Abre-se este trabalho com uma poesia homenageando o Dr. Joaquim Eduardo de Alencar, como lutador pioneiro e resistente em defesa da liberdade e da saÃde pÃblica. Na introduÃÃo, faz-se breve relato sobre a vida do autor, continua-se falando sobre a motivaÃÃo da pesquisa, o seu contexto, a importÃncia de se resgatar a memÃria do IMEP, citam-se os procedimentos de pesquisas. No capÃtulo 1, trata, genÃrica, resumidamente e num esboÃo cronolÃgico, das aÃÃes de saÃde desenvolvidas no Brasil e no CearÃ. Procura-se conceituar e situar os movimentos da Reforma SanitÃria, Medicina Social, Integral, Preventiva e ComunitÃria, dentro da realidade do ensino mÃdico e no final tenta-se mostrar, a partir de um estudo feito pelo PESES (Programa de Estudos SÃcio- EconÃmicos em SaÃde), ÃrgÃo criado por convÃnio entre a FundaÃÃo Oswaldo Cruz (FIOCRUZ) e a Financiadora de Estudos e Projetos (FINEP), como se deu a evoluÃÃo da chamada "ideologia preventivista" e a criaÃÃo dos Departamentos de Medicina Preventiva nas Universidades, para poder se comparar com o IMEP e com o "novo modelo de atenÃÃo a saÃde da famÃlia", proposto para o Cearà (ANDRADE, et al.,1995) e para todo o paÃs (BRASIL, 1997a). No capÃtulo 2, chega-se finalmente a experiÃncia do IMEP, objetivo principal da tese, em que se trabalha na sua histÃria e nas suas realizaÃÃes e propostas. Propostas, hoje reproduzidas evolutivamente, com outros nomes mas com o mesmo espÃrito, com a mesma formulaÃÃo. Algumas deveriam ser repensadas e inclusive, retornarem a idÃia original, por mais correta e abrangente. No capÃtulo final, se faz uma anÃlise da atual polÃtica de saÃde do paÃs e seus reflexos no Estado do CearÃ, e, pretensiosamente, quer se propor o renascimento de trabalhos semelhantes à experiÃncia do IMEP, fazendo-se a sua comparaÃÃo no contexto atual.

Receiving personalised feedback on body mass index and other health risk indicators may prompt behaviour change. Few studies have investigated men’s reactions to receiving objective feedback on such measures and detailed information on physical activity and sedentary time. The aim of my research was to understand the meanings different forms of objective feedback have for overweight/obese men, and to explore whether these varied between groups. Participants took part in Football Fans in Training, a gender-sensitised, weight loss programme delivered via Scottish Professional Football Clubs. Semi-structured interviews were conducted with 28 men, purposively sampled from four clubs to investigate the experiences of men who achieved and did not achieve their 5% weight loss target. Data were analysed using the principles of thematic analysis and interpreted through Self-Determination Theory and sociological understandings of masculinity. Several factors were vital in supporting a ‘motivational climate’ in which men could feel ‘at ease’ and adopt self-regulation strategies: the ‘place’ was described as motivating, whereas the ‘people’ (other men ‘like them’; fieldwork staff; community coaches) provided supportive and facilitative roles. Men who achieved greater weight loss were more likely to describe being motivated as a consequence of receiving information on their objective health risk indicators. They continued using self-monitoring technologies after the programme as it was enjoyable; or they had redefined themselves by integrating new-found activities into their lives and no longer relied on external technologies/feedback. They were more likely to see post-programme feedback as confirmation of success, so long as they could fully interpret the information. Men who did not achieve their 5% weight loss reported no longer being motivated to continue their activity levels or self-monitor them with a pedometer. Social support within the programme appeared more important. These men were also less positive about objective post-programme feedback which confirmed their lack of success and had less utility as a motivational tool. Providing different forms of objective feedback to men within an environment that has intrinsic value (e.g. football club setting) and congruent with common cultural constructions of masculinity, appears more conducive to health behaviour change.

