Background: The South Western Sydney Area Health Service (SWSAHS) contains many areas of socio-economic disadvantage and ethnic diversity. It has a high incidence of lung cancer, which is the leading cause of cancer deaths. The aims of this study were to document lung cancer patterns of care (POC) for SWSAHS residents, compare POC before and after the opening of an oncology centre in SWSAHS and compare POC with other areas in NSW. Methods: The study population consisted of SWSAHS residents diagnosed with lung cancer in 1993 and 1996. A clinical audit of medical records was performed to extract details on patient demographics, management of lung cancer and outcomes. Collaborating investigators performed identical studies in the Northern Sydney Area Health Service (NSAHS) and the Hunter Area Health Service (HAHS) for lung cancers diagnosed in 1996. Results: The SWSAHS study population comprised 527 patients. Nine percent did not have a pathological diagnosis. Twelve percent did not see a lung cancer specialist. Twenty-eight percent did not receive any treatment throughout the course of their illness. The median survival was 6.7 months and five-year actuarial survival was 8% (95% CI 6%-10%). Increasing age and poorer performance status were associated with a lower likelihood of obtaining a pathological diagnosis, specialist referral and treatment. Socio-economic factors did not influence POC. The establishment of an oncology center resulted in more referrals to medical oncologists and palliative care services. Other aspects of POC and survival were similar. Variability in POC was noted between SWSAHS, NSAHS and HAHS. HAHS residents were almost twice as likely not to have pathological confirmation of diagnosis or treatment. Despite this survival was not significantly different. Conclusions: This study has identified deficiencies in the management of lung cancer. To improve outcomes, referral to specialists and utilisation of treatment, particularly radiotherapy and chemotherapy, needs to be increased. Ageist and nihilistic attitudes need to be overcome. Prospective data collection is necessary to ensure quality of patient care. The formation of national guidelines for the management of lung cancer will play an important role in achieving better outcomes.

Thesis (Ed.D.) -- Teachers College, Columbia University, 1991. / Typescript; issued also on microfilm. Sponsor: Seymour Rigrodsky. Dissertation Committee: Eleanor B. Morrison. Includes bibliographical references: (leaves 82-87).

No description available.

Research and analysis regarding the employment outcomes of vocational education completers are growing in importance. States and their educational systems are increasingly confronted with the need to justify programs and funding and to provide evidence of the numbers and status of students graduated, obtaining employment, and continuing in postseconday education. The need to review, improve, and implement effective programs, and to serve the practical needs of all students, including those in targeted populations, will continue in the future. The purposes of this study were to investigate and describe Virginia's vocational program completers by employment status, earnings, and job satisfaction through a review of three years of follow-up data. Descriptive statistics, including frequencies, percentages, and overall distributions, were used to identify characteristics of 9,474 employed vocational completers, in order to provide relevant data for improving vocational education in Virginia and for use in establishing baseline data for future studies. In looking at employment outcomes for targeted populations, this study found that employment figures resembled those of non-targeted populations, with high percentages reporting employment related to the service area completed. Vocational completers identified as having limited English proficiency were reported in very small numbers. Earnings data indicated clearly that with each consecutive year of the three years for which data were included, vocational completers were earning higher wages. Earnings also increased with each consecutive year for completers from targeted populations, with vocational completers who were academically disadvantaged or disabled receiving higher wages than completers from economically disadvantaged backgrounds. Completers from economically disadvantaged backgrounds also reported lower levels of job satisfaction and more part-time employment. Additionally, vocational completers in all service areas reported high levels of job satisfaction. Further longitudinal research should be conducted in order to better analyze vocational completers' transition to the workforce. Such research could be useful when planning and implementing policy, requesting grant funding, and instituting educational innovations. / Ph. D.

Floods are becoming more frequent and the magnitude of direct consequences, relating to destruction of critical infrastructure and loss of life, has highlighted the importance of flood management. This thesis proposes a new methodology to quantify the impact of predicted and historic flooding events on emergency services. The approach moves beyond simple flood inundation mapping by accounting for the relationship between flood depth and vehicular speed. A case study was presented for Calgary Alberta, where the depths of a predicted 100-year flood and an historic 2013 flood event were modelled. The methodology applied geographic information systems (GIS) to flood depth mapping, utilizing digital elevation models (DEMs), flood extents, and hydrological data. Flood depths were then assigned to links comprising the road network, where the maximum vehicle speed was calculated as a function of the standing depth of water on a link. The flooded network was used to derive service areas for several types of emergency services (emergency medical services (EMS), fire, and police), following targeted response times. The results quantified and located the residential and work populations that no longer meet the targeted response times. During both flood scenarios, EMS were found to have the greatest reduction in accessibility, with 23% to 47% of residents and workers, respectively, not served. Fire services were seen to be more resilient with only 3% to 9% of residents and workers, respectively, not served. The results for police services were similar to fire services. However, the former have a greater range of response times, meaning these areas represent those that are completely isolated during both flood events. Overall, the proposed methodology quantified vulnerable populations on a partially degraded network, which can be used to develop evacuation plans and emergency response strategies, minimizing disturbances in the network and the number of people affected. / Thesis / Master of Science (MSc)

