Global ETD Search

21	The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Spillover Effect:Do Siblings Reap the Benefits? January 2019 (has links) abstract: Objective: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a federally-funded program that provides supplemental food packages, nutrition education, and healthcare referrals to low-income women, infants, and children under 5, who are at the highest nutritional risk. This study explores if household WIC participation is associated with healthier dietary behaviors among age-ineligible children (5-18-years-old) in WIC households. Consumption frequency of fruits, vegetables, 100% juice, sugar-sweetened beverages (SSBs), and energy-dense snacks (sweet and salty snacks) among children from WIC and income-qualifying non-WIC households were compared. Methods: Data were obtained from two cross-sectional panels (2009-10 and 2014) of the New Jersey Child Health Study conducted in four low-income New Jersey cities. Questions from previously validated surveys assessed consumption frequency of fruits, vegetables, SSBs, and sweet and salty snacks. Analyses were confined to 570 children between 5-18 yrs; of which 365 (5-11 yrs: 237, 12-18 yrs: 128) resided in WIC participating households and 205 (5-11 yrs: 138, 12-18 yrs: 67) in income-qualifying non-WIC households. Over half of the sample was African American and 43% were Hispanic. Multivariable analyses were conducted to compute incidence rate ratios (IRRs) using negative binomial regression to compare the differences in eating behaviors of children in WIC vs. Non-WIC households Results: Household WIC participation was associated with a slightly higher frequency of vegetable consumption among 12-18-year-old children (IRR= 1.25, p=.05); differences were significant among older males (12-18-years-old) (p=.006), and not in females. Frequency of 100% juice consumption was significantly higher among younger females (5-11-years-old) in WIC households who consumed juice about 44% more frequently (p=.02) compared to similar age girls in non-WIC households. Hispanic children in WIC households reported a lower frequency of SSBs consumption (p=.01); this association was only true among males (p=.02). Conclusions: Household WIC participation is associated with healthier dietary behaviors among age-ineligible children living in the households, suggesting a positive spillover effect of the program. Proposed changes to WIC packages are likely to have dietary implications not only for WIC participants but also for non-participating children residing in WIC households, / Dissertation/Thesis / Masters Thesis Nutrition 2019 Public policy Public health Nutrition Dietary Behaviors Low-income Infants and Children WIC WIC package revisions WIC Spillover Effect
22	Fonction endothéliale et rigidité artérielle, deux intégrateurs du risque cardiovasculaire : Etude à jeun et pendant la période post prandiale chez le sujet sain et le diabétique de type 2 / Endothelial function and arterial stiffness, two integrators of cardiovascular risk : Study during fasting and during postprandial period in healthy subjects and in patients with type 2 diabetes Fysekidis, Marinos 06 December 2016 (has links) Introduction : L’objectif de cette thèse était d'étudier les intégrateurs de risque cardiovasculaire chez des sujets qui représentent le continuum glycémique de la normo-glycémie jusqu'à la découverte du diabète, avant et après un petit déjeuner standardisé. Les paramètres que nous étudions étaient les suivants : l’endothélium, la rigidité artérielle et le système nerveux végétatif ou autonome (SNA). Méthodes : Dans un premier temps, nous avons mené une étude métabolique en utilisant des holters glycémiques. Ensuite nous avons étudié des sujets normo-glycémiques (NUTRIVASC: NCT01579409) intolérants au glucose (ACCES: NCT01521312) et diabétiques de type 2 avant et après un traitement par insuline (INSUVASC: 01022658). Nous avons étudié aussi le rôle des facteurs dit non classiques avec deux études sur l’association de la rigidité artérielle à la fibrose hépatique et la neuropathie diabétique. Conclusions : Nos résultats ont montré que la variabilité glycémique est plus forte en présence d’une dysglycémie et augmente avec l'HbA1c. Nous avons retrouvé une bonne corrélation entre la cinétique de la charge orale en glucose et celle d’un petit déjeuner standardisé. Chez les personnes âgées saines, l'augmentation du débit cardiaque après l'ingestion d'un repas dépend de l'augmentation de la FC sans que cet effet passe par l'inhibition vagale. Quatre semaines de traitement par insuline améliorait la fonction endothéliale microvasculaire à jeun. Parmi les patients diabétiques normotendus, ceux avec une neuropathie périphérique étaient deux fois plus susceptibles d'avoir une valeur de VOP > 90ème percentile des valeurs de référence que ceux sans neuropathie.La fibrose hépatique était corrélée à la rigidité artérielle indépendamment de l’âge et de la PA chez des sujets normotendus. Notre travail montre l’intérêt des explorations de la phase post-prandiale et l’étude des plusieurs cibles cardiovasculaires pour comprendre les différences de la PA et de la FC. / Introduction : The primary objective of this thesis was to study, at fasting and during the postprandial period, cardiovascular risk integrators in subjects representing the continuum from normoglycemia to insulin treated type 2 diabetes. We studied the following parameters : endothelial function, arterial stiffness and autonomic nervous system. Methods We have (i) conducted a metabolic study in obese subjects with