In 2004, Métis Nation offices began to register and issue identification cards to Métis citizens who met certain criteria. While many Métis people did register, and are registering, there are many who have not, and will not. As a result, some question the validity of the registry because it is unclear how it can reflect an accurate picture of the culture when not all Métis are represented. Through in-depth, unstructured interviews, my reflexive ethnography traces the accounts of six Métis citizens in southern Saskatchewan. I explore their stories about their Métis-ness, and their experiences with the registry. I also explore my own experiences with the registry and my journey to un/discover my own Métis-ness. The findings are presented in a creative non-fiction essay. The conclusions suggest that identification cards cannot grant someone admission to a culture; rather, cultural identity requires time, effort, intent, active participation, and meaningful connection with others.

Improving access to affordable housing is often approached through efforts to increase the supply of such housing, as the need to make better use of existing resources and coordinating the efforts of housing providers is often overlooked. A central housing registry in Winnipeg would be one approach to improving coordination and better access for low-income households to affordable housing. This study explores different examples of housing registries that exist in Canada and the United States. It provides insight into the benefits and challenges of housing registries through web searches and a survey. A focus group was also used to gain insight on the local context for developing a central housing registry. This research will increase the awareness of the benefits of a central housing registry and provides recommendations on how to approach the development and implementation of a central housing registry.

Improving access to affordable housing is often approached through efforts to increase the supply of such housing, as the need to make better use of existing resources and coordinating the efforts of housing providers is often overlooked. A central housing registry in Winnipeg would be one approach to improving coordination and better access for low-income households to affordable housing. This study explores different examples of housing registries that exist in Canada and the United States. It provides insight into the benefits and challenges of housing registries through web searches and a survey. A focus group was also used to gain insight on the local context for developing a central housing registry. This research will increase the awareness of the benefits of a central housing registry and provides recommendations on how to approach the development and implementation of a central housing registry.

No description available.

The quality of care for Swedish patients with acute myocardial infarction (AMI) is continuously increasing. Nevertheless, a great potential for improvement still exists. The aim of the present study was to design and implement a systematic quality improvement (QI) collaborative in the area of AMI care, and to validate its usefulness primarily by analyzing its effect on hospital adherence to national guidelines. Also, the impact on patient morbidity and mortality was to be evaluated. The intervention was based on proven QI methodologies, as well as interactive use of a web-based quality registry with enhanced, powerful feedback functions. 19 hospitals in the intervention group were matched to 19 similar control hospitals. In comparison with the control group, the intervention group showed significantly higher post-interventional improvements in 4 out of 5 analyzed quality indicators (significance shown for ACE-inhibitors, Clopidogrel, Heparin/LMWH, Coronary angiography, no significance for Lipid-lowering therapy). From baseline to the post-intervention measurement, the intervention hospitals showed significantly lower all-cause mortality and cardiovascular re-admission rates (events per 100 patient-years; -2,82, 95% CI -5,26 to -0,39; -9,31, 95% CI -15,48 to -3,14, respectively). No significant improvements were seen in the control group. The improved guideline adherence rates in the intervention hospitals were sustained for all indicators but one (ACE-inhibitors), this during a follow-up measurement three months after study support withdrawal. No effects were seen on any indicators other than those primarily targeted. In conclusion, by combining a systematic QI collaborative with the utilization of a national quality registry, significant improvements in quality of care for patients with AMI can be achieved.