Catchment populations and cross-boundary flow characteristics of health facilities in Natal and KwaZulu have not previously been determined. As this information is essential to objective health service planning the present study was undertaken. Utilization. cross-boundary flow and catchment populations were determined in 1986 for each hospital and clinic in Natal and KwaZulu. All of the 61 hospitals and 178 clinics in Natal and KwaZulu which are operated by the public sector were included in the study. The ratio of clinics-to-hospitals was 2.9 1. The overall average population per hospital and clinic was 106775 and 36591 respectively. The size of the catchment populations of hospitals varied from 334972 to 272 and of clinics from 253159 to 877. Factors associated with these variations are discussed. Inter-regional cross-boundary flow of patients varied appreciably. The greatest influx of patients was experienced by the Durban sub-region where the teaching hospital is situated while the greatest influx of patients was experienced in the Port Shepstone sub-region. Attendance rates per person per annum. according to racial group, were 0.9, 2.1, 1.7 and 0.8 respectively for Blacks, Coloureds, Indians and Whites. Recommendations in respect of the distribution of health facilities and the routine collection and use of health information relevant to the management process are submitted. / Thesis (M.Med.)-University of Natal, Durban, 1987.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-09-16T14:58:22Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação José Alencar.pdf: 11855557 bytes, checksum: 87f02b7466a5ff333776545c567edae5 (MD5) / Made available in DSpace on 2016-09-16T14:58:22Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação José Alencar.pdf: 11855557 bytes, checksum: 87f02b7466a5ff333776545c567edae5 (MD5) Previous issue date: 2016-03-16 / FACEPE / Este trabalho tem como objetivo compreender quais os fatores que determinantes para a formação de uma rede de cidades sobre influência de Imperatriz MA, tendo como foco quatro regiões de saúde localizadas no centro-oeste e sul do Maranhão: Região de Saúde Açailândia, Região de Saúde Barra do Corda, Região de Saúde Balsas e a relação dessas com a Região de Saúde Imperatriz. Para tanto, inicialmente se buscou realizar a fundamentação teórica dos conceitos chaves para o trabalho, como cidade média, rede urbana, diferenciação urbano-rural, região de saúde. Segue-se então para a caracterização de Imperatriz enquanto cidade média e polo regional segue então foram caracterizadas as quatro regiões de saúde em estudo visando caracterizar a rede urbana sob influência de Imperatriz, especialmente em relação aos serviços de saúde; para tanto é vital a utilização de dados levantados em várias instituições como IBGE, IPEA, DATASUS. Mediante a caracterização das regiões de saúde pôde-se concluir que Imperatriz se destaca como cidade média na qual vivem 93% de sua população municipal, também possui os melhores índices socioeconômicos e de saúde entre as quatro regiões. Também é um polo comercial, de educação e de saúde. Estes são fatores que centralizam em Imperatriz uma rede de cidades que constitui sua região de influência, tendo os serviços de saúde um importante papel de atração populacional. / This work aims to understand which factors decisive for the formation of a network of cities under the influence of Imperatriz - MA, focusing on four health regions located in the Midwest and southern Maranhão Health Region Açailândia, Region health Barra do Corda, Region health Balsas and the relationship of these with the Region health of Imperatriz. Therefore, initially sought to accomplish the theoretical basis of the key concepts to work, on average, urban network, urban-rural differentiation, health region. It follows then to characterize Imperatriz as average and regional hub city following were then characterized the four health regions in the study to characterize the urban network under the influence of Imperatriz, especially in relation to health services; for this it is vital to use data collected in various institutions such as IBGE, IPEA, DATASUS. By the characterization of health regions could be concluded that Imperatriz stands as average city in which they live 93% of its municipal population, also has the best socio-economic and health indexes among the four regions. It is also a commercial hub, education and health. These are factors that centralizes in Imperatriz a network of cities is its area of influence, and the health services an important role in population attraction.

