Although the importance of physical activity (PA) on the overall wellbeing of children is well-documented, the ever-evolving digitalization of the world continues to promote sedentarism and exacerbate the pandemic of childhood physical inactivity. Physical inactivity can negatively impact a child’s mental and physical health and increases their risk of developing noncommunicable diseases (NCDs), such as obesity and diabetes. Establishing PA as a lifelong habit early in life is imperative to reducing the global burden of NCDs and improving population health. Marginalized populations, particularly newcomers, face unique structural barriers that hinder their access to PA opportunities. This study aims to describe existing PA interventions among newcomer families and children and provide evidence-based recommendations for future initiatives. Using a scoping review methodology, a systematic search of four databases, followed by eligibility screening, identified 21 articles to include in the final review. Data from each of the 21 articles was extracted and organized into two tables: one summarizing the study characteristics, and the other highlighting barriers, facilitators, and gaps. A thematic analysis of the extracted data revealed seven key themes: barriers to engagement, culturally tailored interventions, the role of social support networks, positive health outcomes, sustainability and scalability, acculturation stress and identity, and tailored communication strategies. The evident implications of the results suggest the critical need for more inclusive, longitudinal, and sustainable PA interventions that target newcomer families and children. The findings of this study hope to inform future research and policies that address the structural barriers faced by newcomer populations and reduce existing health disparities related to PA. Overall, the significance of this study lies in its scientific contributions to empower newcomer populations, improve their overall health outcomes, and create healthier, more active generations. / Thesis / Master of Science (MSc)

Yes / Digital health twins (DHTs) have been evolving with their diverse applications in medicine, specifically in older care settings, with the increasing demands of older adults. DHTs have already contributed to improving the quality of dementia and trauma care, cardiac treatment, and health care services for older individuals. Despite its many benefits, the optimum implementation of DHTs has faced several challenges associated with ethical issues, quality of care, management and leadership, and design considerations in older care settings. Since the need for such care is continuously rising and there is evident potential for DHTs to meet those needs, this review aims to map key concepts to address the gaps in the research knowledge to improve DHT implementation. The review aims to compile and synthesize the best available evidence regarding the problems encountered by older adults and care providers associated with the application of DHTs. The synthesis will collate the evidence of the issues associated with quality of care, the ethical implications of DHTs, and the strategies undertaken to overcome those challenges in older care settings. The review will follow the Joanna Briggs Institute (JBI) methodology. The published studies will be searched through CINAHL, MEDLINE, JBI, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. Studies published in English from 2002 will be considered. This review will include studies of older individuals (aged 65 years or older) undergoing care delivery associated with DHTs and their respective care providers. The concept will include the application of the technology, and the context will involve studies based on the older care setting. A broad scope of evidence, including quantitative, qualitative, text and opinion studies, will be considered. A total of 2 independent reviewers will screen the titles and s and then review the full text. Data will be extracted from the included studies using a data extraction tool developed for this study. The results will be presented in a PRISMA-ScR (Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews) flow diagram. A draft charting table will be developed as a data extraction tool. The results will be presented as a "map" of the data in a logical, diagrammatic, or tabular form in a descriptive format. The evidence synthesis is expected to uncover the shreds of evidence required to address the ethical and care quality-related challenges associated with applying DHTs. A synthesis of various strategies used to overcome identified challenges will provide more prospects for adopting them elsewhere and create a resource allocation model for older individuals. DERR1-10.2196/51153. / A publishing grant has been received from Linnaeus University as part of the University Library’s research support.

