Ever since the 1990s, when the Private Finance Initiative (PFI) was developed as the primary method for delivering major public-sector capital projects in the UK, it has been severely criticised for the lack of design quality in the buildings that it produced. The main driver for this thesis was to redress that situation. The development of an Architectural Design Quality Evaluation Tool was based on a live project with a metropolitan council in the North East of England. The aim was to improve the design quality of schemes that had been submitted through a PFI to replace the council’s entire sheltered housing stock. The Tool has two functions. It was a substantial part of the assessment process, which selected the preferred bidding consortium from the original six bidders, through a series of stages. However, it was also directed at improving the quality of all submitted designs through an iterative process. While existing tools provide useful benchmarks, and some offer means of structuring an evaluation, none are totally applicable in the context of PFI competitive bidding processes. Moreover, the existing tools are good for evaluating performance attributes of buildings, and these are important, but do not substantially tackle the less tangible amenity attributes that are vital to engendering the feeling of home. This Tool emphasises the amenity attributes without neglecting performance, thus generating a design quality hierarchy. The criteria for assessment are derived from academic publications. In order to reflect the hierarchy, each criterion was weighted on a scale of one to five, in accordance with multivariable utility theory. The percentage allocation to each main heading of the Tool was determined by the local authority Project Team. A User Guide was developed to assist the evaluation of schemes. The Tool itself was appraised at the final stage, assisting the selection of the preferred bidder. The designs were evaluated in three reviews, thus providing 156 results. The Tool and its development have been published, and the Tool and the User Guide accepted by the Homes and Communities Agency as an example of good practice. Both currently appear on its website. The Tool continues to assist other social housing providers with the design quality of their own projects.

Diabetes is a leading cause of premature death and disability in the United States and vulnerable populations may be at increased risk. Racial residential segregation, population density, and other factors influence the built environment, which in turn affects access to health-related facilities. Using the theory of fundamental causes, this study aims to determine whether neighborhood-level sociodemographic factors, the built environment, and subsequent access to health-related facilities are associated with diabetes prevalence in Georgia’s population. A built environment assessment of all health facilities located in the state of Georgia was conducted using health data from the 2014 Behavioral Risk Factor Surveillance System and demographic data from the 2010 US Census. Geospatial techniques, including hot-spot analyses and the two-step floating catchment area method were used to determine the effect of racial concentration, socioeconomic status, and population density on access to health-related facilities and thus on diabetes prevalence. Linear and spatial regression analyses were conducted to determine the significance of the association between access to facilities and diabetes prevalence. The results of the geospatial and regression analyses show that socioeconomic factors significantly affect the built environment, which in turn significantly influence diabetes prevalence. This interdisciplinary study contributes to the literature by providing a comprehensive analysis of the relationship between sociodemographic factors, the built environment, and diabetes prevalence in a southeastern state. Keywords: Diabetes, Disparities, Access, Racial Segregation, Urban/Rural, Built Environment Diabetes is a leading cause of premature death and disability in the United States and vulnerable populations may be at increased risk. Racial residential segregation, population density, and other factors influence the built environment, which in turn affects access to health-related facilities. Using the theory of fundamental causes, this study aims to determine whether neighborhood-level sociodemographic factors, the built environment, and subsequent access to health-related facilities are associated with diabetes prevalence in Georgia’s population. A built environment assessment of all health facilities located in the state of Georgia was conducted using health data from the 2014 Behavioral Risk Factor Surveillance System and demographic data from the 2010 US Census. Geospatial techniques, including hot-spot analyses and the two-step floating catchment area method were used to determine the effect of racial concentration, socioeconomic status, and population density on access to health-related facilities and thus on diabetes prevalence. Linear and spatial regression analyses were conducted to determine the significance of the association between access to facilities and diabetes prevalence. The results of the geospatial and regression analyses show that socioeconomic factors significantly affect the built environment, which in turn significantly influence diabetes prevalence. This interdisciplinary study contributes to the literature by providing a comprehensive analysis of the relationship between sociodemographic factors, the built environment, and diabetes prevalence in a southeastern state.

