Background Multimorbidity, the co-existence of multiple health conditions in an individual, is a significant Public Health challenge. However, it has no consensus definition or measure, and its determinants and outcomes are not fully understood. Resilience may be a mechanism by which the experience of multimorbidity can be improved but there has been little study of this. Aim To define and measure the prevalence of multimorbidity and resilience to multimorbidity, to assess the role of mental health and childhood socio-economic status (SES) and to investigate the long-term outcomes. Objectives 1. To determine how multimorbidity and resilience to multimorbidity should be defined and measured in Public Health research 2. To assess the prevalence of multimorbidity and resilience to multimorbidity using the measures identified in objective one 3. To assess the role of mental health conditions and childhood SES in the occurrence of multimorbidity and resilience to multimorbidity 4. To assess the impact of multimorbidity and resilience to multimorbidity on long-term outcomes Method Systematic reviews of the literature were conducted to address objective one. The analysis of two contrasting study populations was used to address objectives two to four. These were the Australian cross-sectional Diamond study and the Aberdeen Children of the 1950s cohort study. Results Multimorbidity was defined as the presence of two or more conditions and was measured by patient self-report and healthcare administrative data. Resilience was the presence of good self-reported outcomes despite multimorbidity. Multimorbidity prevalence ranged from 3% to 38%. Mental health conditions led to an increased burden of multimorbidity and a reduced prevalence of resilience. Childhood SES and other SES factors were associated with multimorbidity. Childhood SES and other SES factors were associated with multimorbidity. Multimorbidity was associated with poorer outcomes. Conclusion The findings in this thesis can be used to improve consensus approaches to studying multimorbidity and resilience, and to develop interventions to tackle these.

The primary aim of this thesis is to consider whether the social work complaints procedure in Scotland is an appropriate means of dealing with dissatisfaction experienced by users of community care services. Debate in the socio-legal literature has focused on different models of justice in grievance and appeal mechanisms for users of public services. Set in the context of this wider debate, this study looks at the operation of the social work complaints procedure in Scotland, focusing on the experiences of complainants in two local authorities. Setting the research in context, the thesis looks at recent policy developments in community care in Scotland, at recent changes to the health complaints procedure and at proposals to change the social work complaints procedure in Scotland, England and Wales. The main source of data is interviews with people who had made complaints in the two local authorities. As well as looking at complainants’ views, the study also considers the views of people responsible for running the complaints procedure in both local authorities. Focus groups with community care service users were used to explore the views of those who may not have used the complaints procedure. A key concern is whether it is possible to distinguish different types of complaints: those which are primarily ‘appeals’ against refusal of services; and those which are about the way that people are treated. Using the experiences of people who had made complaints in both local authorities and a database of all complaints to one local authority, it is shown that it is not easy to make this distinction although some complaints fall more clearly into one category or the other. The classification of complaints relates closely to what people want from a complaints procedure. The purpose of a grievance procedure can be considered in terms of ‘models of justice’. The motivations of complainants and the views of those who operate the procedure are considered in the context of literature on models of justice. The thesis looks at how the complaints procedure operates in each of the two local authorities and considers the relative value of ‘informal’ and ‘formal’ processes. It goes on to look at what happens when people make formal complaints, whether complaints are resolved and what people think about this. Barriers to complaining are also considered. Finally the thesis looks at complaints which reach the end of the complaints procedure - the complaints review committee - and those which reach the Scottish Public Services Ombudsman. The thesis concludes that there is considerable ambiguity as to the purpose of the community care complaints procedure. Some complainants use the procedure as an ‘appeal’ against decisions made by the local authority, while others just want to get their problems ‘sorted out’. Some complainants are, at least in part, attempting to get the local authority to improve services for others. The emphasis of local authority staff in this study is primarily on ensuring that complainants have an opportunity to have their ‘voice’ heard. The word ‘complaining’ itself carries connotations which some service users see as negative, although others are more assertive in their use of the word. In procedural terms there is much that can go wrong between the initial ‘informal’ complaint and the more independent level of the procedure: the complaints review committee. There are considerable problems in defining ‘complaints’ and ensuring that they are handled within the guidelines. This means that it is difficult for justice to be seen to be done.