Bakgrund: Folkhälsan i Sverige blir allt bättre men trots detta ökar skillnaderna i hälsa mellan olika grupper. En individs hälsa i ungdomsåren påverkar hälsan resten av livet och detta är en av anledningarna att folkhälsoinsatser är prioriterade till barn och ungdomar. En individs livskvalitet förändras beroende på olika faktorer runtomkring. För att undersöka ungdomars livskvalitet krävs det att mätinstrumenten som används är validerade till målgruppen. Syfte: Studien syftar dels till att psykometriskt utvärdera och anpassa mätinstrumentet Minneapolis-Manchester Quality of Life Instrument – Adolescent Form (MMQL) till en svensk ungdomspopulation, dels till att beskriva livskvaliteten bland unga och analysera ojämlikheter utifrån klassiska bakgrundsfaktorer. Metod: En kvantitativ ansats med tvärsnittsdesign användes i studien. Datamaterial från Liv och Hälsa Ung 2014 användes och avgränsades till årskurs 9 på grundskolan och årskurs 2 på gymnasiet i Västerås. Resultat: Faktoranalysen resulterade i en modell av mätinstrumentet MMQL bestående av sju faktorer innehållande 33 frågor. Den interna reliabiliteten av instrumentet undersöktes genom Cronbach’s Alpha vilket visade goda resultat. Ungdomarnas hälsorelaterade livskvalitet är generellt sett god och i nivå med vad andra internationella studier visat. Dock finns det betydande skillnader mellan grupper; tjejer har sämre livskvalitet än killar, de äldre ungdomarna sämre än de yngre och de med låg familjeekonomi har sämre livskvalitet än de med hög familjeekonomi. Slutsats: Den anpassade versionen av MMQL visade goda psykometriska egenskaper i en svensk ungdomskontext. Ungdomarnas livskvalitet är god och i nivå med andra internationella studier men fördelningen av livskvalitet är inte jämlik. / Background: Public health in Sweden is getting better, however, there are increasing differences in health between different groups of society. An individual’s health during adolescence continuously affects the health for life and is one reason why public health interventions are prioritized among children and adolescents. An individual’s quality of life change depending on various factors, which contributes to a better or worse quality of life. To examine young people’s quality of life it requires that the instrument that is being used is validated to the targets group. Aim: The study aims to both evaluate the psychometric properties and adapt the Minneapolis-Manchester Quality of Life Instrument – Adolescent Form (MMQL) instrument to a Swedish youth population, as well as to describe the quality of life amongst young people and analyzes inequalities based on classical background factors. Method: A quantitative approach to the cross-sectional design was used in the study. Data and material from Liv och Hälsa Ung 2014 was used but restricted to the 9th grade in elementary school and grade 2 in upper secondary schools in Västerås. Results: The factor analysis resulted in a 7-factor model of the measure instrument MMQL containing 33 questions. The internal reliability of the instrument was assessed by Cronbach’s Alpha, which showed good results. In regards to the distribution of health-related quality of life statistically significant differences were found between genders as well as between age groups. Conclusion: The customized version of MMQL showed good psychometric properties in the context of Swedish youth. Young people’s quality of life in Västerås is good and on par with other international studies, however, the distribution of quality of life is not equal.

