Mental health has a long history of proving to be a tough concept to define. Multiple forms of knowledge and representation seek to inform as to the nature of mental health, all contributing to the production of immense complexity as to the experience of living with mental health difficulties. This thesis sets out to explore this, by getting as close as possible to mental health service users' actual experiences. A range of forms of knowledge that pertain to inform as to service users' experiences are explored, prior to analysing a corpus of interviews with service users. These are analysed through the development of a Deleuzian Discourse Analysis. Service users' experiences are analysed in terms of the relation between discursive and non-discursive factors, which include forms of mainstream psychiatric discursive practice, such as the application of diagnostic criteria and administration of treatments, along with how such practices are experienced in non-discursive dimensions of service user embodiment and space. The challenges facing service users are seen to operate around identity and control in relation to forms of psychiatric knowledge, along with presenting particular problems with regard to how user embodiment is felt, primarily in relation to psychiatric medication, and how these are driven into the production of service user spaces, i.e. day centres. Finally, a politics of affectivity is offered, as a way to unfold the complexity of service user experience, and to emphasise the existence and potential for change that can be gained through deterritorialising mental health.

This study aims to explore the factors which affect the technological employees¡¦ utilization of alternative medicine in Taiwan. The research modifies Aday and Anderson model to form the research framework. This reasearch focus on the relationship between predisposition factors, enabling factors , needs factors of technological employees and the utilization of alternative medicine services. 600 copies of questionnaires were conducted in July 2005 to January 2006, with 520 of them returned that makes a response rate of 86.67%. The conclusions of this study are presented as follows: 1. A total of 274(52.7%) of technological employees have ever utilized alternative medicine, 243(46.7%) of technological employees have never utilized alternative medicine and 3(0.6%) of technological employees is the missing data. 2. On average each person has utilized 1.40 alternative medicine service visits and has spent NT$740.73. 3. The alternative medicine used most commonly by technological employees are naprapathy (17.1%), hydropathy (13.6%), feet massage (10.0%), massage (9.7%) and acupuncture (8.9%). 4. Technological employees¡¦ age, occupation, the position of occupation, income, the methods of acquiring alternative medicine, residence,the recommendations of family or friends,and perceived physical health are the factors to affect the utilization of alternative medicine. Technological employees¡¦ religion of Buddhism is the factors to affect the number of visits of alternative medicine. Technological employees¡¦gender of womem and other methods of acquiring alternative medicine are the factors to affect the expenditure of alternative medicine. The suggestions of this study are that Department of Health may help the public to acquire accurate information concerning alternative medicine and plan for having the health insurance coverage of alternative medicine.In addition, hospitals or the alternative medicine providers may increase promotion of alternative medicine, marketing for alternative medicine services bases on the major findings from this study.

Thesis (M.S.)--University of Hawaii at Manoa, 2007. / Includes bibliographical references (leaves 16-17). / vi, 17 leaves, bound 29 cm

Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 6 uppsatser.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

Abstract The aim of this cross-sectional controlled study was to determine frequent attenders' chronic diseases and their reasons for encounter in primary health care. Furthermore, the study aimed to determine the associations of social, psychological and family factors with frequent attendance in a Finnish health centre. Patients who made eight or more annual visits to physicians in the health centre during one year were defined as frequent attenders (FA). All the FAs during 1994 (N=304) and 304 randomly selected age- and sex-matched controls constituted the study population. The data were collected from annual statistics, medical records and postal questionnaires. Over one third of the study population was interviewed. International Classification of Primary Care (ICPC) was used to determine the reasons for encounter and Symptom Checklist - 36 (SCL-36) to assess the psychological distress. Toronto Alexithymia Scale -20 (TAS-20) was used as a measure of alexithymia and Whiteley Index (WI) to determine hypochondriacal beliefs. The results showed that 4.7% of the whole population aged 15 years or older in Oulainen were FAs. They accounted for 23.5% of all visits made within the respective age group. The mean age of the FAs was 49.8 years. Over two thirds of them were female. The FAs had lower basic education and occupational status than the controls. The FAs visited physicians in the health centre mostly for reasons related to the musculoskeletal, respiratory and digestive systems. There appeared to be more chronic diseases among the FAs than among the controls. The FAs had over three times more mental disorders than the controls. The interviewed FAs had significantly more psychological distress, somatization and hypochondriacal beliefs than the controls. The risk of frequent attendance was higher in the older family life cycle phases than in the younger family life cycle phases. Multivariate analyses showed chronic somatic disease and hypochondriacal beliefs to be risk factors for frequent attendance. Concurrence of somatization and hypochondriacal beliefs increased the risk to be a FA. As a conclusion, the results emphasize the need to consider the FAs' own bodily concerns expressed as hypochondriacal beliefs when managing them. Furthermore, the study implicates a need to integrate the biomedical, psychological and social dimensions in the care of FAs in primary health care.

