The purpose with this essay is to explore the social changes in relation to changes in mortality for the two largest ethnic groups in Estonia; ethnic Estonians and the Russian minority. Since this is a geographical essay, my purpose is also to explore these changes in relation to the country’s internal geography. As these changes appear over time in space, the content is partly rooted in a time geographical point of view. It is also rooted in a regional geographical point of view, since I have been comparing the mentioned changes between different areas in Estonia (with considerations on developments abroad). Two different development lines can be seen as a consequence of the social changes taking place in the 1990s. While the ethnic Estonians situation has improved, the Russian minority’s situation has instead declined regarding to social existence and health. As a result the mortality has increased enormously for the Russian minority. The ethnic Estonians had also a mortality increase in practically all studied causes of death in all studied areas, but this increase wasn’t as high as for the Russian minority. Nevertheless, when comparing two different counties with each other as well as with the country as whole, the pattern seems to be more complicated. The Russians living in the western county of Läänemaa, have been affected more favourably by the social change than those living in the north-eastern county of Ida-Virumaa. Except for mortality by alcohol poisoning, the Russians living in Läänemaa had a much lower mortality increase than those living in Ida-Viruma and even compared with the country as whole. It seems as those Russians living in the western parts of Estonia have been affected more favourably than those living in the north-eastern parts. These structures are very much depending on the history, since most of the Russians living in the north-eastern area immigrated during the Soviet era, while the western parts had a much earlier immigration of Russians. Considering the time and place of the Russian immigration, one can divide the Russian minority in two groups; those in the west, and those in the east.

The purpose of the study was to investigate the assumptions that underpin contemporary hospital infection control programs from the perspective of the influence of clinical culture on the integration and ownership of the infection control program. The results of numerous studies have linked low levels of adherence with infection control principles amongst health care providers as the most significant factor contributing to nosocomial infection. Despite early successes in reducing nosocomial infection rates, results derived from current research demonstrate that nosocomial infection has remained a challenge to healthcare providers and patients alike and outbreaks are regularly reported in the infection control literature. Serious economic and social impact has resulted from the increasing levels of antibiotic resistance that have been reported amongst pathogens associated with nosocomial infection. This interpretive study takes an ethnographic approach, using multiple data sources to provide insight into the culture and context of infection control practice drawing upon clinicians' work and the clinician's perspective. There were three approaches to data collection. A postal survey of surgeons was conducted, a group of nurses participated in a quality activity, and a clinical ethnography was conducted in an intensive care unit and an operating theatre complex. Data were analysed in accordance with the qualitative and quantitative approaches to data management. Findings indicate that the clinical culture exerts significant influence over the degree to which the infection control program activities change practice and that rather than imposing the infection control program on the clinical practice setting from outside, sustained practice change is more likely to be achieved if the motivation and impetus for change is culturally based. Moreover surveillance, if it is to influence clinicians and their practice, must provide confidence in its accuracy. It must be meaningful to them and linked to patient care outcomes. Contemporary hospital infection control programs, based on assumptions about a combination of surveillance and control activities have resulted in decreased nosocomial infection rates. However, sustained infection control practice change has not been achieved despite the application of a range of surveillance and control strategies. This research project has utilized an ethnographic approach to provide an emic perspective of infection control practice within a range of practice contexts. The findings from this study are significant within the context of spiraling health costs and increasing antibiotic resistance associated with nosocomial infection.