Objetivo: Descrever o comportamento da tuberculose (TB) na comunidade boliviana residente em quatro distritos do município de São Paulo (MSP), Belém, Bom Retiro, Brás e Pari, no período de 1998 a 2008, analisar seu possível impacto na tendência dessa doença e investigar possíveis disparidades em relação ao acesso aos serviços e na qualidade do atendimento entre bolivianos e brasileiros. Metodologia: Estudo descritivo de casos notificados de TB entre migrantes bolivianos. Os dados foram obtidos junto à vigilância da TB do MSP. As variáveis de interesse foram: características sócio-demográficas, aspectos diagnósticos, clínicos e terapêuticos, comportamentais, co-morbidades e indicadores de acesso aos serviços e de qualidade do atendimento. A análise foi efetuada comparando a as variáveis de interesse entre pacientes de nacionalidade boliviana e brasileira residentes nos mesmos distritos. Para a comparação de proporções aplicamos o teste do qui-quadrado ou teste exato de Fisher e para médias o teste de Kruskal-Wallis. Resultados: Foram notificados 2434 casos de TB nos distritos estudados, dos quais 67,5 %, 30,4% e 2,1% eram, respectivamente de nacionalidade brasileira, boliviana e outras; a participação boliviana foi crescente no período, elevando-se de 15% para 53% dos casos; observando-se uma queda de 43,5% no número absoluto de casos entre os brasileiros e um incremento de 250% entre bolivianos. A incidência na área de estudo em 2008 era 3,5 vezes maior do que a verificada, em média, no MSP. Comparados aos brasileiros os bolivianos eram mais jovens (média: 26 versus 39 anos; p<=0,0001) e a prevalência de desemprego entre eles era mais baixa (2,4% versus 10,4%; p<0,0001). Para o período de 2006 a 2008, os bolivianos apresentam taxas mais elevada de cura (70,9% versus 62,1%; p<0,001) e de tratamento supervisionado (81,9% versus 62,2%; p<0,001) e menores de história de TB no passado (6,9% versus 16,9%; p<0,0001), abandono de tratamento (16,9% versus 22,4%; p<0,001), de letalidade por TB (1,6% versus 4,8%; p<0,001) e de recidiva (4,9% versus 9,2%; p<0,001). A prevalência de co-morbidades era mais baixa entre bolivianos. Em torno de 88% dos casos de ambas as nacionalidades o diagnóstico e o tratamento foi efetuado em serviços públicos de saúde. Conclusão: A TB mostrou-se um relevante problema entre bolivianos, contribuído para a manutenção de elevada incidência na área de estudo, justificando estratégias específicas de intervenção. Os resultados sugerem que o cumprimento das diretrizes do Sistema Único de Saúde, de acesso universal aos serviços constitui instrumento efetivo de promoção da equidade em saúde. / Objective: Describing the tuberculosis in the bolivian community resident in the districts of Belém, Bom Retiro, Bras and Pari, located in the municipality of São Paulo (MSP), in the period 1998 to 2008, analyze its possible difference in relation to access services and quality of health care among bolivians and brazilians. Methods: Descriptive study of notified cases of TB among bolivian immigrants. The data are obtained from the TB surveillance of the MSP. The variables of interest were socio-demographic characteristics, diagnostic aspects, clinical and therapeutical, behavioral, comorbidities and indicators of access to services and quality of care. The analysis was performed comparing the variables between bolivians and brazilians patients residing in the same districts. For comparison of proportion was applied the chi-square test or Fisher exact test and for means the Kruskal-Wallis test. Results: Were reported 2434 TB cases in districts studied, whom 67,5%, 30,4% e 2,1% were respectively brazilians, bolivians and others nationalities; the bolivian participation increased in the period, rise from 15% to 53% of all cases, observing a drop of 43,5% in the absolute numbers of cases among the brazilians and a increase of 250% among bolivians. The incidence in study area in 2008 was 3,5 times greater than that seen on average in MSP. Compared to brazilians, bolivians were younger (mean: 26 versus 39 years, p=0.0001 and the prevalence of unemployment was lowest (2,4% versus 10,4%, p<0,0001. In 2006 to 2008, bolivians have higher rates of cure (70,9 versus 62,1%, p<0,001) and supervised treatment (81,9% versus 62,2%), and lower rates of TB in past (6,9% versus 16,9%, p<0,0001), neglect (16,9 % versus 22,4%, p<0,001), TB mortality (1,6% versus 4,8%, p<0,001) and relapse (4,9% versus 9,2%, p<0,001). The prevalence of comorbidities was lower among bolivians. Around 88% of cases of both nationalities the diagnosis and treatement was done in public health services. Conclusions: The TB is significant problem among bolivians, contributing to the maintenance of high incidence in the study area, justifying specific strategies of intervention. The results suggest that compliance with the guidelines of Sistema Único de Saude of universal access to services is an effective instrument for promoting equity in health.

Despite increased access to care and interventions aimed to change health behavior, socioeconomic health disparities have remained unchanged, even for preventable illness and disease. Health behavior theories and interventions heavily rely on perceptions of control over one's fate and thus ignore populations with low perceptions of personal control. Poverty is associated with an external locus of control (LOC), while both poverty and external LOC are associated with less health protective behavior. The purpose of this quantitative study was to explore the role of LOC as an adaptive response to poverty and to discover the risks and benefits to physical and psychological health associated with LOC orientation. Using cross-sectional survey methodology, 136 adult participants from the United States were recruited through snowball sampling to anonymously complete measures of the Multidimensional Locus of Control (MLOC), the Health Promoting Lifestyles II (LPII), the Kessler Psychological Distress Scale (KP10), and a demographic questionnaire. Hierarchical regression and bivariate analyses were used to test the hypotheses. According to the study findings, chance LOC mediated the relationship between socioeconomics and health lifestyles, while external-chance was associated with less healthy lifestyle choices than external-powerful others. Internality did not offer any psychological protections from anxiety and depression for low socioeconomic populations. Implications for social change are to further the understanding of the role of perceived control on health beliefs, behavior and psychological well-being for marginalized populations to promote the development of appropriately targeted, culturally sensitive health interventions.

No description available.

