The importance and benefits of involving community members in health policy making-­-from the first step of needs assessment through to actual policy development--are increasingly being recognized. This thesis describes the evaluation of a community consultation process which was part of a needs assessment conducted by Saskatoon District Health, in Saskatchewan, Canada. In September 1995, a Children and Youth Working Group was formed, made up of volunteers representing service providers, users, and families. Their mandate was to develop and priorize recommendations on ways to improve the health status of children and youth in the District, which has a total population of approximately 300,000. In addition to a comprehensive epidemiological assessment, the Working Group engaged in a community consultation process which solicited input from the general community, with a specific emphasis on key groups such as youth, Aboriginal, immigrant/refugees, and service providers in health, education, social services, and justice. In this process, information on perceived needs of children and youth was collected through 20 focus groups (n=213) and a questionnaire (n=1,985). Based on a synthesis of the quantitative and qualitative data, the Working Group drafted a set of recommendations, which were then discussed at a community meeting for input and feedback. <p> This research evaluates the effectiveness of the consultation process in facilitating community participation using three sources of data: the entire consultation process was observed (from January 1996 until February 1997), including the focus groups, Working Group meetings, and the final community meeting; interviews (2) were held with the Working Group (n=9), with selected individuals who had participated in the consultation (n=7), and with non-participants (n=2); and documentation produced by the Working Group (i.e., minutes, notes, background material) was reviewed. These data were analyzed thematically according to criteria established jointly by the representatives of the member groups of the Population Health Project (Working Group, Coordinating Group, Research Advisory Group) and the researcher. The effectiveness was gauged by comparing the findings with the criteria and with the components of meaningful community consultation as defined by the Working Group (appropriateness, timeliness, completeness, accuracy, representativeness, relevance). The themes which emerged from the analysis deal with the participants' feelings about their participation or non­participation, the success of the consultation process, the nature of the data collected; by-­products of the process, and the consultation's influence on the outcome of the needs assessment. The results of this analysis are presented and conclusions drawn regarding factors that contribute to or impede effective public participation in health needs assessment.

School psychologists have increased their practice of consultation within the schools due to mandates by the National Association of School Psychologists (NASP) and positive outcomes associated with the service. Previous research has examined how training directors at school psychology graduate programs viewed consultation training. The current study investigated how school psychologists view their training in consultation and how they view the practice of consultation in school systems. A random sample of 510 school psychologists from across the country was sent a survey to obtain their perspectives on consultation. A 46% return rate was achieved. The respondents were divided into two groups based on the practitioner’s years of experience (i.e., more than 10 years experience and less than 10 years experience) in order to make comparisons based on when the school psychologists received their training. Results indicated that recent graduates reported more comprehensive training in consultation, a heavier emphasis on collaborative and problem-solving consultation and significantly higher levels of satisfaction with consultation training and practice. However, recent graduates did not perceive their skills with consultation to be higher than school psychologists with less training, but more experience.

This dissertation uses population-based administrative healthcare data to evaluate the outcomes, processes-of-care and practice variation associated with preoperative medical consultation in Ontario, Canada. First, a multicentre cross-sectional study was conducted to develop a novel algorithm for identifying preoperative medical consultations using administrative data. The optimal claims-based algorithm was a physician service claim for a consultation by a cardiologist, general internist, endocrinologist, geriatrician, or nephrologist within 120 days before the index surgery. This algorithm had a sensitivity of 90% (95% confidence interval [CI], 86 to 93) and specificity of 92% (95% CI, 88 to 95). Second, we conducted a population-based cohort study to evaluate the association of preoperative medical consultation with outcomes and processes-of-care. After adjustment for measured confounders using propensity-score methods, consultation was associated with increased preoperative testing, preoperative pharmacological interventions, 30-day mortality [relative risk (RR) 1.16; 95% CI, 1.07 to 1.25], 1-year mortality (RR 1.08; 95% CI, 1.04 to 1.12), and mean hospital stay (difference 0.67 days; 95% CI, 0.59 to 0.76). These findings were stable across subgroups, as well as sensitivity analyses that tested for unmeasured confounding. Third, temporal trends and practice variation in consultation were evaluated within the population-based cohort. The proportion of patients undergoing consultation remained relatively stable over the study period, at approximately 39%. Although patient-level and surgery-level factors did predict consultation use, they explained only 6.8% of variation in consultation rates. By comparison, inter-hospital differences in rates were substantial (range, 1.9% to 86.8%), were not explained by surgical volume or teaching status, and persisted after adjustment for patient-level and surgery-level factors. Overall, this dissertation highlights the need for research to identify interventions for safely decreasing perioperative risk, define mechanisms by which consultation influences outcomes, examine factors that influence practice variation in medical consultation, and identify patients who benefit most from preoperative medical consultation.

