Thesis (Ph.D.)--University of British Columbia, 1999. / Title from PDF t.p. (viewed Sept. 22, 2005). Includes bibliographical references and index. Issued also in microfiche. Issued also in print.

PURPOSE: This study is a quantitative analysis of the relationship between obesity and food availability in the United States. A vast amount of literature has been produced examining various food and socioeconomic variables for their effect on obesity rates; however, this is the first research project to use the USDA’s Food Environment Atlas in a nationwide quantitative study. METHODS: This study uses multivariate statistical analysis to study the effect of 24 variables identified in the 2015 USDA Food Environment Atlas on county-wide obesity rates. The primary regression of concern looks specifically at the effect five food availability variables (grocery stores, specialty food stores, SNAP stores, supercenters, and convenience stores) have on obesity rates. RESULTS: Grocery store and specialty food store density is negatively correlated to percent countywide obesity, while supercenter and SNAP store density is positively correlated to percent obesity. Convenience store density had virtually no effect on percent obesity. Potentially confounding variables such as density of recreational facilities and farmers’ markets were also negatively correlated with obesity. Additionally, density of fast-food and full-service restaurants were negatively correlated with obesity, while perpetual poverty was positively correlated to percent obesity. CONCLUSION: The analyses presented in this study suggest that greater availability of grocery stores and specialty food stores may help to curb rising obesity rates. Policy recommendation and considerations based on the results are discussed and explored for their potential utility in addressing the obesity epidemic confronting the United States.

No description available.

Thesis (M.S.H.P.) / BACKGROUND: Emergency department (ED) visits for psychiatric issues have grown at a disproportionately higher rate than other visits. This has been attributed to factors including severe cuts in mental health (MH) services and identified as a culprit in ED overcrowding. Little is known, however, about how mental health reason-for-visit (MHRFV) interacts with patient and hospital characteristics to affect wait times to see an ED provider. OBJECTIVE: To determine if wait time (WT) to see a provider at the ED differs for those presenting with MHRFV and how various patient and hospital-level characteristics interact to affect it. METHODS: Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for visits to EDs throughout the United States. We examined data for patients ≥ 18 years of age who visited an ED in years 2009 and 2010. Patient weights were used to generate national estimates. Patients’ primary reasons-for-visit were used to identify the MH group for analysis and comparison to all other RFVs. Predictors of WT were chosen based on the Andersen Behavioral and ED overcrowding models. WTs were log-transformed for initial bivariate and final multivariate regression models to assure a more normal distribution. RESULTS: Mean WT was 56.5 and 55.8 minutes for MHRFV and all others respectively with a shared median of 31 minutes. As expected with our large sample (n = 47,831), all variables of interest were significantly associated with WT. Adjusting for patient and hospital level characteristics, a multivariate regression revealed that MHRFV prolonged WT by about 50%. After adjustment for independent variables, interactions with MHRFV were tested as the main outcomes of interest. Blacks with MHRFV had WTs 62% longer, patients age 41-64 31% longer, payer status of Medicare/Medicaid or no coverage had WTs about 24% and 14% longer than private insurance. Conversely, patients at government owned hospitals had WTs 145%, and non-profits 42%, lower than private hospitals. CONCLUSIONS: This is the first time that ED WT has been examined in this depth with a sample of patients presenting with MH issues. The results indicate that disparities are more pronounced in this subgroup of ED patients. / 2031-01-01

(Thesis: M.S.P.H.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / INTRODUCTION: Although serious complications of invasive bedside procedures are rare they can be life threatening. Interest in identifying and preventing complications of bedside procedures has been heightened recently in light of such complications increasingly being linked to hospital reimbursement. In part I of this thesis we present the validation of ICD-9-CM codes for identification of the two most common complications associated with central venous catheterization. In part II we determine the impact of the development of a medical procedure service (MPS) on patient safety surrounding bedside procedures and resident education. METHODS: Part I: Cases of iatrogenic pneumothorax and central line associated blood stream infections (CLABSI) identified by ICD-9-CM codes in discharge data provided by Boston University Medical Center to the University HealthSystem Consortium were compared with those revealed by medical record abstraction of central venous catheters placed between 7/10-12/11. Part II: Retrospective cohort analysis of consecutive adults admitted to the internal medicine service who underwent a bedside medical procedure between 7/10-12/11 comparing characteristics and outcomes of procedures performed by the MPS versus primary services. RESULTS: Part I: The ICD-9-CM code for iatrogenic pneumothorax (512.1) had a sensitivity of 66.7%, specificity of 100%, positive predictive value of 100% and negative predictive value of 99.5%. The ICD-9-CM codes for CLABSI (999.31 and 999.32) had a sensitivity of 41.7%, specificity of 98.0%, positive predictive value of 20.0% and negative predictive value of 99.3%. Part II: We evaluated 1707 bedside procedures (548 by MPS, 1159 by primary services). While the MPS was more likely to successfully complete procedures (95.8% vs. 92.8%, p=0.02) and to use best practice safety process measures (95.4% vs. 51.0%, p<0.0001), the composite rate of major complications was similar (1.6% vs. 1.9%, p=0.71). CONCLUSIONS: Complications associated with invasive beside procedures are rare. The low sensitivity and variable positive predictive value of ICD-9-CM codes for detection of complications of central venous catheterization limits their use for internal quality improvement purposes. While use of a medical procedure service was associated with increased use of evidence based process measures, it did not significant affect the rate of major complications associated with bedside procedures. / 2031-01-01

