This qualitative study examines how parents have conceptualised the MMR controversy and offers an assessment of parents’ perceptions of vaccine-preventable diseases and childhood immunisation. Methods-Eighteen focus groups were conducted in central Scotland between November 2002 and March 2003, with a diverse range of parents to ensure maximum variation in terms of age, socio-economic circumstances, likely views about vaccination and family circumstances. Findings-There are some potentially serious misunderstandings and gaps in knowledge about many of the diseases, which generally led to a diminished sense of urgency for vaccination. Parents deciding about MMR vaccination have to balance the perceived risk of disease against the perceived risk of MMR, and the perceived ability of their child’s immune systems to cope with the challenge of vaccines, or to fight the disease. Parents often questioned the safety of combining several antigens into one vaccine, as they were concerned it could be too potent for their child’s immune system and could potentially cause long-term damage. In some circumstances parents preferred to withhold MMR vaccination because it was easier for them to live with the risk of their child naturally contracting one of the diseases than with the risk of causing their child permanent damage as they perceived other parents may have unwittingly done. There is also a need for further research to investigate how parents caring for autistic children have been affected by the debate and to reassure parents based on sound evidence that giving these vaccines in a combined form is safe. Indeed, as the new pentavalent vaccine (DtaP/IPV/Hib) is introduced into the programme, it is crucial that these concerns about immune overload are taken into account to reassure parents in their wider reappraisal of vaccine risk.

Mémoire (M.Adm.)-- Université du Québec à Chicoutimi, 1994. / Résumé disponible sur Internet. Ce mémoire a été réalisé à l'Université du Québec à Chicoutimi dans le cadre du programme de maîtrise en gestion des petites et moyennes organisation de l'UQAC extensionné à l'UQAT. CaQCU CaQCU Document électronique également accessible en format PDF. CaQCU

Thesis (M.S.P.H.)--University of Michigan, 1934.

Thesis (M.S.P.H.)--University of Michigan, 1934.

In Scotland, life expectancy and health outcomes are strongly tied to socioeconomic status. Specifically, socioeconomically deprived areas suffer disproportionately from high levels of premature multimorbidity and mortality. To tackle these inequalities in health, challenges in the most deprived areas must be addressed. One avenue that merits attention is the potential role of general medical practitioners (GPs) in helping to address health inequalities, particularly due to their long-term presence in deprived communities, their role in improving patient and population health, and their potential advocacy role on behalf of their patients. GPs can be seen as what Lipsky calls ‘street-level bureaucrats’ due to their considerable autonomy in the decisions they make surrounding individual patient needs, yet practising under the bureaucratic structure of the NHS. While previous research has examined the applicability of Lipsky’s framework to the role of GPs, there has been very little research exploring how GPs negotiate between the multiple identities in their work, how GPs ‘socially construct’ their patients, how GPs view their potential role as ‘advocate’, and what this means in terms of the contribution of GPs to addressing existing inequalities in health. Using semi-structured interviews, this study explored the experience and views of 24 GPs working in some of Scotland’s most deprived practices to understand how they might combat this growing health divide via the mitigation (and potential prevention) of existing health inequalities. Participants were selected based on several criteria including practice deprivation level and their individual involvement in the Deep End project, which is an informal network comprising the 100 most deprived general practices in Scotland. The research focused on understanding GPs’ perceptions of their work including its broader implications, within their practice, the communities within which they practise, and the health system as a whole. The concept of street-level bureaucracy proved to be useful in understanding GPs’ frontline work and how they negotiate dilemmas. However, this research demonstrated the need to look beyond Lipsky’s framework in order to understand how GPs reconcile their multiple identities, including advocate and manager. As a result, the term ‘street-level professional’ is offered to capture more fully the multiple identities which GPs inhabit and to explain how GPs’ elite status positions them to engage in political and policy advocacy. This study also provides evidence that GPs’ social constructions of patients are linked not only to how GPs conceptualise the causes of health inequalities, but also to how they view their role in tackling them. In line with this, the interviews established that many GPs felt they could make a difference through advocacy efforts at individual, community and policy/political levels. Furthermore, the study draws attention to the importance of practitioner-led groups—such as the Deep End project—in supporting GPs’ efforts and providing a platform for their advocacy. Within this study, a range of GPs’ views have been explored based on the sample. While it is unclear how common these views are amongst GPs in general, the study revealed that there is considerable scope for ‘political GPs’ who choose to exercise discretion in their communities and beyond. Consequently, GPs working in deprived areas should be encouraged to use their professional status and political clout not only to strengthen local communities, but also to advocate for policy change that might potentially affect the degree of disadvantage of their patients, and levels of social and health inequalities more generally.