No description available.

There has been a growing interest among policymakers in the potential role of physical activity (PA) as a strategy to mitigate the challenges associated with an aging population, specifically the potential pressures on the health care system presented by an increasing need and demand for long term management of chronic health conditions. In this dissertation, the relationship between PA and health service utilization among older adults and the role of PA in reducing health services utilization in this population is examined via two studies. Study 1: The purpose of Study 1 was to examine relationships between LTPA and health services utilization in a nationally representative sample of community-dwelling adults aged 50 years and older. Methods: This study involved a secondary analysis of data from the Cycle 3.1 of the Canadian Community Health Survey. The analysis was restricted to individuals aged 50 years and older, resulting in an unweighted sample of 56,652 adults (48%M; 52%F; mean age 63.5±10.2 years), stratified a priori into three age groups (50 – 64 years, 65 – 79 years, 80 years and older). Self-reported use of general physician (GP) services, specialist physician services and hospital services for the 12-month period prior to the survey were the outcomes of interest. The main independent variable of interest was self-reported LTPA for a 3-month period prior to the survey. A comprehensive set of predisposing, enabling, and health need factors associated with health services utilization were included as control variables in all analyses. Separate multiple logistic and negative binomial regression models were used to assess the association between LTPA and each dichotomous and count-based dependent variable, respectively. Bootstrap re-sampling procedures were applied in all regression analyses. Results In the 50-64 year age group, active individuals were 27% less likely to report any contact with a GP (OR=0.73; p<.001) and had 8% fewer GP consultations (IRR=0.92; p<.01) than their inactive counterparts. Among 65 to 79 year olds, active respondents were 18% less likely than their inactive counterparts to have had an overnight hospitalization in the previous 12 months (OR=0.82, p<.05). Across all age groups, higher levels of non-leisure physical activity was associated with lower health services utilization. Study 2: The purpose of Study 2 was to investigate the effects of a randomized community-based PA intervention (50+ in motion) on participants’ health service utilization and healthcare costs over a 5-year period. Methods: 50+ in motion was a randomized clinical trial comparing the effectiveness of a class-based (CB) and home-based (HB) exercise program for older adults with select chronic health conditions (hypertension, dyslipidemia, type 2 diabetes mellitus, osteoarthritis, overweight or obesity). Of the 172 participants randomized, 59 CB and 69 HB participants granted access to their administrative health data. Data pertaining to GP and specialist physician services utilization and costs as well as hospital services utilization and costs were obtained for all consenting participants from the Saskatchewan Ministry of Health for the year prior to enrolment in the 50+ in motion study through to 48-months post-randomization, for a total of 5-years of data. Independent variables including demographic characteristics, physical activity, sedentary behaviour, cardiovascular endurance, functional fitness, body composition, blood pressure, and self-reported physical and mental health status were collected directly from participants prior to randomization and then annually for 4 years. Longitudinal effects of the 50+ in motion intervention on health services utilization and healthcare costs were assessed using the generalized estimating equation (GEE) approach with covariates selected for inclusion based on methods of purposeful selection. Results: There were no significant differences in health services utilization or health care costs between the CB and HB interventions until the final year of the study when the HB group had 60% more GP visits than the CB group and were 89% less likely than the CB group to be frequent users of specialist services. There were no significant differences between the randomization groups in healthcare costs. Measures of functional fitness emphasizing lower body strength, endurance and power were more consistently associated with lower health services utilization than CV endurance, body composition or physical activity. Sedentary behavior was associated with higher hospital costs, independent of physical activity, functional fitness and health status. Overall Conclusion: Taken together, the two studies in this thesis address a significant gap in the Canadian literature and provide novel insights into the relationships between PA, health and health services utilization in older adults. While further research is needed to improve our understanding of the relationships between physical activity and sedentary behaviour, physical fitness, and health services utilization, the findings presented in this thesis suggest reducing sedentary behaviour and improving functional fitness in older adults may be as important as physical activity, if not more so, in terms of potential impact on health services utilization and health care costs. For health care professionals and policymakers at all levels, the findings highlight the advantages of a multi-pronged, interdisciplinary approach to the development of public health initiatives and interventions focused on increasing PA participation and functional fitness among older adults.

