Older adults living with dementia are marginalized in society through the socially constructed binaries of old/young, able/disabled and ultimately us/them. These are manifested in a culture dominated by approaches towards illnesses that favor clinically inclined models of care which entail the search for cures rather than attention to the care required by and for individuals. To heighten their vulnerability, from an individual perspective, the cognitive nature of dementia often prevents people living with it from having a voice in their representation. Person-centered care is a philosophy that recognizes the importance of who the individual is and where they are situated in an effort to create a more holistic care experience. The Lodge at Broadmead is a residential care facility that has operationalized an explicitly person-centered philosophy of care. The main objectives of this project were to gain an understanding of the lived experience and implementation of person-centered dementia care from the many different perspectives contained within this facility as well as the methodological barriers associated with including people living with dementia in this type of research. To this end, one-on-one interviews and focus groups were conducted with a total of 16 staff members and leadership at The Lodge at Broadmead as well as one resident. These were informed by a 4 month period of observation in the form of volunteer work. Three main themes emerged around the implementation of person-centred care at The Lodge at Broadmead: identity maintenance, facilitating relationships, and aligning values. These themes represent the most important theoretical links between the physical and social aspects of the environment, and person-centred care’s ultimate goal of maintenance and enhancement of personhood for the residents. Drawing from my own research experience, there were several methodological challenges in undertaking the research as well which were: the institutional necessity of consent by proxy, a rigid interview approach, and not enough time spent with the residents. / Graduate / 0336 / 0351 / kyle.plumb@gmail.com

Older adults living with dementia are marginalized in society through the socially constructed binaries of old/young, able/disabled and ultimately us/them. These are manifested in a culture dominated by approaches towards illnesses that favor clinically inclined models of care which entail the search for cures rather than attention to the care required by and for individuals. To heighten their vulnerability, from an individual perspective, the cognitive nature of dementia often prevents people living with it from having a voice in their representation. Person-centered care is a philosophy that recognizes the importance of who the individual is and where they are situated in an effort to create a more holistic care experience. The Lodge at Broadmead is a residential care facility that has operationalized an explicitly person-centered philosophy of care. The main objectives of this project were to gain an understanding of the lived experience and implementation of person-centered dementia care from the many different perspectives contained within this facility as well as the methodological barriers associated with including people living with dementia in this type of research. To this end, one-on-one interviews and focus groups were conducted with a total of 16 staff members and leadership at The Lodge at Broadmead as well as one resident. These were informed by a 4 month period of observation in the form of volunteer work. Three main themes emerged around the implementation of person-centred care at The Lodge at Broadmead: identity maintenance, facilitating relationships, and aligning values. These themes represent the most important theoretical links between the physical and social aspects of the environment, and person-centred care’s ultimate goal of maintenance and enhancement of personhood for the residents. Drawing from my own research experience, there were several methodological challenges in undertaking the research as well which were: the institutional necessity of consent by proxy, a rigid interview approach, and not enough time spent with the residents. / Graduate / 0336 / 0351 / kyle.plumb@gmail.com

