Background. Access to health care in northern and rural communities has been an ongoing challenge. Training undergraduate medical students in regional sites is one strategy to enhance physician recruitment and retention in rural regions. With this goal in mind, in 2004, the Northern Medical Program was created to bring undergraduate medical education to Prince George. The NMP is also hypothesized to have wider impacts on the community. This study aimed to describe perceptions of the broader impacts of the NMP. Methods. In this qualitative study, semi-structured interviews were conducted with community leaders in various sectors of Prince George. The interviewer probed about perceived current and anticipated future impacts of the program, both positive and negative. A descriptive content analysis was performed. A conceptual framework of hypothesized impacts was created based on the literature and a model of neighbourhood social capital by Carpiano (2006). Findings. Comments were overwhelmingly positive. Impacts were described on education, health services, economy, politics, and media. Some reported negative impacts included tension between the NMP and other departments at UNBC, and a strain on health system resource capacity. Participants also reported that the NMP has impacted social capital in the region. Social capital, defined as the resources belonging to a network of individuals, was a pervasive theme. Impacts on social cohesion, various forms of social capital, access to social capital and outcomes of social capital are described. Conclusions. The full impact of the NMP will likely not be felt for at least a decade, as the program is still relatively new to Prince George. Findings suggest that an undergraduate medical education program can have pervasive impacts in an underserved community. Evaluation of the impact of such programs should be broad in scope. Findings also suggest that impacts of the program on other community sectors and on social capital may in fact lead to greater human capital gains than originally anticipated. A comprehensive communication strategy should be developed and maintained to ensure continued stakeholder support for the program. Next steps include identifying key quantifiable indicators of community impact to track changes in the community over time.

Background. Access to health care in northern and rural communities has been an ongoing challenge. Training undergraduate medical students in regional sites is one strategy to enhance physician recruitment and retention in rural regions. With this goal in mind, in 2004, the Northern Medical Program was created to bring undergraduate medical education to Prince George. The NMP is also hypothesized to have wider impacts on the community. This study aimed to describe perceptions of the broader impacts of the NMP. Methods. In this qualitative study, semi-structured interviews were conducted with community leaders in various sectors of Prince George. The interviewer probed about perceived current and anticipated future impacts of the program, both positive and negative. A descriptive content analysis was performed. A conceptual framework of hypothesized impacts was created based on the literature and a model of neighbourhood social capital by Carpiano (2006). Findings. Comments were overwhelmingly positive. Impacts were described on education, health services, economy, politics, and media. Some reported negative impacts included tension between the NMP and other departments at UNBC, and a strain on health system resource capacity. Participants also reported that the NMP has impacted social capital in the region. Social capital, defined as the resources belonging to a network of individuals, was a pervasive theme. Impacts on social cohesion, various forms of social capital, access to social capital and outcomes of social capital are described. Conclusions. The full impact of the NMP will likely not be felt for at least a decade, as the program is still relatively new to Prince George. Findings suggest that an undergraduate medical education program can have pervasive impacts in an underserved community. Evaluation of the impact of such programs should be broad in scope. Findings also suggest that impacts of the program on other community sectors and on social capital may in fact lead to greater human capital gains than originally anticipated. A comprehensive communication strategy should be developed and maintained to ensure continued stakeholder support for the program. Next steps include identifying key quantifiable indicators of community impact to track changes in the community over time.

