<p> <b>Introduction:</b> Substance Use Disorders (SUDs) cause significant distress to millions of Americans and considerable impact to society at large. Stigmatization of mental illness has been identified as the number-one barrier to seeking healthcare and it is unclear to what degree Mental Health Professionals (MHPs) share this negative bias. Education in SUDs for MHPs may play a role in reducing stigma in the treatment of SUD patients. The effect of education in SUDs on implicit and explicit attitude change is investigated longitudinally in a Substance Abuse Counseling MA Degree Program in Psychology. Academic outcomes and student demographic characteristics are assessed. <b>Hypotheses: </b> Implicit and explicit attitudes will change over the study period and will be related at follow-up. Knowledge acquired of SUDs will predict attitude change. <b>Methods:</b> This study was longitudinal, following 20 students over one year of study via assessment at baseline and follow-up. The drop-out rate was 20%, with 16 students remaining at follow-up. Implicit attitudes were assessed included the SC-IAT, explicit attitudes were assessed with the SAAS (general attitudes), DDQ (discrimination), and SDS (social distance). Academic progress was assessed via an Addictions Knowledge Test and the DDPPQ (confidence treating SUDs). <b>Results:</b> No significant change was found for implicit attitudes. Significant change in the positive direction was found for the SAAS. SAAS scores were positively correlated with DDQ scores at baseline and DDQ and SDS scores at follow-up. Both Addictions Knowledge Test Scores and DDPPQ scores and increased significantly over the study period, but they were not significantly related. DDPPQ scores were positively correlated with all explicit attitude measures. <b>Conclusion:</b> The CMHSAC Program was effective in increasing positive explicit attitudes toward SUDs, but it is unclear if personal attitudes actually shifted or if awareness was brought to the problematic nature of stigma instead. Students&rsquo; self-perception of their confidence and competence to work clinically strongly predicted explicit attitude change. Actual knowledge and confidence may not be directly related. Further research is needed to clarify the facets of education that are most effective in stigma reduction. Larger studies should be conducted to further investigate the effect of education on implicit attitudes.</p>

Changes to the technological landscape of the National Health Service (NHS) in the UK have often raised debates on information privacy and patient confidentiality. This has been especially pertinent in the context of HIV health services, where patient records have been historically segregated from hospital notes to protect confidentiality and account for the nature of the condition as a stigmatised terminal illness. However, as current anti-retroviral treatment extends life expectancy, HIV is increasingly managed in ways similar to other chronic conditions and integrated patient management has been proposed as best practice. This shift offers a unique opportunity to study reconfigurations of privacy and confidentiality practices from the perspective of data users. This thesis focuses on a technological integration project between the stand-alone systems used in two HIV specialist outpatient centres and the centralised Electronic Patient Records (EPR) of their respective NHS Hospital Trusts. The case study methodology draws on 46 semi-structured interviews with health and IT professionals, supplemented by an analysis of organisational documents and observation of work practices over a period of six months in the two clinics. In weaving together different theoretical concepts, this thesis contributes to an in-depth, empirically informed understanding of privacy and confidentiality practices in healthcare. Firstly, by looking at how HIV practitioners cultivate their professional identities at the intersection of general medical and HIV-specific confidentiality, this thesis argues that identity work is an important component in the reconfiguration of privacy practices. Secondly, this research draws attention to the role of political negotiations for privacy change, as HIV professionals and EPR developers came in conflict over the ethics of the technological integration project in the hospitals studied here. Thirdly, this thesis illustrates how confidentiality practices are shaped within the co-construction of information infrastructures and medical work, especially in relation to HIV normalisation. A number of implications for practice and policy also emerge from this study.

