People who use illegal drugs all too often experience stigma and discrimination, criminalization and marginalization in Canada. Substance use has both immediate and chronic health consequences that may require healthcare. However, people who use illegal drugs often experience difficulty accessing equitable care, and stigma has been identified as a key barrier to access. This study explores the provision of health care by nurses in an emergency department for people who use illegal drugs, and the impact of hospital policies and procedures on nurses’ capacity to provide care. The study uses data from in-depth interviews with nurses and policy leaders, and analyses policy documents discussed by nurses in the interviews. This study found that neoliberal policies that result in downsizing of social programs means that patients come to emergency departments with a broad set of health and socials needs that extend beyond what nurses can do. The study also uncovered a lack of cultural safety for Aboriginal patients seeking care. Finally, the study discovered the existence of a culture of stigma in the emergency department. The culture of stigma is transmitted and taken up through individual attitudes, relations of power, intake and treatment protocols, critical policy absences and problematic policy. This study concludes with recommendations for policy development and for future research in this area. / Graduate / 0680 / 0573 / 0569 / heyriver@shaw.ca

Dissertation (Ph.D.)--University of South Florida, 2006. / Title from PDF of title page. Document formatted into pages; contains 303 pages. Includes bibliographical references.

Submitted by Maike Costa (maiksebas@gmail.com) on 2017-03-14T14:56:25Z No. of bitstreams: 1 arquivototal.pdf: 2575793 bytes, checksum: fb59e16c014996b7933557b60e120266 (MD5) / Made available in DSpace on 2017-03-14T14:56:25Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 2575793 bytes, checksum: fb59e16c014996b7933557b60e120266 (MD5) Previous issue date: 2015-12-15 / Introduction: Mobile applicative (apps) development is a relatively new phenomenon that is increasing rapidly due to the popularity and portability of smartphones. The idea to use apps to screening oral conditions is still a novelty. Purpose: The aim of this study was to develop a mobile applicative focusing oral cancer screening. Methods: The app content comprised questions about oral cancer profile and short videos of oral examination. The development of this app was performed by a team formed by technology of information professionals and oral pathologists. The app development process was made following the steps: 1) reality and risk factors study, observing the real conditions of collection of data 2) development phase, with implementation of the needs observed in the field study and 3) field test, when the implementation passed by some refinement or even redraw. The app was developed using Android system (4.4.2 version), with JAVA language and focused sociodemographic data, risk factors for oral cancer, tobacco and alcohol uses, solar exposition and other contributing factors such unprotect oral sex, oral pain and prosthesis use. Afterwards, we obtained data of survey of a high risk population for oral cancer and evaluated the sensitivity/specificity/ accuracy and predictive values of clinical oral diagnosis between two blinded trained examiners, who used movies and data from the app, and in loco oral examination as gold standard. This trainning process with examiners was divided in theorical and practical approaches during 8 hours. Results: On reality and risk factors study, we percept the need of clarification of some questions about use of prosthesis as well to establish better conditions to make movies on external light. We modified the initial version and performed the followed to field test with good comprehension and adequacy. On survey/ concordance analysis, we evaluated 55 high risk individuals for oral cancer. Of them, 31% presented homogeneous/heterogeneous white lesions with possible potential of malignancy. Regarding clinical diagnosis by examiners using videos, when compared with the gold standard, the sensitivity was between 82% and 100% (average 91%), specificity between 81% and 100% (average 90.5%) and accuracy from 87.27% to 95.54% (average 90.90%), and considering found lesions. Evaluating the examiner with better concordance with gold standard for risk lesions, the kappa value between than was 0.597. Conclusion: Mobile app with videos and data collection could be an interesting alternative to oral examination and physical formularies filling on oral cancer surveys. / Introdução: Os aplicativos móveis (apps) de desenvolvimento é um fenômeno relativamente novo que está aumentando rapidamente, devido à popularidade e portabilidade dos smartphones. A ideia de usar aplicativos para triagem de condições bucais ainda é uma novidade. Objetivo: Desenvolver um aplicativo móvel para uso em triagem de câncer bucal. Métodos: O desenvolvimento deste app foi realizado por uma equipe formada por profissionais da tecnologia em informação e patologistas bucais. O processo de desenvolvimento de aplicativo foi feito seguindo as etapas: 1) estudo dos fatores de risco e realidades, observando as condições reais de coleta de dados 2) fase de desenvolvimento, com a implementação das necessidades observadas no estudo de campo e 3) teste de campo, quando a implementação passou por alguns refinamentos ou mesmo redesenho. O app foi desenvolvido usando o sistema operacional Android (versão 4.4.2), com a linguagem JAVA e abrangeu dados sócio demográficos, fatores de risco para o câncer bucal, como histórico de tabagismo, etilismo e exposição solar, além de outros fatores contribuintes, como sexo oral desprotegido, sintomatologia dolorosa em boca e uso de prótese dentária. O mesmo foi utilizado por cirurgiões dentistas da atenção básica. Posteriormente, foram obtidos dados de pesquisa com uma população de alto risco para câncer bucal e avaliou a sensibilidade / especificidade / valores preditivos de diagnóstico bucal clínico entre dois examinadores treinados, que usavam filmes e dados do aplicativo, e em exame bucal in loco como o padrão ouro. Esse treinamento com os examinadores se deu em 8 horas de duração, dividido em teoria e prática. Resultados: No estudo de fatores de risco e realidades, percebeu-se a necessidade de clarificação de algumas questões sobre o uso de prótese, bem como para estabelecer melhores condições de fazer filmes em luz externa. Modificou-se a versão inicial e executou-se a seguir para teste de campo com boa compreensão e adequação. Na análise de pesquisa/ concordâncias foram avaliados 55 indivíduos de alto risco para o câncer bucal. Destes, 31% apresentaram lesões brancas homogêneas/heterogêneos com possível potencial de malignidade. Quanto ao diagnóstico clínico por examinadores usando vídeos, quando comparado com o padrão-ouro, a sensibilidade foi entre 82% e 100% (média 91%), especificidade entre 81% e 100% (média 90,5%), e acurácia entre 87,27% e 95,54% (média 90,90%), considerando as lesões encontradas. Avaliando o examinador que apresentou melhor concordância com o padrão ouro para lesões de risco o os valor de Kappa entre eles foi de 0,597. Conclusão: O app móvel com vídeos e coleta de dados pode ser uma alternativa interessante para o exame bucal e preenchimento de formulários em pesquisas de câncer de boca.