Background: Emergency medical admissions in the United Kmgdom have been rising for many years. This rise has resulted in increasing pressures on hospitals' resources, with consequent difficulties in coping with peaks of admissions. This rise has not been intended or planned. The epidemiology of emergency medical admissions is poorly understood. Aims: To investigate the epidemiology of emergency medical admissions in Glasgow in terms of time, person and place. To explore variations in Glasgow's general practices' and hospitals' emergency medical admission rates. Literature review: Articles relating to variations in emergency medical admission rates were identified by searching bibliographic databases, cross referencing from known articles, consulting other researchers and hand searching of journal indexes. Relevant articles were included in a systematic review of the epidemiology of varying rates of hospitals' emergency admissions. Articles that postulated causes of the rise of emergency admissions or factors associated with varying admission rates were also reviewed. A summary of mechanisms whereby hospitals might cope with pressures of emergency admissions concluded the literature review. Published evidence of variations of rates of hospital emergency admission was limited. Most articles were found to contain postulated associations with variations in hospitals' emergency admissions. While many published mechanisms for hospitals to adapt to pressures from emergency admissions were identified, only a minority of these had been formally evaluated. 3 Setting: Greater Glasgow Health Board residents (813,029 adults at June 1997). Data obtained from the Health Board's Community Health Index (CHI). Subjects: 537,798 Greater Glasgow Health Board residents admitted to Glasgow hospitals7 medical beds between 1980 and 1997 (43,236 patients in 1997). Data obtained from Scottish Morbidity Record database one (SMRl). Methods: Anonymised CHI and SMRl datasets linked by patients' general practitioners' codes, using a computer database package. Standardised emergency medical admission rates were calculated by the database. Computerised maps of standardised emergency medical admission ratios were plotted for Glasgow7s postcode sectors to show geographical variations. Correlation and logistic regression were used to explore variations in standardised emergency medical admission ratios. Outcome measures: Crude emergency medical admission rates. Standardised emergency medical admission ratios adjusted for patients7 age, sex and Carstairs7 deprivation categories. Results: The numbers of emergency medical admissions doubled between 1980 and 1997. Emergency medical admission rates increased steeply with increasing age of patients, more than doubling for every two decades. Men above 40 years had approximately 20% higher age specific emergency medical admission rates than women. Emergency medical admission rates were more than twice as high amongst patients from Glasgow's most deprived areas, compared with the most affluent. Cardiovascular disease (ICD10 chapter IX) discharge diagnoses were commonest (27.2% in 1997)' followed by the non-specific diagnoses in ICDlO chapter XVII (21.0%). The non-specific diagnoses mainly comprised chest pain (9.6%) which was the commonest reason for admission. Between 1980 and 1997, non-specific diagnoses (ICD10 chapter XVII) increased at twice the rate of all other ICDlO chapters of diagnoses. There were two areas of Glasgow that had raised standardised emergency medical admission ratios (adjusted for patients' ages, sex and deprivation). These corresponded to the catchment areas of two acute hospitals, which had substantially higher adjusted emergency medical admission ratios than had the other three. There was a 2.51 fold variation between the top and bottom deciles of Glasgow's general Practices' crude emergency medical admission rates. After adjustment for their patients' age, sex and deprivation characteristics, this reduced to a 1.87 fold variation. Additional adjustment for general practices' admitting hospitals (along with their patients' age, sex and deprivation) accounted for a total of 84% of the inter-practice variation in crude emergency medical admission rates. Fundholding general practices had modestly raised emergency medical admission rates (odds ratio 1.06.) There were no associations between practices' rates of emergency medical admissions and any other measured practices' characteristics (including numbers of partners, practices' sizes or dispersions, immunisation and cytology rates). Conclusions: This large study discovered epidemiological associations between emergency medical admission rates and patients' sex and socioeconomic deprivation that had not previously been shown. It showed that emergency admission rate variations between general practices were only partly accounted for by patient characteristics. Apart from fundholding status, difference between practices were not related to variations in their rates of emergency medical admissions. However, a substantial part of the variation between general practices could be attributed to differences between their admitting hospitals.

