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Comprehensive Psychosocial Distress Screening in Patients Newly Diagnosed with Lung Cancer – A Mixed Methods StudyEmidio, Oluwabunmi M. 28 January 2022 (has links)
Background: Patients with newly diagnosed lung cancer have one of the highest rates of psychosocial distress which may be reduced by identifying factors associated with psychosocial distress. This dissertation examined the association of neighborhood-level Social Determinants of Health (SDOH) and delay in treatment initiation with psychosocial distress. It also qualitatively explored perceptions and practices of the lung cancer care team regarding psychosocial distress screening.
Methods: Sociodemographic, clinical, and SDOH data of patients newly diagnosed with lung cancer between 2017 and 2021 was analyzed via logistic regression. Thematic analysis was done for interviews conducted with the lung cancer care team.
Results: SDOH and delay in treatment were not significantly associated with psychosocial distress. However, a high deprivation level of SDOH was associated with delay in treatment initiation. Qualitatively, four principal themes emerged: (1) Timing and frequency of screening: Multiple screenings at different time points may be more effective; (2) Training needs: All staff would benefit from training; (3) Staffing needs: More psychologists and social workers are needed to address identified patient psychosocial distress and; (4) Opportunity for holistic patient care: Consistent communication of distress screening information to physicians and surgeons may enhance a holistic care model for patients.
Conclusions: The lung cancer care team valued psychosocial distress screening and identified opportunities for improving screening processes. The finding of association of high deprivation level of SDOH with greater delay in treatment initiation suggests that targeted interventions to reduce delay in treatment initiation, focusing on economically marginalized groups may be warranted.
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Kvalita života v dimenzi zdraví: Česko v regionálním pohledu / Quality of life in dimension of health: Czechia in regional perspectiveSmetanová, Marie January 2021 (has links)
This thesis focuses on the quality of life in dimension of health at the regional level in the Czechia for the period 2010-2019. The main aim of this work is to describe and evaluate the spatial differentiation and spatio-temporal variability of the concept quality of life in dimension of health at the regional level of administrative districts of municipalities with extended powers. The assessment is based on objective indicators mapping the health status of the population, lifestyle, and the availability of primary health care. The theoretical part describes definitions quality of life, the characteristics of whole concept, health, its determinants, and inequalities that arise in health and can resonate at the regional level. This work also describes the types of prevention, as an effective tool in reducing health inequalities and the possible promotion of public health, in the form of improving health literacy. The analytical part is based on factor and cluster analysis and methods of spatial autocorrelation. In the Czech Republic, significant regional differentiation of quality of life in health dimension has been found. Furthermore, spatial patterns were discovered drawing attention to problematic and favourable areas within the observed concept. It turned out that the resulting quality of...
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Global Health Experiences in the Development of Healthcare ProfessionalsModayil, Maria I. 24 September 2020 (has links)
No description available.
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Mind, Body, Spirit: Muslim Women's Experiences in TherapyAlia Azmat (11204100) 30 July 2021 (has links)
This dissertation presents in the form of two distinct chapters conceptually related in nature. The first chapter integrates literature from various fields such as indigenous, womanist, and feminist lenses to propose nine principles when working with Muslim women. The purpose of the second chapter is to examine Muslim women’s experiences in therapy at university counseling centers. The study explores women’s experiences from a social determinants of health perspective and a narrative inquiry method—namely, how intrapersonal, interpersonal, institutional, community, and policy factors inform women’s experiences. Qualitative analysis from interviews with six women suggests Muslim women navigate multiple systems which inform their beliefs about health and their experiences in therapy.