The importance and benefits of involving community members in health policy making-­-from the first step of needs assessment through to actual policy development--are increasingly being recognized. This thesis describes the evaluation of a community consultation process which was part of a needs assessment conducted by Saskatoon District Health, in Saskatchewan, Canada. In September 1995, a Children and Youth Working Group was formed, made up of volunteers representing service providers, users, and families. Their mandate was to develop and priorize recommendations on ways to improve the health status of children and youth in the District, which has a total population of approximately 300,000. In addition to a comprehensive epidemiological assessment, the Working Group engaged in a community consultation process which solicited input from the general community, with a specific emphasis on key groups such as youth, Aboriginal, immigrant/refugees, and service providers in health, education, social services, and justice. In this process, information on perceived needs of children and youth was collected through 20 focus groups (n=213) and a questionnaire (n=1,985). Based on a synthesis of the quantitative and qualitative data, the Working Group drafted a set of recommendations, which were then discussed at a community meeting for input and feedback. <p> This research evaluates the effectiveness of the consultation process in facilitating community participation using three sources of data: the entire consultation process was observed (from January 1996 until February 1997), including the focus groups, Working Group meetings, and the final community meeting; interviews (2) were held with the Working Group (n=9), with selected individuals who had participated in the consultation (n=7), and with non-participants (n=2); and documentation produced by the Working Group (i.e., minutes, notes, background material) was reviewed. These data were analyzed thematically according to criteria established jointly by the representatives of the member groups of the Population Health Project (Working Group, Coordinating Group, Research Advisory Group) and the researcher. The effectiveness was gauged by comparing the findings with the criteria and with the components of meaningful community consultation as defined by the Working Group (appropriateness, timeliness, completeness, accuracy, representativeness, relevance). The themes which emerged from the analysis deal with the participants' feelings about their participation or non­participation, the success of the consultation process, the nature of the data collected; by-­products of the process, and the consultation's influence on the outcome of the needs assessment. The results of this analysis are presented and conclusions drawn regarding factors that contribute to or impede effective public participation in health needs assessment.

The purpose of this study was to determine whether radiologists could accurately assess osteopenia on chest plain films. Two chest radiologists evaluated lateral chest films from 100 patients (80 female and 20 male), ranging in age from 16 to 86 years, for osteopenia and its associated findings. Intra- and interobserver agreement was determined using weighted kappa statistics, and accuracy was assessed by making comparisons to bone mineral density as measured by the non-invasive gold standard of dual-energy x-ray absorptiometry (DXA). Overall, radiologists were good at identifying signs of late, but not early, disease. Intraobserver consistency was substantial for fish vertebrae (Kw1=0.638; Kw2=0.0.712) with moderate interobserver agreement (Kw=0.45). Similarly for wedged vertebrae, intraobserver consistency was substantial to moderate (Kw1=0.654; Kw2=0.533) with substantial interobserver agreement (Kw=0.622). These radiographic signs correlated with true disease as shown by high specificity values. Therefore, this study indicates that if osteopenia is suspected (i.e., there is a wedge or fish vertebra) or its associated features are seen on a CXR, it is crucial for radiologists to comment on it. The literature suggests that referring physicians do not pay attention to such findings in radiology reports. Radiologists could effect change in clinical treatment by not burying these findings in the report body, but instead putting it in the impression, along with a recommendation that the finding be followed up with DXA. Because effective interventions for women with osteoporosis exist, the results of this study will contribute to a major change in the practice of chest radiology and improve womens health by preventing the devastating disability associated with osteoporosis.