Many diseases can be prevented or mitigated through behaviour change, but we lack a quantitative model that can accurately predict these changes and inform policies designed to promote them. Here we introduce a quantitative model of health behaviour that takes into account individual-level barriers, the health system, and spread between individuals. We investigate limits of the model where each of these determining factors is dominant, and use them to predict behaviour from data. We apply the model to individual-level geographic barriers to mothers giving birth in a health facility, and find evidence that ease-of-access is a major determinant of delivery location. The geographic barriers allow us to explain the observed spatial distribution of this behaviour, and to accurately predict low prevalence regions. We then apply the model to the role of the health system in determining health facility usage by mothers of sick children. We show that local health facility quality does predict usage, but that this predictive power is significantly less than that gained by including unaccounted-for spatial correlation such as social influence. We also show evidence that results-based funding, rather than traditional input-based funding, increases usage. We develop a psychologically-motivated ‘complex contagion’ model for social influence and incorporate it into a general model of behaviour spread. We apply this model to short-lived behavioural fads, and show that ‘nudges’ can be very effective in systems with social influence. We successfully fit the model to data for the online spread of real-world behaviour, and use it to predict the peak time and duration of a fad before the peak occurred. Finally, we discuss ways to incorporate disease state into the model, and to relax the limits used in the rest of the thesis. We consider a model which links health behaviour to disease, and show that complex contagion leads to a feature that is not present in traditional models of disease: the survival of an epidemic depends non-trivially on the initial fraction of the population that is infected. We then introduce two possible models that include both social influence and an inhomogeneous population, and discuss the type of data that might be required to use them predictively. The model introduced here can be used to understand and predict health behaviours, and we therefore believe that it provides a valuable tool for informing policies to combat disease.

The main areas considered within this qualitative study are the extent to which the Adult Support and Protection (Scotland) Act (2007) (ASPA) impacts upon the civil and human rights of adults’ by exploring the “problem” it was developed to resolve, the reality of implementation and the construction of thresholds for intervention in practice. Despite a level of clarity about the need for this legislation inconsistencies of understanding about where the ASPA should be targeted created challenges for implementation, particularly around the issue of capacity. The scope of the population for whom the ASPA was intended remains sizeable and broadly unformed. The vision of the framers that the ASPA would provide support and protection for a range of adults at risk of harm without being overly intrusive in their lives appears, at least partly, to have been realised. Challenges to implementation have largely focused on; the parameters of the ASPA and the population it aims to protect, the conceptualising of what an adult protection referral might consist of and the impact of this understanding on thresholds for intervention. Procedural challenges identified were specifically related to the involvement of health and the understanding of adult protection of other stakeholders, for example the police, inconsistent recording of data and information sharing. The interaction between formal and informal knowledge and consideration of a range of key concepts drawn upon by practitioners to determine thresholds for intervention creates a built in inconsistency of approach with a clear element of subjectivity. The rights based approach integral to all intervention under the ASPA, was well applied by the practitioners in the study and could be considered to have protected the citizenship of the adults to some extent. Perhaps more accurately it could be said that the already conditional citizenship experienced by many of the adults was not further eroded.