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[en] LEGAL REGIME OF ULTRA-PROCESSED FOODS ADVERTISEMENT IN BRAZIL: AN ANALYTICAL PERSPECTIVE IN LIGHT OF THE COMMERCIAL DETERMINANTS OF HEALTH / [pt] REGIME JURÍDICO DA PUBLICIDADE DE ALIMENTOS ULTRAPROCESSADOS NO BRASIL: UMA PERSPECTIVA CRÍTICA À LUZ DOS DETERMINANTES COMERCIAIS DA SAÚDECARLA DA SILVA DE BRITTO PEREIRA 30 June 2022 (has links)
[pt] O consumo de alimentos ultraprocessados, ao lado do consumo do tabaco e
do álcool, constitui uma das principais causas de doenças crônicas não
transmissíveis – principal causa de mortes em adultos no Brasil –, sendo a
publicidade de tais produtos considerada pela Organização Mundial da Saúde um
dos fatores comerciais determinantes deste problema de saúde pública. A situação
demanda a análise quanto a se o controle jurídico da publicidade no país tutela, de
forma suficiente, os direitos fundamentais à saúde e à proteção do consumidor
impactados pelas estratégias de marketing da indústria alimentícia. Neste sentido,
o trabalho se propõe a realizar esta análise, com o intuito de compreender o regime
jurídico de controle da publicidade no Brasil, por meio das normas do Código de
Defesa do Consumidor e da autorregulamentação publicitária, assim como a
natureza da proteção jurídica da publicidade no Direito brasileiro, a partir dos
conceitos de liberdade de expressão comercial e livre iniciativa, a fim de identificar
a legitimidade de restrições a estes direitos, com foco em estudos doutrinários e
pesquisas em Tribunais brasileiros, sobretudo no âmbito do Superior Tribunal de
Justiça e do Supremo Tribunal Federal; realizando, por fim, algumas proposições
críticas, com o objetivo de contornar os problemas verificados – em especial a
necessidade de regulação específica para estabelecer medidas restritivas à
publicidade destes alimentos. / [en] The consumption of ultra-processed foods, together with the consumption
of tobacco and alcohol, constitutes one of the main causes of non-communicable
diseases – the principal cause of deaths in adults in Brazil –, being the advertisement
of such products deemed by the World Health Organization as one of the
commercial determinants of such public health problem. The situation demands the
analysis of the sufficiency of the legal regulation of commercial speech in the
country, with a view to verify if it duly protects the fundamental rights to health
and consumer protection once impacted by marketing strategies adopted by the
food industry. Thus, this work proposes to carry on such analysis, with the intent to
understand the legal regime of commercial speech regulation in the country,
through the norms of the Consumer Protection Statute and the self-regulation code,
as well as the nature of the legal protection of commercial speech under Brazilian
law, related to the notions of rights to freedom of commercial speech and free
enterprise, with the purpose to identify the legitimacy of restrictions to such rights.
The work will focus in academic studies as well as research on Brazilian courts
decisions, specially under the Superior Court of Justice and the Constitutional
Supreme Court, finally, from an analytical perspective, aiming to identify existing
problems – mainly, the need to implement specific regulation establishing
restrictive measures to advertisements of ultra-processed foods.
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Activité physique et exposition à l’environnement bâti : analyses d’équité par accélérométrie et GPSPaquette, Simon 08 1900 (has links)
Objectifs. Pour augmenter l’activité physique populationnelle et réduire les inégalités relatives à
l’environnement bâti, on doit identifier le rôle des profils sociodémographiques individuels dans
les niveaux d’activité physique et d’exposition aux environnements bâtis favorables au mode de
vie actif.
Méthodes. Cette étude combine des données d’accélérométrie et de GPS collectées auprès de 820
participants durant 10 à 30 jours entre 2018 et 2020 dans les études INTErventions urbaines,
Recherche-Action, Communautés et sanTé (INTERACT) et Réseau Express Métropolitain (REM).
Différents modèles de régressions multiniveaux ‒journées nichées dans des individus‒ testent les
associations et les interactions entre les profils sociodémographiques, les niveaux d’exposition à
des facteurs environnementaux susceptibles de favoriser le mode de vie actif (infrastructures de
transports, commerces, densité bâtie et espaces verts) et la proportion journalière de minutes
actives. Les résultats sur l’échantillon de l’application EthicaData sont comparés à ceux sur
l’appareil SenseDoc.
Résultats. Les participants plus âgés, universitaires ou sans emploi ainsi que les femmes sont
moins actifs. Les participants plus âgés, non-universitaires, sans emploi ou à haut revenu ainsi que
les hommes sont moins exposés à l’environnement bâti favorable à l’activité physique.
Discussion. Les niveaux d’activité physique et d’exposition à l’environnement bâti ainsi que les
effets de l’exposition environnementale ne varient pas systématiquement en défaveur des groupes
désavantagés systémiquement. Des associations sont inattendues entre l’exposition à
l’environnement bâti et le mode de vie actif. Les résultats basés sur le GPS sont concordants entre
EthicaData et SenseDoc, mais discordants pour ceux basés sur l’accélérométrie. / Aim. To increase population levels of physical activity and reduce inequalities related to built
environment, we must identify the role of individual-level sociodemographic profiles in physical
activity levels, and in levels of exposure to built environment that may contribute to active living.
Method. This study combines accelerometry and GPS data collected among 820 participants
during 10 to 30 days between 2018 and 2020 within the INTErventions, Research, and Action in
Cities Team (INTERACT) and Reseau Express Metropolitain (REM) studies. Multiple multilevel
models ‒days nested within individuals‒ test associations and interactions between socio demographic profiles, levels of exposure to environmental factors susceptible to promote active
living (transport infrastructures, shops, built density and green spaces) and the daily proportion of
active minutes. Results on the EthicaData application subset are compared to those on the
SenseDoc device subset.