Made available in DSpace on 2015-05-14T13:24:12Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1946686 bytes, checksum: 952ef0dbe79ff59c23b4762772e9a7d6 (MD5) Previous issue date: 2011-11-07 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This article presents a brief review of the history of Aids epidemic, analyzing tendencies, stigma, prejudice, factors of social, economic and cultural vulnerability, gender relations and points out the answers to that disease given by Brazilian social movements and government of Brazil. In the area of sexuality and the safe sexual practice, we identify some difficulties that women experience: the negotiation about the condom use, lack of autonomy and empowerment, gender violence and lack of awareness about the risk of women become infected by HIV. All this strengthened by a sexist culture that has denied women s right to experience their sexuality in a free way, making them increasingly vulnerable to HIV/AIDS. / A história da epidemia da Aids, retrata tendências, estigmas, preconceitos, fatores de vulnerabilidades sócio, econômico e culturais, relações de gênero e políticas públicas direcionadas a responder um dado epidemiológico, principalmente, a ações referentes a feminização da Aids no Brasil e na Paraíba. A dissertação buscou compreender e analisar as representações sociais da epidemia da Aids junto as mulheres soropositivas do estado da Paraíba, na perspectiva de gênero e das vulnerabilidades, compreendendo a dimensão da sexualidade em interface da adoção ou não de práticas preventivas relacionadas com o cuidado da sua saúde sexual e reprodutiva, a luz das políticas públicas de saúde destinada a estas mulheres. Identificar as mulheres, seu perfil, desejos, necessidade e sonhos fizeram parte de nossas análises. O estudo revelou a interface entre a cultura machista, patriarcal e vivência das mulheres na sua descoberta do soropositividade, as relações de gênero e as desigualdades existentes entre o mundo produtivo e reprodutivo das mulheres, apontando os dilemas vividos na sexualidade, nos relacionamentos familiares e com suas redes de apoio. Analisar a partir dos discursos sobre o cotidiano soropositivo das mulheres contribui para analisar como são pensadas, ou não, as políticas públicas para este segmento, dar voz possibilita construir um mundo com menos desigualdades e exclusão, torná-las sujeitos de diretos é possibilitar o exercício da cidadania.

