Background: Physical activity (PA) is an important component of type 2 diabetes management, yet the amount and type of PA support provided by different types of health care providers (HCPs) is largely unknown. Purpose: This study identified differences in the amount and type of PA supports provided by HCPs, and determined whether HCPs use the Canadian Diabetes Association (CDA) PA guidelines or Canada’s Physical Activity Guide (CPAG) in practice. Methods: Eight of 14 Winnipeg Regional Health Authority primary care clinics specializing in diabetes education agreed to participate in the study. In-person interviews were conducted with health care providers (n=48) and patients with type 2 diabetes (n=26). HCPs were given a total PA support score based on scores in three subcategories behaviour change support (BC), assessment/prescription support (AP) and information/referral/community resources support (IRCR), as reported by HCPs themselves and patients. Results: There was no difference in PA support between the 3 HCP types, but there was a significant difference between HCP report and patient report of PA support. Just over one half of HCPs report using the CDA guidelines unprompted or prompted. Conclusions: HCPs recognize the importance of PA in type 2 diabetes management, but implementing strategies to increase certain types of PA support and facilitate understanding between HCPs and patients would allow for optimal PA counseling in primary care.

The elderly experience their health getting significantly deteriorated as they age. They suffer not only from chronic diseases but from various geriatric diseases such as high blood pressure, arthritis and cardiovascular disease. Their mental health also retreats creating challenges for the elderly from the loss of short term memory to dementia. Furthermore, after they retire, the elderly’s social network decreases as their social activities are inevitably limited to a small group of people like families and friends. With the face of such impairments in their physical, mental and social health, many elderly cannot help but are being institutionalized or sent to specialized places like nursing homes, which provide them professional care. However, a study indicates that most Americans prefer to stay in their homes as they get older since they can maintain their social connections to neighbors and friends, be close to their medical caregivers in town as well as attain emotional comfort and security with familiar surrounding and environments. On top of that, Americans of all ages value on keeping their ability of independence and autonomy by controlling their lives in general. Various health care-aid devices and services appear to offer specific support to health care activities for the elderly in their homes. However, such aids have more focused only on when the elderly’s health is degraded or on very specific areas such as tracking health data like blood pressure, blood sugar and calorie intakes. The elderly need comprehensive understanding about their health problems, healthy daily habits and timely interactions with their families and caregivers, in order to keep independent living safely in their places. Smart Home technology has much potential to support the elderly’s independent living as well as interactions with others. To better understand this, we conducted a user-centered design project which looks at the management of the elderly’s health enabled by Smart Home technology.

Introduction/ Objectives: Stroke, the third leading cause of death in Canada, is projected to rise in the next 20 years as the population ages and obesity rates increase. Family caregivers fulfill pertinent roles in providing support for family members who have survived a stroke, from onset to re-integration into the community. However, the transition from rehabilitation to home is a crucial transition for both the stroke survivor and family caregiver. As the stroke survivor transitions home from a rehabilitation facility, family caregivers provide different types of support, including assistance with navigating the stroke rehabilitation system. They also are a constant source of support for the stroke survivor providing them with continuity during the transition. In this exploratory study we examined family caregivers’ perceptions and experiences navigating the stroke rehabilitation system. The theories of continuity care and complex adaptive systems were used to examine the transition home from hospital or stroke rehabilitation facility, and in some cases back to hospital. Methodology: Family caregivers (n=14) who provide care for a stroke survivor were recruited 4-12 weeks following the patient’s discharge from a stroke rehabilitation facility. Interviews were conducted with family caregivers to examine their perceptions and experiences navigating the stroke rehabilitation system. Directed content analysis was used to explore the perceptions of family caregivers as they reflected on the transitions home. The theories of continuity of care and complex adaptive systems were used to interpret their experiences. Results/Conclusions: During the transition home from a rehabilitation facility, family caregivers are a constant source of support, providing the stroke survivor with continuity. Emergent themes highlight the importance of the caregiving role, and barriers and facilitators that impact the role, and influence continuity of care. Also, supports and services in the community were limited or did not meet the specific needs of the family caregiver. The acknowledgment of the unique attributes of each case will ensure supports and services are tailored to the family caregiver’s needs. Mitigation of systemic barriers would also decrease complexity experienced at the micro-level in the stroke rehabilitation system, and better support the family caregiver during the transition home from a stroke rehabilitation facility.

