This study assessed the role of the International Organization for Migration (IOM) in HIV-prevention among mobile and vulnerable populations (MVPs) and potential emigrants in Beitbridge. A mixed-method approach, which combines quantitative and qualitative approaches, was used in this action research. A total of 20 in-depth face-toface interviews were conducted with key informants and 56 self-administered questionnaires were completed by MVPs and potential emigrants in Beitbridge. The study found that a number of effective strategies are currently being implemented as a preventative measure by the IOM within MVPs and potential emigrants’ communities in Beitbridge. At the same time, however, in order to ensure sustainability of these HIVprevention initiatives, the IOM must promote long-term synergies with other strategic partners throughout the project cycle. It is recommended that, the IOM strategically position itself by moving a step further from being the sole provider of emergency humanitarian support towards devising sustainable and durable solutions among MVPs and potential emigrants. / Sociology / M.A. (Social Behaviour Studies in HIV-AIDS)

Submitted by Izabel Franco (izabel-franco@ufscar.br) on 2016-10-04T14:13:08Z No. of bitstreams: 1 DissMYJS.pdf: 1946203 bytes, checksum: 3b57c2da542dcf929a01526c6b558c77 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-20T18:24:28Z (GMT) No. of bitstreams: 1 DissMYJS.pdf: 1946203 bytes, checksum: 3b57c2da542dcf929a01526c6b558c77 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-20T18:24:36Z (GMT) No. of bitstreams: 1 DissMYJS.pdf: 1946203 bytes, checksum: 3b57c2da542dcf929a01526c6b558c77 (MD5) / Made available in DSpace on 2016-10-20T18:24:42Z (GMT). No. of bitstreams: 1 DissMYJS.pdf: 1946203 bytes, checksum: 3b57c2da542dcf929a01526c6b558c77 (MD5) Previous issue date: 2015-12-18 / Não recebi financiamento / The enhance of the Unified Health System (SUS) in this country is still a challenge for the Brazilian public health, in order to allow the health services access for the whole population, with a good care quality, which includes the difficulties that homeless people have to be cared at the health services in this national territory. Despite that aforementioned population is numerically greater in the metropolis, nowadays even at medium-sized cities, such as São Carlos, there are people in this condition, justifying this city’s choice as the research field. This work aimed to analyze the caring practices and the conceptions of the homeless population in the city of São Carlos, from the speech of health professionals that work with that. Thereunto, social research methodology has been utilized, having as a tool the semi-structured interview, the focal groups with sixteen health services professionals from SUS who work with the health care for the homeless, and a representative of the specialized service for the homeless population from the Unified System of Social Assistance. For analyzing the data, the Content Analysis techinique has been used. In the light of the vulnerability concept and articles about the SUS and the homeless population care, five major content categories were discussed, extracted from the interview/focal groups. These were: Conceptions about the homeless population; Conceptions about the homeless population’s health care; Care provided to homeless population’s health; Knowledge about the network and intersectoral approach; Training for professionals to take care of the homeless. It has been argued that there is a need to occur a permanent education process for the workers, about the multiple intrinsic aspects of the street population caring. And that the municipal, state and federal managements enable the adequate working conditions, so that this work may happen with quality. / Ainda é um desafio para a saúde pública brasileira a potencialização do seu Sistema Único de Saúde (SUS) de forma a possibilitar a toda população o acesso aos serviços de saúde, e o cuidado ser realizado com qualidade. O que inclui a dificuldade da população em situação de rua em acessar os serviços de saúde neste território nacional. Apesar dessa população ser numericamente maior em metrópoles, atualmente, mesmo em cidades de médio porte, tal como São Carlos, existem pessoas nessa condição, justificando-se a escolha do município enquanto campo de pesquisa. O presente trabalho teve como objetivo analisar as práticas de cuidado e concepções sobre a população em situação de rua no município de São Carlos, a partir da fala dos profissionais de saúde que a realizam. Tratou-se de uma pesquisa social, tendo como instrumento a entrevista semi-estruturada e os grupos focais com 16 profissionais de serviços de saúde do SUS que praticam o cuidado as pessoas em situação de rua e um representante do serviço especializado para População de Rua do Sistema Único de Assistência Social. Para analisar os dados, foi utilizada a técnica da análise de conteúdos. À luz do conceito de vulnerabilidade e artigos a respeito do SUS e o cuidado à População em Situação de Rua discutiu-se cinco grandes categorias de conteúdos extraídos da entrevista/grupos focais. Foram essas: concepções sobre a População em Situação de Rua; concepções sobre o cuidado à saúde da População em Situação de Rua; cuidado realizado à saúde da População de Rua; conhecimento sobre a rede e intersetorialidade; formação para os profissionais cuidarem da População em Situação de Rua. Nos comentários finais, discutiu-se que existe a necessidade de ocorrerem processos de educação permanente para os trabalhadores sobre os diversos aspectos intrínsecos ao cuidado à população de rua. E que as gestões municipais, estaduais e federais possibilitem as condições adequadas de trabalho para que este trabalho possa ocorrer com qualidade.