The primary purpose of this dissertation was to understand if emergency department utilization patterns are associated with subsequent drug overdose death. Specifically, it was hypothesized that that increasing emergency department (ED) utilization (as measured by such indices as two or more visits in 72-hours, two or more visits in a 30-day period, four or more visits in a 365-day period) was associated with increasing risk of fatal unintentional drug overdose compared with patients without two or more visits in a given time frame. Using ED data from the New York State Department of Health's (NYSDOH) Statewide Planning and Research Cooperative System (SPARCS) for the years 2006-2010 linked with unintentional fatal prescription drug overdose data from death certificates and medical examiner case files from the New York City Department of Health and Mental Hygiene (NYC DOHMH) and the NYSDOH for the years 2006-2010, a retrospective dynamic cohort of ED encounter data was conducted. In the first study, the patient population consisted of 1,755,734 New York State residents who were 18-64 years of age and had selected diagnoses on their entry visit. Extended Cox proportional hazards regression models were conducted to estimate the association of ED utilization patterns and subsequent drug overdose death. Compared to time periods in which patients had no visits within a year, patients who had 3, 4-10, or > 10 visits in a year had elevated risks of prescription drug overdose death after adjustment for demographic characteristics: 3 visits (adjusted hazard ratio (aHR 4.77, 95% CI 3.60, 6.15)), 4 - 10 (aHR 7.39, 95%CI 5.81, 9.41), and > 10 ED (aHR 18.37, 95% CI 13.38, 25.23). ED utilization patterns are strong predictors of subsequent overdose death. Understanding the timing of overdose death in relation to ED utilization is essential to recognizing which patients to target with overdose prevention interventions. Identifying time-periods of increased risk may be used as an indicator for developing prediction tools to classify patients at increased risk for overdose.

Emergency departments (ED) provide access to care for large numbers of patients who have nonemergent medical needs. More than half of the patients presenting to the ED at Salem Hospital in Salem, Oregon, were found to be seeking care for nonemergent medical needs. In an effort to provide an alternative location for receiving this medical care, the hospital opened an Urgent Care Center (UCC) a few blocks from the ED. The purpose of this study was to determine who uses the ED, why, and what effect the UCC had on providing an alternative to the ED. My anthropological methodology uses both quantitative and qualitative techniques. Included in the study is a random retrospective chart review of 462 patients who utilized the ED and 183 patients who utilized the UCC. The collected data were analyzed and compared with information found in the literature review. Interviews with hospital staff and patients using the two facilities are integrated into the analysis. My own experience as a nurse allows me a certain insider's perspective which was useful in interpreting data, while doing observation, and during the interview process. Findings from my research show that the Urgent Care Clinic does provide an alternative source of health care to the ED for many people. This is particularly true for those whose usual source of care is unavailable and for those who are unable to find a primary care provider to accept them. The emergency department provides nonemergent care for large numbers of patients, some of whom have psycho-social problems which differ as compared to the general population. Some of these patients have moderate psychiatric dysfunction and/or addiction problems or homelessness as well as underlying medical problems, all of which are barriers to obtaining care in a regular office setting. In some cases, the emergency department provides the best option of available care. / Graduation date: 1999