This thesis explores alcohol use during pregnancy in relation to guidance, attitudes and social norms. The research was conducted in England, where at the time of the study pregnant women were advised to abstain but limit their intake if they chose to drink, and Sweden, where complete abstinence was endorsed. Alcohol use during pregnancy can have harmful effects on the developing foetus, yet there is an unsettled debate as to whether a safe limit exists. In some countries more than half of pregnant women report drinking and while factors such as age, socio-economic status, and pre-pregnancy drinking habits may influence continued drinking, there is a lack of research addressing wider socio-cultural factors, drinking occasions, and partner drinking. A greater understanding of why women drink during pregnancy can inform policy and practice to prevent alcohol-related birth defects. A mixed methods research study was undertaken, comprised of a survey, completed by 347 parents, and interviews with 44 parents and 16 midwives, aimed at exploring cross-cultural differences in prenatal alcohol use from a socio-ecological perspective. Data from the three strands were synthesised and contrasted using triangulation and mapped into meta-themes. The findings showed that English women were significantly more likely to drink during pregnancy than Swedish women. Partner drinking did not appear to influence women’s decisions around alcohol. Moral values underpinned the discourses of whether prenatal alcohol is acceptable; Swedish parents advocated for the rights of the foetus whilst English parents weighed that right against the woman’s right to autonomy. Consistent communication of an abstinence message was evident in Sweden, whereas English parents’ experiences varied, some even reported conflicting advice. In contrast, all midwives advised pregnant women to abstain. The findings suggest that clear communication of an abstinence message may contribute to shared social norms against drinking during pregnancy. However, a lack of clear evidence as to the effects of low level drinking was interpreted differently in the two countries.

Obesity is a complex condition that affects all age groups and socioeconomic strata and places significant burdens on health and social care systems in both developed and developing countries. Overeating and a lack of exercise, along with smoking and high alcohol use, are the most common causes of non-communicable diseases, which account for almost two-thirds of global deaths each year. This programme of PhD research aimed to better understand dietary and other health risk behaviours by considering the influence of evolutionary behavioural strategies, while controlling for other determinants of health risk behaviours, including childhood experience and socioeconomic variables. In the first study, young adults (n=393; aged 18-30 years) completed a bespoke self-report questionnaire and provided data on their developmental experiences and their socioeconomic environments, in addition to a range of behavioural choices and evolutionary strategies (e.g. reproductive behaviour). In the second study, a secondary analysis of the second iteration of the North West Mental Well-being Survey (NWMWBS) 2012/13 was undertaken to supplement findings from study 1. These studies were analysed using regression analysis and Latent Class Analysis. Across both studies, there was a clustering of risk behaviours. Adverse childhood experiences and lower socioeconomic status were found to be predictive of health risk behaviours, including unhealthy eating, binge drinking and smoking cigarettes. Various evolutionary behavioural strategies were found to be predictive of health risk behaviours. Reproductive strategy was found to be predictive of BMI; health offsetting was found to be predictive of risky eating behaviour and physical activity; investing behaviour was found to be predictive of BMI, general health risk taking, binge drinking, current daily smoking, and violence; altruism was found to be predictive of eating preference; trust was found to be predictive of general health risk taking, current daily smoking, and physical activity; cooperation was found to be predictive of current daily smoking; and, planning behaviour was found to be predictive of current daily smoking, and risky sexual practices. Overall, the research suggests that childhood experiences and socioeconomic inequality are key determinants of behavioural strategies, and that such strategies are likely to be adaptive.

No description available.