A Síndrome da Imunodeficiência Adquirida (aids) configura-se como um dos grandes fenômenos da saúde pública na atualidade. Considerada como uma condição crônica manejável e controlável, porém não curável, torna-se necessário pensar em mecanismos que possibilitem minimizar os episódios de agudização e instabilidade das condições clínicas e de saúde. Esse estudo objetivou analisar as condições clínicas das pessoas que viviam com aids em acompanhamento nos serviços de assistência especializada (SAE) em HIV/aids do município de Ribeirão Preto-SP. Trata-se de um estudo descritivo, do tipo inquérito exploratório. A população do estudo constituiu-se pelas pessoas que viviam com aids (PVHA) em acompanhamento nos cinco SAE da rede pública municipal, no período de julho/2011 a fevereiro/2012, que atendiam aos seguintes critérios de inclusão: idade igual/superior a 18 anos, residentes no município e não pertencentes ao sistema prisional. Foram realizadas entrevistas com apoio de um questionário estruturado. Utilizaram-se fontes primárias e secundárias de informação. Os dados coletados foram digitados, armazenados e analisados por meio do programa Statistica, versão 9.0 da Statsoft. Os indivíduos foram caracterizados em relação ao perfil sociodemográfico e clínico, a partir de técnicas estatísticas descritivas. A seguir, os mesmos foram classificados em quatro grupos específicos, organizados a partir da articulação dos seguintes indicadores: marcadores do HIV/aids (carga viral e doenças oportunistas), situação imunológica (contagem de linfócitos T-CD4+) e a presença de outras condições crônicas. Utilizou-se teste qui-quadrado de proporção para identificar associação entre os grupos formados e as variáveis do perfil sociodemográfico. Foram entrevistadas 301 PVHA. Identificou-se paridade na proporção homens/mulheres, predomínio da faixa etária entre 40 e 64 anos, ensino fundamental incompleto, indivíduos solteiros/divorciados ou viúvos, classe econômica C, empregados/autônomos/afastados e que possuíam moradia própria. Quanto às condições clínicas no momento da entrevista, importante parcela possuía linfócitos T-CD4+ superiores a 500 células (61,5%), carga viral indetectável, ausência de doenças oportunistas e manifestações clínicas. Identificou-se elevado percentual de outras condições crônicas, com destaque para a hipertensão arterial sistêmica. Em relação à constituição dos grupos, mais da metade das PVHA foram classificadas como instáveis. Ao se analisar tais grupos, considerando as variáveis sociodemográficas, houve associação estatística significativa apenas no que se refere à ocupação. Urge a necessidade de delineamento e operacionalização de tecnologias capazes de ampliar a percepção acerca das necessidades e demandas dos das PVHA, oferecendo novas oportunidades para se refletir sobre a organização dos serviços e das práticas de saúde no controle do HIV/aids / The Acquired Immunodeficiency Syndrome (AIDS) is characterized as one of the greatest phenomena of public health today. It is considered a manageable and controllable chronic condition, but without possibilities of cure. For its care one need to consider mechanisms that allow the decrease of instability episodes and the worsening of clinical conditions and health status. This study aimed to analyze the clinical conditions among people living with aids in follow-up at the HIV/AIDS specialized assistance services (SAS) in Ribeirão Preto-SP. This is a descriptive and exploratory survey. The study population was composed by people living with AIDS (PLWHA) in follow-up at five local SAS during the period of July/2011 up to February/2012, who met the following inclusion criteria: aged above 18 years old, living in the city and outside the prison system. Interviews were conducted by using a structured questionnaire. We used primary and secondary sources of information. The collected data were entered, stored and analyzed using the Statistica software, version 9.0 from Statsoft. Individuals were characterized in relation to sociodemographic and clinical profile by applying descriptive statistics techniques. They were then classified into four specific groups, classified through the following indicators: HIV/aids markers (viral load and opportunistic infections), immune status (CD4+ T cell count) and the presence of other chronic conditions. We used chi- square ratio test for identifying association between these groups and the sociodemographic variables. A total of 301 PLWHA were interviewed. We identified male/female ratio parity, and the predominant characteristics: age between 40 and 64 years old, incomplete primary education, single/divorced or widowed individuals, economic class C, employed/autonomous/retired and owning their own house. As for the clinical conditions at the time of interview, a significant amount of interviewees presented CD4+T-cells count over 500 (61,5%), undetectable viral load, clinical manifestations and absence of opportunistic diseases. We identified a high percentage of other chronic conditions, especially hypertension. Regarding the formation of groups, more than half of PLWHA were classified as unstable. A statistically significant association only with regard to the occupation was found when analyzing such groups and considering sociodemographic variables. There is an urgent need to design and operate technologies that expand the perception of PLHA demands, offering new opportunities to reflect on the organization of services and health practices in the control of HIV/aids

Un corpus de recherches en sciences sociales et en santé publique menées principalement en Amérique du Nord depuis les années 1980 montre que l'absence de logement personnel a un effet délétère sur l'état de santé, physique et psychique des familles sans logement. En France, les études quantitatives sur la santé des femmes sans-domicile restaient exceptionnelles avant la réalisation de l'enquête ENFAMS conduite en Ile-de-France en 2013. A partir des données de cette enquête, nous avons montré que, bien qu’elles soient plus jeunes que les femmes en population générale, la santé des femmes sans logement est plus mauvaise, en particulier en ce qui concerne leur santé mentale et leur santé nutritionnelle. Malgré un état de santé plus mauvais, les femmes sans logement ont moins recours aux soins que les femmes en population générale. Cette thèse a permis de souligner l’importance du suivi gynécologique dans l’accès au dépistage des cancers féminins puisque la proportion de femmes dépistées du cancer du col de l’utérus est deux fois plus élevée chez les femmes avec un suivi que chez celles sans suivi. Nous avons aussi montré que dans le contexte français d’une couverture maladie universelle et de l’existence de filets de protection sociale, nous ne retrouvons pas les associations classiquement observées entre renoncement aux soins et ressources financières ou assurance maladie. Les professionnels en soins primaires doivent s’appuyer sur les fenêtres d’opportunité de dépistage qu’offre chacun de leur contact avec les services de soins. Les stratégies d’amélioration à l’accès aux soins de ces femmes ne doivent pas seulement viser à lever les obstacles financiers. / Social sciences and public health research conducted mainly in North America, since the 1980s, have shown that homelessness has a significant impact on health, physical conditions and psychological health of families without housing. In France, quantitative studies on homeless women were scarce until the realization of the ENFAMS survey in Paris region in 2013.Based on data from this survey, we showed that, although younger than women in the general population, the health of homeless women is worse, especially with regards to their mental health and nutritional status. Despite their poor health, homeless women have less access to health care than women in the general population. Our research has highlighted the importance of gynecological follow-up in accessing women's cancer screening since the proportion of women who were screened for cervical cancer was twice as high among women with follow-up than among women without follow-up. We have also shown that in the French context of universal health coverage and numerous social safety nets, we do not find the classic associations between unmet health care needs and financial resources or health insurance status.Primary care professionals need to rely on windows of opportunity provided by each of their contact with health care services to make them benefit from cancer screening. Strategies to improve the access to health care of these women must not only aim to remove financial barriers.