O presente estudo se propôs a responder à questão de investigação: como a Modelagem Matemática pode contribuir como um meio do educando ser protagonista da sua aprendizagem, aspirando a sua autonomia? A pesquisa apresenta uma proposta de sequência de tarefas em um ambiente de aprendizagem de Modelagem Matemática, dividida em três partes, que são: o convite para realizar modelagem, uma experiência com a temática água e uma experiência com um tema de livre escolha. O estudo foi desenvolvido durante o segundo semestre de 2016, com uma turma de terceiro ano do Ensino Médio de uma escola municipal de Sapucaia do Sul, no horário regular de aula. Apoiada na teoria da Modelagem Matemática em uma perspectiva Sócio-crítica de Barbosa (2001), elaboração de perguntas em um ambiente de Modelagem Matemática de Sant’Ana e Sant’Ana (2009) e na Pedagogia da Autonomia de Paulo Freire (1996), e utilizando o estudo de caso como metodologia, o presente trabalho evidenciou que os estudantes podem ser ativos na construção dos seus conhecimentos. Além disso, percebeu-se, como resultados, que quando lhes é oportunizado um ambiente de liberdade e consideração, que respeita as suas escolhas, os alunos vão assumindo sua responsabilidade pela sua aprendizagem, construindo, aos poucos, suas preferências, suas opções e sua autonomia. / The present study aims to answer the research question: how can Mathematical Modeling contribute as a way for the learner to be the protagonist of their learning by aspiring to their autonomy? The research presents a task sequence proposal in a mathematical modeling-learning environment, divided into three parts. Such parts are the invitation to perform modeling, an experience with water theme, and an experiment with a theme of free student’s choice. The study was developed during the second semester of 2016, with a third year High School class from a municipal school in Sapucaia do Sul, at regular school hours. Based on the theory of Mathematical Modeling in a Socio-critical perspective of Barbosa (2001), elaboration of questions in an environment of Mathematical Modeling of Sant'Ana and Sant'Ana (2009) and in the pedagogy of autonomy of Paulo Freire (1996), and using the case study as a methodology, the present study showed that students can be active in the construction of their knowledge. In addition, it was noticed that, when it is offered an environment of freedom and consideration, respecting their choices, students will assume their responsibility for their learning, gradually building their preferences, their choices and their autonomy.

This thesis critically assesses the scope and method of criminalisation of the concept of fraud under the Fraud Act 2006 through the discussion of an apparent ‘duality’ between (co-existing) criminal and non-criminal resolution mechanisms. The reader will find social sciences theory and mixed-methods research techniques being used to identify and characterise a dysfunction between legislation and the social function of fraud control and its resolution. The 2006 Act appears to present a categorical and monolithic headline offence of fraud qualified by dishonesty, yet it is not clear that the Act clearly identifies the scope of effective criminalisation with respect to fraud. The dishonesty-based conduct offence provided in the Fraud Act 2006 is examined in the context of contemporary theory and practical considerations that relate to the discipline of law-enforcement. This work investigates pre-industrial modes of fraud resolution and identifies industrial-era points of divergence between the concepts of fraud and theft (a similar headline offence defined and criminalised under the Theft Act 1968). The work also offers an empirical study of survey-based data collection involving one-hundred-and-forty participants (N=140). It measured the practical extent of criminalisation of fraud in terms of participant indications of the (typically) most likely official outcome in response to sixteen hypothetical examples of fraud offences. The survey results appear to support practical, contextual, and theoretical considerations from the literature on the inhibitors to the consistent application of a conduct-based general fraud offence. The data and findings highlight the advantages of detailed actus reus-based criminalisation of types of fraud that require additional control through effective criminalisation.