Dans quelle mesure le concept de genre constitue-t-il une clé de lecture pertinente aux rapports entre dynamiques territoriales et dynamiques sanitaires ? Cette thèse propose de répondre à cette interrogation en analysant la participation au dépistage organisé du cancer colorectal et sa promotion dans les Hauts-de-Seine (92). Les villes de Boulogne-Billancourt et de Gennevilliers, ainsi que deux quartiers populaires de chacune d’elles sont comparés à partir de données quantitatives (taux de participation au dépistage) et qualitatives (observations, entretiens semi-directifs). Il apparaît que les disparités spatiales (inter ou infra-communale) et sexuées de participation au dépistage du cancer colorectal se déclinent différemment selon les territoires étudiés et ne reflètent pas l’inégale répartition spatiale des classes sociales. L’analyse des trajectoires de recours au médecin généraliste, acteur clé du programme, révèle des représentations et pratiques territoriales spécifiques aux contextes gennevillois et boulonnais, mais aussi aux hommes et aux femmes de ces espaces. L’étude de la promotion de ce dépistage permet de mieux comprendre les modes d’organisations et de développement des communes et quartiers ciblés (types et réseaux d’acteurs politiques, professionnels ou associatifs). Elle révèle également la nécessité de prendre en compte le genre dans l’analyse des déclinaisons locales d’une politique nationale de santé publique. Enfin, les représentations et les pratiques des médecins généralistes s’ancrent dans des parcours professionnels, des normes sociales dominantes et des dynamiques territoriales originales. / To which extent does the concept of gender can be a strategic concept to understand links between health and territorial dynamics? The following study aims to investigate this topic by analyzing the attendance at colorectal cancer screening sessions and its promotion in the Hauts-de-Seine (Paris region). We draw a comparison between the towns of Boulogne-Billancourt and Gennevilliers, and two of their popular districts, based on quantitative (attendance rates to screening sessions) and qualitative data (observations, semi-directive interviews). Among the findings, it appears that spatial and gendered disparities regarding colorectal cancer screening vary depending on the places studied and do not reflect the unequal distribution of social classes. The analysis of health-seeking behaviors to a general practitioner – a key actor of this screening program – highlights spatial representations and practices which are specific to the contexts in Boulogne-Billancourt and in Gennevilliers, as well as to women and men. The study of the promotion of colorectal cancer screening also enables us to better understand the ways these towns and districts are developed and organized (type and network of political, professional and associative stakeholders). In addition, the study stresses on the necessity to take gender into account when it comes to the analysis of local implementations of a national public health policy. Lastly, professional backgrounds, dominant social norms and spatial dynamics are an integral part of general practitioner’s representations and practices.

Made available in DSpace on 2014-07-29T14:44:40Z (GMT). No. of bitstreams: 1 Dissertacao Flavia de Oliveira Santos.pdf: 3787377 bytes, checksum: 4f812631959f480f49dda6032848eec6 (MD5) Previous issue date: 2011-04-25 / Today the cities are environments conducive to the development of diseases, especially respiratory diseases, as a function of their growth is common to see suspended particulate materials from industrial, transport, burning of vegetation, burning of refuse, which is aggravated the occurrence of houses without ventilation and excess moisture, especially in outlying areas. As this research scenario, the city of Caldas Novas is located in Goias State, holds the largest source of thermal waters of Brazil, has a fragile physical environment in relation to the occupation process, mainly due to the water table to drop in approximately 60% of urban area varies between 0 and 5 m deep. Sector West of the city, which sits at the foot of the Serra de Caldas, and is the subject of this research study, occupies an area of about 14km ² and a population of about 1634 people. This study aims to understand the social and environmental influence on the incidence of respiratory diseases in Caldas Novas (GO). To carr y out this work we chose to do a study of integrated analysis of landscape elements (Geosystem), it was possible to perform diagnosis of environmental health (respiratory diseases) in Sector West of the city of Caldas Novas (GO). The integrated analysis shows correlation between rainfall, urban development, social conditions and water table drop, aggravation of respiratory diseases in the city. In this sense, these illnesses are the result of dynamic and complex systems favored by the local landscape. But it is believed that although the influence of all these environmental aspects, the water table has suspende a more intense, causing moisture in homes and consequently the onset of mold which aggravates respiratory diseases / Nos dias atuais as cidades são ambientes propícios ao desenvolvimento de doenças, sobretudo as doenças respiratórias, pois em função do seu crescimento é comum observarmos materiais particulados em suspensão oriundos de atividades industriais, transportes, queimadas de vegetação, queimadas de lixos, o que é agravado pela ocorrência de moradias sem ventilação e com excesso de umidade, principalmente nos bairros periféricos. Assim como cenário desta pesquisa, a cidade de Caldas Novas localiza-se no Estado de Goiás, é detentora do maior manancial de águas termais do Brasil, possui um meio físico frágil em relação ao processo de ocupação, devido principalmente ao lençol freático suspenso que em aproximadamente 60% da área urbana varia entre 0 e 5m de profundidade. O Setor Oeste da cidade, que se localiza no sopé da Serra de Caldas, e é objeto de estudo dessa pesquisa, ocupa uma área de aproximadamente 14km² e uma população de aproximadamente 1634 pessoas. Nesse sentido, esse trabalho tem como objetivo compreender a influência socioambiental na incidência de doenças respiratórias em Caldas Novas (GO). Para a realização desse trabalho optou-se por fazer um estudo de análise integrada dos elementos da paisagem (Geossistema), em que foi possível realizar diagnóstico da saúde ambiental (doenças respiratórias) do Setor Oeste da cidade de Caldas Novas (GO). A análise integrada demonstra correlações entre as precipitações, evolução urbana, condições sociais e lençol freático suspenso, no agravamento das doenças respiratórias na cidade. Nesse sentido, essas doenças são resultados de sistemas dinâmicos e complexos favorecidos pela paisagem local. Porém acredita-se que embora tenha a influência de todos esses aspectos socioambientais, o lençol freático suspenso possui uma atuação mais intensa, o que provoca umidade nas residências e consequentemente o aparecimento de mofos que agrava as doenças respiratórias.