This dissertation examines the experiences of Latina immigrants in Atlanta, GA in accessing and receiving reproductive healthcare. Although Atlanta is a new destination city for immigrant labor, the state of Georgia has passed anti-immigrant legislation, including a 2011 law that allows local police to check immigrants’ documentation while investigating unrelated violations. This localization of immigration policing heightens immigrants’ risk of detention and deportability. In combination with media discourses of illegality, local immigration policing instills fear in immigrants, which deters them from going out in public in order to perform everyday tasks such as seeing a doctor. Latinas immigrants’ ascribed illegality is not only an issue when trying to access reproductive healthcare, however, but also inflects their interactions with health service providers. Moreover, legal and pragmatic barriers to reproductive healthcare are bound up with ideological notions of Latinas’ reproduction. Drawing from 68 interviews with recent Latina immigrants and immigrant advocates, I detail how experiences of receiving reproductive healthcare foster a “biological citizenship” – which can be defined as the ways in which an individual or group claims inclusion through biological means – that eases Latinas’ outsider status. By enacting biological citizenship through the care of their bodies, which are often viewed and treated as undeserving of care, I contend that undocumented immigrants act politically via one of the few avenues that is open to them, albeit one – the care of the body – that is often overlooked. Additionally, they are creating a bit of security in an overwhelming insecure environment. This research finds that Latina immigrants’ access to reproductive healthcare is impeded not only by anti-immigrant laws and inflammatory discourse, but also by pragmatic issues such as lack of health insurance and language differences. Moreover, legal and pragmatic barriers to reproductive healthcare are bound up with ideological notions of Latinas’ reproduction. For example, Latinas are frequently portrayed as “hyperfertile” in anti-immigrant discourse. Latina immigrants’ reproduction is viewed as threatening to the nation-state and is thus often blatantly or covertly treated to render Latinas as “undeserving” of citizenship and the welfare state. Interestingly, however, in the context of the aging population of the U.S., there are other discourses making their way onto the scene. These discourses reveal that Latina reproduction, though much maligned, was concomitantly viewed as the solution to revitalizing the eroding lower rungs of the U.S. population pyramid. Additionally, political pundits drew on the trope of the hyperfertile Latina immigrant to construct the hopes of an eventual permanent Democratic majority, which would be facilitated by the exponential breeding of Hispanic immigrants. However, this research corroborates 2015 statistics from the Centers of Disease Control that show that Hispanic fertility is steeply declining, thus undermining the demographic and political dreams which relied on tropes of the hyperfertile Latina. This study aims to expand conceptions of citizenship by examining reproductive healthcare as a site where risk is negotiated and borders of membership are both constructed and broken down. The lens of biological citizenship emphasizes the political nature of healthcare access and allows for analyzing Latina immigrants’ everyday experiences with reproductive health as they are shaped by state policies, anti-immigrant legislation, and gendered portrayals of illegality. In doing so, this study complicates healthcare access and draws out both the non-biological determinants and non-biological implications of this access.

No description available.

Primary health care (PHC) is a term used to refer to the parts of the health system that people interact with most of the time when health care is needed. It is considered the first point of contact for health services in Canada. Access to PHC services is an important issue regarding health care delivery in Canada today. There is a need to advance current understanding of access to PHC providers at local scales such as neighbourhoods. The primary objective of this study is to examine the variation in geographic (spatial) accessibility to permanently located primary care services in the Canadian urban environment. Furthermore, the analysis of spatial patterns of accessibility, both visually and statistically using GIS, is to provide a better understanding of among and between neighbourhood variations. This research took place in the 14 urban areas across Canada: Victoria and Vancouver, British Columbia; Calgary and Edmonton, Alberta; Saskatoon, Saskatchewan; Winnipeg, Manitoba; Hamilton, and Toronto, Ontario; Montréal and Québec, Quebec; Halifax, Nova Scotia; St. John’s, Newfoundland; Saint John, New Brunswick; and Ottawa–Gatineau, Ontario and Quebec. A GIS based method, the Three-Step Floating Catchment Area (3SFCA), was applied to determine the spatial accessibility to PHC services (accessibility score). First, for increasing geocoding match rates with reduced positional uncertainty, an integrated geocoding technique was developed after an empirical comparison of the geocoding results based on manually built and online geocoding services and subsequently applied to generate geographic coordinates of PHC practices which are an essential element for measuring potential access to health care. Next, the results of the Three-Step Floating Catchment Area (3SFCA) method was compared with simpler approachs to calculate the City level physician-to-population ratios and this research highlights the benefit of using the 3SFCA method over simpler approaches in urban areas by providing similar or comparable results of City level physician-to-population ratios with the advantage of intra-urban measurements. Further, the results point out that considerable spatial variation in geographical accessibility to PHC services exists within and across Canadian urban areas and indicate the existence of clusters of poorly served neighbourhoods in all urban areas. In order to investigate the low accessibility scores in relation to population health care needs, spatial statistical modeling techniques were applied that revealed variations in geographical accessibility to PHC services by comparing the accessibility scores to different socio-demographic characteristics across Canadian urban settings. In order to analyse how these relationships between accessibility and predictors vary at a local scale within an urban area, a local spatial regression technique (i.e., geographically weighted regression or GWR) was applied in two urban areas. The results of GWR modelling demonstrates intra-urban variations in the relationships between socio-demographic variables and the geographic accessibility to PHC services. In addition, the influences of “unit of analysis” on accessibility score were analyzed using spatial statistical modeling that emphasize the use of units of analysis that are pertinent to policy and planning purposes such as city defined neighbourhoods. Overall, this research shows the importance of measuring geographic accessibility of PHC services at local levels for decision makers, planners, researchers, and policy makers in the field of public health and health geography. This dissertation will advance current understanding of access to primary care in Canadian urban settings from the perspective of the neighbourhood.