Background: Physical activity (PA) is an important component of type 2 diabetes management, yet the amount and type of PA support provided by different types of health care providers (HCPs) is largely unknown. Purpose: This study identified differences in the amount and type of PA supports provided by HCPs, and determined whether HCPs use the Canadian Diabetes Association (CDA) PA guidelines or Canada’s Physical Activity Guide (CPAG) in practice. Methods: Eight of 14 Winnipeg Regional Health Authority primary care clinics specializing in diabetes education agreed to participate in the study. In-person interviews were conducted with health care providers (n=48) and patients with type 2 diabetes (n=26). HCPs were given a total PA support score based on scores in three subcategories behaviour change support (BC), assessment/prescription support (AP) and information/referral/community resources support (IRCR), as reported by HCPs themselves and patients. Results: There was no difference in PA support between the 3 HCP types, but there was a significant difference between HCP report and patient report of PA support. Just over one half of HCPs report using the CDA guidelines unprompted or prompted. Conclusions: HCPs recognize the importance of PA in type 2 diabetes management, but implementing strategies to increase certain types of PA support and facilitate understanding between HCPs and patients would allow for optimal PA counseling in primary care.

THE AUSTRALIAN HEALTH CARE SYSTEM has an overarching objective to improve the well-being of all Australians in an equitable and efficient manner. But like most developed economy health care systems, it has experienced a continual increase in demand for health care services along with increased pressure to improve efficiency, quality, and sustainability. To assist in health sector management, policy formulation, investment decisions and reform, the Australian government developed the National Health Performance Framework (NHPF). The NHPF employs performance indicators across nine dimensions of health care, including Effectiveness, Appropriateness, Efficiency, Responsiveness, Accessibility, Safety, Continuity, Capability, and Sustainability. While the National Health Performance Committee has recognised that performance indicators used within the NHPF are inadequate, this thesis argues that the solution is not a simple matter of collecting additional data and constructing new and ???improved??? indicators. Due to resource constraints within the health care system there is an implicit performance trade-off across dimensions. The NHPF must take into consideration the value individuals place on the health care dimensions to enable a shift of limited resources to those areas that are most valued. The starting point for the NHPF should be to determine what society wants out of a health system. The purpose of this thesis is to determine Australian society???s preferences for performance across the nine NHPF dimensions of health care. This is achieved using a choice modelling experiment, which describes the performance of the current health care system and alternative health care systems the government could work towards, and asks respondents to compare and choose which system they prefer. A mixed multinomial logit model is used to analyse respondent choices in order to incorporate alternative tastes across attributes, and correlation of tastes across alternatives and scenarios. Relative values attached to the nine NHPF dimensions of health care are calculated and preferences for the dimensions are ranked. The thesis concludes by exploring individual preferences derived form the choice modelling experiment in the context of social welfare theory. It also outlines the strengths and weaknesses of the methodology, provides suggestions for further research, and offers a use for social preferences in the development of performance frameworks within the Australian health care system.

This thesis deals with a medical and social view of taking healing hemp (cannabis). It is a theoretical thesis elaborated based on the analysis of the available Czech and foreign information sources and professional publications. The thesis target is to map the issue of taking healing hemp by means of the information from the available foreign and Czech literature. The thesis focuses on the most important issues dealt with by the professional as well as lay public and on the development of the solution of this issue. I was captured by this issue after my internship in Belgium, where I had the opportunity to travel through neighbouring Netherlands and to get to know, from the viewpoint of a foreigner, the opinions and access of the inhabitants to the hemp as healing and relaxing mean. The first chapter deals with using the healing hemp in the historical context. Hemp represents one of the oldest crops and for this reason the history of hemp in the period of antiquity, Middle Ages and modern times is described. The following chapter focuses on the individual substances contained in hemp. In this chapter, the endo-cannabinoid system and three kinds of substances contained in hemp strains are analysed canabinoids (THC), canabidiols (CBD), canabinols (CBN). The chapter presents the profile of one of the most important personalities associated with hemp, professor Raphael Mechoulam, the main icon and discoverer of THC. The chapter three devotes to toxicology and addiction when taking hemp, which occurs quite rarely among users of hemp drugs. In this chapter, influence of hemp on the memory of user is treated, as well as the influence of hemp on the occurrence of lungs diseases discussed constantly in connection with smoking and in the last part of this chapter, the addiction and influence of hemp on users psyche is analysed. The following chapter is devoted to the issue of the drug policy, especially defining the status of healing hemp in the law, research of healing hemp and legalization of hemp in the Czech Republic. This chapter is devoted in detail to the legalization of hemp in the world, especially in the states like California, Israel, Canada and Netherlands where the hemp was legalized for healing purposes many years ago. The present science brings a wide spectrum of clinical research examining the effects of hemp during the treatment of many diseases. For this reason, the chapter dealing with hemp in connection with medicine is present in the thesis. Six areas were chosen from individual medicine branches on which this chapter is focused. The reader learns about the healing effects of hemp in the area of oncological diseases, psychiatric diseases, palliation of pain, dermatological diseases, multiple sclerosis and HIV/AIDS. In the last chapter, the opinions and experiences of the professional public in connection with hemp are described. This part deals with the contribution of the newest knowledge presented at the Prague conference about healing hemp. In this part of thesis, also the international hemp Cannafest Trade Fair is mentioned held in 2015 in Prague. It follows clearly from the thesis that the health and social issues connected with healing hemp is the topic of extensive and long-lasting discussions at present. In the area of the lay public, there is interest in this form of medical treatment which is supported quite a lot. The thesis may be used as information source by medical/paramedical and social employees and organizations supporting the legal use of healing hemp. It could represent the base of a professional article for the journal dealing with this topic as e.g. professional journals "Legalization" or "Health." Last but not least, the thesis should serve as complex of information for the persons who decided to take the hemp or consider this possibility.