Até a Ilustração, em decorrência da grande influência da religião no imaginário popular, das enormes limitações do saber médico e da ausência de serviço público de saúde, o êxito do processo de cura dos enfermos era predominantemente concebido antes de tudo como uma graça de Deus, concedida aos que fossem dignos de merecê-la. Por essa razão, a maior parte da população ficava entregue à sua própria sorte quando se via ameaçada pelas doenças. A partir de então, com o impulso dado à ciência, que já vinha sendo estimulada desde a Renascença, a elite médica começou a reformular as bases da medicina. Em meio a isso, foi mostrando a possibilidade de os problemas de saúde serem combatidos, inclusive preventivamente, por meio da combinação entre as técnicas de tal campo de conhecimento e ações governamentais. Assim, ela mobilizou-se para, por um lado, aprimorar os seus recursos contra as enfermidades com novas descobertas, por outro, elaborar propostas destinadas à melhora das condições da saúde pública, uma vez que essa melhora estava sendo cada vez mais compreendida como um pré-requisito do avanço da civilização e como uma necessidade humanitária. No Brasil, a elite médica que aqui atuou no século XIX, em sintonia com a reformulação do seu saber que estava ocorrendo na Europa e com alguns ideais da Ilustração, sobretudo o de progresso, empenhou-se para apresentar meios que pudessem superar a péssima situação sanitária do país. Dessa forma, seguindo a tendência de seus pares europeus, ela buscou promover a institucionalização da medicina, criando instituições de pesquisa e divulgação de conhecimento, para defender seus interesses corporativos e combater as causas que muito comprometiam a saúde dos indivíduos em geral, inclusive dos escravos. Entre elas, dedicou especial atenção àquelas que poderiam ser superadas com a mudança de costumes, tanto em relação ao corpo das cidades, quanto aos corpos dos seus habitantes. Com esse objetivo, os médicos que integravam a elite do seu campo de conhecimento no Brasil defenderam a intervenção governamental na vida social para impor novos hábitos condizentes com os preceitos da higiene à população, bem como a necessidade de a saúde ser transformada em objeto de interesse público, de acordo com o que estava ocorrendo na Europa desde a Ilustração, o que, com efeito, aos poucos foi aproximando o seu saber ao poder do Estado. Desse modo, eles acabaram, por meio dessa aproximação e do seu esforço destinado a promover uma reforma dos costumes prejudiciais à saúde, sendo convertidos na sociedade brasileira em um dos seus principais agentes reformadores a partir do século XIX. / Until the Enlightenment, due to the large influence of religion in peoples lives, the great limitations of medical knowledge and the absence of a decent public health service, the success of the healing processes was mainly conceived as Holy Grace, presented to those who were found worthy of it. Thus people were forced to rely on their own luck when threatened by diseases. From then on, with the throttle in science, which had already been encouraged ever since the Renaissance, the medical elite began to reformulate the basis of medicine. Meanwhile, it began to show a possibility of effective treatment for health problems, including preventive medicine through by combining its techniques along with governmental action. Hence it was mobilized so that on one hand it could develop its resources against diseases with new discoveries while on the other hand elaborating propositions to improve public health conditions, since it became clear that this was a requirement for the advancements in society and a human necessity. In Brazil, the medical elite had its major influence during the XIX century, in synchrony with the reformulating of its knowledge, the same went on in Europe enforced by Enlightenment ideals, particularly that of progress, working its way to change the decadent sanitary system of the country. Hence, following a European tendency, it struggled to promote the institutionalizing of medicine, creating research institutions and means to spread knowledge, to defend its corporative interests and fight the cause of health problems among the general public, including the slaves. Among which special focus was dedicated to those that could be overcome by the change of habits, in terms of city prospects, as well as its inhabitants. With this in mind, physicians who were part of the elite in their field of work in Brazil defended government intervention within social aspects to impose habits condescend with the hygienic precepts of the population, as well as the need of making health an object of public interest, accordingly to what had been happening in Europe since the Enlightenment, which, as a result, little by little approximated its knowledge to State power. Thus it was accomplished through this approximation and struggle destined to promote change in the habits which were prejudicial to health, having thus been converted in Brazilian society in one of its main reforming agents since the 19th century.

Aim: To investigate how diversity within the African migrant population in Scotland affects their understandings of HIV and uptake of HIV testing and treatment, in order to improve HIV-related outcomes. Background: In the UK, Africans have the worst outcomes for HIV infection, primarily due to late diagnosis. Improvement requires better understanding of the barriers to healthcare engagement. This PhD study investigates how diversity among first generation African migrants in Scotland could affect engagement with general healthcare and HIV related interventions and services. Methods: I conducted qualitative research, involving participant observation at two sites (an African religious group and an asylum seeker/refugee drop-in centre) and interviews with African migrants attending these and three additional sites (two advocacy charities and a student association). Data were collected in two cities (Glasgow and Edinburgh) and two smaller towns (Paisley and Kirkcaldy). I interviewed 27 Africans, including economic migrants (n=8), students (n=9) and asylum seeker/refugees (n=10) and 14 representatives from organisations with high levels of African attendees (e.g., country associations, community organisations, advocacy groups, commercial establishments and religious based organisations). Thematic data analysis was carried out. Results: Diversity of the population and related issues of identity: Participants were highly diverse and reported considerable heterogeneity in the African diaspora in Scotland. The identity of “African” was bound with various negative stereotypes and appeals to this identity did not necessarily have relevance for participants. Nature of African affiliated organisations in Scotland: There were a wide range of organisations that advertised their remit as catering for the African diaspora. They varied in consistency and sustainability and contributed towards healthcare engagement to different degrees. Engagement with healthcare: There were multiple experiences and understandings of the healthcare system within the sample as a whole, and to an extent by migrant type. Whilst the majority reported successful and satisfactory service use, distinct barriers emerged. These included: understandings of rights and access to care based on African models of healthcare; the interplay of religious based understandings with ideas about access to healthcare; and assumptions and anxiety about the connections between visa status and health status. Knowledge of HIV and engagement with HIV related services: Participants had good knowledge about HIV, with some notable exceptions, but there was no patterning by migrant type. They had diverse views about risk of HIV infection, most of which did not align with the HIV epidemiology that identifies African migrants as an at risk group. Most of the sample did not think targeting African migrants for HIV interventions would be successful and were hostile to the proposal for various reasons, especially because they believed it would perpetuate stigma and prejudice towards the African diaspora. There were mixed experiences of HIV related services, and prompts to test for HIV had elicited a range of reactions, the majority negative. Conclusion: Diversity within the African diaspora in Scotland should be taken into account to improve the salience and relevance of future HIV interventions. Attitudes towards current HIV testing promotion suggest that a more cooperative approach could be taken with African communities to build on existing relationships of trust and understandings of HIV.