This paper had the objective of tracing a cartography of deinstitutionalization processes at CAPSad (Psychosocial Attention Centre) in Aracaju referring to the period I was part of the management of this service - in 2007. To reach this goal, we used field diary as field register and mnemonic register. This is a cartographic narrative, understood as a narrative which forces a detachment from what is said, to research the conditions for its production. Focused on CAPSad micropolitical sphere, we brought up concrete situations from the service‟s routine articulating it to social and historical conditions and also with the Integral Attention to Alcohol and Other Drugs Users Policy and Psychiatric Reform. This paper is not only a description of a personal management experience, it points to a collective field of management and work processes implicated with specific political policies and also the questioning and to wonder about what is already instituted. The deinstitutionalization paradigm intended by the Psychiatric Reform gather potency when linked to real and concrete problems that appear on daily practices, which solutions are built by the people who experience and legitimate these practices. / Essa dissertação buscou traçar uma cartografia de processos de desinstitucionalização no CAPSad (Centro de Atenção Psicossocial Álcool e Outras Drogas), no município de Aracaju-SE, no período em que estive compondo a gestão local deste serviço - no ano de 2007. Para tanto, utilizamos de registros escritos (diários de campo) e registros mnemônicos. Trata-se de uma narrativa cartográfica, entendida aqui como uma narrativa que força um descolamento do dito para a busca das condições de sua produção. Com foco na esfera micropolítica do CAPSad, trazemos à tona situações concretas do cotidiano do serviço articulando-as com condições sociais, históricas e políticas de formulação, implantação e implementação da Política de Atenção Integral a Usuários de Álcool e Outras Drogas e da Reforma Psiquiátrica. Mais que descrição da experiência de ocupação de um lugar de gestão, esta narrativa aponta para a construção de um espaço coletivo de gestão de processos de trabalho, comprometido com certas diretrizes políticas, mas também com o questionamento e estranhamento ao instituído. O princípio de desinstitucionalização, apregoado pela Reforma Psiquiátrica adquire potência quando articulado aos problemas reais e concretos que emergem do cotidiano das práticas, cujas soluções são construídas pelos próprios sujeitos que os vivenciam e os tornam legítimos

Orientador: June Barreiros Freire / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T23:12:03Z (GMT). No. of bitstreams: 1 Rocha_DanielCarvalho_M.pdf: 4468907 bytes, checksum: 93da059a7ca2b729b236e52eaa795293 (MD5) Previous issue date: 2014 / Resumo: No Brasil, o debate sobre a organização da assistência à saúde ocupou-se até o momento principalmente da discussão em torno da Atenção Básica (ou Atenção Primária em Saúde) e do ambiente hospitalar, em diferentes vertentes. Entre estes dois pólos, a Atenção Ambulatorial Especializada não teve o mesmo tratamento por parte de pesquisadores e formuladores de políticas públicas de saúde. As investigações sobre esse nível assistencial centraram seu foco, até o momento, na questão da oferta e demanda, sem avançar na discussão sobre especificidades que se passam no modo de produção do cuidado nos serviços especializados e sua interação com outros equipamentos. O princípio da integralidade, pressuposto constitucional do Sistema Único de Saúde, e o "nó crítico" que vem representando o acesso à Atenção Especializada no país, exigem um esforço no aprofundamento da compreensão desta área. O presente estudo, situado no âmbito de um Mestrado Profissional em Saúde Coletiva, Política e Gestão em Saúde, propõe-se a contribuir na redução dessa lacuna, realizando uma discussão sobre a gestão do cuidado na Atenção Ambulatorial Especializada a partir de uma revisão de literatura analisada em diálogo com a vivência da coordenação da Atenção Especializada em uma Secretaria Municipal de Saúde registrada através de um Diário de Campo / Abstract: In Brazil, the debate on the organization of health care has minded mainly the discussion on primary care (or Primary Health Care ) and the hospital. Between these two poles, the Specialized Ambulatory Care did not have the same treatment by health researchers and policymakers. The investigations about this level of care your has focused, so far, the issue of supply and demand, without advancing the discussion about specifics that are in healthcare production on specialized services and their interaction with other services. The principle of compreensive health care, a constitutional presumption of brazilian national health system, and the critical factor that has been representing the access to specialized care in the country, require an effort to deepen their understanding of this area. This study, situated within a Professional Master in Public Policy and Management Health Health, proposes to contribute to filling this gap by conducting a discussion of health care management in the Specialized Ambulatory Care with a literature review analyzed in dialogue with the experience of coordination of Specialized Care in a City Health Department recorded through a field diary / Mestrado / Política, Gestão e Planejamento / Mestre em Saúde Coletiva, Política e Gestão em Saúde