Submitted by ERIC MATEUS NASCIMENTO DE PAULA null (eric.gyn@gmail.com) on 2016-07-30T15:23:11Z No. of bitstreams: 1 DISTRIBUIÇÃO ESPACIAL DA LEISHMANIOSE VISCERAL NO ESTADO DE SÃO PAULO, BRASIL, NO PERÍODO DE 1970 A 2014 Eric Mateus Nascimento de Paula.pdf: 3717410 bytes, checksum: 71497894de34d4d26508834cfadfd11a (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-08-02T13:37:45Z (GMT) No. of bitstreams: 1 paula_emn_me_jabo.pdf: 3717410 bytes, checksum: 71497894de34d4d26508834cfadfd11a (MD5) / Made available in DSpace on 2016-08-02T13:37:45Z (GMT). No. of bitstreams: 1 paula_emn_me_jabo.pdf: 3717410 bytes, checksum: 71497894de34d4d26508834cfadfd11a (MD5) Previous issue date: 2016-04-14 / Atualmente, no Brasil, a leishmaniose visceral (LV) é classificada como uma enfermidade reemergente, em processo de transição epidemiológica, juntamente com um aumento da incidência nas áreas endêmicas e presente em quatro das cinco regiões do território nacional. Assim, este trabalho objetiva analisar a evolução e a distribuição espacial da LV no Estado de São Paulo, desde o seu primeiro registro até o ano 2014, com vistas a fornecer subsídios para as autoridades de saúde pública para melhoria do programa de controle. Por meio de um estudo descritivo, dados secundários obtidos junto ao Centro de Vigilância Epidemiológica (CVE) e à Superintendência de Controle de Endemias (SUCEN) do Estado de São Paulo foram analisados e tratados em um sistema de informações geográficas (ArcGis 10.1), com confecção de mapas de distribuição. Observou-se que existem dois padrões distintos da distribuição da LV no estado: o da região oeste, definido pela ocorrência de casos humanos, alta prevalência de casos caninos e um maior número de municípios onde L. longipalpis está presente; e o da região leste, caracterizada pela ausência de notificação de casos humanos, até mesmo onde o flebotomíneo e casos caninos são presentes. Deduz-se que a expansão ocidental dos casos caninos e humanos seguindo a mesma rota de expansão do vetor não é coincidência, isso porque os registros do flebotomíneo precedem as notificações da doença no cão e, subsequentemente, no ser humano. A pesquisa serve de base para estudos futuros e fornece subsídios para ações do Programa Estadual de Controle. Sugere-se que haja um contínuo levantamento da presença do vetor e vigilância sorológica dos cães, bem como educação da população para que esteja receptiva à eutanásia dos cães em casos positivos, uma vez que em relação ao ciclo do vetor, nada pode ser feito. / Nowadays, in Brazil, visceral leishmaniasis (VL) is classified as a re-emerging disease, in a clear process of epidemiological transition, along with an increased incidence in endemic areas, and present in four of the five regions of the country. Therefore, this essay aims to analyze the evolution and spatial distribution of VL in São Paulo, since its first record until the year 2014, in order to provide information for public health authorities to improve the control program. By means of an ecological and descriptive study, secondary data obtained from the Centro de Vigilância Epidemológica (CVE) and the Superintendência de Controle de Endemias (SUCEN) of São Paulo were analyzed and treated in a geographic information system (ArcGIS 10.1), with confection distribution maps. It was observed that there are two distinct patterns of distribution of LV in São Paulo: one in the western region, defined by the occurrence of human cases, high prevalence of canine cases and a greater number of municipalities where sand fly is present; the other, represented by the eastern region, characterized by the absence of reporting human cases, even where the sand flies and canine cases are present. It follows that western expansion of canine and human cases following the same expansion route as the vector is not a coincidence, since the phlebotomine sandflies records precede the notifications of the disease in dogs and subsequently in humans. The research is the basis for future studies and provides subsidies for actions of the State Control Program. It is suggested that there is a continuous survey of the presence vector and serological monitoring of dogs as well as education of the population so that it is receptive to euthanasia dogs in the positive cases, since in relation to the vector cycle, nothing can be done.

No description available.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13302号 / 論医博第2191号 / 新制||医||1040(附属図書館) / (主査)教授 福原 俊一, 教授 湊谷 謙司, 教授 松村 由美 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Introduction Lung cancer is the most common cause of cancer-related death in the United States (US). Tobacco smoking is a well-recognized cause of lung cancer. About 2% of the United States (US) population lives in Tennessee (TN). Nearly 21 % of TN adults are current smokers as per 2019 data, compared to 14% across the US. The percentage of smokers has historically been high in TN and its surroundings. This can be attributed to the area's socio-economic and cultural characteristics, along with large areas of tobacco farming in the region. This increases the risk of lung cancer in the TN population. Surveillance Epidemiology and End Results Program (SEER) is a collection of cancer registries across the US, covering about 35% of the US population (TN cancer registry is not a part of SEER). Our study compares lung cancer incidence and characteristics in the TN cancer registry with the SEER 18 registry. Materials and Methods Data were collected from the TN cancer registry and SEER separately for lung and bronchial cancer. Data was analyzed for different histological subtypes, age groups, gender, stage at diagnosis, and rural/urban residence. Stata and Microsoft Excel were used in data analysis. A Chi-square test was used to calculate the statistical significance. Results From 2008 to 2017, 58644 cases of lung cancer were reported in the Tennessee cancer registry. During the same period, 519112 cases were reported in the SEER registry. The most frequent histological subtype of lung cancer in TN and SEER was adenocarcinoma (frequency of 17,503 Vs. 182346), followed by squamous cell carcinoma and small cell carcinoma. Most cancers in TN and SEER were diagnosed at stage of distant metastasis (46% vs. 52% ), followed by regional metastasis, localized, and in situ (Image1). The frequency of lung cancer diagnosis was high among those older than 65 in TN and SEER (64% vs. 69%). Males had a higher incidence of lung cancer in both registries. Most lung cancers were reported in the urban area in both registries. Chronic obstructive pulmonary disease was the most commonly reported secondary diagnosis (3,099), followed by pleural effusion in the TN database; the comparable data were not available in SEER. Relative survival at 12 months and five years for lung cancer in TN were 46.6 % and 19.5 % (Vs. 46.4% and 19.9% in SEER) Discussion and Conclusion If both registries were perfect, then lung and bronchial cancer incidence will be 9241 and 6048 per million in ten years in TN and SEER, respectively. But after careful analysis, we conclude that such analysis will be erroneous. The proportion of different histological types, stage at diagnosis, age groups, and gender were in the same order in both groups. Although chi-square test values are significant for all the variables, we infer no conclusion considering the data's inherent bias. Further in-depth analysis of the data is required.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13494号 / 論医博第2259号 / 新制||医||1060(附属図書館) / (主査)教授 石見 拓, 教授 大鶴 繁, 教授 近藤 尚己 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM