Aim To describe the epidemiology of tuberculosis in the city of Liepaja during the last 27 years and the management of patients with tuberculosis during the period 1993-2002; to identify problems in tuberculosis management relevant to increasing level of morbidity and the registered high levels of drug-resistance. Material and methods The cases were all persons reported with tuberculosis in 1975-2002. The data sources were the yearly Health Statistics books at the Latvian Office of Medical Statistics. The study used data from the available 655 individual patient records from Liepaja Tuberculosis Dispensery and TB Register of 1993 – 2002. Information was extracted selectively and extraction sheets containing the variables of interest were developed. The incidence differences according to sex and age, possible clustering of patients in high-risk living areas of the city, differences in occupation of the patients were studied. The differences of time from disease symptoms to diagnosis, as well as investigation data, treatment regimens, the proportions of treatment outcomes were analysed. Analysis was done using EPI-INFO programme for statistical analysis. Results In the 1980s tuberculosis was under control in Latvia and the incidence was at the European average level. After Latvia had regained independence in 1991, with economical and political disruption and changes in the health care system, TB incidence and mortality in the country increased rapidly as well as in Liepaja. Although not very high compared to global TB rates, there was great concern about TB control in Latvia. In addition, the emergence of drug resistance and multi-drug resistant bacteria made the TB epidemic more serious. The TB incidence increase in children suggested that there was quite a big number of undetected cases of TB. Tuberculosis control and early detection activities were not integrated into the PHC system. Treatment results of TB were quite poor and showed high proportions of interruptions, defaults, relapses. The tuberculosis control Programme in Latvia and Liepaja put much effort into the improvement of the epidemiological situation with TB, focusing on TB control activities and management during the period 1993-2002. The incidence of tuberculosis in Liepaja was higher than in Latvia, particularly in some living areas in the city, and above endemic level. Mortality rate in average was higher as in the whole country. The proportion of socially sensitive groups (children, unemployed, pensioners, disabled) comprised more than 50 % of the tuberculosis incidence. Incidence among medical staff was higher than in general population in the all professional groups. Medical delay of diagnosis decreased, but early detection of tuberculosis was not fully integrated in PHC system. There were quite big differences in numbers of MDR-TB in years 1993-2002. DOTS was introduced in Liepaja five years later than in Latvia –in year 2000 and strategy was not fully successful. The number of positive treatment outcomes increased, but the registered numbers of treatment relapses and defaults were higher than in Latvia . Conclusions The situation with regard to tuberculosis development and tuberculosis management in Liepaja during the period under study was unfavourable. Particularly : the incidence and mortality rates, much variation in the diagnostic process, results of treatment ,a high proportion of MDR-TB , unsatisfactory links between local government, family doctors and medical professionals and multi-sectoral collaboration in TB control activities , the objectives set up by WHO for DOTS treatment were not reached / <p>ISBN 91-7997-139-3</p>

In a recent report on the state of homelessness in Canada, it is estimated that at least 200,000 Canadians access homeless emergency services or sleep outside per year, with approximately 30, 000 homeless on any given night (Gaetz, Donaldson, Richter, Gulliver, 2013, 5). A strategy to address homelessness is Housing First. Housing First is an evidenced-based housing intervention strategy which provides homeless individuals with immediate access to housing and supports. A unique feature of this program is that participants are offered immediate housing of their choice. Prior to the introduction of Housing First, housing intervention strategies focused on “housing readiness” and often required sobriety or psychiatric treatment prior to entry. The Housing First approach has demonstrated significant recovery, cost savings and housing retention rates in The Mental Health Commission of Canada’s (MHCC) At Home/Chez Soi project—one of the world’s largest research studies utilizing a randomized control trial to study the outcomes of the Housing First approach. The At Home/Chez Soi project operated in five cities across Canada; Toronto, Montreal, Moncton, Winnipeg and Vancouver. Approximately 14% of At Home/Chez Soi participants had three or more moves and a portion of individuals in the MHCC’s study struggled to achieve stable housing. In an early findings report released by the MHCC one of the main themes that emerged from qualitative interviews conducted by At Home/Chez Soi project researchers included “changes in the social aspects of day to day life” once acquiring housing. Some of these changes were described to be negative. This finding highlights the impacts that the acquisition of housing may have on the experiences of Housing First participants. This demonstrates a need for further research to explore how social experiences relate to housing retention and mental health recovery in Housing First programming. In this research, I address this gap by focusing on understanding the social experiences of participants of Housing First programming for whom the transition into stable housing was difficult. More specifically, I ask “In relation to factors that impact housing retention, what is the experience of social connection and sense of community for a group of participants who had difficulty transitioning into housing provided through the At Home/Chez Soi Housing First program?” In this thesis, I present qualitative findings from narratives collected from 5 participants of the At Home/Chez Soi project for whom the transition to stable tenancy was difficult. Semi-structured interviews were conducted with five participants who had a range of experiences with housing retention including one participant who remained in their first apartment, and four others who had between 1-4 moves during their involvement in the At Home/Chez Soi project. In this research, I explored whether the fundamental needs of social connection and sense of community are instrumental in producing positive outcomes such as mental health recovery and housing retention in Housing First programming. Using narrative methodology and interpretive description, I further explore how the unmet needs of social connection and sense of community can assist in understanding the challenges experienced by individuals who struggle to transition into stable housing. The findings demonstrate that participants experienced a shift in social connection and sense of belonging to the “street”, to a feeling of connection to the housed community. All of the participants expressed wanting to disassociate themselves from the DTES. This was difficult because of stigmatization particularly on the part of the landlords and neighbours in their new communities. Discriminatory treatment in their housing served to reinforce negative feelings of self. The process of shifting to a sense of belonging to the housed community presented additional challenges, such as periods of isolation and/or being in the difficult position of saying “no” to friends in order to preserve their tenancy by abiding by the rules of the Residential Tenancy Act (RTA). Participants overcame these challenges by making adjustments in meeting their social needs. Some ways that participants demonstrated resilience included connecting with professionals, creating community in local shops, setting boundaries with old friends, and in some instances, cutting off from old friends. I conclude that social connection is paramount for these individuals. I also contend that the participants are resourceful in ensuring these needs are met. Recommendations for new or existing Housing First programming are made to ensure sensitivities and practices are geared to supporting these connections including offering flexibility and choice around locations and activities for weekly meetings with case managers. Other recommendations, specific to the transition into housing include incorporating a survey of important shops or services during the housing search process, and ensuring a good landlord-tenant fit during the housing selection process. / Graduate / 0617 / jynene_s@hotmail.com