Aims: The aims of this thesis were to investigate the risk of severe maternal morbidity amongst women from different socioeconomic groups in the UK, explore why these differences exist and compare these findings to the setting in Australia. Methods: Three separate analyses were conducted. The first used UK Obstetric Surveillance System (UKOSS) data to assess the incidence and independent odds of severe maternal morbidity by socioeconomic group in the UK. The second analysis used quantitative and qualitative data from the 2010 UK National Maternity Survey (NMS) to explore the possible reasons for the difference in odds of morbidity between socioeconomic groups in the UK. The third analysis used data from the Victorian Perinatal Data Collection (VPDC) unit in Austra lia to assess the incidence and odds of severe maternal morbidity by socioeconomic group in Victoria. Results: The UKOSS analysis showed that compared with women from the highest socioeconomic group, women in the lowest 'unemployed' group had 1.22 (95%CI: 0.92 - 1.61) times greater odds associated with severe maternal morbidity. The NMS analysis demonstrated that independent of ethnicity, age and parity, women from the lowest socioeconomic quintiJe were 60% less likely to have had any antenatal care (aOR 0.40; 95%CI 0.18 - 0.87), 40% less likely to have been seen by a health professional prior to 12 weeks gestation (aOR 0.62; 95%CI 0.45 - 0.85) and 45% less likely to have had a postnatal check with their doctor (aOR 0.55; 95%CI 0.42 - 0.70) compared to women from the highest quintile. The Victorian analysis showed that women from the lowest socioeconomic group were 21% (aOR 1.21 ; 95% CI 1.00 - 1.47) more likely and that Aboriginal and Torres Strait Islander women were twice (aOR 2.02; 95%CI 1.32 - 3.09) as likely to experience severe morbidity. Discussion: The resu lts suggest that women from the lowest socioeconomic group in the UK and in Victoria have increased odds of severe maternal morbidity. Further research is needed into why these differences exist and efforts must be made to ensure that these women are appropriately prioritised in the future planning of maternity services provisio n in the UK and Australia.

This thesis presents an empirical investigation into substance use, situational characteristics and sexual outcomes in men who have sex with men (MSM) motivated by the high rates of substance use in MSM; the association between substance use and sexual risk behaviours in MSM; the lack of specific theory addressing relationships between substance use, sexual interactions and social interactions between MSM; and the need for clearer understandings of encounter-level associations with sexual risk. Qualitative metasynthesis. This thesis begins with laying the methodological groundwork for a qualitative metasynthesis that theorises the relationship between substance use and social spaces in MSM, with a particular focus on sexual outcomes. The qualitative metasynthesis derives the key organising perspective of ‘littoral spaces’ in which substance use is associated with a pre-planned, though temporary, escape from the boundaries of everyday life to engage in maximal sensory exploration, including through sexual contact. <b>Systematic review of multiple-event analyses. The thesis then turns to a systematic review of previous quantitative multiple-event analyses examining associations between situational characteristics and sexual outcomes, which establishes the need for additional multiple-event analyses addressing specific substance use, location of sex, partner serodiscordance and partner type. Multiple-event analyses. Finally, informed by the qualitative metasynthesis and the systematic review of event-level analyses, this thesis presents multiple-event analyses addressing unprotected anal intercourse (UAI), pleasure and control as sexual outcomes in MSM in England. These analyses found that substance use was associated with greater odds of UAI and pleasure, but not with control, and that non-private locations of sex were associated with decreased odds of UAI and pleasure, but not control. Furthermore, there was sparse evidence of interactions between respondent and partner substance use and between respondent substance use and location of sex in associations with sexual outcomes. These analyses contribute to understandings of associations between substance use, situational characteristics and sexual risk behaviour by presenting the first known analyses on MSM in England and by examining sexual outcomes besides UAI.

Thesis (M.A.) - Carleton University, 2002. / Includes bibliographical references (p. 88-95). Also available in electronic format on the Internet.

