My thesis explores the knowledge, subjectivities and work performances that activist social workers bring to their practice in Ontario, Canada during a period of workplace restructuring that includes cuts to services, work intensification, increased surveillance and the evolving discourses of neoliberalism. A key aspect of my dissertation is the exploration of tensions between the attachments, desires and aspirations of the activist social work self and what that self must do every day to get by. I am interested in how it is that social workers produce and maintain their sense of identities – their integrity, ethics and responsibilities as activists – while also managing to navigate the contradictions of restructured workplaces. My aim is to understand not how power in the form of restructuring policies is imposed on people, but rather, how power acts through subjects who find themselves both implicated in, and struggling to resist neoliberal restructuring. My research lens draws on Michel Foucault’s ideas about governmentality and on feminist poststructural, critical race, and postcolonial theories. I use these theories to see neoliberal strategies of rule as working in diffuse ways through social and health service workplaces, encouraging service providers to see themselves as individualized and active subjects responsible for particular performances that enact specific types of change. My research findings reveal that activist social workers respond to neoliberal strategies of rule in multiple ways while constituting themselves through a variety of competing discourses that exist in their lives. Social workers subjectivities appear to be produced through a range of discourses drawn from their family histories, unique biographies and the intersections of socially produced distinctions that are based on gender, race, class, sexuality, age and nationalism. My dissertation traces some of the many ways that social workers position themselves within and beyond the changing context of neoliberalism. In doing so, my research reveals tentative pathways for building critical resistance practices and suggests future social welfare measures that are based on social justice and equity.

From September 2000 through May 2001, a team of two psychologists and two psychology graduate students (myself included) from the University of Saskatchewan delivered a variety of psychological services to a remote reserve community in northern Saskatchewan via telehealth from the Royal University Hospital in Saskatoon. Using telehealth, we provided psychoeducational information, therapy, assessments, case consultations and support services to Aboriginal health workers in this community. The present study is an evaluation of the use of telehealth in the delivery of psychological services to remote reserve communities. A semi-structured interview was employed to gain knowledge about the experiences of people involved in this telehealth project as well as the insights, thoughts and beliefs of Aboriginal and non-Aboriginal mental health workers regarding the use of telehealth with remote communities. In total, eight interviews were conducted for this study. Results indicate that although telehealth technology was seen as positive, psychology is often perceived in a negative manner by Aboriginal people. Due to this disconnection between Aboriginal people and Western psychology, psychological service provision with telehealth needs to be considered in conjunction with building relationships and trust in the community. Despite the difficulties, the results indicate that there is much that can be gained by providing psychological services to remote Aboriginal communities via telehealth.

Purpose: The first objectives of the current study was to determine whether disparities exist in mental health and mental health service use between minority and majority Canadian Francophone and Anglophone communities both within and outside of Quebec. The second objectives was to examine if official language minority-majority status was associated with the presence of common mental health problems and mental health service utilization.<p> Methodology: The current study used data from the Canadian Community Health Survey: Mental Health and Well-being, Cycle 1.2.7 Two main comparisons were made: Quebec Francophones to Quebec Anglophones, and outside Quebec Francophones to outside Quebec Anglophones. Twelve-month and lifetime prevalences of mental disorders and mental health service use were examined through bivariate analyses. Logistic regression analyses determined whether official language minority-majority status significantly predicts mental health problems and mental health service use using the Determinants of Health Model8-10 and Andersens behavioural model.11-13<p> Results: Very few significant differences were found between official language groups both outside and within Quebec, though some notable differences were found between Quebec and outside Quebec: Anglophones and Francophones outside Quebec had a higher prevalence of poor mental health and low life satisfaction compared their respective language counterparts in Quebec. Respondents from outside Quebec had a higher prevalence of consulting with a psychiatrist than respondents from Quebec. There was no significant association between membership in an Official Language Minority Community and mental health problems, and mental health service use. Implications: Although our results indicate that very few differences exist between official language minority and majority groups, these findings remain important and can help aid key stakeholders redirect resources and develop policies and programs towards areas and geographic locations wherein health disparities exist.