Background Many trials in the USA, Canada, Europe and Australia have attempted to evaluate the effectiveness of preventive in-home health assessment and home care programs for older people. Trials have differed widely in their processes, including the dependence levels of subjects, assessment components and locations (clinic/home), intensity of case management (frequency of contact, length of follow-up period, scope of interventions) and methods of case management (telephone/visits). Preventive programs use valuable health resources and, although there has been inconclusive evidence of their effectiveness, programs combining preventive in-home health assessment and home care for older people have been introduced into public policy in Australia and internationally. Ongoing research is therefore essential in order to identify the positive benefits for older people, and establish their effectiveness with regard to health resource utilisation. Purpose The purpose of the study was to maintain the health status of older people living alone in the community by implementing a preventive health assessment and follow-up home care program. Research Design An experimental group was compared with a control group using a cluster randomised controlled trial methodology. Health outcomes were measured pre and post intervention, including health perception, functional ability, psychosocial status, client satisfaction, and health resource utilisation. Population and Sample The population for this study consisted of people aged 75 years and over who lived alone in Independent Living Units within managed retirement facilities, and who were highly independent in their activities of daily living. The final sample totalled 124, comprising of an experimental group (n=61) and a control group (n=63). The sample resided in South East Queensland. Intervention The intervention for the study "A Community Preventive Health Model for over 75s Living Alone" comprised of five major elements: 1) targeting before health and/or social crisis, and while community care needs were low; 2) linking clients with a community nurse; 3) comprehensive health assessments and identification of needs; 4) introduction of basic health care and community services and referrals if required; and 5) case management by three-monthly telephone contact. Assessments and case management were carried out by experienced community care registered nurses, and case management was performed for a one year period. The control group received health assessments and phone calls similar to the experimental group for data collection purposes, and to balance the risk of a Hawthorne effect due to regular contacts with participants. However all aspects of case management were omitted from all episodes of contact with the control group. For ethical reasons control group participants were supplied with a summary of their health assessment results to share with their GP if they wished. Data Collection and Instruments Measures of health perception, functional ability and psychosocial status occurred at two points (baseline and after 12 months). Measures of health resource utilisation, mortality and client satisfaction were measured after twelve months. A combination of several widely-used, valid and reliable instruments, as well as some newly developed data collection tools, were used to measure health outcomes. Data Analysis Independent group t-tests and Chi-square tests were used to examine for baseline differences between the experimental and control groups, and also to analyse health resource utilisation data at Time 2. A series of ANCOVA tests were applied to test the remaining hypotheses, so that the effects of Time 1 scores and potential confounding variables could be incorporated into the analyses. Results The experimental group and control group were homogenous at baseline for all demographic variables and all major outcome variables. The intervention model was applied for one year, with 66% (n = 40) in the experimental group having at least one unmet need identified and appropriate interventions undertaken. Only a small proportion of interventions (16%) were recorded as not being followed through by clients, and the majority (59%) resulted in needs being met or problems resolved. Results showed no benefits were gained from the program after one year for experimental group participants for the outcomes of health perception, functional ability, psychosocial status, health resource utilisation and mortality. However, the experimental group did show a statistically significantly higher level of satisfaction with care. Conclusions Comprehensive assessments performed by Registered Nurses with expertise in gerontology resulted in the identification of previously undetected unmet needs. When comprehensive assessment was combined with low intensity case management for a one year period, higher levels of client satisfaction with care were achieved. Therefore a model involving Registered Nurses with advanced knowledge and experience in aged care, working in collaboration with General Practitioners and community service organisations, could have considerable benefits in identifying unmet needs and improving client satisfaction. However, no client benefit was detected for quality of life outcomes, nor was a reduction in health resource utilisation found. This result from an Australian cohort is consistent with findings from many other international trials (Van Haastregt et al., 2000). It is possible that methodological issues are masking the effect of the intervention. Are we measuring appropriate outcomes? Are we expecting long-term outcomes in short time frames? Are we applying the model appropriately across a diverse older population? Further research to explore these questions is recommended for the future.

Four different case management programs delivered by UnitingCare Community Options (UCCO) in the eastern suburbs of Melbourne were examined against the expectations of case management as a policy solution to a range of perceived policy problems at the micro-, meso- and macro-levels. The micro-level expectations were related to client and family experiences of the service system and outcomes. At the meso-level expectations were focused on perceived service delivery problems such as poor matching of services to the needs of ‘complex’ clients including a lack of integration, flexibility and responsiveness to clients’ needs and preferences. Perceived macro-level policy problems were concerned with a variety of issues including increasing rates of institutionalisation, increasing costs to governments, lack of economic efficiency and the desire to create market or quasi-market conditions in the community care service delivery sector. (For complete abstract open document)

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2002. / Härtill 5 uppsatser.

Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2005. / Title from first page of PDF document. Document formatted into pages; contains [1], iii, 36 p. Includes bibliographical references (p. 30-31).

Diplomarbeit Hochschule für Angewandte Psychologie Zürich, 2005.

Thesis (M. of Gerontological Studies)--Miami University, Dept. of Sociology and Gerontology, 2005. / Title from first page of PDF document. Document formatted into pages; contains [1], v, 57 p. : ill. Includes bibliographical references (p. 49-51).

its boundaries, the recovery principle, patient's motivation and the case management provides the description of changes in client's motivation to abstain and f consequently, written down and recorded with the organization's internal system and was also carried out. The client's casuistry was chosen by method of ultimate selection, as it Studying the qualitative relation and its effects on client's transformation progress, it may client's positive relation with the counsellor could imply their occurrence. Further, aspects - - -