La collaboration entre les professionnels de la santé s’avère être nécessaire pour faire face au vieillissement de la population, à la prévalence des maladies chroniques et à la pénurie de personnel chez certaines professions de la santé (OMS, 2010). De plus, pour favoriser une collaboration optimale et offrir des soins de qualité, des équipes choisissent désormais d’adopter une approche de soins en partenariat patient où la collaboration interprofessionnelle se déroule en valorisant les savoirs expérientiels du patient à l’égard de la vie avec la maladie et en l’intégrant dans l’équipe de soins. L’Université de Montréal (UdeM) offre une formation à l’éducation à la collaboration interprofessionnelle (EIP) visant à enseigner des compétences de la pratique collaborative en sciences de la santé et en sciences psychosociales en partenariat avec le patient. L’EIP est confrontée à divers défis, entre autres, de logistique, de communication et de cloisonnement des professions. Pour surmonter ces obstacles, l’UdeM s’est donc tournée vers le numérique afin de permettre à des équipes interprofessionnelles d’étudiants de collaborer en ligne et en présentiel. Cette étude s’intéresse donc à décrire comment les étudiants réunis en équipe interprofessionnelle collaborent dans le contexte du cours hybride de Collaboration en sciences de la santé (CSS) en partenariat avec le patient offert par l’UdeM. Nous décrivons comment les étudiants collaborent en ligne et en présentiel et nous identifions les compétences du référentiel de compétences mobilisées. Notre étude propose un cadre conceptuel basé sur l’apprentissage collaboratif en mode hybride (en ligne et en présentiel) de l’EIP composé 1) du modèle de Chiocchio, Grenier, O’Neill, Savaria et Willms (2012) permettant de décrire comment les équipes d’étudiants mobilisent les dimensions de la collaboration (communication, synchronisation, coordination implicite et explicite); 2) du référentiel de compétences de la pratique collaborative et de partenariat patient en santé et services sociaux (Direction collaboration partenariat patient [DCPP] et Comité interfacultaire opérationnel l’Université de Montréal [CIO-UdeM], 2016) et 3) de la typologie du travail interprofessionnel de Xyrichis, Reeves, Zwarenstein (2018). 18 Notre étude emploie une méthodologie mixte convergente. Nous avons mené cette étude auprès d’une cohorte de 1435 étudiants de deuxième année de baccalauréat dans le cadre du cours CSS2900 provenant de treize programmes à l’UdeM. Ce cours se divise en trois volets: 1) formation en ligne 2) activité intraprogramme, 3) atelier interprofessionnel en présentiel coanimé par un professionnel de la santé et un patient formateur. Premièrement, nous avons analysé le Journal de bord collaboratif (JBC) de douze équipes interprofessionnelles d’étudiants (n=60), soit un corpus de cette cohorte. Deuxièmement, nous avons partagé un questionnaire La collaboration en équipes interprofessionnelles à la cohorte à la fin du cours et celui-ci a été répondu par 321 participants. Les résultats indiquent que les participants de l’étude ont majoritairement et similairement mobilisé les dimensions de la collaboration. La communication et la coordination seraient tributaires de la synchronisation lorsque la collaboration se déroule en ligne. L’usage des médias sociaux et d’un outil d’écriture collaborative en ligne auraient favorisé la collaboration en mode hybride. En présentiel, le patient partenaire coanimateur a soutenu des équipes pour faire le point sur leurs apprentissages et ainsi développer des compétences du référentiel du cours CSS2900. Le contexte de l’étude en mode hybride permet aux équipes de collaborer sur une longue période, à la manière d’une classe inversée (figure 29). Ceci favoriserait le développement des compétences du référentiel (DCPP et CIO-UdeM) et le décloisonnement des professions. Les contextes d’apprentissage où les pratiques des compétences effectives ont été mobilisées semblent se rapprocher du réseautage interprofessionnel et de la collaboration consultative de la typologie de Xyrichis et coll. (2018). / Collaboration among health professionals is required to contend with population aging, the prevalence of chronic illnesses, and staff shortages in certain health professions (WHO, 2010). As well, to foster optimal collaboration and provide good quality of care, some teams are now adopting a patient partnership approach in which the patient’s experiential knowledge of living with illness is valued as part of the interprofessional collaboration and the patient is integrated into the healthcare team. The Université de Montréal (UdeM) offers a program in interprofessional collaboration education (IPE) geared towards teaching the competencies required for collaborative practice in both health sciences and psychosocial sciences in partnership with patients. The IPE is confronted with a variety of challenges related to logistics, communication, and the compartmentalization of professions, among others. To overcome these obstacles, the UdeM has turned to digital technology to help interprofessional teams of students to collaborate online and in person. This study focused on describing how students in interprofessional teams collaborate in the hybrid course entitled Health Sciences Collaboration in Partnership with Patients, offered by the UdeM. We describe how students collaborate online and in the classroom, and we identify the competencies in the competency framework used. Our study proposes a conceptual framework based on the IPE’s hybrid (online and in person) collaborative learning model, which we constructed using: 1) the model