alla föräldrar i studierna och när den fungerar så hjälper den föräldrarna att våga vara med sitt barn, vårda det och känna sig som barnets förälder. / Background: Initially the care of the preterm children was focused on the sick child and the care-givers. Nowadays, it focuses on the families around the children and many different forms of care are introduced in a lot of countries. The care-givers task is to help the parents to teach them to take care of their preterm child and to support the families. About 15 million children are born preterm (before 37 weeks) around the world each year. Aim: To describe parents´ experiences in taking care of their preterm child at a neonatal ward. Method: A literature review of nine scientific studies that where done in qualitative design. The studies where found in the databases CINAHL Complete and Pubmed. Two of the studies where found from two other studies´ references. The studies where red and summarized and divided into themes and subthemes. Results: The result are presented in two themes, To care for the child with subthemes To be with your child and allowed to take care of it and Experiences of kangaroo-care and skin to-skincare and Different forms of care. And the second theme was The importance of the care-givers with subthemes The significance of the caregivers support and encouragement and Difficulties with communication and the value of information and competence. This literature review showed that the parents wanted to take care of their preterm child. The parents wished to get support so that they dared to take care of the child. They wanted the care-givers to plan the day with them so they could be part of the care for their child. They also wanted to get information about the child’s health condition. Discussions: The result showed that the parents wanted to take care of their child at the neonatal ward and it was important that they were teached how to do it. The neonatal ward is a completely new world for the parents and they were afraid of hurting the child because it was so small and vulnerable. The result showed that parents all around the world had similar experiences regarding taking care of their preterm child. The result was discussed using Katie Erikssons´ nursing theory of caring with the concepts trim, play and learn. To trim means the daily care of the child. They care for another human being, to wash it, change diapers and to care for it. To learn means that the parents´ need help to learn to take care about the small vulnerable child. To play means that the parents try to find new solutions and practice by trial and error. Different forms of care are introduced in many countries in the world and their aim are to help parents and caregivers provide the best care for the premature children. These different forms of care are not studied specifically in this study. Good communication and information are very important for the parents. When it works it helps the parents to dare to be with their child and care for it and let them feel like they are the child’s parent.

Thesis (M.S.)--University of Michigan, 1983.

Thesis (M.S.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed June 2, 2008). Includes bibliographical references (p. 33-42).

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2003.