Background: Physical activity (PA) is an important component of type 2 diabetes management, yet the amount and type of PA support provided by different types of health care providers (HCPs) is largely unknown. Purpose: This study identified differences in the amount and type of PA supports provided by HCPs, and determined whether HCPs use the Canadian Diabetes Association (CDA) PA guidelines or Canada’s Physical Activity Guide (CPAG) in practice. Methods: Eight of 14 Winnipeg Regional Health Authority primary care clinics specializing in diabetes education agreed to participate in the study. In-person interviews were conducted with health care providers (n=48) and patients with type 2 diabetes (n=26). HCPs were given a total PA support score based on scores in three subcategories behaviour change support (BC), assessment/prescription support (AP) and information/referral/community resources support (IRCR), as reported by HCPs themselves and patients. Results: There was no difference in PA support between the 3 HCP types, but there was a significant difference between HCP report and patient report of PA support. Just over one half of HCPs report using the CDA guidelines unprompted or prompted. Conclusions: HCPs recognize the importance of PA in type 2 diabetes management, but implementing strategies to increase certain types of PA support and facilitate understanding between HCPs and patients would allow for optimal PA counseling in primary care.

Introduction/ Objectives: Stroke, the third leading cause of death in Canada, is projected to rise in the next 20 years as the population ages and obesity rates increase. Family caregivers fulfill pertinent roles in providing support for family members who have survived a stroke, from onset to re-integration into the community. However, the transition from rehabilitation to home is a crucial transition for both the stroke survivor and family caregiver. As the stroke survivor transitions home from a rehabilitation facility, family caregivers provide different types of support, including assistance with navigating the stroke rehabilitation system. They also are a constant source of support for the stroke survivor providing them with continuity during the transition. In this exploratory study we examined family caregivers’ perceptions and experiences navigating the stroke rehabilitation system. The theories of continuity care and complex adaptive systems were used to examine the transition home from hospital or stroke rehabilitation facility, and in some cases back to hospital. Methodology: Family caregivers (n=14) who provide care for a stroke survivor were recruited 4-12 weeks following the patient’s discharge from a stroke rehabilitation facility. Interviews were conducted with family caregivers to examine their perceptions and experiences navigating the stroke rehabilitation system. Directed content analysis was used to explore the perceptions of family caregivers as they reflected on the transitions home. The theories of continuity of care and complex adaptive systems were used to interpret their experiences. Results/Conclusions: During the transition home from a rehabilitation facility, family caregivers are a constant source of support, providing the stroke survivor with continuity. Emergent themes highlight the importance of the caregiving role, and barriers and facilitators that impact the role, and influence continuity of care. Also, supports and services in the community were limited or did not meet the specific needs of the family caregiver. The acknowledgment of the unique attributes of each case will ensure supports and services are tailored to the family caregiver’s needs. Mitigation of systemic barriers would also decrease complexity experienced at the micro-level in the stroke rehabilitation system, and better support the family caregiver during the transition home from a stroke rehabilitation facility.

Background: Physical activity (PA) is an important component of type 2 diabetes management, yet the amount and type of PA support provided by different types of health care providers (HCPs) is largely unknown. Purpose: This study identified differences in the amount and type of PA supports provided by HCPs, and determined whether HCPs use the Canadian Diabetes Association (CDA) PA guidelines or Canada’s Physical Activity Guide (CPAG) in practice. Methods: Eight of 14 Winnipeg Regional Health Authority primary care clinics specializing in diabetes education agreed to participate in the study. In-person interviews were conducted with health care providers (n=48) and patients with type 2 diabetes (n=26). HCPs were given a total PA support score based on scores in three subcategories behaviour change support (BC), assessment/prescription support (AP) and information/referral/community resources support (IRCR), as reported by HCPs themselves and patients. Results: There was no difference in PA support between the 3 HCP types, but there was a significant difference between HCP report and patient report of PA support. Just over one half of HCPs report using the CDA guidelines unprompted or prompted. Conclusions: HCPs recognize the importance of PA in type 2 diabetes management, but implementing strategies to increase certain types of PA support and facilitate understanding between HCPs and patients would allow for optimal PA counseling in primary care.