Reproduction de : Thèse d'exercice : Médecine. Médecine générale : Nantes : 2008. / Bibliogr.

Thesis (D. Min.)--Dallas Theological Seminary, 2003. / Abstract. Includes bibliographical references (leaves [189]-193).

No description available.

The research literature has repeatedly emphasized the importance of parent involvement and parent training in the early intervention of young children with autism spectrum disorder (ASD). In fact, parent mediated Early Intensive Behavioral Intervention (EIBI) programs have become a popular method of treatment in recent years. Studies examining these programs have demonstrated that a number of variables may significantly impact the outcomes of EIBI. Moreover, an examination of the psychotherapy literature underscores the importance of a strong parent-therapist alliance as a correlate of positive processes and outcomes in child therapy; while there is very little research examining the working alliance as a factor in parent consultation.The purpose of the present study was to examine the relationship between the working alliance and the consultation process in parent-mediated EIBI for young children with ASD. Forty-four parents of children with an ASD, who were also conducting home-based EIBI programs, completed the Working Alliance Inventory (WAI) (Horvath & Greenberg, 1989) plus other measures that assessed treatment process and outcome. In addition, eight independent consultants completed similar measures to assess perceptions of alliance, process, and outcomes of their consultees.The results showed parent ratings of the working alliance were significantly correlated with parent ratings of treatment acceptability for child treatment as well as for parent consultation. Parent ratings of alliance also correlated significantly with parent ratings of parent progress in consultation and child progress in treatment. Consultant ratings of alliance were significantly correlated with both parent progress and parent improvement in consultation. This suggests that the working alliance may be a contributing factor to the process and outcome of consultation with parents of children with ASD.The results of the present study were compared to the current literature on the therapeutic alliance and relationship factors in consultation. The limitations of the present study and suggestions for future research are also discussed.

This dissertation aims to use a system thinking approach to describe and evaluate the Lead-Acid Battery Recycling Program in British Columbia, compare it with other provincial regulated recycling programs and identify strategies on how it can be improved. The research is presented in the manuscript based format, comprised of four interrelated chapters. Following the introduction, chapter 2 describes a multiple regression analysis to assess how various factors identified by informed stakeholders have contributed to recycling rate in 14 transportation zones from 1995 to 2005. This study demonstrates that the existing recycling scheme ineffectively promotes recycling as it has achieved an average of 75% over the past 13 years with large fluctuations among transportation zones. The regression also shows that recycling rate of transportation zones are not highly influenced by LME lead prices and Transportation Incentive (which can be explained by the strong market power of the recycling plants responsible for setting up the price of scrap lead to which the collectors respond). Chapter 3 identifies key components that influence the performance of varied recycling systems based on a comparative analysis of provincial recycling systems informed by expert interviews. In chapter 4, comprehensive evaluation criteria for the lead-acid battery recycling program is developed based on objectives and performance measures elicited through an extensive stakeholder consultation process with various individuals and organizations. Fundamental objectives identified by stakeholders include: reduce environmental impacts, reduce occupational health impacts, reduce net costs, increase equity in resource consumption patterns and increase systematic learning. In chapter 5, we use multiple criteria decision analysis (MCDA) to design and assess effective recycling strategies to meet societal objectives previously identified in the chapter 4. Recycling strategies were compiled using the results of chapter 3. The results reveals that the optimal policy for the lead-acid battery recycling system combines a return to retailer program financed through an advanced disposal fee included in the battery price in combination with increased plant or recycling capacity domestically. This research also provides relevant contributions to the refining and application of value-focused thinking and decision analysis methodologies.