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No. of bitstreams: 1 DISSERTACAO LARISSA - FINAL.pdf: 8679628 bytes, checksum: a12ca3c85ef2ff38eed5ce4b8339b8ed (MD5) Previous issue date: 2018-04-20 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The Metropolitan Region of Manaus (Região Metropolitana de Manaus - RMM) is located in the Legal Amazon and includes natural aspects and singular occupation, whose population is fixed in its extensive hydrographic network and dense forest. The natural aspects of the RMM determine ways of access different from the other Metropolitan Regions (Regiões metropolitanas - MR) of Brazil, especially for those who seek health in the state capital. Considering the context of population mobility in search of health at different levels of hierarchy in the study area, the present study aimed to perform a comparative analysis of the conditions of geographical access to health in the municipalities of the RMM. As a methodology, secondary data surveys, fieldwork and the use of geoprocessing techniques were carried out. The results showed that low population density, natural aspects and the organization of healthcare levels, subject the RMM population to travel long distances in search of health care, especially for the specialized care established in the city of Manaus. However, this situation also occurs in Primary Health Care (PHC) establishments, located closer to the population, especially during periods of drought in the Amazonian rivers. The seasonality of the Amazonian rivers influences the "go" and "come" of the metropolitan population of Amazonas, inducing the use of different modalities of transportation and forms of geographical access to health, and consequently, temporality, distances, costs, and direction of the itineraries vary at different times of the year. Geographic access to health becomes more unfavorable due to the low supply of physical and human health resources, especially of doctors and beds. In this sense, the low supply of these resources combined with the seasonality of the Amazonian rivers, produce health regionalizations, which differ from the Regional Health drawings that intersect the RMM. This variation of geographical access to health can induce death cases that could be avoided or reduced by effective actions of accessible and localized health services closer to the population (avoidable death), considering that this death variable represented about 70% of the deaths between the years 2010 to 2015 in the study area, to highlight: deaths due to diseases of the circulatory system, ill-defined cause, external causes, and neoplasias, whose deaths occur in residences and on public roads. Therefore, considering the results achieved in this study, it is concluded that it is necessary to plan health with a focus on Physical and Human Geography specific to the Amazon, in order to serve populations located far from urban centers, aspiring to health as the right of all, regardless of socio-spatial characteristics of disparate territories, such as the Amazon. / A Região Metropolitana de Manaus (RMM) está localizada na Amazônia Legal, e comporta aspectos naturais e de ocupação singular, cuja população estar fixada em sua extensa rede hidrográfica e floresta densa. Os aspectos naturais da RMM determinam maneiras de acesso diferente das demais Regiões Metropolitanas (RM) do Brasil, principalmente para aqueles que buscam saúde na capital do estado. Considerando o contexto da mobilidade da população em busca de saúde em diferentes níveis de hierarquia na área de estudo, o presente trabalho teve o objetivo de realizar uma análise comparativa das condições de acesso geográfico à saúde nos municípios da RMM. Como metodologia, realizou-se levantamentos de dados secundários, trabalhos de campo e a utilização de técnicas de geoprocessamento. Os resultados demonstraram que a baixa densidade demográfica, os aspectos naturais e a organização dos níveis de atenção à saúde, submetem a população da RMM a percorrer extensas distâncias em busca de atendimento à saúde, principalmente para a atenção especializada, estabelecida na cidade de Manaus. No entanto, essa situação também ocorre nos estabelecimentos de Atenção Primária em Saúde (APS), localizados mais “próximos” da população, principalmente em períodos de seca dos rios Amazônicos. A sazonalidade dos rios amazônicos influencia no “ir” e “vir” da população metropolitana