THE AUSTRALIAN HEALTH CARE SYSTEM has an overarching objective to improve the well-being of all Australians in an equitable and efficient manner. But like most developed economy health care systems, it has experienced a continual increase in demand for health care services along with increased pressure to improve efficiency, quality, and sustainability. To assist in health sector management, policy formulation, investment decisions and reform, the Australian government developed the National Health Performance Framework (NHPF). The NHPF employs performance indicators across nine dimensions of health care, including Effectiveness, Appropriateness, Efficiency, Responsiveness, Accessibility, Safety, Continuity, Capability, and Sustainability. While the National Health Performance Committee has recognised that performance indicators used within the NHPF are inadequate, this thesis argues that the solution is not a simple matter of collecting additional data and constructing new and ???improved??? indicators. Due to resource constraints within the health care system there is an implicit performance trade-off across dimensions. The NHPF must take into consideration the value individuals place on the health care dimensions to enable a shift of limited resources to those areas that are most valued. The starting point for the NHPF should be to determine what society wants out of a health system. The purpose of this thesis is to determine Australian society???s preferences for performance across the nine NHPF dimensions of health care. This is achieved using a choice modelling experiment, which describes the performance of the current health care system and alternative health care systems the government could work towards, and asks respondents to compare and choose which system they prefer. A mixed multinomial logit model is used to analyse respondent choices in order to incorporate alternative tastes across attributes, and correlation of tastes across alternatives and scenarios. Relative values attached to the nine NHPF dimensions of health care are calculated and preferences for the dimensions are ranked. The thesis concludes by exploring individual preferences derived form the choice modelling experiment in the context of social welfare theory. It also outlines the strengths and weaknesses of the methodology, provides suggestions for further research, and offers a use for social preferences in the development of performance frameworks within the Australian health care system.

This thesis deals with a medical and social view of taking healing hemp (cannabis). It is a theoretical thesis elaborated based on the analysis of the available Czech and foreign information sources and professional publications. The thesis target is to map the issue of taking healing hemp by means of the information from the available foreign and Czech literature. The thesis focuses on the most important issues dealt with by the professional as well as lay public and on the development of the solution of this issue. I was captured by this issue after my internship in Belgium, where I had the opportunity to travel through neighbouring Netherlands and to get to know, from the viewpoint of a foreigner, the opinions and access of the inhabitants to the hemp as healing and relaxing mean. The first chapter deals with using the healing hemp in the historical context. Hemp represents one of the oldest crops and for this reason the history of hemp in the period of antiquity, Middle Ages and modern times is described. The following chapter focuses on the individual substances contained in hemp. In this chapter, the endo-cannabinoid system and three kinds of substances contained in hemp strains are analysed canabinoids (THC), canabidiols (CBD), canabinols (CBN). The chapter presents the profile of one of the most important personalities associated with hemp, professor Raphael Mechoulam, the main icon and discoverer of THC. The chapter three devotes to toxicology and addiction when taking hemp, which occurs quite rarely among users of hemp drugs. In this chapter, influence of hemp on the memory of user is treated, as well as the influence of hemp on the occurrence of lungs diseases discussed constantly in connection with smoking and in the last part of this chapter, the addiction and influence of hemp on users psyche is analysed. The following chapter is devoted to the issue of the drug policy, especially defining the status of healing hemp in the law, research of healing hemp and legalization of hemp in the Czech Republic. This chapter is devoted in detail to the legalization of hemp in the world, especially in the states like California, Israel, Canada and Netherlands where the hemp was legalized for healing purposes many years ago. The present science brings a wide spectrum of clinical research examining the effects of hemp during the treatment of many diseases. For this reason, the chapter dealing with hemp in connection with medicine is present in the thesis. Six areas were chosen from individual medicine branches on which this chapter is focused. The reader learns about the healing effects of hemp in the area of oncological diseases, psychiatric diseases, palliation of pain, dermatological diseases, multiple sclerosis and HIV/AIDS. In the last chapter, the opinions and experiences of the professional public in connection with hemp are described. This part deals with the contribution of the newest knowledge presented at the Prague conference about healing hemp. In this part of thesis, also the international hemp Cannafest Trade Fair is mentioned held in 2015 in Prague. It follows clearly from the thesis that the health and social issues connected with healing hemp is the topic of extensive and long-lasting discussions at present. In the area of the lay public, there is interest in this form of medical treatment which is supported quite a lot. The thesis may be used as information source by medical/paramedical and social employees and organizations supporting the legal use of healing hemp. It could represent the base of a professional article for the journal dealing with this topic as e.g. professional journals "Legalization" or "Health." Last but not least, the thesis should serve as complex of information for the persons who decided to take the hemp or consider this possibility.