BACKGROUND: In the U.S., more than two-thirds of college and university students report gambling in the past year. Although most U.S. college students gamble without experiencing clinically significant symptoms, they do experience more problems compared to more mature adult populations. It is estimated that 16.3% of U.S. college students experience clinical or subclinical gambling disorder. Gambling disorder is a serious mental health problem on college campuses with the potential for negative academic, financial, and mental health outcomes. This study is only the second to assess college gambling policies in the U.S. and the first to assess college gambling policies at two time-points. METHODS: To gather gambling policies and supporting web-based materials, I completed extensive searches of websites for 117 U.S. colleges and universities. I assessed each school’s policies and supporting web-based materials using a modified version of Shaffer et al.’s (2005) gambling policy assessment. The policy-coding instrument includes questions about state-level gambling characteristics, school-level characteristics, school gambling policies, and implementation of the Task Force on College Gambling Policy’s 2009 recommendations. RESULTS: A previous assessment of gambling policies among this sample of U.S. colleges and universities found that only 25 had a gambling policy. By the beginning of the 2016-17 academic year, a review of each college and university’s policies revealed that 82 colleges and universities (70.1%) now have a gambling policy, representing a 228% increase. This follow-up assessment further explores college and university gambling policies by reviewing the location and scope of those policies, plus whether certain state or college/university characteristics are associated with having a gambling policy in 2017. CONTRIBUTION: In addition to the study findings, I provide college and university health practitioners with a guide to assess, select, and implement problem gambling policies and programs that are responsive to their campus needs based on SAMHSA’s Strategic Prevention Framework.

Philosophiae Doctor - PhD / This study addresses the issue of the low participation in or enrolment of the poor in Ghana’s National Health Insurance Scheme (NHIS). The low enrolment of the poor in the NHIS is attributed to the difficulty in identifying who qualifies for exemptions from paying health insurance premiums. In an attempt to address this problem, the purpose of this study was, therefore, to develop a model for identifying very poor households for health insurance premium exemptions in the Kassena-Nankana District of Northern Ghana in an effort to increase their access to equitable health care

Entre 2008 et 2011, plus de 22 000 cas de rougeole ont été signalés en France. Comment la résurgence de cette « maladie du passé » peut-elle s’expliquer ? Un vaccin efficace existe pour s’en prémunir, mais il apparaît que de plus en plus de Français se méfient de cette méthode jugée dangereuse, inutile et/ou contre-nature. La résistance et l’hésitation face aux vaccinations ont gagné de nombreux pays occidentaux. La territorialisation de récentes épidémies de rougeole en Europe et en France donne à voir les espaces de sous-vaccination, corrélés à l’implantation de populations réfractaires aux vaccins. Comprendre l’inscription géographique du vaccino-scepticisme implique donc de relier les pratiques vaccinales aux contextes socio-territoriaux dans lesquels elles prennent place. L’analyse multiscalaire proposée dans ce travail permet ainsi d’articuler les modalités locales du refus vaccinal avec une approche plus globale du système de santé. Enfin, l’étude des représentations des différents acteurs (patients-citoyens, professionnels de santé, médias, experts et décideurs politiques) montre que la politique vaccinale est devenue plus qu’un investissement de santé publique, un enjeu de société. / Between 2008 and 2011, more than 22 000 cases of measles were reported in France. How can the resurgence of this “disease from the past” be explained? The existing vaccine is effective, yet it seems that more and more French people are wary of this method of protection which they consider dangerous, useless and/or unnatural.The reluctance and hostility to vaccination have spread across numerous western countries. The study of the territories affected by recent epidemics of measles in France and Europe points out spaces of sub-vaccination, correlated to vaccination-resisting populations. To understand the geographical localisation of this resistance, it is therefore necessary to connect the vaccinal practices with the social and territorial contexts of the skeptical populations. A multi-level analysis allows to articulate the local modes of vaccinal refusal with a more global approach to public health policy. Finally, a close study of the perceptions of the different actors involved (patients-citizens, healthcare professionals, media, experts and political decision makers) shows that vaccinal policy has become more than an investment of public health and is now a real societal challenge.