Post-graduate students specializing in Community Health, are attached to different health authorities during their training. During these attachments they are exposed to the day-to-day management of health services and experience at first hand, the difficulties as well as the successes that are encountered in tending to the health needs of communities. It is also expected that post-graduate students do research projects during their attachments, usually on topics on which the health services managers need information. The topic discussed in this report was an assignment given to the author at the start of his attachment to the department of Hospital (Health) Services of the Cape Provincial Administration. The period of attachment was from February to May 1987. The whole question of the regionalization of health services is a complex one, and it is necessary that any proposals for a system of regionalization benefit from the inputs of many experts in different fields. However, as has been the experience in the United States of America, such inputs are no guarantee -that a successful system of regionalization will result. (1) In the local front, the Department of Works, at the request of the Director of Hospital Services, began an investigation into the existing system of regionalization of hospital services in 1985. This attempt was aborted, possibly because of the magnitude of the task, among other things. (2). What follows hereafter should therefore be seen as merely a framework for the development of a system of regionalization rather than as a blueprint for such a system. Perhaps a few remarks about the age-old problem of line-staff conflict would not be amiss at this stage. During the development of this framework, it became apparent that line officials might be expecting a quick proposal of regions and/ or sub-regions for the delivery of health services based on a purely management approach. As a staff official, the author naturally had different expectations. The report is an attempt to marry the two sets of expectations and it is left to the reader to judge to what extent, if at all, the author has succeeded in this attempt. Much of the data used in the study are new, and computation was done largely by hand. The generation of the data, was therefore time-consuming and much of the first phase of the study was devoted to the generation of the data and collection of data that were available from other sources. The study has proved to be a fascinating one and it is hoped that permission will be obtained to pursue the study in more detail. This report should therefore be seen as a preliminary report which addresses the question of regionalization of health services in the Cape Province in 'macro' terms. And finally, the author hopes that some of the information in this report may prove of value to those responsible for the delivery of health services to the people of the Cape Province.

The health system of a municipality has in their day-to-day challenge of ensuring that all its service network and information systems and work is executed in full, following the prerogatives of the SUS, not only ensuring the right of access health services as well as developing activities to prevent major diseases and disorders that plague the citizens of the municipality. In this context, this paper is to investigate the spatial organization of the city of São Cristóvão-SE Health Systems, with emphasis on Health Units agreements with the SUS. Through this goal, one approach is to recognize how these units are structured, and this was based on multiple meanings of space, both in geography and in view of health agencies. For this it was necessary to carry out the field work, construction and supply of georeferenced database and preparation of thematic maps. In total 21 health establishments that are part of the municipal Health System, to analyze the data collected were identified, it can be noted that the distribution of health facilities is disproportionate to the need of the population, since they are located mostly in two areas, the Municipal Headquarters and Housing Complex Rosa Elze, leaving areas without a proper physical structure and human health. It was observed that the total number of people served in the establishments is not proportional to the size of the coverage area of each unit, in this case it appears that there must be an error in filling these data, despite going up in 2012 are the most recent. Given the results of this study, we propose initially to managers distribute the units of health according to the population covered, distribute specialties according to the needs of health, contextualize the services to be offered from the analysis of life and work local population. Otherwise it will be possible to improve the services offered, creating healthy spaces where access to health will be increasingly closer to changing surface integral, benefiting the local population. / O Sistema de saúde de um município tem no seu dia-a-dia o desafio de garantir que toda a sua rede de atendimento e sistemas informacionais trabalhe e seja executado de forma integral, seguindo as prerrogativas do SUS, não só assegurando o direito ao acesso aos serviços de saúde como também desenvolvendo atividades que previnam as principais doenças e agravos que assolam os cidadãos do município. Neste contexto, este trabalho tem como objetivo geral investigar a organização espacial dos Sistemas de Saúde do município de São Cristóvão-SE, com ênfase para as Unidades de Saúde conveniadas com o SUS. Através desse objetivo, um dos enfoques consiste em reconhecer como estão estruturadas essas unidades, e para isto baseou-se nos múltiplos sentidos de espaço, tanto na visão da geografia quanto na dos órgãos de saúde. Para tanto fez-se necessário realizar, trabalhos em campo, construção e alimentação do banco de dados georreferenciados e confecção de mapas temáticos. No total foram identificados 21 estabelecimentos de saude que fazem parte do Sistema de Saude municipal, ao analisar os dados recolhidos, pode-se destacar que a distribuição de estabelecimentos de saude é desproporcional a necessidade da população, uma vez que eles estão localizados na sua maioria em duas áreas, na Sede Municipal e no Conjunto Habitacional Rosa Elze, ficando áreas sem uma apropriada estrutura física e humana de saúde. Observou-se que a quantidade total de pessoas atendidas nos estabelecimentos não é proporcional ao tamanho da área de abrangência de cada unidade, nesse caso constata-se que deve haver um erro no preenchimento desses dados, que apesar de irem ate 2012 são os mais recentes. Diante dos resultados deste estudo, propõem-se inicialmente aos gestores distribuir as unidades de saude de acordo com a população coberta, distribuir as especialidades de acordo com as necessidades de saude, contextualizar os serviços a serem oferecidos a partir da analise de vida e trabalho da população local. Pois assim seria possível melhorar os serviços ofertados, criando-se espaços saudáveis onde o acesso a saude estará cada vez mais próxima de mudar de superficial para integral, beneficiando a população municipal.

This project was an assessment of elderly health care needs and access. Three urban San Bernardino communities in zip codes 92405, 92410, and 92411 were targeted. The assessment was structured according to King's theoretical construction of community as a multilevel interaction between personal, interpersonal and social systems. The components of the assessment included digital photographs, web-based internet assessments, key informant interviews, and community business visits.