Made available in DSpace on 2016-06-02T20:30:59Z (GMT). No. of bitstreams: 1 6781.pdf: 1060045 bytes, checksum: 44dd78f66094315ba519c95c465d4469 (MD5) Previous issue date: 2015-03-26 / Financiadora de Estudos e Projetos / Rheumatic diseases have been defined as those relating to musculoskeletal and connective tissues. Through the analysis of the literature it is observed a significant prevalence among patients with these pathologies, and both depression and anxiety. The present study investigated, in two different studies, the relations between rheumatic diseases and mental disorders. The Study 1 presents a literature reviews organized in the form of article. The manuscript presents the product of a literature review in brazilian and foreign databases, in the last 25 years, examining the results on the prevalence of mental disorders in rheumatic diagnoses patients, particularly anxiety and depression. The review was organized to systematize the principal addressed rheumatologic diseases, the countries where the investigations were implemented, the populations investigated in these studies, and the prevalence observed between depression and anxiety in each case. In Study 2 indicators of depression and anxiety in users of rheumatology ambulatory are described, in a health and teaching unit, with exclusive service to users of the Social Health System. It was evaluated 85 patients, 76 women and 9 men, aged between 41 and 70 years. In the evaluation, the following instruments were used: 1) The questionnaire for survey of general information; 2) Beck Depression Inventory (BDI); 3) Beck Anxiety Inventory (BAI); 4) Inventory of Stress Symptoms of Lipp (ISSL); and; 5) Brazilian Economic Criteria of the ABEP. The results showed that 51.8% of the sample had a education equal or less to complete primary, and 31.8% are retired or removed by social security provision. In addition, 68.2% of them were identified as inserted into economic classes with power consumption equal or less than to Class C1; 37,6% of users had two or more diagnosis of rheumatic diseases. Indicators showed that 43.5% of users were under medical treatment with at least one psychotropic substance, with treatment duration ranging from 2 to 21 years. Users under psychotropic drug prescription had significantly higher scores of depression (Mann-Whitney: z = 6.513, p <0.000), anxiety (Mann- Whitney: z = 6.083, p <0.000) and stress (Mann-Whitney: z = 6.119; p <0.000). The rheumatics diseases most frequently found in the population were Fibromyalgia (n = 33), Osteoarthritis (n = 33) and Rheumatoid arthritis (n = 24). In the general population, there was a prevalence of 43.5% of depression, 57% anxiety and 31.4% of stress. Considering the prevalence of depression in the Fibromyalgia, Osteoarthritis and Rheumatoid Arthritis were observed respectively values of 87.9%, 60.6% and 37.5%. Anxiety showed a prevalence of 72.7% in Fibromyalgia, 36.4% in Osteoarthritis, and 29.2% in Rheumatoid Arthritis. It was discussed the importance of evaluation and multidisciplinary intervention, in particular the psychologist role, for the care of