do Amazonas, induzindo a utilização de diferentes modais de transportes e formas de acesso geográfico à saúde, e consequentemente, a temporalidade, as distâncias, os custos e a direção dos itinerários variam em diferentes épocas do ano. O acesso geográfico à saúde torna-se mais desfavorável em virtude da baixa oferta dos recursos físicos e humanos de saúde, principalmente de médicos e leitos. Neste sentido, a baixa oferta destes recursos combinada com a sazonalidade dos rios amazônicos, produzem regionalizações de saúde, que se diferem dos desenhos das Regionais de Saúde que entrecortam a RMM. Essa variação de acesso geográfico à saúde podem induzir casos de mortes que poderiam ser evitadas ou reduzidas por ações efetivas dos serviços de saúde acessível e localizados mais próximos da população (morte evitável), tendo em vista que essa variável de morte representou cerca de 70% das mortes entre os anos de 2010 à 2015 na área de estudo, a destacar: mortes por doenças do aparelho circulatório, causa mal definida, causas externas e neoplasias, cuja mortes ocorrem nas residências e em vias públicas. Portanto, considerando os resultados alcançados neste trabalho, conclui-se que é necessário planejar a saúde com foco na Geografia Física e Humana específicas da Amazônia, no intuito de atender as populações localizadas distantes dos centros urbanos, aspirando a saúde como o direito de todos, independentemente das características socioespaciais de territórios díspares, como os Amazônicos.

A constatação de que muitos cemitérios, a maioria públicos, apresentam problemas e impactam o meio ambiente, poluindo o solo e as águas subterrâneas com contaminantes diversos, tem levado ao aumento dos estudos sobre essas potenciais fontes de poluição. No entanto, apesar de existirem metodologias para a constatação de contaminação do solo e das águas subterrâneas, não existem metodologias específicas, ou mesmo consagradas, para os processos de investigação e estabelecimento da área efetivamente contaminada, fazendo com que muitos sejam os critérios adotados para a investigação e diversificadas sejam as conclusões obtidas. Ainda, em relação à espacialização das plumas de contaminantes, raros são os resultados conclusivos, levando inclusive à preocupação sobre o comportamento dos vários contaminantes já conhecidos no solo, seu caminho até as águas subterrâneas e a real extensão dos impactos, em área e em efeitos deletérios à saúde pública. Este estudo visa demonstrar que a expansão da pluma de contaminantes, e sua área de abrangência, é agravada pela influência de fatores ambientais, físico-geográficos, a partir das características pedológicas, geomorfológicas e climáticas, associadas, dos locais onde estão (ou serão) implantados os cemitérios. Através de levantamento bibliográfico e de pesquisas empíricas foram correlacionadas determinadas características de relevo, clima e solo, presentes nos locais dos cemitérios, elaborando-se cenários de espacialização das plumas de contaminantes e sua possível escala de contaminação e de riscos socioambientais. Três áreas modelo foram selecionadas pelas suas características físico-geográficas diferenciadas e por trabalhos anteriores que definiram seus potencias de contaminação e algumas características físicas (geologia, hidrogeologia e outras): O cemitério de Vila Nova Cachoeirinha (PACHECO, 1991 e MATOS, 2001) e o cemitério de Vila Formosa (PACHECO, 1991), no município de São Paulo, e o cemitério de Areia Branca (PACHECO, 1991), no município de Santos. Concluímos que há influência dos fatores ambientais, físico-geográficos, principalmente do solo e da pluviosidade, na espacialização das plumas de contaminação oriundas dos cemitérios. / The finding that many cemeteries, mostly public, present problems and impact the environment, polluting the soil and groundwater with various contaminants, has led to an increase in studies on these potential sources of pollution. However, although there are methods for the realization of soil and groundwater contamination, there are no specific methodologies, or even dedicated to the research process and establishment of effectively contaminated area, causing many criterias to be the adopted for the research and diversifieds reached conclusions. Still, in relation to the spatial distribution of the plumes of contaminants, there are very few conclusive results, leading even to the concern about the behavior of various