p. 1-82 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-24T18:05:08Z No. of bitstreams: 1 6666.pdf: 630775 bytes, checksum: 8921d0a14b9bc29b29c13991a2c7ca75 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:00:59Z (GMT) No. of bitstreams: 1 6666.pdf: 630775 bytes, checksum: 8921d0a14b9bc29b29c13991a2c7ca75 (MD5) / Made available in DSpace on 2013-05-04T17:00:59Z (GMT). No. of bitstreams: 1 6666.pdf: 630775 bytes, checksum: 8921d0a14b9bc29b29c13991a2c7ca75 (MD5) Previous issue date: 2010 / A temática da participação e controle social é central à afirmação do Direito à Saúde, defendida pelo movimento da Reforma Sanitária Brasileira e constituída na institucionalização do SUS, principalmente na experimentação dos fóruns instituídos para a formulação e controle da execução das políticas de saúde. Essa experimentação tem motivado um crescimento geométrico na produção de conhecimento na área da participação e controle social em saúde, num debate em que a análise crítica das experiências tem considerável valor. Nesse sentido, objetivamos analisar criticamente a emergência e desenvolvimento do projeto MobilizaSUS na Bahia, no período de 2007 a 2009, enfatizando a identificação das contradições enfrentadas no cotidiano institucional, para subsidiar desenhos avaliativos do projeto e colaborar com o debate na área. O projeto apresenta como novidade a re-discussão da relação dos atores da sociedade política (burocracia estatal) com os da sociedade civil (movimentos sociais), guiando-se por diretrizes que envolvem diálogo, participação, consideração da experiência, construção coletiva, autonomia e reflexão crítica. Suas ações e atividades estão hierarquizadas a partir do desenvolvimento de seminários e da formação de rede, envolvendo atores de lócus regional e de lócus municipal. Sua implementação tem apontado fragilidades e limites relacionados à mobilização de poderes político, administrativo e técnico por parte dos atores envolvidos e também uma potência transformadora relacionada principalmente a características do método que o constitui. Assim, para um desenho avaliativo, sugerimos a construção de um modelo teórico-lógico que parta dos componentes do método do MobilizaSUS articulados a um olhar sobre os possíveis efeitos deste nos atores envolvidos. / Salvador

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2013-05-31T12:07:17Z No. of bitstreams: 1 DISS MARCUS VALERIUS. 2013.pdf: 1432194 bytes, checksum: 35dae1fd9bb1f1d0da750566b0dd637d (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-31T12:19:08Z (GMT) No. of bitstreams: 1 DISS MARCUS VALERIUS. 2013.pdf: 1432194 bytes, checksum: 35dae1fd9bb1f1d0da750566b0dd637d (MD5) / Made available in DSpace on 2013-05-31T12:19:08Z (GMT). No. of bitstreams: 1 DISS MARCUS VALERIUS. 2013.pdf: 1432194 bytes, checksum: 35dae1fd9bb1f1d0da750566b0dd637d (MD5) Previous issue date: 2013 / As diretrizes da atenção à saúde auditiva no Brasil foram definidas apenas no ano de 2004 pela Política Nacional de Atenção à Saúde Auditiva (PNASA). Destaca-se nesta, a necessidade de se estruturar uma rede de serviços regionalizada e hierarquizada que estabelecesse uma linha de cuidados integrais no manejo das principais causas e reabilitação da deficiência auditiva. Diante das limitações no dimensionamento da problemática da atenção à saúde auditiva no país, visto a escassez de informações de alcance nacional e que proponham uma imagem-objetivo da PNASA, esse estudo tem como objetivo propor a Imagem-objetivo da Política Nacional de Atenção à Saúde Auditiva. Tratou-se de um estudo de modelização de uma intervenção que foi desenvolvido em duas etapas. A primeira analisou os documentos oficiais que instituíram a política, que subsidiou a construção de um modelo teórico lógico e uma matriz preliminar com níveis, dimensões, e critérios/padrões da PNASA, apontados como desejáveis para o processo de implementação da PNASA, os quais, na segunda etapa, foram validados por especialistas através da técnica de consenso ―Delphi‖. Para a análise, as respostas foram submetidas a um tratamento estatístico por meio do calculo de tendência central e de dispersão, bem como houve uma análise das sugestões dos especialistas. Foi obtido como resultado o consenso de um modelo lógico e uma matriz com 20 critérios/padrões da PNASA, com 11 dimensões e 3 níveis (gestão, organização e características de governo). O nível da gestão obteve 91%(10) dos seus critérios considerados como muito importantes, seguido dos níveis da organização e características de governo obtiveram 63%(5) considerados da mesma forma. Em relação ao grau de consenso, o nível das características de governo obteve 63%(5) dos seus critérios com alto grau de consenso, seguido do nível da gestão com 55%(6) e do nível da organização com 50%(4). Essa imagem-objetivo proposta poderá ser base para estudos de avaliação de implantação em todo o território nacional, como ferramenta de gestão. / Salvador