Thesis (M.P.H.)--University of Michigan, 1947.

Thesis (M.S.)--University of Tennessee, Knoxville, 2009. / Title from title page screen (viewed on Mar. 17, 2010). Thesis advisor: Suzanne Allard. Vita. Includes bibliographical references.

Thesis (M.P.H.)--University of Michigan, 1947.

Thesis (M.P.H.)--University of Michigan, 1945.

Thesis (Ph.D.) -- University of Western Sydney, Hawkesbury, 1999. / Bibliography : leaves 322-339.

The relationship of culture and healthcare plays an important role in the success of health care access for everyone. In recent decades, the United States has opened its door to welcome not only refugees and immigrants from Europe, but also from other countries all over the world. Coming to the United States, these ethnic groups must overcome many problems to adjust to the American healthcare system. Meanwhile, American health providers not only misunderstand their refugees and immigrant clients' culture, but also want them to conform to the requirement of purely biomedical treatment. The result is that access to healthcare for immigrant groups in the United States is likely to be difficult because of significant cultural differences between the clients and healthcare provider. This research used in depth-interviews, participant observations, and a case study to explore the interaction between culture and healthcare for Vietnamese refugee and immigrant adults and elderly living in the Greater Springfield, Massachusetts area; the level of their involvement in the American healthcare and in traditional healthcare; the extent of integration of American healthcare and traditional healthcare; the obstacles they face in accessing and using American healthcare; and the importance of health education in successful healthcare access. Theories of acculturation, such as Models of Acculturation (Padilla, 1980) and Health Care System Model (Kleinman, 1978a) were used to process the study data to determine the extent of the influence of culture on the effectiveness of healthcare. Finally, based on data analysis, I explain how Vietnamese refugee and immigrant adults and elderly acculturate to the American healthcare system, and make recommendations for improving healthcare for them, as well as for other ethnic groups throughout America.

Objective: The future of public health in Canada depends on the competence of today’s public health students. The Public Health Agency of Canada (PHAC) core competence categories are designed to guide public health practice and the training of public health students. The objectives of this study were to understand public health graduate students’ perception of the PHAC core competencies and report the usability of a practicum placement software in the facilitation of competence-based learning. Methods: Twelve students in the first year of the graduate program in public health participated in two focus group sessions. Participants were asked to select their top and least desired PHAC competencies and then discuss the reasons for their selection. Factors that may have influenced the category selection and their opinion on improving the competence categories were discussed. The system usability scale (SUS) was administered to the student participants and two staff members to help understand the usability of the practicum placement software in the facilitation of competence-based learning. Results: Partnership, collaboration, and advocacy emerged as the top-desired, with public health sciences being the second top-desired. The assessment and analysis category was the least desired, followed by the Leadership competence category. Prior educational background, future career goals with respect to job prospects were among the key factors that influenced the students’ competence selection. Conflict resolution, outreach, and community engagement were some of the suggestions of categories that could be included in the core competence categories. The system usability score for InPlace platform was 61.8 (95% 56.7- 66.9). Conclusions: Overall, students believe that the PHAC core competencies are comprehensive. They suggested seeing certain terminologies become a prominent part of the competence categories. The use of InPlace platform in the facilitation of competence-based learning may require more time for adequate user experience. / Thesis / Master of Public Health (MPH)

<strong>Background:</strong> Cardiovascular disease (CVD) can have its beginnings in childhood, especially if the child is overweight. Without intervention, increased risk factors in childhood track in adulthood, putting the individual at increased risk for early cardiovascular morbidity and mortality. As a result, childhood health outcomes are an increasingly popular area for health research. However, little progress has been made on the most effective way to enable children to lead healthy lives. <strong>Methods:</strong> This thesis incorporated five studies. Firstly, a systematic review and meta-analysis of 63 papers involving nearly 50,000 school children examined the relationship between body mass index (BMI) categories and CVD risk factors. Secondly, a focus group study with 46 students to discuss their knowledge and attitudes towards health, health behaviours and health education. Thirdly, a focus group study with six mothers to discuss screening weight in childhood, and their perceptions of childhood health and health education. Fourthly, a component analysis to establish the characteristics of nine successful educational interventions on children’s health. Finally, a pilot intervention and feasibility study involving 314 students. <strong>Results:</strong> Overweight and obese BMI categories were associated with substantial increases in CVD risk factors measured and that the association with obesity was greater than that with being overweight. The focus group studies found that the depth of knowledge and the perceived depth of knowledge that participants had about CVD risk factors affected their attitudes and behaviours, although not in the same way. The pilot intervention was deemed feasible. A significant change was brought about in the students’ knowledge of cardiovascular disease and raised their self-efficacy towards ensuring the health of their hearts. <strong>Conclusion:</strong> The effect of obesity on cardiovascular risk factors is greater than that of being overweight. Additionally, studies in this area are hindered by inconsistent measurements and definitions of the BMI categories. Secondly, both parents and children need to be equipped with deep knowledge and understanding to facilitate attitude and behaviour change towards healthy living. Finally, the pilot intervention should be trialled in a randomised, controlled trial.

Historicamente, as diferentes concepções de Saúde Coletiva influenciaram tanto no ensino específico deste campo do saber como na formação geral do médico. Partindo deste pressuposto, o presente trabalho teve como objetivo estudar o ensino da Saúde Coletiva na graduação médica, buscando apreender suas configurações e as conseqüentes implicações nas propostas curriculares de três universidades do Paraná (Brasil): Universidade Estadual de Londrina (UEL), Universidade Federal do Paraná (UFPR) e Universidade Positivo (UnicenP). Constituíram-se também em eixos de investigação, além das concepções de Saúde Coletiva, a relação ensino-aprendizagem, as ênfases assumidas pelo programa e os vínculos com os serviços de saúde. A pesquisa qualitativa foi realizada com base na análise documental dos projetos pedagógicos (os cursos instituídos) considerando como eles são efetivamente vividos, de acordo com a ótica dos agentes envolvidos. Para tanto, foram feitas entrevistas com 11 gestores, 18 professores, e foram constituídos 4 grupos focais de estudantes, considerados atores-chave nos três cursos de Medicina. Os resultados evidenciaram a inserção de 5% a 20% da área de Saúde Coletiva nos currículos, dependendo das estratégias de ensino, mas sempre em abordagens acadêmicas fortemente vinculadas aos serviços de saúde, uma realidade que é fortalecida pelo grau de consolidação do SUS em ambas as cidades (Curitiba e Londrina). Independentemente da natureza da universidade, da configuração organizacional e acadêmica do curso e dos diferentes modos de inserção docente, a Saúde Coletiva se faz presente e se assume com considerável relevância para a formação médica. Ainda que não se constitua um eixo articulador da graduação em dois casos estudados, a área traz à dimensão técnica do saber médico o equilíbrio necessário representado pela consciência dos desafios e o compromisso com a realidade. De modo inverso, em função da complexidade da formação, a presença maciça da Saúde Coletiva ao longo de um curso não garante necessariamente o ideal da profissionalização médica. / Historically, different concepts of Public Health have influenced the specific teaching of this field of knowledge as well as medical education. The objective of this paper is to study the teaching of Public Health in medical schools, focusing on its structure and implications in curriculum design in three universities in Paraná - Brazil: State University of Londrina (UEL), Federal University of Paraná (UFPR) and the Positivo University (UnicenP). The research questions focused on the content of Public Health selected in their respective curricula, the teaching-learning relationships, program emphasis and the partnerships established with public health services. Qualitative research data collection from the perspective of key informants was carried out based on the analysis of pedagogical projects and on how they were effectively experienced. Eleven managers and 18 teachers were interviewed and 4 focus groups with students were developed in the three universities. Outcomes showed the presence of between 5% to 20% of Public Health themes in the course syllabi, depending on the teaching strategies used. However, they always appeared associated with academic issues strongly linked to health services, which were strengthened by the local development of the Comprehensive Health Care System in the two cities, Curitiba and Londrina in which studies were carried out. Public Health is present and very relevant in the curriculum required for doctors qualification regardless of the characteristics of the university studied, the bureaucratic and academic course structures and the different methods for hiring teachers. Besides not being a main articulator axis in two of the medical courses studied, Public Health provides the necessary balance for the technical dimension of medical knowledge, represented by the awareness of the challenges and commitment to the reality. On the contrary, because of the complexity of medical education, the strong presence of Public Health in the other medical course studied not necessarily guarantees the ideal qualification of the medical professional