Social life, and particularly health care delivery, in a small isolated community is more complex and nuanced than has been reflected in much of the literature on physician retention, which has never extended the notion of the “workload” past the physician’s formal role in the health care setting. Despite having been acknowledged by provincial and national government policies, few of what Anderson and Rosenberg (1990) describe as “unidimensional solutions” have resolved the “multidimensional issues” of physician retention in northern Canada. This thesis employs a qualitative framework to investigate the practice and lifestyle experiences of general practitioners on the Queen Charlotte Islands (Haida Gwaii) to provide a local analysis of physician retention problems experienced by isolated communities. By including both physicians and community members as key informants, the project attempts to determine whether a difference exists between physicians’ perceptions of place and their roles and the voiced expectations of the communities they serve. The research uses a combination of in-depth interviews and questionnaires with physicians (n=6) and community members (n=12) to determine the various roles played by a physician in a small community. It queries whether the community in question expects physician to take up roles outside of the medical space, whether physicians are influenced by these expectations and whether these may contribute to the cessation of practice in remote communities. This thesis examines not only health care-related factors involved in medical practice, but also the informal settings of the community at large, including the general interactions that are incorporated into a physician’s character in a close-knit and isolated place. The findings of the thesis demonstrate that there are significant gaps between what community members and physicians believe is reasonable behaviour and the reality of physicians’ experiences in their respective island communities. The lack of boundaries perceived by physicians in their communities often leads to social isolation, which has the opposite intended effect of respite, instead leading to further disengagement from the local community, finally resulting in a decision to locate elsewhere. / Thesis (Master, Geography) -- Queen's University, 2009-09-26 18:55:16.51

Through a qualitative analysis of the use of intestinal parasites for treating immune system disorders, this research illustrates how contingency emerges in the context of the human relationship to hookworms. The affect of the human–nonhuman relationship is an important part of understanding the direction of evolutionary medicine today, and has implications for the politics of biological health innovations. The shift from the bad parasite to a parasite that at least sometimes heals, discursively and materially, has opened new spaces for patients to change the way they relate to medical knowledge, medical professionals, and pharmaceutical companies. Hookworms are banned by the FDA, which sets the scene for lively, but sometimes rebellious, hybridity between host and parasite. Underground and do-it-yourself hookworm therapy cultures have sprung up in around the site of the gut. I argue that not only is material hookworm affect as important as human discourses in negotiating the rapidly advancing field of biome reconstruction, but it also plays a role in how that biome reconstruction takes place, conventionally or otherwise.

Thesis (Ph. D.)--University of Oklahoma. / Bibliography: leaves 93-110.