Results. Participants who are older, have a university profile or are unemployed, along with
women, are less active. Participants who are older, don’t have a university profile, are unemployed
or have a higher income, along with men, are less exposed to built environment that may contribute
to physical activity.
Discussion. The levels of physical activity and exposure to built environment, and the effects of
environmental exposure on physical activity, do not vary systematically in disfavor of systemically
disadvantaged groups. Some associations between exposed built environment and active living are
unexpected. Results based on the GPS are consistent between EthicaData and SenseDoc, but
inconsistent for those based on accelerometry.
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“Black Wombs Matter" : A Case Study of the Maternal Deaths of Black Women in the US, Based on the Documentary AftershockMeignen, Eva Maggy Mireille January 2023 (has links)
The maternal mortality rate in the USA is the highest in the industrialized world. Black women in the USA are three times more likely to die due to pregnancy and childbirth-related health issues than their white counterparts. According to 2017–2019 data from the CDC, 80% of these deaths are preventable.The purpose of this thesis is to understand how women’s bodily autonomy is both racialized and politicized. Key questions here are: What is the relationship between access to healthcare and reproductive rights? How are reproductive rights racialized? How is bodily autonomy racialized and politicized?This research is based on a literature review and a case study of the documentary Aftershock, released in July 2022. Aftershock charts the deaths of two young Black American women after they gave birth and shows how their partners and families stood together and became effective activists determined to fight the Black maternal mortality epidemic in the US, and thereby increase awareness and bring about change in society.
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Development of Enhanced User Interaction and User Experience for Supporting Serious Role-Playing Games in a Healthcare SettingAlow, Mark Lee January 2022 (has links)
No description available.
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Transformer les pratiques professionnelles vis-à-vis des personnes prestataires de l’aide sociale : développement participatif et évaluation d’une formation continue en cabinet dentaireLévesque, Martine C. 01 1900 (has links)
L’objectif de la présente thèse est de générer des connaissances sur les contributions possibles d’une formation continue à l’évolution des perspectives et pratiques des professionnels de la santé buccodentaire. Prônant une approche centrée sur le patient, la formation vise à sensibiliser les professionnels à la pauvreté et à encourager des pratiques qui se veulent inclusives et qui tiennent compte du contexte social des patients. L’évaluation de la formation s’inscrit dans le contexte d’une recherche-action participative de développement d’outils éducatifs et de transfert des connaissances sur la pauvreté. Cette recherche-action aspire à contribuer à la lutte contre les iniquités sociales de santé et d’accès aux soins au Québec; elle reflète une préoccupation pour une plus grande justice sociale ainsi qu’une prise de position pour une santé publique critique fondée sur une « science des solutions » (Potvin, 2013).
Quatre articles scientifiques, ancrés dans une philosophie constructiviste et dans les concepts et principes de l’apprentissage transformationnel (Mezirow, 1991), constituent le cœur de cette thèse. Le premier article présente une revue critique de la littérature portant sur l’enseignement de l’approche de soins centrés sur le patient. Prenant appui sur le concept d’une « épistémologie partagée », des principes éducatifs porteurs d’une transformation de perspective à l’égard de la relation professionnel-patient ont été identifiés et analysés.
Le deuxième article de thèse s’inscrit dans le cadre du développement participatif d’outils de formation sur la pauvreté et illustre le processus de co-construction d’un scénario de court-métrage social réaliste portant sur la pauvreté et l’accès aux soins. L’article décrit et apporte une réflexion, notamment sur la dimension de co-formation entre les différents acteurs des milieux académique, professionnel et citoyen qui ont constitué le collectif À l’écoute les uns des autres. Nous y découvrons la force du croisement des savoirs pour générer des prises de conscience sur soi et sur ses préjugés.
Les outils développés par le collectif ont été intégrés à une formation continue axée sur la réflexion critique et l’apprentissage transformationnel, et conçue pour être livrée en cabinet dentaire privé. Les deux derniers articles de thèse présentent les résultats d’une étude de cas instrumentale évaluative centrée sur cette formation continue et visant donc à répondre à l’objectif premier de cette thèse. Le premier consiste en une analyse des transformations de perspectives et d’action au sein d’une équipe de 15 professionnels dentaires ayant participé à la formation continue sur une période de trois mois. L’article décrit, entre autres, une plus grande ouverture, chez certains participants, sur les causes structurelles de la pauvreté et une plus grande sensibilité au vécu au quotidien des personnes prestataires de l’aide sociale. L’article comprend également une exploration des effets paradoxaux dans l’apprentissage, notamment le renforcement, chez certains, de perceptions négatives à l’égard des personnes prestataires de l’aide sociale.