Background. Access to health care in northern and rural communities has been an ongoing challenge. Training undergraduate medical students in regional sites is one strategy to enhance physician recruitment and retention in rural regions. With this goal in mind, in 2004, the Northern Medical Program was created to bring undergraduate medical education to Prince George. The NMP is also hypothesized to have wider impacts on the community. This study aimed to describe perceptions of the broader impacts of the NMP. Methods. In this qualitative study, semi-structured interviews were conducted with community leaders in various sectors of Prince George. The interviewer probed about perceived current and anticipated future impacts of the program, both positive and negative. A descriptive content analysis was performed. A conceptual framework of hypothesized impacts was created based on the literature and a model of neighbourhood social capital by Carpiano (2006). Findings. Comments were overwhelmingly positive. Impacts were described on education, health services, economy, politics, and media. Some reported negative impacts included tension between the NMP and other departments at UNBC, and a strain on health system resource capacity. Participants also reported that the NMP has impacted social capital in the region. Social capital, defined as the resources belonging to a network of individuals, was a pervasive theme. Impacts on social cohesion, various forms of social capital, access to social capital and outcomes of social capital are described. Conclusions. The full impact of the NMP will likely not be felt for at least a decade, as the program is still relatively new to Prince George. Findings suggest that an undergraduate medical education program can have pervasive impacts in an underserved community. Evaluation of the impact of such programs should be broad in scope. Findings also suggest that impacts of the program on other community sectors and on social capital may in fact lead to greater human capital gains than originally anticipated. A comprehensive communication strategy should be developed and maintained to ensure continued stakeholder support for the program. Next steps include identifying key quantifiable indicators of community impact to track changes in the community over time. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

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Orientador: Carlos Magno Castelo Branco Fortaleza / Resumo: As Infecções Relacionadas à Assistência à Saúde (IRAS) são grave problema de saúde pública em todo o mundo, tendo sua incidência especialmente alta nos países em desenvolvimento. Porém, pouco se sabe sobre a magnitude de seu impacto no Brasil. Faltam dados sobre o impacto de IRAS no pós-alta, incluindo: reinternação, consultas médicas, consumo de medicamentos, autonomia, capacidade laboral e qualidade de vida. Este trabalho objetivou investigar prospectivamente o impacto médico e social das IRAS em pacientes dispensados de um hospital de cuidados terciários no interior do estado de São Paulo, Brasil. Realizou-se um estudo de coorte pareada que incluiu pacientes dispensados do hospital de ensino da Faculdade de Medicina de Botucatu (450 leitos). Sendo 55 indivíduos que tiveram IRAS, juntamente com 110 pacientes não expostos (sem IRAS) como grupo de comparação. Estes, foram seguidos com chamadas telefônicas semanais por 24 semanas. Abordando a necessidade de consultas médicas, o número de medicamentos prescritos, a dependência de cuidadores familiares, as readmissões hospitalares e o tempo necessário para voltar ao trabalho ou às atividades habituais. Os testes estatísticos univariados incluíram testes de Qui-quadrado e Mann-Whitney, quando apropriado. Os modelos de regressão Cox multivariável para readmissão e retorno ao trabalho / atividades usuais foram aplciados. No estudo, as IRAS foram associadas a reinternações mais frequentes e precoces (Hazzard Ratio[HR]=4,84; Interval... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Submitted by Emília Carolina Oliveira De Souza (emi_carol_2@hotmail.com) on 2018-08-21T21:50:57Z No. of bitstreams: 1 DISSERTACAO EMILIA.pdf: 1565247 bytes, checksum: 493e1d829e53b388219f595e7a7e5e7d (MD5) / Approved for entry into archive by Sulamita Selma C Colnago null (sulamita@btu.unesp.br) on 2018-08-22T18:33:05Z (GMT) No. of bitstreams: 1 souza_eco_me_bot.pdf: 1565247 bytes, checksum: 493e1d829e53b388219f595e7a7e5e7d (MD5) / Made available in DSpace on 2018-08-22T18:33:05Z (GMT). No. of bitstreams: 1 souza_eco_me_bot.pdf: 1565247 bytes, checksum: 493e1d829e53b388219f595e7a7e5e7d (MD5) Previous issue date: 2018-08-21 / As Infecções Relacionadas à Assistência à Saúde (IRAS) são grave problema de saúde pública em todo o mundo, tendo sua incidência especialmente alta nos países em desenvolvimento. Porém, pouco se sabe sobre a magnitude de seu impacto no Brasil. Faltam dados sobre o impacto de IRAS no pós-alta, incluindo: reinternação, consultas médicas, consumo de medicamentos, autonomia, capacidade laboral e qualidade de vida. Este trabalho objetivou investigar prospectivamente o impacto médico e social das IRAS em pacientes dispensados de um hospital de cuidados terciários no interior do estado de São Paulo, Brasil. Realizou-se um estudo de coorte pareada que incluiu pacientes dispensados do hospital de ensino da Faculdade de Medicina de Botucatu (450 leitos). Sendo 55 indivíduos que tiveram IRAS, juntamente com 110 pacientes não expostos (sem IRAS) como grupo de comparação. Estes, foram seguidos com chamadas telefônicas semanais por 24 semanas. Abordando