rheumatic diseases. / As doenças reumatológicas têm sido definidas como aquelas relativas ao sistema musculoesquelético e tecidos conectivos. Através da análise da literatura observa-se uma prevalência significativa entre indivíduos acometidos por estes quadros, depressão e ansiedade. O presente trabalho investigou a relação entre doenças reumáticas e transtornos mentais em dois diferentes estudos. O Estudo 1 apresenta uma revisão bibliográfica organizada na forma de artigo. O manuscrito apresenta o produto de uma revisão bibliográfica, em bases de dados brasileiras e estrangeiras, nos últimos 25 anos, examinando os resultados referentes à prevalência entre diagnósticos reumatológicos e transtornos mentais, em particular, ansiedade e depressão. O levantamento foi organizado de forma a sistematizar os principais quadros reumatológicos endereçados, os Países onde as investigações foram implementadas, as populações analisadas nestes estudos, além da prevalência observada entre depressão e ansiedade em cada caso. No Estudo 2 é descrita uma avaliação de indicadores de depressão e ansiedade em usuários de ambulatórios de reumatologia, numa Unidade Saúde-Escola de uma instituição de ensino superior, com atendimento exclusivo a usuários do Sistema Único de Saúde (SUS). Foram avaliados 85 usuários, sendo 76 mulheres e 9 homens, com idade variando entre 41 e 70 anos. Na avaliação foram utilizados os seguintes instrumentos: 1) Questionários para levantamento de informações gerais; 2) Inventário Beck de Depressão (BDI); 3) Inventário Beck de Ansiedade (BAI); 4) Inventário de Sintomas de Stress da Lipp (ISSL); e; 5) Critério Econômico Brasil da ABEP. Os resultados evidenciaram que 51,8% da amostra apresentaram uma escolaridade igual ou inferior ao fundamental completo, sendo que 31,8% encontram-se aposentados ou afastados pela previdência. Além disto, 68,2% deles foram identificados como inseridos em classes econômicas com poder de consumo igual ou menor à Classe C1; 37,6% dos usuários apresentavam dois ou mais diagnósticos de doenças reumatológicas. Indicadores apontaram que 43,5% dos usuários estavam sob tratamento medicamentoso com pelo menos uma substância psicotrópica, com tempo de tratamento que variou de 2 a 21 anos. Usuários sob prescrição medicamentosa psicotrópica apresentaram escores significativamente maiores de depressão (Mann-Whitney: z=6,513; p<0,000), ansiedade (Mann-Whitney: z=6,083; p<0,000) e estresse (Mann-Whitney: z=6,119; p<0,000). As doenças com maior frequência na população foram Fibromialgia (n=33), Artrose (n=33) e Artrite Reumatoide (n=24). Na população geral, observouse uma prevalência de 43,5% de depressão, 57,% de ansiedade e 31,4% de estresse. Considerando especificamente a prevalência de depressão, na Fibromialgia, Artrose e Artrite Reumatoide foram observados, respectivamente, os valores de 87,9%, 60,6% e 37,5%. A ansiedade obteve prevalência de 72,7% na Fibromialgia, 36,4% na Artrose, e 29,2% na Artrite Reumatoide. Discute-se a importância da avaliação e intervenção multiprofissional, em particular do psicólogo, para o cuidado das doenças reumatológicas.