En France, sous l'impulsion de la loi du 4 mars 2002 relative aux droits des malades et à la qualité du système de santé, des modifications profondes de la relation de soin en faveur d'une participation plus active des patients ont été engagées imposant un repositionnement de chaque acteur de cette relation. La loi précise que l'implication des patients dans les processus de prise de décision doit être recherchée y compris lorsque les patients présentent des limitations de leurs capacités de décision. L'affirmation de ces droits va de pair avec la reconnaissance de capacités de décision aux patients et le développement d'une décision médicale partagée. Elle entraîne néanmoins, lorsque ces capacités sont atteintes, des difficultés concrètes dans le recueil du consentement du patient et/ou de ses représentants légaux et aidants. Il est aujourd'hui reconnu que les besoins en santé orale des patients présentant des limitations durables de leurs capacités de décision sont non satisfaits et augmentés par rapport à la population générale. Ces inégalités de santé résultent de nombreux obstacles dans l'accès aux soins et à la prévention, mais aussi dans la prise en charge, et alors que le principe d'égal accès au soin de tous les citoyens est reconnu comme un fondement juridique national. Cette situation constitue une perte de chance pour ces personnes d'autant plus qu'une santé bucco-dentaire dégradée peut avoir, au-delà des conséquences locales, des répercussions sur la santé générale et plus particulièrement sur la qualité de vie et l'intégration sociale. Ces difficultés cumulées quotidiennement conduiraient donc à privilégier des thérapeutiques symptomatiques sans réflexion de l'ensemble des acteurs autour d'une réhabilitation fonctionnelle globale. Pourtant, il est reconnu que la lutte contre les inégalités de santé passe par le développement d'une prise en charge globale de la santé. S'appuyant sur une participation des différents acteurs et notamment des patients aux prises de décision, celle-ci prévoit un décloisonnement entre les domaines relevant du sanitaire, du social et de l'éducatif pour un continuum par priorité. Ce travail, par une recherche qualitative et participative, a pour objectif d'explorer les raisons des limitations de réponse thérapeutique auprès de chaque acteur de la relation de soin - les patients, les aidants et les chirurgiens-dentistes. Une fois celles-ci mieux comprises, les différentes représentations sont confrontées et les tensions éthiques qui s'y dégagent discutées. Puis, des pistes d'évolution de la prise en charge de la santé orale, et au-delà, des évolutions sociétales sont proposées pour espérer à terme réduire les inégalités de santé. / In France, under the impulse of the Law of 4 March 2002 on patients' rights and the quality of the health system, deep changes have been undertaken in the care relationship for a more active participation of patients. This imposes a repositioning of each individual involved in the relationship. The law specifies that the involvement of patients in decision-making should be sought even when they present limitations of their decision-making abilities. The affirmation of these rights is consistent with the recognition of patients' decision-making abilities and the development of a shared decision. Nevertheless, when the limits of these abilities are reached, it leads to practical difficulties in the consent of patients and/or legal guardians and caregivers. It is now recognized that the oral health needs of patients with enduring limitations of their decision-making abilities are not satisfied, and are increased compared to those of the general population. These health inequities result from many barriers in access to care and prevention, but also during care, and yet the principle of equal access to care for all citizens is recognized as a national legal principle. This situation constitutes a loss of opportunity for these people - especially as, beyond its local impacts, impaired oral health may have impacts on their overall health and particularly on their quality of life and social integration. These limitations, which accumulate day after day, may lead to symptomatic therapies being favoured without concerted thinking on a global functional rehabilitation. Yet it is recognized that the fight against health inequalities requires the development of comprehensive overall health care. This means that, relying on the participation of the different stakeholders including patients in decision-making, the barriers separating areas concerning health, social and educational care have to be abolished for a continuum by priority. The aim of this work is to explore, by qualitative and participatory research, the reasons for the limitations of the therapeutic response from each member of the care relationship - patients, caregivers and dentists. Once these reasons have been better understood, the different representations are considered face to face and the ethical tensions that emerge are discussed. Then, ways in which the management of oral health can be improved and, beyond this evolution, ways in which society could change are proposed with the ultimate hope of reducing health inequalities.

Ante la baja concientización sobre el cuidado del medio ambiente, así como de prácticas relacionadas a la protección del ambiente en las entidades públicas, pese a contar con un marco normativo sobre la materia y entes reguladores, se tuvo a bien desarrollar en el Ministerio de la Mujer y Poblaciones Vulnerables (MIMP) sede central y sede Miraflores, la Campaña ECOMIMP 2019 dirigida a todos los/as trabajadores/as de las distintas modalidades contractuales de la institución. La citada Campaña desarrollada en los meses de noviembre y diciembre del año 2019, tuvo por finalidad sensibilizar y concientizar a los/as trabajadores/as del MIMP, sobre el cuidado y protección del medio ambiente, a través de actividades competitivas de segregación de residuos sólidos y ahorro de recursos entre oficinas, siendo las oficinas con mayores cantidades de residuos sólidos segregados en la competencia que obtuvieron (primer, segundo y tercer puesto). Los ganadores tuvieron como premio visitar una de las plantas recicladoras de Lima, con el fin de conocer y fomentar prácticas sobre el manejo adecuado de los residuos. Finalmente, y a efectos de medir el impacto de la campaña ECOMIMP 2019 en los trabajadores/as del MIMP, se elaboró un cuestionario de 29 preguntas (entre abiertas y cerradas), las mismas que fueron validadas por profesionales de distintas entidades públicas, y que tuvieron por objeto obtener información sobre sus experiencias durante el desarrollo de la campaña, así como la repercusión de la misma en su vida diaria (distintos ámbitos). La investigación se enmarca en un diseño no experimental, transversal y de enfoque cuantitativo, en el que se obtuvo una muestra de 121 encuestados con un margen de error de 5%. / Given the low awareness of caring of the environment, as well as practices related to the protection of the environment in the public entities, despite having a regulatory framework on the subject and regulatory entities, it developed in the Ministry of the Women and Vulnerable Populations (MIMP) headquarters and Miraflores headquarters, the ECOMIMP 2019 Campaign aimed at workers of the different contractual modalities of the institution. The aforementioned Campaign developed in the months of November and December in 2019, had the purpose of sensitizing and raising awareness to the workers of the MIMP, on the care and protection of the environment, through competitive activities of segregation of solid waste and saving of resources between offices, being the offices with the highest amounts of segregated solid waste in the competition they obtained (first, second and third place). The winners had the prize of visiting one of the recycling plants in Lima, in order to learn about and promote practices on the proper management of the waste. Finally, and in order to measure the impact of the ECOMIMP 2019 campaign on the MIMP workers, a questionnaire of 29 questions (between open and closed) was prepared, the same ones that were validated by professionals from different public entities, and which had the objective to obtain information about their experiences during the development of the campaign, as well as its repercussion in their daily life (different scopes). The research is framed in a non-experimental design, transversal and quantitative approach, in which a sample of 121 respondents was obtained with a margin of error of 5%. / Trabajo de investigación