contaminants known on the ground, their way to the groundwater and the actual extent of impacts in the area and harmful effects to public health. This study aims to demonstrate that the expansion of the contaminant plume, and its coverage area is exacerbated by the influence of environmental, physical and geographical factors, from soil, geomorphological and climatic characteristics associated, on the places where cemeteries are (or will be) deployed. Through literature and empirical research were correlated certain prominent land relief, climate and soil characteristics, present in local cemeteries, creating spatial scenarios of contaminants plumes and their possible contamination scale and environmental risks. Three model areas were selected for their different physical-geographical characteristics and previous works that defined their potential contamination and some physical characteristics (geology, hydrogeology and others): The Vila Nova Cachoeirinha cemetery (PACHECO, 1991 and MATOS, 2001) and Vila Formosa cemetery (PACHECO, 1991), in São Paulo, and the cemetery of Areia Branca (PACHECO, 1991), in the city of Santos. We conclude that there is influence of environmental factors, physical geography, especially soil and rainfall, in the spatial distribution of contamination plumes coming from the cemeteries.

Introduction / présentation du contexte : La création des ARS s’est accompagnée d’un pilotage régionalisé de la gouvernance sanitaire. Si les modalités administratives de découpage des territoires sanitaires sont connues, nous proposons une analyse géographique des logiques de fréquentation effectives des établissements hospitaliers qui semblent échapper à ce cadre réglementaire.Méthodes employées et sources de donnéesA partir du PMSI-MCO, nous avons étudié les flux inter-régionaux hospitaliers pour dix motifs de recours. L’analyse a été complétée par une analyse cartographique associant les mobilités à différents découpages géographiques et historiques, en Bourgogne et pour neuf autres régions test.Principaux résultats : La cartographie des mobilités hospitalières en Bourgogne et pour chaque région test montre que les flux de patients s’insèrent dans des ensembles territoriaux souvent cohérents au regard des limites que nous avons utilisées. Nos résultats indiquent que les frontières administratives régionales ne délimitent pas toujours des territoires homogènes. Pour chaque région test, des frontières invisibles apparaissent, héritées de la sédimentation historique et façonnées par des interfaces géographiques multiples.Discussion/Conclusion : La géographie aide à mieux comprendre l’organisation des flux hospitaliers, qui échappent aux logiques administratives régionales de la planification actuelle. A l’heure de la création de nouvelles grandes régions, l’outil géographique apparaît essentiel pour contribuer à l’instauration d’une gouvernance sanitaire plus pragmatique. / Introduction / presentation of the context : The creation of ARS (Regional Healthcare Agencies) was accompanied by the regionalized organization of healthcare. Even though the administrative procedures for dividing the country into areas for healthcare coverage are well known, we propose a geographic analysis of the reasons why patients attend one hospital rather than another, which seem to escape the logic used by the authorities.Methods employed and sources of data : Using the PMSI-MCO, we studied the flow of patients living in one region to hospitals in other regions according to ten reasons for visiting hospitals. The analysis was completed by a cartographic analysis, which related the flow to different geographical and historical divisions in Burgundy and in nine other test regions.Main results : The cartography of hospital flow in Burgundy and for each test region showed that the choices made by patients were often coherent with regard to the limits that we used. Our results indicate that regional administrative boundaries do not always create homogeneous territories. For each test region, invisible boundaries appear. They stem from historical sedimentation and were shaped by numerous geographic dynamics.Discussion/ConclusionGeography makes it easier to understand hospital flow, which escapes the logic of current regional administrative planning. Now, with the creation of new super-regions, geography appears to be an essential tool to establish more pragmatic healthcare coverage.