Este trabalho tomou como objeto de estudo a relação entre saúde, Estado e ética no âmbito do Sistema Único de Saúde brasileiro. Utilizando os espaços público e privado como categorias de análise, teve como objetivo verificar como a reforma do setor saúde, especificamente a legislação complementar Norma Operacional Básica de 1996 (NOB/96), que tem servido de base à reforma, e a Lei n. 9.637/98, que cria as Organizações Sociais e o Programa Nacional de Publicização, coadunam-se com o princípio ético, presente na Constituição “saúde é direito de todos e dever do Estado”. A análise baseou-se na legislação do SUS. Observou-se que o direito à saúde não está garantido na reforma do setor saúde, pois a concepção de Estado presente no SUS e aquela da reforma são diferentes. A análise mostrou ainda que a atual reforma tende a privatizar a saúde tanto na forma dos Programas da Saúde da Família e do Agente Comunitário da Saúde como através da transformação dos equipamentos de saúde de maior complexidade em organizações públicas não-estatais, submetendo a assistência à saúde às leis do mercado. Esse processo faz parte da reforma liberalizante do Estado brasileiro e acompanha a crescente privatização do espaço público, na contemporaneidade, que permite que o poder político seja ocupado por agências internacionais que impõem suas normas aos Estados nacionais. / This study took as a general object the relationship among health, State and ethics under the scope of the Brazilian Health Care System (BHCS). Utilizing public and private spheres as analytical categories, it had a particular objective of verifying how the health reform - particularly the complementary legislation Basic Operational Norm/96 and the law n. 9.637/98, that creates Social Organizations and the National Publicizing Program -, is in accordance with the ethical principle of the Constitution health is a citizen right and a State duty. Analysis was based on the BHCS legislation. It was observed that the right to health is not guaranteed by the health reform, mainly because its conception of State is different from that of the Constitution. Analysis shows yet that the current reform tends to privatize health care through both the Health Family Program and Community Health Agent Program and through the transformation of high complex health services in non-state health organizations. This process is part of the Brazilian State liberalizing reform and follows closely the growing privatization of public sphere on contemporary societies, that has being allowing international agencies to occupy political power by imposing their norms to the National States.

Este estudo teve como objetivo compreender e desvelar o sistema de referência e contra-referência, no contexto do Sistema Único de Saúde do município de Botucatu/SP/BR, a partir da experiência de enfermeiras que vivenciam essa prática. Para tanto, optei pela pesquisa qualitativa, modalidade do fenômeno situado, vertente metodológica da fenomenologia. Seguindo essa trajetória fenomenológica, cheguei às descrições das treze enfermeiras entrevistadas através da questão: \"Gostaria que você discorresse sobre a sua vivência e percepção em relação ao sistema de referência e contra-referência no Município de Botucatu\". Inicialmente, realizei um breve histórico do Sistema Único de Saúde no Brasil, contextualizando, a seguir, o sistema de referência e contra-referência, para depois explicitar os fundamentos metodológicos utilizados. A construção dos resultados deu-se a partir da análise e compreensão individual dos depoimentos (análise ideográfica) e, também, através da interpretação das convergências evidenciadas entre todos os depoimentos (análise nomotética). Evidenciei nessa análise treze temas, os quais foram reduzidos a três categorias: o funcionamento do sistema de referência e contra-referência, as possibilidades de encaminhamento e fatores estruturais do sistema local. As convergências obtidas permitiram vislumbrar um caminho que indica, enquanto essência deste estudo, que embora o sistema de referência e contra-referência no Município de Botucatu apresente problemas estruturais com precária organização, ocultando dificuldades de integração entre os serviços e, em alguns casos, desproporção demanda/oferta de serviços, existem reais possibilidades de melhoria do mesmo, uma vez que o Município conta com os três níveis de complexidade e, no momento, existe um fator de impulsão, que é o financiamento de propostas através do Programa UNI / This study aimed to understand and to care counter-reference and reference system upon the context of the Health Unique System in Botucatu-SP, Brazil from the nurses who experience this practice. I adopted a qualitative research, situated fenomena model, methodologically derived from phenomenology. Following this phenomenology course, I reached the descriptions from 13 nurses interviewed on the following question: \"I would like you to elucidate your experience and perception regarding counter-reference and reference system in Botucatu\". At first I performed a brief record about the Health Unique System in Brazil contextualizing as it follows counter-reference and reference system to explicit methodological basis afterwards. Results were obtained from analysis and individual comprehension from evidences (ideographic analysis) and also through the interpretation of the attested convergencies among all the evidences (nomothetic analysis). I attested 13 themes in this analysis, and they were reduced into 3 categories: counter-reference and reference system operation, guiding possiblities and local system structural factors. The convergencies allowed to glimpse at a way which indicates that although counter-reference and reference system in Botucatu show structural problems with scarce organization, hiding integrations difficulties among services, and in some cases, disproportion demand / supply, there are real betterment possibilities once the city has three complexity levels, and at the moment there is an impulsion factor, which is the proposals sponsoring through UNI Project