Orientador: Márcio Ajudarte Lopes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-21T04:41:03Z (GMT). No. of bitstreams: 1 Sabino-Bezerra_JoseRibamar_M.pdf: 706707 bytes, checksum: b8506aa0a1421e51da4a54f078ea6623 (MD5) Previous issue date: 2012 / Resumo: O câncer bucal é responsável por elevados índices de mortalidade e morbidade na população brasileira. Apesar dos avanços científicos, não houve melhora na sobrevida ao longo de décadas, fato relacionado principalmente ao diagnóstico em estágios avançados. Campanhas de prevenção têm sido realizadas com o intuito de melhorar este cenário. O objetivo deste trabalho foi comparar duas estratégias de prevenção vigentes: a Campanha de Prevenção e Detecção Precoce do Câncer Bucal, preconizada pelo Ministério da Saúde, e o Projeto Busca Ativa de Lesões Bucais, Lesões Malignas e Potencialmente Malignas da Cavidade Bucal FOP-UNICAMP. Os resultados demonstraram que a população examinada na Campanha de Prevenção e Detecção Precoce do Câncer Bucal, foi predominantemente composta por mulheres, que não fumavam ou bebiam, que, desta forma, não se enquadravam no grupo de risco para o câncer de boca. Já a população estudada no Projeto de Busca Ativa de Lesões Bucais, Lesões Malignas e Potencialmente Malignas da Cavidade Bucal da FOP-UNICAMP foi composta principalmente de homens, fumantes e ex-fumantes e etilistas. Com relação ao diagnóstico de lesões malignas observou-se 1,80% (Campanha de Prevenção e Detecção Precoce do Câncer Bucal) vs 4,11% (Projeto Busca Ativa de Lesões Bucais, Lesões Malignas e Potencialmente Malignas da Cavidade Bucal FOP-UNICAMP). Entretanto, as duas estratégias foram capazes de detectar inúmeras outras lesões bucais, contribuindo para melhor promover saúde nestas populações. Sendo assim, conclui-se que para diagnóstico de lesões malignas, o Projeto Busca Ativa de Lesões Bucais, Lesões Malignas e Potencialmente Malignas da Cavidade Bucal FOP-UNICAMP parece ser mais eficiente / Abstract: Oral cancer is responsible for high rates of morbidity and mortality in Brazilian population. Despite scientific advances, there was no improvement in survival over decades, fact mainly related to the diagnosis in advanced stages. Prevention campaigns have been carried out in order to improve this scenario. The objective of this study was to compare two existing prevention strategies: the Campaign for Prevention and Early Detection of Oral Cancer, Department of Health, from Piracicaba and region, and the Project Active Search of Benign, Malignant and Potentially Malignant Lesions of the Oral Cavity FOPUNICAMP. The results showed that the population examined in the Campaign for Prevention and Early Detection of Oral Cancer was mainly composed of women, who did not smoke or drink, consequently not fit at risk-group for oral cancer. On the other hand, the population studied in the Project Active Search of Benign, Malignant and Potentially Malignant Lesions of the Oral Cavity FOP-UNICAMP was mainly composed of males, smokers and former smokers, and active alcoholics. Regarding the diagnosis of malignant lesions it was observed 1.80% (Campaign for Prevention and Early Detection of Oral Cancer) vs 4.11% (Project Active Search of Benign, Malignant and Potentially Malignant Lesions of the Oral Cavity FOP-UNICAMP). However, both strategies were able to detect many other oral lesions contributing for better promote health to these populations. Thus, we concluded that for diagnosis of malignant lesions, the Project Active Search of Benign, Malignant and Potentially Malignant Lesions of the Oral Cavity FOP-UNICAMP seems to be more efficient / Mestrado / Patologia / Mestre em Estomatopatologia