continuous glucose monitoring systems ; (ii) studied subjects with normal glycemia (NUTRIVASC: NCT01579409), impaired glucose tolerance (ACCESS : NCT01521312) and (iii) type 2 diabetes before and after insulin treatment (INSUVASC: 01022658) ; and finally (iv) we studied the association of arterial stiffness with hepatic fibrosis and with diabetic neuropathy. Results(i) Glucose variability was higher in the presence of dysglycemia and increased with HbA1c. The kinetics of oral glucose tolerance test compared to a standardized breakfast were well correlated. (ii) In elderly patients without cardiovascular risk factors, the post-prandial increase in cardiac output depended on the increase in heart rate which was not driven by cardiac vagal inhibition ; The French National Nutrition Program recommendations had favorable effects on heart rate and myocardial viability. (iii) A 4-week treatment with insulin in addition to metformin improved microvascular endothelial function at fasting. (iv) In normotensive patients with diabetes, those with peripheral neuropathy have a two-fold higher risk for increased arterial stiffness than those without neuropathy. Finally, liver fibrosis correlates with arterial stiffness independently of age and blood pressure in normotensive subjects. Conclusions : Our work underlines the importance of exploring cardiovascular integrators during post prandial period in healthy subjects and in diabetic patients, according to their diet and their hypoglycemic and anti-hypertensive treatments. Fonction Endothéliale Programme National Nutrition Santé Traitement par insuline Cutaneous blood flow Arterial stifness Endothelial Function
23	Uncovering the Role of Community Health Worker/Lay Health Worker Programs in Addressing Health Equity for Immigrant and Refugee Women in Canada: An Instrumental and Embedded Qualitative Case Study Torres Ospina, Sara 29 January 2013 (has links) “Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship. Canada Case Study Inequity Immigrants Refugees Community Capacity Building Alberta Health Services Multicultural Health Brokers Health Human Resources Workforce Health Brokers Lay Health Promoters Lay Health Workers Authoritative Knowledge Experiential Knowledge Feminist Families Qualitative Research Child Welfare Cultural Brokering Community Health Workers Models Co-operatives Women Women's Urban Citizenship Empowerment Embedded Case Study Research Social Determinants of Health Social Change Social Work Urban Citizenship Universal Programs Unregulated Health Care Workers Theory Typology Perinatal Health Racialized Gender Race Class Discrimination Diversity Health Worker Co-operatives Policy Makers Urban Citizenship Universal Programs Access to Health Services Equity Access to Social Services Cultural Competence Racism Canada Prenatal Nutrition Program Public Health Primary Care Health Promotion Violence Prevention Immigrant Health Care Workers Immigrant Community Health Workers
24	Uncovering the Role of Community Health Worker/Lay Health Worker Programs in Addressing Health Equity for Immigrant and Refugee Women in Canada: An Instrumental and Embedded Qualitative Case Study Torres Ospina, Sara 29 January 2013 (has links) “Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship. Canada Case Study Inequity Immigrants Refugees Community Capacity Building Alberta Health Services Multicultural Health Brokers Health Human Resources Workforce Health Brokers Lay Health Promoters Lay Health Workers Authoritative Knowledge Experiential Knowledge Feminist Families Qualitative Research Child Welfare Cultural Brokering Community Health Workers Models Co-operatives Women Women's Urban Citizenship Empowerment Embedded Case Study Research Social Determinants of Health Social Change Social Work Urban Citizenship Universal Programs Unregulated Health Care Workers Theory Typology Perinatal Health Racialized Gender Race Class Discrimination Diversity Health Worker Co-operatives Policy Makers Urban Citizenship Universal Programs Access to Health Services Equity Access to Social Services Cultural Competence Racism Canada Prenatal Nutrition Program Public Health Primary Care Health Promotion Violence Prevention Immigrant Health Care Workers Immigrant Community Health Workers
25	Uncovering the Role of Community Health Worker/Lay Health Worker Programs in Addressing Health Equity for Immigrant and Refugee Women in Canada: An Instrumental and Embedded Qualitative Case Study Torres Ospina, Sara January 2013 (has links) “Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship. Canada Case Study Inequity Immigrants Refugees Community Capacity Building Alberta Health Services Multicultural Health Brokers Health Human Resources Workforce Health Brokers Lay Health Promoters Lay Health Workers Authoritative Knowledge Experiential Knowledge Feminist Families Qualitative Research Child Welfare Cultural Brokering Community Health Workers Models Co-operatives Women Women's Urban Citizenship Empowerment Embedded Case Study Research Social Determinants of Health Social Change Social Work Urban Citizenship Universal Programs Unregulated Health Care Workers Theory Typology Perinatal Health Racialized Gender Race Class Discrimination Diversity Health Worker Co-operatives Policy Makers Urban Citizenship Universal Programs Access to Health Services Equity Access to Social Services Cultural Competence Racism Canada Prenatal Nutrition Program Public Health Primary Care Health Promotion Violence Prevention Immigrant Health Care Workers Immigrant Community Health Workers

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