While persons with disabilities are not a homogenous group, most are likely to be disproportionately impacted by climate change and the “natural” disasters that result from these changes. As a social worker living with chronic health conditions and a particular interest in disability and public policy, I was curious about how Canada’s Federal Government climate change policies and initiatives address persons with disabilities and their diverse needs. My research explored how matters of health and disability have been taken up in recent Canadian Federal Government climate change policies and strategies through an analysis of six significant climate change documents. Framed by a feminist, poststructural-inspired critical disability lens, the documents were examined through an inductive approach to reflexive thematic analysis, with the aim of contributing to critical conversations around the intersections of disability justice, climate justice, and related social justice matters. Through reflexive thematic analysis, I identified three key themes: persons with disabilities are widely absent from Canadian Federal Government climate change documents, both as collaborators as well as groups considered in climate change planning; adaptation to climate change and climate resilience are central in government climate mitigation strategies; and healthy and normative body-minds are presumed by the documents, which broadly assume all people have the same capacities to adapt. Subthemes included both a prioritization of the economy, and a foregrounding of a productive, compulsory, able-bodied and able-minded citizen around which climate change strategies are designed. I conclude with some suggestions for how Canada’s climate change policies may become more inclusive for persons with disabilities. / Graduate

No description available.

The concept of interprofessional practice and education is not new but has recently gained attention as the result of a paradigm shift in the future of healthcare and how it is delivered and financed. Universities are now addressing ways to incorporate interprofessional education and learning experiences into the curriculum to ensure graduating healthcare professionals are competent to collaborate as a team and deliver quality effective healthcare. A regional research university in East Tennessee with health programs across five Health Science colleges (Clinical and Rehabilitative Health Sciences, Medicine, Nursing, Pharmacy, and Public Health), Psychology, and Social Work has offered an interprofessional rural course for more than six years. The two-semester course is focused on vulnerable or underserved populations and rural communities in the south central Appalachian region. Each course section comprised of 8 to 10 students is led by a team of two or more faculty who represent a cross section of healthcare disciplines and focuses on a specific population or community. The student groups develop interprofessional working relationships among each other and faculty while partnering with rural communities. Using a community-based participatory research approach they prioritize health needs, and develop and implement evidence-based strategies to address the identified needs. Interprofessional education, cross cultural learning, and a university/community partnership within the context of the Hispanic migrant farmworker population are addressed in this paper. The course process, target population, cultural learning, and student outcomes are specifically discussed.

Indiana University-Purdue University Indianapolis (IUPUI) / Extreme Heat Events are the leading cause of weather-related mortalities in the continental United States. Recent publications have suggested that vulnerability to extreme heat is impacted by variations in environmental and socioeconomic conditions, even across small spatial units. This study evaluated the usefulness of socioeconomic variables and satellite-derived environmental measurements as predictors of heat-related vulnerability during the July 14-17, 1995 heat wave in Chicago, IL. Geospatial analysis and statistical processes were implemented to identify and rank characteristics of vulnerable populations. Results suggest population density, educational attainment, age, and financial indicators are among the best predictors of heat vulnerability. Proximity to and intensity of Urban Heat Islands also appears to influence neighborhood vulnerability levels. Identification and mapping of vulnerability variables can distinguish locations of increased vulnerability during extreme weather conditions. These vulnerability maps could be utilized by city officials to plan and implement aid programs to specific high risk neighborhoods before an extreme heat event, and resulting health implications, occur. Continued study and implementation of these variables could also assist in identifying vulnerable populations in other urban environments, improve utilization of location-specific heat warning systems and impact new building policies to decrease vulnerability variables across the country.