Background: The use of addictive substances during pregnancy is a serious health and social problem. Pregnancy is, in itself, one of the most important and most critical periods in a woman's life, and addictive substances in this case are significantly complicated. Pregnant drug addicts need complex care, paradoxically, however, they often do not have access or use it to a small extent. Objectives: The aim of this work is to map the health and social care provided to pregnant women using addictive substance. In the Czech Republic programs are being implemented for mothers with children or pregnant women using addictive substance. Programs include individual counseling, psychotherapy, relapse prevention, family and partner therapy, parent groups, mothers and social work. The aim of the thesis is to focus on the health and social care provided to this client. Methods: Research is a series of case studies of clients focusing on personal and social history, on their somatic and psychological condition, retrospective view of the course of pregnancy, care of women during pregnancy. The plan of work is therefore the elaboration of detailed studies of specific mothers - users. The intention is to compile the overall picture of the given cases in a broader context, not only from the point of view of the...

Este trabalho tomou como objeto de estudo a relação entre saúde, Estado e ética no âmbito do Sistema Único de Saúde brasileiro. Utilizando os espaços público e privado como categorias de análise, teve como objetivo verificar como a reforma do setor saúde, especificamente a legislação complementar Norma Operacional Básica de 1996 (NOB/96), que tem servido de base à reforma, e a Lei n. 9.637/98, que cria as Organizações Sociais e o Programa Nacional de Publicização, coadunam-se com o princípio ético, presente na Constituição “saúde é direito de todos e dever do Estado”. A análise baseou-se na legislação do SUS. Observou-se que o direito à saúde não está garantido na reforma do setor saúde, pois a concepção de Estado presente no SUS e aquela da reforma são diferentes. A análise mostrou ainda que a atual reforma tende a privatizar a saúde tanto na forma dos Programas da Saúde da Família e do Agente Comunitário da Saúde como através da transformação dos equipamentos de saúde de maior complexidade em organizações públicas não-estatais, submetendo a assistência à saúde às leis do mercado. Esse processo faz parte da reforma liberalizante do Estado brasileiro e acompanha a crescente privatização do espaço público, na contemporaneidade, que permite que o poder político seja ocupado por agências internacionais que impõem suas normas aos Estados nacionais. / This study took as a general object the relationship among health, State and ethics under the scope of the Brazilian Health Care System (BHCS). Utilizing public and private spheres as analytical categories, it had a particular objective of verifying how the health reform - particularly the complementary legislation Basic Operational Norm/96 and the law n. 9.637/98, that creates Social Organizations and the National Publicizing Program -, is in accordance with the ethical principle of the Constitution health is a citizen right and a State duty. Analysis was based on the BHCS legislation. It was observed that the right to health is not guaranteed by the health reform, mainly because its conception of State is different from that of the Constitution. Analysis shows yet that the current reform tends to privatize health care through both the Health Family Program and Community Health Agent Program and through the transformation of high complex health services in non-state health organizations. This process is part of the Brazilian State liberalizing reform and follows closely the growing privatization of public sphere on contemporary societies, that has being allowing international agencies to occupy political power by imposing their norms to the National States.

Este estudo teve como objetivo compreender e desvelar o sistema de referência e contra-referência, no contexto do Sistema Único de Saúde do município de Botucatu/SP/BR, a partir da experiência de enfermeiras que vivenciam essa prática. Para tanto, optei pela pesquisa qualitativa, modalidade do fenômeno situado, vertente metodológica da fenomenologia. Seguindo essa trajetória fenomenológica, cheguei às descrições das treze enfermeiras entrevistadas através da questão: \"Gostaria que você discorresse sobre a sua vivência e percepção em relação ao sistema de referência e contra-referência no Município de Botucatu\". Inicialmente, realizei um breve histórico do Sistema Único de Saúde no Brasil, contextualizando, a seguir, o sistema de referência e contra-referência, para depois explicitar os fundamentos metodológicos utilizados. A construção dos resultados deu-se a partir da análise e compreensão individual dos depoimentos (análise ideográfica) e, também, através da interpretação das convergências evidenciadas entre todos os depoimentos (análise nomotética). Evidenciei nessa análise treze temas, os quais foram reduzidos a três categorias: o funcionamento do sistema de referência e contra-referência, as possibilidades de encaminhamento e fatores estruturais do sistema local. As convergências obtidas permitiram vislumbrar um caminho que indica, enquanto essência deste estudo, que embora o sistema de referência e contra-referência no Município de Botucatu apresente problemas estruturais com precária organização, ocultando dificuldades de integração entre os serviços e, em alguns casos, desproporção demanda/oferta de serviços, existem reais possibilidades de melhoria do mesmo, uma vez que o Município conta com os três níveis de complexidade e, no momento, existe um fator de impulsão, que é o financiamento de propostas através do Programa UNI / This study aimed to understand and to care counter-reference and reference system upon the context of the Health Unique System in Botucatu-SP, Brazil from the nurses who experience this practice. I adopted a qualitative research, situated fenomena model, methodologically derived from phenomenology. Following this phenomenology course, I reached the descriptions from 13 nurses interviewed on the following question: \"I would like you to elucidate your experience and perception regarding counter-reference and reference system in Botucatu\". At first I performed a brief record about the Health Unique System in Brazil contextualizing as it follows counter-reference and reference system to explicit methodological basis afterwards. Results were obtained from analysis and individual comprehension from evidences (ideographic analysis) and also through the interpretation of the attested convergencies among all the evidences (nomothetic analysis). I attested 13 themes in this analysis, and they were reduced into 3 categories: counter-reference and reference system operation, guiding possiblities and local system structural factors. The convergencies allowed to glimpse at a way which indicates that although counter-reference and reference system in Botucatu show structural problems with scarce organization, hiding integrations difficulties among services, and in some cases, disproportion demand / supply, there are real betterment possibilities once the city has three complexity levels, and at the moment there is an impulsion factor, which is the proposals sponsoring through UNI Project