Objetivo: Descrever o comportamento da tuberculose (TB) na comunidade boliviana residente em quatro distritos do município de São Paulo (MSP), Belém, Bom Retiro, Brás e Pari, no período de 1998 a 2008, analisar seu possível impacto na tendência dessa doença e investigar possíveis disparidades em relação ao acesso aos serviços e na qualidade do atendimento entre bolivianos e brasileiros. Metodologia: Estudo descritivo de casos notificados de TB entre migrantes bolivianos. Os dados foram obtidos junto à vigilância da TB do MSP. As variáveis de interesse foram: características sócio-demográficas, aspectos diagnósticos, clínicos e terapêuticos, comportamentais, co-morbidades e indicadores de acesso aos serviços e de qualidade do atendimento. A análise foi efetuada comparando a as variáveis de interesse entre pacientes de nacionalidade boliviana e brasileira residentes nos mesmos distritos. Para a comparação de proporções aplicamos o teste do qui-quadrado ou teste exato de Fisher e para médias o teste de Kruskal-Wallis. Resultados: Foram notificados 2434 casos de TB nos distritos estudados, dos quais 67,5 %, 30,4% e 2,1% eram, respectivamente de nacionalidade brasileira, boliviana e outras; a participação boliviana foi crescente no período, elevando-se de 15% para 53% dos casos; observando-se uma queda de 43,5% no número absoluto de casos entre os brasileiros e um incremento de 250% entre bolivianos. A incidência na área de estudo em 2008 era 3,5 vezes maior do que a verificada, em média, no MSP. Comparados aos brasileiros os bolivianos eram mais jovens (média: 26 versus 39 anos; p<=0,0001) e a prevalência de desemprego entre eles era mais baixa (2,4% versus 10,4%; p<0,0001). Para o período de 2006 a 2008, os bolivianos apresentam taxas mais elevada de cura (70,9% versus 62,1%; p<0,001) e de tratamento supervisionado (81,9% versus 62,2%; p<0,001) e menores de história de TB no passado (6,9% versus 16,9%; p<0,0001), abandono de tratamento (16,9% versus 22,4%; p<0,001), de letalidade por TB (1,6% versus 4,8%; p<0,001) e de recidiva (4,9% versus 9,2%; p<0,001). A prevalência de co-morbidades era mais baixa entre bolivianos. Em torno de 88% dos casos de ambas as nacionalidades o diagnóstico e o tratamento foi efetuado em serviços públicos de saúde. Conclusão: A TB mostrou-se um relevante problema entre bolivianos, contribuído para a manutenção de elevada incidência na área de estudo, justificando estratégias específicas de intervenção. Os resultados sugerem que o cumprimento das diretrizes do Sistema Único de Saúde, de acesso universal aos serviços constitui instrumento efetivo de promoção da equidade em saúde. / Objective: Describing the tuberculosis in the bolivian community resident in the districts of Belém, Bom Retiro, Bras and Pari, located in the municipality of São Paulo (MSP), in the period 1998 to 2008, analyze its possible difference in relation to access services and quality of health care among bolivians and brazilians. Methods: Descriptive study of notified cases of TB among bolivian immigrants. The data are obtained from the TB surveillance of the MSP. The variables of interest were socio-demographic characteristics, diagnostic aspects, clinical and therapeutical, behavioral, comorbidities and indicators of access to services and quality of care. The analysis was performed comparing the variables between bolivians and brazilians patients residing in the same districts. For comparison of proportion was applied the chi-square test or Fisher exact test and for means the Kruskal-Wallis test. Results: Were reported 2434 TB cases in districts studied, whom 67,5%, 30,4% e 2,1% were respectively brazilians, bolivians and others nationalities; the bolivian participation increased in the period, rise from 15% to 53% of all cases, observing a drop of 43,5% in the absolute numbers of cases among the brazilians and a increase of 250% among bolivians. The incidence in study area in 2008 was 3,5 times greater than that seen on average in MSP. Compared to brazilians, bolivians were younger (mean: 26 versus 39 years, p=0.0001 and the prevalence of unemployment was lowest (2,4% versus 10,4%, p<0,0001. In 2006 to 2008, bolivians have higher rates of cure (70,9 versus 62,1%, p<0,001) and supervised treatment (81,9% versus 62,2%), and lower rates of TB in past (6,9% versus 16,9%, p<0,0001), neglect (16,9 % versus 22,4%, p<0,001), TB mortality (1,6% versus 4,8%, p<0,001) and relapse (4,9% versus 9,2%, p<0,001). The prevalence of comorbidities was lower among bolivians. Around 88% of cases of both nationalities the diagnosis and treatement was done in public health services. Conclusions: The TB is significant problem among bolivians, contributing to the maintenance of high incidence in the study area, justifying specific strategies of intervention. The results suggest that compliance with the guidelines of Sistema Único de Saude of universal access to services is an effective instrument for promoting equity in health.