A reforma sanitária, ocorrida após a constituição de 1988, criou o Sistema Único de Saúde (SUS), descentralizando a gestão em saúde pública no Brasil e delegando mais autonomia e responsabilidade aos municípios. Esta descentralização traz inúmeros benefícios, pois aproxima a gestão das realidades locais. Os municípios são peculiares e podem apresentar dificuldades em atingir os mesmos padrões de serviços de saúde dos demais entes federados e, eventualmente, incorrer na desigualdade em saúde. Para garantir a integralidade no atendimento, as Redes Regionais de Atenção à Saúde (RRAS) articulam o sistema de maneira a satisfazer os diferentes níveis de complexidade. Procurou-se nesta pesquisa encontrar padrões espaciais destoantes na distribuição de recursos de saúde no estado de São Paulo, de maneira a caracterizar eventuais desigualdades em saúde. Os dados foram analisados por RRAS e por aglomerados de munícipios de atributos similares. Os resultados indicam diferenças regionais nos vários aspectos pesquisados, sobretudo na cobertura por equipes de saúde da família, no acesso aos serviços de saúde e na oferta e ocupação de leitos. Estas diferenças variam conforme se dista da capital do estado e estão associadas à renda e à presença da saúde suplementar. / The health care reformulation, which started after the constitution of 1988, created the Unified Health Care System (SUS), decentralizing the management of public health care in Brazil and delegating more autonomy and responsibility to counties.This decentralization brings numerous benefits because it approaches the county management to local area realities. Counties have different features and may have difficulties achieving the same health care standards of other federative entities and possibly create health care inequalities. To ensure comprehensiveness in health care, the Regional Health Care Networks (RRAS) articulate the system in order to provide the different levels of complexity. It is aimed in this research to find dissonant spatial patterns in health care resources distribution in the state of São Paulo, in order to characterize any inequalities. The data was analyzed by the RRAS and clusters of counties of similar attributes. Results indicate regional differences in several aspects of the research, mostly in family health care teams coverage, access to health care services and availability and bed occupancy rate. These differences vary according to how distant from the state capital the county is and are associated with income and health insurance attendance.

Class of 2006 Abstract / Objectives: To determine acceptance rate of pharmacist recommendation in an interdisciplinary chronic pain clinic. Subjects: Veterans enrolled in the Southern Arizona Veterans Administration Health Care System (SAVAHCS) Methods: The study will be a retrospective chart review. Data will be collected from electronic medical records. Included in this database are demographics, consult notes, medication history, and physician visits. Information unavailable will be medical care received outside the SAVAHCS closed system that is not disclosed by the patient. Number and types of recommendations, as well as acceptance of these options by the primary care provider will be calculated. Results: The number and type of recommendations initiated within 30 days will be calculated; and acceptance rates will be compared pre and post changes in the format of relaying these recommendations. Implications: The results will determine whether changing how the recommendation is presented to patients primary care providers (by the pharmacist) will affect acceptance rate.

Class of 2017 Abstract / Objectives: To determine the efficacy and toxicity of fluorouracil/leucovorin/oxaliplatin (FOLFOX) versus capecitabine/oxaliplatin (XELOX) in the treatment of colorectal cancer (CRC) in the adjuvant (aCRC) and metastatic (mCRC) setting in Veterans at the Southern Arizona Veteran Affairs Health Care System (SAVAHCS). Methods: A retrospective chart review was conducted to collect efficacy and toxicity data. Subjects were included based on age, treatment setting and regimen in the preset 5-year period, and appropriate diagnosis via International Classification of Diseases-Revision 9 (ICD-9) codes. Efficacy was measured via 1-year disease-free survival (DFS) for aCRC, progression-free survival (PFS) for mCRC, and overall survival (OS) for both settings. Results: A total of 79 subjects were initially enrolled with 51 and 54 all-male subjects included in the efficacy and toxicity analysis, respectively. Mean range of age was 63-72 years old. Subjects were divided into four groups: FOLFOX aCRC (17) and mCRC (19), XELOX aCRC (10) and mCRC (8). No difference was found in 1-year DFS and OS between aCRC groups, and PFS between mCRC groups; a higher incidence of 1-year OS with FOLFOX in the mCRC setting was noted (p = 0.03). No difference was found in toxicity between FOLFOX and XELOX, except a higher incidence of hand-foot syndrome in XELOX (p = 0.0007). Conclusions: Efficacy between FOLFOX and XELOX in aCRC and mCRC is similar, while toxicity is slightly more prevalent in XELOX due to increased hand-foot syndrome incidence. These findings agreed with the results reported by prospective clinical trials.