This thesis deals with the health promotion policy of school-age children in the area of nutrition and physical activities, and identifies the most serious problems related to this field of health policy. It also focuses on the main problems associated with the lifestyle of school-age children in the Czech Republic. Proper eating habits and good relationship to physical activities are formed from an early age, so it is necessary in the terms of health promotion to focus mainly on children and their education to a healthy lifestyle. This creates possibilities to achieve an overall improvement in the health status of population. To fulfill the goals of this thesis, secondary data from documents that are related to the observed problem were used together with primary data from qualitative research, which was conducted by expert interviews. School-age children in the Czech Republic do not comply with the dietary guidelines or recommendations for physical activity proccesed by WHO. A related problem is obesity, which is caused by these factors. Health promotion policy responds to these problems by projects and health promotion programmes. Inadequate infrastructure, which does not allow its national exposure, insufficient funding, staffing and lack of skilled workers in this field were identified as the...

Federal support and funding for human embryonic stem cell (hESC) research in the United States lags behind stem cell programs in many countries because of the divisive debate over hESC research and the continually evolving federal policies that have hindered research efforts. The purpose of this phenomenological study was to explore the perceptions of stem cell researchers, stakeholders, and investors in the United States about the effects of the current federal stem cell policy on stem cell research in the United States, the moral disagreement with stem cell research, and their recommendations to improve stem cell research policy in the United States. Rogers's diffusion of innovation theory and Kingdon's agenda-setting theory served as the theoretical frameworks for this study. Data were collected through telephonic semistructured interviews with a snowball sample of 21 participants. Data were analyzed using Attride-Stirling's 6 steps of thematic coding. Findings indicated the need to educate laypersons and legislators, involve the public in the stem cell research policy debate, increase federal funding, and exclude religious considerations from political discussions. The implications for positive social change are directed at stem cell policymakers to focus attention and resources on creating a cohesive federal hESC funding policy to ensure that stem cell research improves in the United States with the goal of developing treatments for conditions that are currently untreatable.

<p>Consistent with the paradigm of evidence informed decision making we assume that research findings are integrated into health services practice and policy. However, there is a gap betweeen research findings and usual practice. Collaborative research, where researchers are encouraged to partner with decision makers to conduct mutually agreed and relevant research, may facilitate prompt utilization of new findings. My study explored decision makers’ experiences of collaborative teams executing federally funded health research. The principles of interpretive description were used to guide sampling, data collection, and analysis. A purposeful sample of 27 decision makers, collaborating on Partnerships for Health System Improvement (PHSI) projects funded by the Canadian Institutes of Health Research, participated in two in-depth interviews. Conventional content analysis was used to identify concepts. The conceptual framework was developed inductively from the descriptive data and provided a structure for interpreting decision maker perspectives. The framework posits an explanation leading to contextual understanding of their experiences. This study describes factors affecting PHSI engagement that include: availability of new funding; positive history with the researcher; prospect of tangible benefits to constituents of decision makers; desire to contribute to research that informs health services programs and policies; capacity building; and knowledge creation. The partnership process is facilitated by fostering connections; identifying required skills and competencies; maintaining a sustainable focus of inquiry; clarifying roles and responsibilities; cultivating a nurturing learning environment. My findings will inform decision makers, researchers, and funding agencies about the experience and legacy of collaborative research partnerships.</p> / Doctor of Philosophy (PhD)