Submitted by icict Monica (monica@icict.fiocruz.br) on 2012-10-17T13:20:45Z Editado por Éder Freyre No. of bitstreams: 1 Volume_Final.pdf: 2681639 bytes, checksum: e5bcf9ba15caf1e974a4866485d60266 (MD5) / Made available in DSpace on 2012-10-17T13:20:45Z (GMT). No. of bitstreams: 1 Volume_Final.pdf: 2681639 bytes, checksum: e5bcf9ba15caf1e974a4866485d60266 (MD5) / Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil. / O conjunto de técnicas de Geomática tem sido um poderoso aliado no apoio à tomada de decisões e manipulação de dados espaciais. Nas últimas décadas tornou-se quase indispensável na gestão de recursos humanose recursos naturais. Na área da Saúde, a Geomática tem viabilizado estudos sobre: análise da distribuiçãode pacientes; variações na ocorrência de epidemias; monitoramento de vetores; avaliação em tempo real de situações de emergência ou catastróficas, entre outros. A associação da Medicina com a Geografia é antiga. A associação entre a saúde e a espacialização das doenças deve considerar a estruturação física do espaço geográfico a partir da caracterização de cada parte componente do sistema como preconiza a perspectiva sistêmica na Teoria Geral de Sistema, pois a população é parte integrante do espaço geográfico no qual ocorrem determinados agravos à saúde. Nestes pontos recai a relevância da presente pesquisa. O estudo foi desenvolvido na área da Bacia Hidrográfica de Jacarepaguá no município do Rio de Janeiro. Com aproximadamente 295 km2 é composta por 19 bairros e tem uma população aproximada de 682000 habitantes. O estudo pretendeu estruturar uma metodologia para inserção das técnicas de Geomática na prática de análises de dados de saúde, apoiada na Teoria Geral de Sistemas, visando contribuir no processo de vigilânciaambiental em saúde permitindo realizar um prognóstico de situações de risco de determinada população. A base cartográfica que apoiou o estudo foi construída através de cartas topográficas da DSG na escala 1:50000. Das cartas foram retiradas informações de planimetria relevantes ao estudo e as informações de altimetria que foram utilizadas na elaboraçãodo modelo digital de terreno (MDT). Com o MDT foi gerado o mapa de declividade por grau que permitiu criar divisões em 5 classes para posterior geração de mapas temáticos com osdados de saúde. Os dados de saúde foram retirados do Sistema de Informações de Notificação de Agravos (SINAN) disponibilizado pelo Ministério da Saúde. A doença analisada foi a leptospirose. Os casos foram localizados pontualmente a partir dos endereços de residência. A hipótese aventada neste estudo era a existência de um alto grau de correlação entre as partes componentes representadas pela estruturação física do espaço e a ocorrência de leptospirose. Com os resultados comprovou-se a hipótese nula, pois somente ocorrem doenças em áreas associadas ao Fundo Chato da Baixada de Jacarepaguá e nos Declives Suavesdos Morros Isolados, também localizados no Subsistema Baixada. Isto demonstra que em termos desta doença existe uma ausência de população nesta componente espacial em áreas de maiores declividades. / The collection of Geomatics’techniques has been a powerful allied to support space data decisions and handling. Last decade, it almost became essential to human and natural resources management. For health, Geomatics has made feasible some researches, such as: analyses about patients’ distribution, epidemics occurrence variation, vector tracking, assessment about emergency or catastrophic situations in real time, among others. The association between Medicine and Geography isold. The association between health and spacialization of diseases may consider the physical structure of geographic space from characterization of each system’s component part as the systemic perspective spreads in General System Theory seeing that the population is part of geographic space which occur some health disorders. Therefore, these facts are the importance of this research that was developed in Baixada de Jacarepaguá, Rio de Janeiro. This place has approximately 295 Km2 and it is compounded by 19 neighborhoods which have an estimate of 682000 inhabitants. The research intended to structure a methodology to insert Geomatics’ techniques into practice of health data analyses, supported by General System Theory, aiming to contribute in the process of environmental monitoring in health which allows a prognosis about situations of risks of certain population. The basic mapping that supported this study was built by topographic charts of DSG on the scale 1:50000. From these charts, planimetry details were taken off and also altimetry information that were used in the development of digital terrain model (DTM). With DTM, the slope mapping by percentage was done and it allowed the creation of compartments in five classes for subsequent generation of thematic maps with health data. The data of this study were found in health information systems released by the Ministry of Health. The analyzed disease was leptospirosis. And its cases were located from addresses of residence. The hypothesis raisedhere was the existence of high correlation among component parts represented by physicalstructure of space and the occurrence of leptospirosis. By the results, it was proved the void hypothesis because diseases only happen in areas which are associated with plain area of the coastal bas of Jacarepaguá and the suave hillside of the hillock, both in subsystem coastal bas. It demonstrates that in terms of leptospirosis, an absence of population exists at this space component in areas of major steepness.

No description available.