State dependency and the lingering impacts of colonialism dancing with Aboriginal peoples are known realities across the Canadian health care landscape. However, delving into the discourses of how to reduce health disparities of a colonized population is a sophisticated issue with many factors to consider. Specifically, nurses can play a central role in the delivery of essential health services to the ‘Other’ within isolated Northern Aboriginal communities. As an extension of the state health care system, nurses have a duty to provide responsive and relevant health care services to Aboriginal peoples. The conducted qualitative research, influenced by a postcolonial epistemology, sought to explore the roles and challenges of nurses working within rural, remote, and Northern Canadian Aboriginal communities, as well as individual, organizational, and system level factors that supported or impeded nurses’ work in helping to meet Aboriginal peoples’ health needs with meaningful care. Theorists include the works of Fanon on colonization and racial construction; Kristeva on semiotics and abjection; and Foucault on power/knowledge, governmentality, and bio-power were used in providing a theoretical framework to help enlighten the research study presented within this dissertation. Critical Discourse Analysis of twenty-five semi-structured interviews with nurses, physicians, and regional health care administrators was deployed to gain a better understanding of the responsibilities and challenges of nurses working in Northern Canada. Specifically, the research study was conducted in one of the three health regions within Northern Saskatchewan. Major findings of this study include: (1) the Aboriginal person did not exist without being in a relation with their colonial agent, the nurse, (2) being ‘Aboriginal’ was constructed as a source of treating illnesses and managing diseases, and (3) as a collective force, nursing was utilized as means of governmentality and as provisions of care situated within colonial laws. Historically, nurses functioned as a weapon to ‘save’ and ‘civilize’ Aboriginal peoples for purposes of the state. Primarily, present day nursing roles focused on health care duties to promote a decency of the state, followed by missionary tasks. In turn, the findings of this research study indicate that nurses must have a better understanding of the impact of colonialism on Aboriginal peoples’ health before they engage with local communities. Knowledge development through postcolonial scholarship in nursing can help nurses and health service providers to strengthen their self-reflective practice, in working towards de-signifying poor discourses around Aboriginal peoples’ health and to help create new discourses.

Despite harm reduction’s social justice roots, the broader understanding of harm reduction is often influenced by morals and values which leaves harm reduction to be conceptualized within a morality policy domain. This study adopts the Qualitative-Narrative Policy Framework (Q-NPF) (Gray & Jones, 2016), to explore the policy beliefs and values that steer current harm reduction policy documents in British Columbia. Four questions guide this study: i) What are the underlying beliefs and values steering harm reduction policy in B.C.? ii) How are these beliefs and values narrated through policy?, iii) In what way do the underlying policy beliefs align with principles of social justice for harm reduction?, and iv) How have policy beliefs shifted since the 2016 public health emergency declaration? The social justice lens for harm reduction (Pauly, 2008) serves as this study’s analytical framework and is supplemented by the Systems Health Equity Lens (Pauly, Shahram, van Roode, Strosher & MacDonald, 2018); both of which emphasize the need for harm reduction to acknowledge and address social and structural conditions that contribute to substance use harms and their inequitable distribution. As this study reveals, there is an ongoing tension between equity-related and non-equity policy beliefs and values characterized within policy documents, thus fueling a policy climate with incongruent and contradictory beliefs. Further, equity-related beliefs are positioned in the confines of equitable access, thus they are not equity-oriented in entirety. Additionally, there have been minimal shifts in policy beliefs since the post-2016 public health emergency declaration yet shifts occur in terms of the specific constructs which form equity-related and non-equity beliefs. Finally, the study outlines potential implications of these beliefs and proposes recommendations to improve harm reduction policy in terms of becoming equity-oriented. This study also outlines methodological contributions to the Q-NPF for future policy narrative and analysis studies. / Graduate / 2022-08-15

The COVID-19 pandemic highlighted the well documented health disparities affecting racial and ethnic minorities, particularly those living in underserved urban settings. Due to historic and contemporary structural racism, these areas are often food deserts, lack adequate access to primary care services, and have higher rates of maternal and infant mortality. The lack of public health infrastructure to respond to emergencies, such as pandemics, can be rapidly met with collective action from communities to take care of their most vulnerable. After providing a basic overview of how structural racism has created the present-day disparities seen in communities such as North Philadelphia, this thesis investigates and makes the case for the capacity of these resilient communities to take care of themselves. To this end, I describe the work of North10 Philadelphia, Fabric Masks for North Philly, and the Maternal Wellness Village—community-based organizations that rapidly pivoted their work to fill the unmet needs of people in North Philadelphia related to food insecurity, personal protective equipment, and childbirth preparation and social support, respectively. I describe the utilization of the services provided by these groups and evaluate the evolution of their work from the onset of the pandemic through present day. Following each case study, I share the stories of the leaders behind each project to give voice to the people fighting for the health and wellbeing of their community. Lastly, I reflect on my positionality as a Black woman and medical student at a large academic institution partnering with these groups and assert the need to maintain partnerships with these and similar organizations to ensure the sustainability of their programming in the long term. / Urban Bioethics