The 21st century experienced several health crises, especially in the form of infectious disease outbreaks such as the SARS outbreak in 2003, the H1N1 in 2009, and Ebola outbreaks in 2013. However, none has produced a worldwide socio-economic and health impact compared to the recent pandemic, known as COVID-19. As of October 4, 2022, more than 614 million cases with 6 million deaths have been reported worldwide. The United States is currently in the leading position with more than 98 million cases and 1 million deaths. The pandemic, however, did not impact the entire region similarly, and the infections and intensity varied with geographical and socio-economic characteristics. In this project, I used a multi-method approach to analyze the relationship between health disparities and COVID-19-related health outcomes in the USA and examine the influence of health disparities reporting on newspaper coverage of COVID-19. This assessment was performed in three ways. First, I have explored the relationship between Mississippi’s county-level COVID-19-related cases and deaths with the Center for Disease Control and Preventions’s Social Vulnerability Index (CDC SVI). Second, I have investigated the spatial pattern of COVID-19 in the USA and its associations with Social Determinants of Health (SDoH) by utilizing the County Health Rankings & Roadmaps (CHRR) dataset.Finally, I analyzed how news media reporting of key health determinants (i.e., age, race, income and gender) is framed, including the role of different stakeholders in the context of COVID-19. Findings revealed a statistical relationship between CDC’s Social Vulnerability Index (SVI) and Mississippi’s county-level COVID-19 cases and deaths. I also found that COVID-19 infections showed considerable spatial heterogeneity as the distribution of COVID-19 cases and deaths varies across the US counties and among the three largest waves. The multiple regression results also exhibited a temporal association between social determinants of health (SDH) indicators and COVID-19-related health outcomes across the USA. Finally, I found that the NYT coverage of COVID-19 dealt more with human interest, responsibility, and conflict than economic and morality frames. The findings revealed the vital role social determinants of health play during a health crisis, such as the COVID-19 pandemic.

<p>Increasingly, informal caregivers are providing hospice palliative care and support to dying friends and family members. These individuals must often negotiate multiple roles and responsibilities as a result of being caregivers and members of the paid labour force. Canada’s federal government has recognized the burden placed on informal caregivers, and legislated the Compassionate Care Benefit (CCB) in 2004. The CCB allows informal caregivers providing hospice palliative care six paid weeks off work to alleviate some of the role strain in the provision of care. Evaluations of the CCB have recognized that the low program uptake has been primarily the result of a lack of awareness. As such, knowledge translation campaigns about the CCB are needed. Stakeholders interviewed, including family caregivers, front-line palliative providers, and employers, have suggested that Canadian social workers are the primary group in need of a targeted knowledge campaign. This research presents the results of the development of a two-stage knowledge translation intervention for social workers. First, the development of appropriate interventions are explored through a qualitative messaging survey (<em>n</em>=16), a focus group (<em>n</em>=8) and key informant interviews (<em>n</em>=3). Preferred intervention formats and messages are identified, and draft knowledge tools are created. Secondly, draft knowledge tools are piloted in workplaces by social workers (<em>n</em>=8), the results of which are captured through participant interviews. The refinement period suggested some of the constraints of space and time on knowledge translation about the CCB and tool use. Hägerstrand’s time geography is explored in relation to tool use and knowledge translation. The research presented herein is relevant to policy makers, program planners, clinicians and researchers working with the fields of hospice palliative care, social work and knowledge translation. This research makes contributions to the knowledge translation and intervention development literatures through the presentation of novel methodologies and the application of time geography.</p> / Master of Arts (MA)

American Indians are distinct in their current geographic isolation and history of exclusionary policies enacted against them. Citizenship and territorial policies from the 1700s through the early 1900s have manifested in the distinctive status of many American Indian communities as sovereign nations, a classification that no other ethnic group in the United States can claim. However, as a result of political and geographic isolation, disparities in heath and economic development have been an ongoing problem within these communities. Among the most distinctive health disparities are in infant mortality and obesity-related complications. This project will focus on South Dakota, a state that was late in its application of assimilationist policies, yet today is home to some of the least healthy reservation communities in the United States. An investigation into the making of reservation healthcare delivery systems and patterns of prenatal care utilization will hopefully reveal patterns of health and economic characteristics that predispose infant mortality. / Master of Science