Le quatrième article fait état de barrières idéologiques contraignant la transformation des pratiques professionnelles : 1) l’identification à l’idéologie du marché privé comme véhicule d’organisation des soins; 2) l’attachement au concept d’égalité dans les pratiques, au détriment de l’équité; 3) la prédominance du modèle biomédical, contraignant l’adoption de pratiques centrées sur la personne et 4) la catégorisation sociale des personnes prestataires de l’aide sociale. L’analyse des perceptions, mais aussi de l’expérience vécue de ces barrières démontre comment des facteurs systémiques et sociaux influent sur le rapport entre professionnel dentaire et personne prestataire de l’aide sociale. Les conséquences pour la recherche, l’éducation dentaire, le transfert des connaissances, ainsi que pour la régulation professionnelle et les politiques de santé buccodentaire, sont examinées à partir de cette perspective. / This thesis aims to generate knowledge on how a continuing education course might contribute to the evolution of oral health professionals’ perspectives and practices. Promoting patient centered care, the course aims to sensitize professionals to poverty issues and to encourage socially inclusive practices that take into account the social context of patients. The course evaluation is nested within a participatory action research project aimed at developing educational and knowledge transfer tools to sensitize oral health professionals to poverty issues and Our research strives to contribute to the fight against social inequities in health and in access to care in Québec; it is grounded in our intent for greater social justice and reflects our belief in the importance of a critical public health founded on a « science of solutions » (Potvin, 2013).
Four scientific articles, grounded in constructivism and in the concepts and principles of transformative learning theory (Mezirow, 1991), constitute the heart of this thesis. The first presents a critical review of the literature on health professional education for patient-centered care. We focus on the concept of shared epistemology as a foundation for patient-centered care and determine and analyse the educational principles allowing for its development in students and practitioners.
Our second article, located within the participatory developmental process, delves into the co-construction of a social realist screenplay portraying poverty and issues of access to dental care. The article examines and reflects on the participatory processes, in particular the co-learning that took place among the partners involved in writing the screenplay and in producing the educational tools on poverty. We discover the potency of shared knowledge among professionals, citizens, educators and academics for enhancing reflection on bias and perspective taking.
The educational tools developed have been integrated into an onsite credited continuing education course on poverty and oral health, privileging critical reflection, founded on transformative learning theory, and integrating dimensions of person-centered care. The results of an instrumental case study among the 15 members of a dental team having participated in the course constitute the last two articles of the thesis. The first describes and analyzes the new meanings and actions among course participants, emphasizing shifts in thinking about the causes of poverty, about life on welfare, about certain patient behaviors and about the participants themselves. New actions refer to changes made in verbal and non-verbal communication and appointment giving policy. The article also examines unanticipated and paradoxical effects of learning, such as the reinforcement of certain beliefs.
The final thesis article presents the case study results in terms of the participants’ experience of their workplace ideologies and how these constitute obstacles or objections to learning or to making practice or policy changes. These ideologies include 1) identification with a for-profit and private market oral health care system; 2) “equal treatment”, a belief constraining concern for equity and the recognition of discriminatory practices; 3) a predominantly biomedical orientation to care; and 4) stereotypical categorization of publically insured patients into « deserving » vs. « non-deserving » poor. This knowledge contributes to our understanding of systemic influences on professionals’ practices and interactions with patients living on welfare. We discuss implications for research, dental education and knowledge translation, as well as in terms of oral health policy and oral health professional regulation.
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Sociokulturně znevýhodněné prostředí a jeho vliv na dítě předškolního věku / Socioculturally disadvantaged environment and its influence on pre-school childHolubová, Petra January 2014 (has links)
SUMMARY: The thesis describes a situation of the part of inhabitants of the Czech Republic that are currently regarded as socio-culturally disadvantaged. It aims to term factors that endanger a healthy and harmonic development of children living in a socio-culturally disadvantaged environment. The means of child protection are specified on international and national level and the current legislation in this field is reviewed. The thesis also deals with the position of ethnic minorities in the Czech Republic and concentrates on Romany minority. On the example of one city district of Prague is presented the lifestyle of Romany community, their cohabitation with the majority and their usage of Romany ethnolect. Possible causes of formation of socially excluded communities are listed together with social and health risks for Romany people that concentrate in such local communities. The situation in the field of education of pre-school children coming from a socio-culturally disadvantaged environment is described and legislative and executive measures to support their access to education are reviewed. Social determinants of health are termed and their impact on Roma community in the Czech Republic is assessed. The research part of the thesis deals with the education of the children attending compensatory...
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