of Chiocchio, Grenier, O’Neill, Savaria, and Willms (2012), to describe how the student teams collaborate and used dimensions of collaboration (communication, synchronisation, explicit and implicit coordination) ; 2) the competency framework for collaborative practice and patient partnership in health and social services (Direction collaboration et partenariat patient [DCPP] and Comité interfacultaire opérationnel de formation à la collaboration, l’Université de Montréal [CIO-UdeM], 2016); and 3) the interprofessional work typology of Xyrichis, Reeves, and Zwarenstein (2018). Our study used a convergent mixed methodology. We conducted this study with a cohort of 1,435 second-year undergraduate students in course CSS2900 coming from 13 20 different UdeM programs. This course is divided in three parts: 1) online training 2) intra- program activity, 3) interprofessional workshop coanimated by a health professional and patient-partner facilitator in classroom. First, we analyzed the online collaboration journal (OCJ) of 12 interprofessional student teams (n = 60). Second, we distributed a questionnaire on Collaboration in Interprofessional Teams to the entire cohort at the end of the course, to which 321 participants responded. The results show that the majority of study participants used the dimensions of collaboration in a similar manner online and in person. Communication and coordination were dependent on synchronization when collaboration occurred online. The use of both social media and an online collaborative writing tool fostered collaboration in hybrid mode. In the classroom, the patient-partner co-facilitator supported the teams as they reviewed their learning (coordination) and, in this way, developed the competencies of the framework for course CSS2900. Under the hybrid study model, the teams were able to collaborate over an extended period, similar to a flipped classroom approach (Figure 29). This fostered development of the framework competencies (DCPP and CIO-UdeM) and helped break down professional boundaries. The learning contexts in which effective competency practices were mobilized appeared analogous to the interprofessional networking and consultative collaboration categories in the typology of Xyrichis et al. (2018).

The diploma thesis deals with problems of depression in older people. Mainly the work is focused on identifying and analyzing the role of nurses in screening for depression in older people in primary care, acute care, long-term care and home care. This thesis was focused on theoretical direction and was used the method of design and demonstration. In this thesis was set one main goals with five research questions. The main goal was to identify and analyze the role of nurses in screening for depression in the elderly. RQ 1: What is the role of the nurse in screening for depression in the elderly? RQ 2: What is the role of the nurse in the primary care in screening for depression in the elderly? RQ 3: What is the role of the nurse in screening for depression in hospitalized patients in acute care? RQ 4: What is the role of the nurse in screening for depression in seniors in long-term and home care? RQ 5: What rating scales and methods are used in screening for depression in the elderly? The thesis introduce the concept of depression. The following are specified the causes of and the important factors that affect depression in the elderly. It also deals the differences in the clinical symptomatology of depression in old age. It explains possibilities and various barriers in the diagnosis of depression. Another chapter introduces complete geriatric examination, diagnostic classification systems, possible screening methods and scales for detection of depression in the elderly population. It also deals methods of pharmacological and non-pharmacological treatment and its possible complications associated with older age. By reason of increased suicide rate caused by depressive disorder the issue of suicidal behavior in the elderly is introduced. The next chapter deals with the nursing process, which is used by nurses in practice. It consists of the evaluation of the patient's health condition, making nursing diagnosis, creating nursing plan and subsequent implementation and evaluation. The nursing process is also needy for providing quality care. The nursing process in the stage of nursing diagnosis, introduces possible nursing diagnosis for a patient suffering from depression, which are based on the latest classification. Finally is described the role of nurses in screening for depression in the elderly in different health facilities and their contribution to the timely evaluation of depression in the elderly. This chapter introduces the role of nurses, nursing screening and collaboration with a physician. The role of nurses in screening for depression in different medical facilities is based on the first phase of the nursing process of assessment. On the basis of objective and subjective information, the nurse will assess the overall health and mental condition of the patient. Primarily, it was investigated what is the role of the nurse in screening for depression. On the basis of content analysis and synthesis it was necessary to used and processed domestic and foreign literature. A number of relevant sources are the results of various studies and Meta-analyzes, mostly from abroad, but also from the Czech Republic. The thesis can serve as a basis for nurses. The result of this thesis is to create e-learning material available for students in the Faculty of Health and Social Sciences of South Bohemia in Ceske Budejovice in the tutorial called Moodle.