a necessidade de consultas médicas, o número de medicamentos prescritos, a dependência de cuidadores familiares, as readmissões hospitalares e o tempo necessário para voltar ao trabalho ou às atividades habituais. Os testes estatísticos univariados incluíram testes de Qui-quadrado e Mann-Whitney, quando apropriado. Os modelos de regressão Cox multivariável para readmissão e retorno ao trabalho / atividades usuais foram aplciados. No estudo, as IRAS foram associadas a reinternações mais frequentes e precoces (Hazzard Ratio[HR]=4,84; Intervalo de Confiança[IC]95%=2,20-10,63; p<0,001). Também se associaram a retorno mais tardio ao trabalho ou atividades usuais (HR=0,30; IC95%=0,19-0,57; p<0,001). Pacientes com IRAS também necessitaram de retornos mais frequentes ao médico e tiveram prescrição de maior número de medicamentos no momento da alta. Por fim, 20% dos sujeitos com IRAS necessitaram que um familiar se afastasse do emprego para atuar como cuidador (contra apenas um no grupo de comparação). Concluímos que as IRAS continuam a exercer impacto sobre morbidade e autonomia mesmo após a alta hospitalar. / Health Care Associated Infections (HAI) are a serious public health problem worldwide, especially in developing countries. However, little is known about the magnitude of its impact in Brazil. There is lack of data on the impact of HAI after discharge, including: readmissions, medical consultations, drug use, autonomy, work capacity, and quality of life. This study aimed to prospectively investigate the medical and social impact of IRAS in patients discharged from a tertiary care hospital in the state of São Paulo, Brazil. A matched cohort study was carried out that included patients from the Hospital of Botucatu Medical School (450 beds). We enrolled 55 subjects with HAI and 110 non-HAI subjects as comparison group. These were followed with weekly phone calls for 24 weeks. The necessity of medical consultations, the number of medications prescribed, the use of medical care, such as hospital readmission and the time needed to return to work or usual activities were analyzed. Univariate analysis included Chi-square and Mann-Whitney tests, when appropriate. Multivariable Cox regression models were used for readmission and return to work /usual activities. In our study, HAI were associated with more frequent and early readmissions (Hazzard Ratio[HR], 4.84; 95% Confidence Interval [CI], 2.20-10.63; P<.001). They were also associated with a later return to work or usual activities (HR, 0.30; 95%CI, 0.19-0.57; P<0.001). Patients with HAI also required more frequent returns to physicians and had a prescription for more medication at discharge. Finally, 20% of the subjects with IRAS needed a family member to move away from the job to act as a caregiver (finding absent in the control group). We conclude that IRAS continue to have an impact on morbidity and autonomy even after hospital discharge.

Emerging river policy has launched small dam removal as a viable option to meet the ecological and social demands for river restoration. As small dam removals gain precedence as a policy tool in river restoration projects there exists a glaring gap in the social considerations, in particular how small dam removals may affect existing community conditions. In order to determine the community impacts that may result, a case study of the Brownsville Dam Removal, in Brownsville Oregon was investigated to address two questions: 1) how has the Brownsville Dam removal affected the social and economic conditions of the community and 2) what indicators can be used to characterize and monitor the impacts. Twenty-nine semi-structured interviews were conducted with four community affiliations: 1) Canal Company members; 2) Calapooia Watershed Council members; 3) City Officials; and 4) community residents. A participatory social impact assessment (SIA) approach was used to validate existing and/or emergent impacts and indicators. The semi-structured interviews assisted in the development of a matrix of impacts and indicators specific to small dam removal. The local impacts and indicators were operationalized and measured. Findings suggest that the social and economic impacts when distributed across the community are minimal in this case of small dam removal. Because local data availability is limited, it was determined that the traditional social impact assessment framework can be vastly improved through the engagement of the community. This research further suggests that when collaboration is extended beyond a unidirectional flow of information (which is often the case in a traditional SIA), issues and concerns are open to deliberation in a non-threatening arena. The Calapooia Watershed Council served as the forum through which the residents of Brownsville were able to enhance their participation in decision making. This also contributed to a learning process that in the end furthered the community's understanding of the dynamic physical changes to the Calapooia River as well as their capacity to solve complex decisions. The case also demonstrated that collective learning is a reflective process of adjustment to the changing circumstances in which the community came to perceive, interpret, and act upon their interest. With a growing number of collaborative partnerships of watershed based management, distinguishable by their decentralized, participatory engagement of stakeholders, it may be likely that these place-based mechanisms will become the nexus to the successful coordination of small dam removal deliberation in the future. / Graduation date: 2010