Worldwide, asthma is a chronic condition which is prevalent and neglected and Scotland has a high prevalence of asthma compared to the rest of the world. In their report on the global burden of asthma, the Global Initiative for Asthma (GINA) Program ranks Scotland as having the highest asthma prevalence in the world, with almost one in every five people affected and 6.3 % of the population in Scotland are seeking treatment at General Practices. The aetiology of asthma is complex and it remains a persistent and chronic problem affecting many people, and prevention and treatment are not working. This thesis makes a unique contribution utlising an interdisciplinary approach from Geography and Public Health to explore the nature and role of the socio-environmental context in relation to the prevalence and management of asthma at Scottish General Practices located in areas of dissimilar deprivation levels. The key focus of the research is the way that health professionals (and related stakeholders) understand the factors that shape the causation and prevalence of asthma (including social and environmental contexts), and how this in turn shapes their management of the condition in their practice. Aim: The overall aim of this research is identify, understand and interpret the nature and role of the socio-environmental context in relation to asthma prevalence and management at the Scottish primary care setting. Methods: The research employed quantitative analysis of a secondary dataset on asthma and a case study analysis of two General Practices located in areas of dissimilar deprivation levels in Scotland. Practices were selected after quantitative data analysis comparing the deprivation scores (SIMD) against crude prevalence rates of asthma. The case study employed in-depth semi-structured interviews with stakeholders involved in asthma care. The results of the study contributed to the understanding of what a conventional deprivation measure does/ does not reveal about asthma–place contexts. It also gave insights on how health professionals perceived their area, patient population and how they integrated these perceptions it into their practice as their understanding or lack of understanding or their inability to act upon their understanding on the importance of the socio-environmental context was one of key factors that shape their management of asthma. The study concluded imparting policy implications and renewed approaches to asthma care and management practices within the Health Services.

Den systematiska litteraturstudien som genomförts beskriver sambandet, utifrån ett genusperspektiv, mellan de tre variablerna lärares förväntningar, agerande och dess påverkan på eleverna inom matematikundervisningen. Studien belyser skillnaderna som finns mellan variablerna och elevernas kön. Resultatet som beskrivs i studien har sin utgångspunkt i tidigare forskning och kommer bland annat att analyseras utifrån modellen: A model for the review of teacher beliefs and gender differences, samt utifrån teorierna socio-matematiska normer och socialkonstruktionism. Det resultat som framkommit i studien visar på en könssegregerad matematikundervisning.

South Africa is a water-scarce country (Otieno and Ochieng, 2004; Wassung, 2010). The current sanitation system mostly used in South African urban areas depends on extensive use of water in a form of flush toilets. The housing sector in major cities is continuously growing and this is putting a strain on water services. The government has explored a range of sanitation technologies including waterborne, the Ventilated Improved (VIP) toilet and ecological sanitation (widely known as ecosan) in a form of a urine diversion dry (UDD) toilet. The latter provides a reasonable solution to the current sanitation challenge. This study explores the perceptions of the users of the UDD toilets installed in the medium density mixed housing development of Hull Street in Kimberley. Understanding the users’ socio-cultural perceptions of the UDD toilet will contribute to future policy making, as the information can be used to improve the future roll-out of the technology in order to make it more acceptable. The study was qualitative in nature and used a phenomenological research design. The sample size comprised 16 participants, 13 of whom were residents of the Hull Street housing project and three were employees of the Sol Plaatje Housing Company (SPHC). The sample was selected by a purposive sampling method. Semi-structured interviews were conducted to collect data for the study. The data was analysed by means of content analysis, which enabled the researcher to identify important themes for the study. The findings of the study revealed dissatisfaction regarding the use of the UDD toilet, which emanates from poor design of the toilet facility. The research was successful in identifying, inter alia, odour, uncomfortable sitting position on the toilet mainly by female users and high cost of operating and maintaining the sanitation system. Recommendations emphasise the importance of involving users in future UDD sanitation projects and educating the public at large about sustainability aspects of this sanitation technology (UDD). One of the key lessons drawn from the study is that challenges experienced by the users should be used to improve future UDD toilets.