My thesis explores the knowledge, subjectivities and work performances that activist social workers bring to their practice in Ontario, Canada during a period of workplace restructuring that includes cuts to services, work intensification, increased surveillance and the evolving discourses of neoliberalism. A key aspect of my dissertation is the exploration of tensions between the attachments, desires and aspirations of the activist social work self and what that self must do every day to get by. I am interested in how it is that social workers produce and maintain their sense of identities – their integrity, ethics and responsibilities as activists – while also managing to navigate the contradictions of restructured workplaces. My aim is to understand not how power in the form of restructuring policies is imposed on people, but rather, how power acts through subjects who find themselves both implicated in, and struggling to resist neoliberal restructuring. My research lens draws on Michel Foucault’s ideas about governmentality and on feminist poststructural, critical race, and postcolonial theories. I use these theories to see neoliberal strategies of rule as working in diffuse ways through social and health service workplaces, encouraging service providers to see themselves as individualized and active subjects responsible for particular performances that enact specific types of change. My research findings reveal that activist social workers respond to neoliberal strategies of rule in multiple ways while constituting themselves through a variety of competing discourses that exist in their lives. Social workers subjectivities appear to be produced through a range of discourses drawn from their family histories, unique biographies and the intersections of socially produced distinctions that are based on gender, race, class, sexuality, age and nationalism. My dissertation traces some of the many ways that social workers position themselves within and beyond the changing context of neoliberalism. In doing so, my research reveals tentative pathways for building critical resistance practices and suggests future social welfare measures that are based on social justice and equity.

Official-language minorities in Canada may face specific issues in accessing health care services that can lead to negative consequences on their health, utilization of health care services and satisfaction with the health care system. A secondary data analysis of the 2006 Survey on the Vitality of Official-Language Minorities revealed significant differences between the Anglophone minority (n=5,161) and the Francophone minority (n=12,029) with regards to general health, and access to and use of health care services. Important predictors of these outcomes included age, education level, household income, marital status and place of residence (urban/rural). Access to health care services in the minority language was associated with self-perceived health in the Anglophone minority only. Health policy recommendations elaborated in light of the findings include working on both the supply and the demand of health care services offered in the two official languages, while taking into consideration important contextual differences between regions.

This thesis was undertaken to assess the characteristics of individuals who smoke crack cocaine and to examine the health-related risks and healthcare needs of this population. A literature review of 147 published articles was conducted to synthesize evidence regarding behaviours associated with crack use and to assess the risks of disease transmission through crack smoking behaviours. Qualitative interviews were subsequently conducted with thirty Ottawa residents who smoke crack to learn about their experiences with healthcare and harm reduction services. Results identified barriers related to accessing primary healthcare and drug treatment programming among people who smoke crack and gaps within existing harm reduction services. Individuals who smoke crack represent a marginalized population who are often missed through traditional health promotion and harm reduction programming. There is a need for increased coverage of current programming and a reduction of factors which currently hinder the delivery and effectiveness of crack-specific harm reduction programs.

Background: School health services of today focus on prevention and health promotion within the school. A collaboration between the school health services and the student care team from the guidelines with focus on the student, is expected. Purpose: The purpose was to illustrate School nurses  vocational experiences and what the role of school health services in the student care team at upper secondary schools of John Bauer in relationship to the vision of the school. Method: Qualitative content analysis with inductive approach was used (Lundman &amp;Hällgren-Graneheim, 2008). Data was collected by interviewing  school nurses at  School of John Bauer. Result: From the results school nurse´s health enhancement-and promoting work, team cooperation, prioritizing, management and co-ordination were found. From the data eight categories were found such as teamwork, health promoting tools, follow-up of schoolenvironment, knowledge, accessibility, low prioritized student care team, inadequate management and co-ordination of the team. Conclusion: According to the study, time limits and lack of comprehension from school management makes it more difficult for school health service to reach its fully potential. Theresults can be used to improve school nurses´ situation through self-education and encourage education of other student care team members and quality assurance.

From September 2000 through May 2001, a team of two psychologists and two psychology graduate students (myself included) from the University of Saskatchewan delivered a variety of psychological services to a remote reserve community in northern Saskatchewan via telehealth from the Royal University Hospital in Saskatoon. Using telehealth, we provided psychoeducational information, therapy, assessments, case consultations and support services to Aboriginal health workers in this community. The present study is an evaluation of the use of telehealth in the delivery of psychological services to remote reserve communities. A semi-structured interview was employed to gain knowledge about the experiences of people involved in this telehealth project as well as the insights, thoughts and beliefs of Aboriginal and non-Aboriginal mental health workers regarding the use of telehealth with remote communities. In total, eight interviews were conducted for this study. Results indicate that although telehealth technology was seen as positive, psychology is often perceived in a negative manner by Aboriginal people. Due to this disconnection between Aboriginal people and Western psychology, psychological service provision with telehealth needs to be considered in conjunction with building relationships and trust in the community. Despite the difficulties, the results indicate that there is much that can be gained by providing psychological services to remote Aboriginal communities via telehealth.

