Thesis (M.H.A.)--University of Michigan, 1972.

Thesis (M.H.A.)--University of Michigan, 1963.

Thesis (M.H.A.)--University of Michigan, 1972.

Thesis (M.H.A.)--University of Michigan, 1963.

Thesis (M.S.)--West Virginia University, 1999. / Title from document title page. Document formatted into pages; contains v, 66 p. : map. Includes abstract. Includes bibliographical references (p. 55-56).

Growth in the elderly population and restraint in the health sector have led to decision makers placing an increasing priority on home care services. In Canada, there are three models of home care: a preventive and maintenance model which is designed to reduce the rate of deterioration for persons with relatively low level care needs; an acute care substitution model where home care substitutes for hospital care; and a long term care substitution model which uses home care as a substitute for facility care. This study focuses on the long term care substitution model. The research question is: In the British Columbia continuing care sector, is home care for the elderly a cost-effective alternative for government funders to care in long term care facilities, by level of care? To answer this question, data were obtained on three cohorts of clients for one year prior to initial assessment and three years post-assessment. The cohorts were new admissions to the British Columbia continuing care system in the 1987/88, 1990/91 and 1993/94 fiscal years. Costs to government for home care services, residential services, pharmaceuticals, fee-for-service physician services and hospital services were analyzed. The central finding of this study was that, on average, the overall health care costs to government for clients in home care are about one half to three quarters of the costs for clients in facility care, by level of care. A related finding was that costs differ by the type of client. The lowest home care costs were for individuals who were stable in their type and level of care. For clients who died the costs for home care were higher, compared to clients in long term care facilities. It was also found that some one half of the overall health care costs for home care clients were attributable to their use of acute care hospital services and that a significant portion of the health costs for home care clients occur at transition points, that is, when there is a change in the client's type, and/or level, of care. These findings are compared to the American literature which indicates that home care is not a cost-effective substitute for residential care. Possible reasons for the differences in findings are discussed. The study concludes with a discussion of the implications of the findings for a series of potential, future, policy agendas regarding: the organization and management of continuing care services; legislation and administrative policy; service delivery; resource allocation; information systems; and research. / Graduate

The ventral tegmental area (VTA) is an important component of the mesolimbic dopamine circuit and processes reward and motivational behaviors. In response to drug exposure, synaptic connections of this circuit can be rewired via synaptic plasticity—a phenomenon thought be responsible for the pathology of addiction. While much is known about dopamine neuron plasticity, less is known regarding plasticity exhibited by VTA GABA cells, specifically inhibitory inputs from outside the VTA. Expanding on the work of Bocklisch et al. (2013), we investigated the plasticity of inhibitory inputs to VTA GABA neurons. Using whole cell electrophysiology in GAD67 GFP mice, we observed that these VTA GABA cells can experience either long-term potentiation (LTP) or long-term depression (LTD) in response to a 5 Hz stimulus. While neither the LTP nor LTD appear to be mediated by the cannabinoid-1 receptor (CB1), the nitric oxide synthase (NOS) pathway, or the dopamine-2 (D2) receptor, the LTP is blocked by APV, an NMDA receptor antagonist, and the LTD is blocked by CGP 54626, an antagonist of the GABAB receptor. Additionally, µ-opioid and adenosine-1 receptors modulated plasticity at this synapse, but chronic morphine administration (10mg/kg) did not block the observed LTP or LTD. Furthermore, we used an optogenetic approach in VGAT-Cre mice to target inhibitory inputs from the lateral hypothalamus (LH) to the VTA. An optical stimulus (5 Hz) caused these inputs to depress, which has not been previously described and may be behaviorally important in reward processing. These novel findings increase our understanding of VTA neural circuitry, ultimately increasing our capacity to better comprehend and treat the pathology of addiction. Additionally, changes in synaptic strength in hippocampal CA1 pyramidal cells are thought to be responsible for the acquisition and retention of short-term memory. Feedforward stratum radiatum interneurons of many subtypes experience LTD, short-term depression (STD), or lack of plasticity, but it is not known whether plasticity correlates with specific interneuron subtypes. Using whole cell electrophysiology and qPCR, we characterized the plasticity expressed by hippocampal interneurons in correlation with their mRNA expression patterns to determine cell subtype. We also assessed the expression of endocannabinoid (eCB) biosynthetic enzymes as well as metabotropic glutamate receptor subunits known to mediate plasticity. Cells exhibiting LTD tended to express mRNA for at least one of the eCB biosynthetic enzymes and the metabotropic glutamate receptor subunit mGluR5. mGluR5 was not expressed by cells exhibiting STD or no plasticity. Cells that exhibited short-term depression tended to express mRNA for at least one of the eCB biosynthetic enzymes, but not mGluR5. This suggests that stratum radiatum interneuron plasticity can be predicted based on mGluR expression, and that these different types of plasticity may have some importance in hippocampal function.

Large numbers of baby boomers and a shift towards home-based long-term care designate a need for a greater understanding of caregiver attitudes surrounding the financing of long-term home-based care. This study examined more fully the types of home-based long-term care services that family caregivers were utilizing for their parents. In addition, the willingness and ability of caregivers to privately fund these services for aging parents were explored. The study utilized a preexisting data set of qualitative interviews that were conducted with 30 family caregivers helping to provide long-term care for an elderly parent or older-generation relative. Participants in the sample used many home- and community-based services such as home health aides and nurses, physical therapists, cleaning services and adult day centers. Often these services were funded via Medicare, Medicaid, care recipient funds, state programs, and caregiver funds. In addition, caregivers were often willing, but unable to pay for long-term parent care on their own. Many caregivers in the study found paying for long-term parent care unnecessary. Family expectations, moral and religious responsibility, and a high aversion to nursing home care were cited as reasons for willingness to fund long-term care at home. Similarly, lack of family support and other personal obstacles were noted as reasons for inability to pay for care. Those who found payment for care unnecessary noted that care recipients had sufficient funds for their own long-term care.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第19275号 / 社医博第66号 / 新制||社医||9(附属図書館) / 32277 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 古川 壽亮, 教授 佐藤 俊哉, 教授 髙橋 良輔 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

No description available.