As school choice opportunities have become more prevalent and information about schools more readily available, there is still a lack of understanding of how parents use information to evaluate schools. The discussion around school judgment-making predominately focuses on whether parents know about school choice and the constraints parents face which limit choice, but I investigate, using 91 interviews of parents living in a low socio-economic community, how parents make judgments and evaluate schools past the discussion of what schools are available to parents and the constraints those parents face. The results of this study are that parents use heuristics—specifically familiarity, endorsement, and representativeness—to help them make judgments about schools. Knowing that parents use heuristics, policy-makers and educators can better address these parents needs and provide information that is more beneficial to them for making judgments about schools.

The constructivist paradigm was used in the research study to focus on the challenges with affordable housing and concentrations of Housing Choice Voucher recipients in a county in Southern California. Viewed through the lens of Social Stratification posed by Max Weber, ones opportunities in life are based on his/her position of class, status and power, where by those with lower positions are excluded from opportunities. The literature discusses the goal of the Housing Choice Voucher Program is to deconcentrate poverty and provide opportunities to move to higher income areas in order to provide opportunities for social upward mobility. Residential socioeconomic segregation has considerable consequences for public health. Keeping in mind the sensitivity of this controversial topic, the researcher protected and maintained confidentiality through the research process. Thus, the member‑checking meeting in which the joint construction is shared with the study participants was held on a secured internet website. Data was gathered by interviewing a diverse group of participants from various levels of agency, including government agencies. This qualitative data was analyzed by identifying “units” of information that were then grouped into categories of topics relevant to the research focus. The result of the final data analysis was a formulation of sixteen categories which was then interpreted in the form of a social construction which concludes that there is a lack of affordable housing in the county, and concentrations of subsidized housing in lower income cities versus affluent cities is due to the demographics of cities as well as exclusion brought on by NIMBY occurrences. Implications for macro Social Work practice included community organizing and policy advocacy at various governmental levels. The termination of the study did not result in the study participants planning to move forward with the solutions that were formed during the research process. A “Thank you” email was sent to the participants with the final joint construction attached as well as the instructions on where to find the final report. The researcher invited the study participants to contact her in the future regarding any opportunities related to affordable and public housing in the County.

HIV/AIDS is a global pandemic with critical demographic, economic, and social implications. The pandemic is widespread in poor regions of the world, including Southeast Asia where its long-term effects are potentially catastrophic. Despite the major impacts of the epidemic being already felt at the household level in many countries, a lack of recognition of the socioeconomic determinants of HIV infection and the economic and social impacts of HIV/AIDS and their relationship with poverty persists. This is due in part to the lack of systematic studies at the household, community, sectoral, and macro levels. The thesis describes a 'vicious circle' between HIV/AIDS, poverty and high-risk behaviour at the individual level. In the poverty-HIV/AIDS cycle, HIV-infected individuals are especially vulnerable to poverty, the poor are more likely to engage in high-risk behaviour such as commercial sex work, and high-risk behaviour in turn makes people susceptible to HIV infection. The thesis examines whether rural Northeast Thailand exhibits characteristics that support the existence of such a cycle. Four key relationships are considered and tested: (i) the relationship between previous HIV infection and current wealth or poverty; (ii) the relationship betweem wealth or poverty and HIV/AIDS knowledge; (iii) the relationship between previous wealth or poverty and current HIV infection; and (iv) the relationship between previous migration and current HIV infection. All four relationships are shown to hold using survey data from Khon Kaen province in Northeast Thailand. Poverty is shown to increase susceptibility to HIV infection, and HIV/AIDS is shown to reduce wealth and hence increase poverty. Under the circumstances, the hypothesis that rural Northeast Thailand exhibits characteristics that would suggest the existence of a poverty-HIV/AIDS cycle cannot be rejected. This thesis also provides several key contributions to the literature on HIV/AIDS and poverty. First, it provides quantitative and qualitative empirical analysis of the impacts of HIV/AIDS on households in a moderately affected region of Thailand. Second, it provides empirical analysis both on whether wealth and poverty affect the risk of HIV infection, and whether HIV infection affects wealth and poverty. The results from this thesis also provide significant empirical evidence of the importance of rural-urban migration in the spread of HIV in Asia. Finally, the thesis investigates the potential effects on the poverty-HIV/AIDS cycle of an ongoing socio-economic intervention, namely breaking the poverty-HIV/AIDS cycle via intensive rural development.