Esta tese teve por objetivo geral analisar a implicação profissional com os apoiadores de humanização e os articuladores de Educação Permanente em Saúde (EPS) dos municípios do Departamento Regional de Saúde (DRS) de Araraquara/São Paulo. Trata-se de uma pesquisa-intervenção Socioclínica, de abordagem qualitativa, realizada com os apoiadores de humanização e os articuladores de EPS dos 24 municípios que compõem o DRS em questão. Foram realizadas entrevistas individuais com 07 sujeitos que desenvolviam ambas as funções em seus municípios e 12 entrevistas grupais, sendo 11 compostas pelo apoiador e articulador e 01 composta por um grupo de 06 apoiadores do município. Portanto, 35 apoiadores e articuladores participaram da pesquisa-intervenção em questão. Foram também utilizados enquanto dispositivos analíticos para a produção dos dados desta pesquisa-intervenção: dez encontros mensais com os apoiadores e articuladores; sete encontros de planejamento e análise e o diário de pesquisa. As entrevistas e os encontros com os apoiadores e articuladores foram transcritos e as apreensões feitas nos encontros de planejamento e análise foram redigidos no diário de pesquisa. Todo esse material, bem como outras anotações feitas em diário, foi analisado a partir dos princípios da Socioclínica Institucional, sendo que um deles corresponde aos momentos de restituição, possibilitando um aprofundamento coletivo das análises realizadas. Os resultados foram apresentados a partir das dimensões libidinal, ideológica e organizacional que compõem a implicação profissional. Dessa forma, identificamos e analisamos com os apoiadores e articuladores os atravessamentos que a profissão inicial (enfermeiro, dentista, psicólogo, etc.) exerce sobre o fazer apoio; a contradição em se pensar em um perfil pronto para o desenvolvimento dessa função; os sentimentos de desânimo, pessimismo e otimismo enquanto componentes da dimensão ideológica que também atravessam o fazer apoio e a articulação de EPS; o tempo, o modo de fazer a gestão e o poder político enquanto analisadores da dimensão organizacional dos apoiadores e dos articuladores; e a ausência/presença do desejo, a vontade de agradar os profissionais de saúde, desenvolvendo uma relação harmônica no trabalho enquanto pistas analisáveis da dimensão libidinal dos apoiadores e dos articuladores. Na medida que o trabalho de análise com os apoiadores e articuladores prosseguiu, mudanças nos modos de se pensar e fazer apoio às equipes de saúde e também o pensar sobre o trabalho de apoiar e articular a EPS foi se modificando, fazendo com que esses profissionais entrassem, eles mesmos, em processos de EPS, refletindo e interrogando o próprio trabalho. O pesquisador ao realizar a análise de implicação também se colocou em processo de interrogação de sua prática, experienciando também a EPS em ato. Concluímos que a análise de implicação profissional consiste em um potente dispositivo disparador de processos de EPS / This thesis had as general objective to analyze the professional implication with the humanization supporters and the articulators of Permanent Health Education (PHE) of the municipalities of the Regional Department of Health (RDH) of Araraquara/São Paulo. It is a Socioclinic intervention research, with a qualitative approach, carried out with the humanization supporters and the articulators of PHE of the 24 municipalities that compose the mentioned RDH. Individual interviews were carried out with 07 participants who performed both functions in their municipalities and 12 group interviews, of which 11 were composed of the supporter and articulator and 01 were composed of a group of 06 supporters of the municipality. Therefore, 35 supporters and articulators participated in the intervention research in question. They were also used as analytical devices for the production of the data of this intervention research: ten monthly meetings with the supporters and articulators; seven planning and analysis meetings and the research diary. The interviews and meetings with the supporters and articulators were transcribed and the apprehensions made in the planning and analysis meetings were written in the research diary. All this material, as well as other diary entries, were analyzed based on the principles of Socioclinic Institutional, one of which corresponds to the moments of restitution, allowing a collective deepening of the analyzes carried out. The results were presented from the libidinal, ideological and organizational dimensions that make up the professional implication. In this way, we identify and analyze with the supporters and articulators the crossings that the initial profession (nurse, dentist, psychologist, etc.) exercises on making support; the contradiction in thinking of a ready profile for the development of this function; the feelings of discouragement, pessimism and optimism as components of the ideological dimension that also cross the support and articulation of PHE; time, management and political power as analysts of the organizational dimension of supporters and articulators; and the absence/presence of desire, the willingness to please health professionals, developing a harmonious relationship at work as analysable clues to the libidinal dimension of supporters and articulators. As the work of analysis with the supporters and articulators continued, changes in ways of thinking and supporting health teams and also thinking about the work of supporting and articulating the PHE was changing, causing these professionals to enter, themselves, in processes of PHE, reflecting and questioning the work itself. The researcher, when performing the implication analysis, also put himself in the process of interrogating his practice, also experiencing PHE in action. We conclude that the professional implication analysis consists of a powerful device triggering PHE processes