Street children are a population highly at risk of HIV/AIDS/STIs, which is becoming an overriding concern. Due to the critical importance of the problem under investigation, this study focuses on the causes and consequences of risks involved in the dynamics of HIV/STIs transmission and the occurrence of AIDS. The study utilised a qualitative paradigm, with two methods of data collection from children and young people in the street; these were observation and in-depth interviews, which emerged as the most appropriate methods for investigating the HIV/AIDS risks and vulnerability of street children. The study was guided throughout by a public health theoretical framework. The study revealed that children leave home due to parental mistreatment; they engage in risky sexual behaviour living in the street, they have little or no understanding of HIV, AIDS and STIs or of the respective relationship between these, and they have negative attitudes towards HIV/ STIs treatment and people affected by HIV/AIDS. Four domains of HIV/STIs and AIDS risks and vulnerability of street children were identified: parental mistreatment (causing vulnerability to exposure and thus the likelihood of acquiring HIV and STIs); high risk-taking sexual behaviour (creating vulnerability to infection); lack of knowledge regarding HIV, AIDS and STIs (vulnerability to re-infection); negative attitudes towards HIV/STIs treatment and people affected by HIV/AIDS (resulting in denial, failure to seek treatment and contributing to the perpetuation of the problem); and the effects of living in the street (increasing vulnerability to progression from HIV to AIDS). By exploring the prime and subsequent root risk factors, these complex interlinking risks have been analytically conceptualised, providing a model which explicates the complete phenomenon of risks and vulnerability to HIV/STIs and AIDS for street children, as well as for broader society, in a cyclical manner. Hence, HIV/STIs and AIDS is not a health problem among street children only, it is a public health problem in the broader society in Nepal. Having identified these problems for street children, this study offers an intervention plan, the CAP model. This model extends previous public health approaches and argues for targeted action to prevent risk and vulnerability for children in the street, and suggestions for policy and legislation which would enable the implementation of the model are offered.

No description available.

No description available.

For the past several decades, the United States led the world in incarceration rates. With nearly 2.3 million people being held in state or federal prisons or local jails in 2019, incarceration rates in the United States are over four times higher than in other developed countries. Disparities exist by gender, race, ethnicity, and other special populations. Males are 13 times more likely to be incarcerated than females. Additionally, black males are 5.7 times and Hispanic males are 2.8 times more likely to be incarcerated than white males. Individuals who experience incarceration have poorer mental and physical health outcomes. People with criminal records or history of incarceration encounter significant barriers to employment as well. Children of incarcerated parents are more likely to experience poor health outcomes and behavioral issues that increase the risk of future incarceration. One intervention that contributes to higher success of reintegration and can prevent rearrest, reconviction, and reincarceration is reentry programs, particularly those with a holistic approach combining employment during and after release, work skills training, mental health and substance use counseling, and support post-release to assist with housing and continued counseling services. Correctional Career Pathways (CCP) is one such program developed and expanded in five Tennessee counties. The first aim of this project was to explore the facilitators, barriers, and impact of the CCP program by analyzing the data collected by the CCP program and highlighting lessons learned in the process. The second aim was to identify opportunities for improvement and sustainability of the CCP by conducting interviews with key partners in CCP implementation across all counties. Information gathered through this project was helpful in creating a roadmap to expand this program to other communities, providing ways to improve the program, and making it more sustainable.

Purpose: Given that CRC Screening disparities in people experiencing homelessness has been heavily understudied, the purpose of this study is to assess how existing knowledge and access to resources about CRC screenings affect the ability to obtain CRC screenings in people experiencing homelessness in Central Florida. Methods: In March 2023, a team of researchers surveyed subjects who do not have stable housing in two Central Florida locations: a local shelter and a resource center serving the predominantly unsheltered. The survey assessed current understanding of CRC screenings and available/lacking resources necessary for completing CRC screening in this population. There was a total sample size of 75 participants, with 36 participants from the shelter and 39 from the service center location. Our inclusion criteria included those who are undomiciled, age 45 and over who speak Spanish or English. Results: The results indicate that there is a statistical difference between those who are screened and not screened when assessing provider counseling (p<0.001), awareness of how to get screened (p<0.001) and access to the same medical provider every visit (p=0.0389). In regard to receipt of CRC screening, there were no statistically significant results when assessing demographics and other resource-related factors. Conclusion: Because data was collected in locations that provided resources, this study may not be representative of all undomiciled individuals in Florida, especially in rural areas. Our results imply a need for provider counseling, patient education and access to a primary care provider. More research needs to be conducted from the physician perspective to understand the context of existing barriers to CRC screening.