Arbetsplatsen är en arena där det finns goda möjligheter att arbeta hälsofrämjande. Inom äldreomsorgen finns det både utmaningar och möjligheter när det gäller att förändra arbetssituationen och på så vis förbättra de anställdas hälsa. För att underlätta detta arbete kan arbetsplatsen ta hjälp av externa samarbetspartners, till exempel företagshälsovården. Syftet med studien var att ta reda på hur de anställda inom äldreomsorgen i en kommun i södra Sverige uppfattar att samarbetet kring hälsofrämjande insatser mellan deras arbetsplats och företagshälsovården fungerar. Datainsamlingsmetoden som användes i denna studie var enkäter utdelade till alla 345 fast anställda. Svarsfrekvensen blev 49 procent. Resultatet visade att personalen uppfattade samarbete mellan chefen och företagshälsovården som bra men att det var obefintligt mellan dem själva och företagshälsovården. De anställda anser att samarbetet kan utvecklas genom bättre kommunikation och information. Slutsatsen som dras i denna studie är att cheferna bör tydligöra företagshälsovårdens roll i det hälsofrämjande arbetet. Genom välfungerande kommunikation och bra informationsspridning kan samarbetet mellan cheferna, de anställda och företagshälsovården förbättras. / The workplace is an arena where there are good opportunities to work health promotive. In the elderly care, there are both challenges and opportunities when it comes to changing the work situation and thereby improve the employees’ health. To facilitate this work, the workplace can take the help of external partners, such as the occupational health service. The purpose of this study was to find out how the employees of the elderly care in a municipality in southern Sweden perceive the cooperation between their workplace and the occupational health service when it comes to working health promotive. The data collection method used in this study was questionnaires distributed to all 345 of the permanently employed. The response rate was 49 percent. The results showed that the employees perceived that the cooperation between managers and the occupational health service was good, but that it was non-existent between themselves and the occupational health service. The staff has the opinion that the cooperation can be developed through better communication and information. The conclusion of this study is that managers should clarify the occupational health service´s role in the health promotive work. Through effective communication and good methods of spreading information, the cooperation between managers, employees and the occupational health service can be improved.

Research Objectives: Osteoporosis has become a significant public health problem in recent years, especially with the growth of the elderly population. Osteoporotic fractures exact a terrible toll on the population with respect to morbidity, cost, and to a lesser extent mortality. These effects can lead to psychological problems, social consequences, functional limitations, and poor quality of life. Thus, knowledge regarding osteoporotic fractures is needed to evaluate the impact of osteoporotic fractures on society, to identify high-risk populations, and to help policymakers to allocate resources accordingly. This study aims to investigate the influence factors of hospital readmissions among osteoporotic fractures patients in Taiwan, and the study results are expected to increase our understanding of the magnitude of the elderly population suffering from osteoporotic fractures and to urge policymakers to develop effective national prevention strategies. Study Design: Using Taiwan¡¦s National Health Insurance database, we identified elderly patients with a hospitalization for osteoporotic fractures between 2001 and 2007. We divided readmissions into different groups (14-day, 30-day, 180-day and over 180-day) and evaluated each group¡¦s demographic, hospital characteristics, and Charlson Comorbidity Index. The claims data are also used to calculate the health services utilization of osteoporotic fractures among those elderly patients with or without readmission of osteoporotic fractures. The data analyses were carried out by Chi-square test, t test, multiple linear regression and multivariate logistic regression. Population Studied: Patients aged 50 or older with osteoporotic fractures were identified based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Principle Findings: Among 5483 osteoporotic fractures patients, 6.9% of them were readmitted within 14 days, 34.7% were readmitted within 30 days and 13.9% were readmitted within 180 days. The medical resource utilizations were significantly higher in patients with readmissions than those without readmission. Age and Charlson Comorbidity Index were significantly affected the probabilities of readmissions. Conclusion: From the perspective of health policy, the issue of osteoporotic fractures will become increasingly important in the future. This national study will help raise awareness of osteoporotic fractures and hopefully motivate public health policy makers to develop effective national prevention strategies against osteoporosis to prevent osteoporotic fractures.