The number of social housing developments in the city of Campo Grande, Brazil, has undergone a significant growth over the past few years. Between 2014 and 2016, averages of 3,000 new homes per year have been constructed in the city, which has around 860,000 inhabitants. However, there seems to be a mismatch between the provision and residents’ needs. This research investigates the history of housing for the lower income people in Brazil; and its development in the city. The theoretical perspective focuses on the concept of community and the nature of home; and the data collection analyses whether these are being delivered in practice. The studies on the history of housing for lower income people in Brazil and its development in Campo Grande identified top down strategies adopted by the government and local authority. By contrast, the investigations of community and home development demonstrate that the residents’ views should be incorporated into any development strategy. The data collection was based in six social housing estates in the city, built between 2011 and 2015, using both quantitative and qualitative methods. The first stage was an investigation of documentation regarding social housing programmes and the local regulations. The second phase involved questionnaires with 464 residents; and the final part centred on interviews with heads of departments in the local authority and 36 residents. The data collection discovered issues regarding a lack of community facilities, and inflexibility in the layout and materials of the houses; especially regarding alterations and extensions. The outcome of the thesis is a set of Guidelines for the Development of Social Housing within the My House My Life Programme, to supplement the local regulations in Campo Grande. They provide guidance from the layout of the estate, to the design of the houses. They have been evaluated by the local authority departments, who have responded positively, and stated that they are willing to incorporate them in future proposals.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Diabetes is a growing public health issue in Canada, and this concern is now extending to children and adolescents. Our goal was to conduct research projects aimed at pediatric diabetes surveillance in Alberta, Canada. To identify diabetes cases, we applied the National Diabetes Surveillance System (NDSS) case definition to retrospectively-collected, population-based datasets. Our first objective was to assess the regional variation in diabetes incidence and prevalence across urban and rural areas between 1995-2007. After observing an unexpected decrease in diabetes incidence between 2002-2006, our second objective was to investigate a possible association with changes in physician remuneration through Alternate Relationship Plans (ARPs) that may have affected the number of diabetes cases identified from administrative data. Our results indicated that there was no regional variation in diabetes incidence and prevalence over the period of study and that there was no association between ARPs and the observed decline in incident diabetes cases. / Epidemiology

The economic and health disadvantage of Canadian single parents relative to the general population is well documented. Most studies, however, have not considered the effects of gender or urban/rural residence on the mental well-being of single parents. These gaps are important to address given that: 1) single father families are growing at a faster rate than single mother families; and 2) 13% of families residing in rural Canada are headed by single parents. Three research questions guided the study: 1) Does the mental health of single parents vary by gender and/or urban- rural residence? 2) Do single parents’ demographic, socioeconomic, and psychosocial characteristics vary by gender and/or urban- rural residence? and 3) Do the demographic, socioeconomic, and social correlates of single parents’ mental health vary by gender and/or urban- rural residence? Data from Statistics Canada’s 2007-2008 Canadian Community Health Survey (Master file) was used, with analyses focused on a subsample of 18-64 year old single parents. The primary dependent variable was self-rated mental health (fair/poor vs. good/very good/excellent). The other dependent variables were the prevalence of anxiety disorders, mood disorders and binge drinking. The primary independent variables were gender and urban/rural residence; the Metropolitan Influenced Zone (MIZ) classification was used to measure residence. Additional independent variables were included to reflect single parents’ demographic characteristics (age, marital status, Aboriginal identity, number and ages of children), socioeconomic position (e.g. household income, education, income assistance home ownership, food security), and psychosocial characteristics (e.g. sense of community belonging). Bivariate and multiple logistic regression analyses were the main statistical techniques applied. Sampling weights and bootstrapping were used to calculate accurate estimates and associated confidence intervals. iii Results indicated that the proportion of single parents who rated their mental health as “fair or poor” did not differ significantly by gender or urban-rural residence. Single mothers were more likely to report mood and anxiety disorders in comparison with single fathers, though the prevalence did not vary by residence. However, single mothers and single fathers living in Strong/Medium MIZ regions of the nation were more likely to report higher proportions of binge drinking compared to their more urban counterparts. Compared to single fathers, a greater proportion of single mothers resided in urban Canada, were less than 45 years of age, never married, self-identified as Aboriginal, had two or more children, and had a child under or equal to five years of age in the household. On most indicators of socioeconomic position, single mothers were significantly more disadvantaged than single fathers but did not differ significantly on psychosocial measures. Demographically, a greater proportion of rural than urban single mothers were of Aboriginal origin had two or more children, and at least once child under the age of 6 years in the household. Regarding socioeconomic characteristics a higher percentage of rural than urban single mothers indicated receiving social assistance, working part-time and having an annual household income of less than $20,000. No significant differences emerged by residence with respect to employment status, food security, home ownership or perceptions of life stress; however, single mothers living in more rural locals were more likely to rate their sense of community belonging as “somewhat or very strong” When data on single fathers was analyzed (Table 4.6), relatively few differences emerge. However, a greater proportion of urban than rural single fathers had a university education and owned their own home. Single fathers in rural regions were more likely than their urban counterparts to report most days as “quite a bit or extremely” stressful. No other statistically significant differences by residence emerged. iv The results of the multiple logistic regression analyses found the following variables to be associated with increased odds of fair/poor self-rated mental health: older age, low household income, being unemployed, being food insecure, experiencing higher levels of life stress and a weaker sense of community belonging. The relationship between demographic, socioeconomic and psychosocial characteristics and self-rated mental health was not modified by gender or urban-rural residence. Thus, the findings of this study will help policy makers identify the factors that adversely affect the mental health of single parents in Canada.

Increasing resettlement in and around Austin, decrease in water discharge rates and loss of endangered species habitat led to the creation of the City of Austin wildlands. The study consisted of a mail survey of 1,000 residents living near the City of Austin’s Water Quality Protection Lands and Balcones Canyonland Preserve for the purpose of identifying residents’ perceptions and knowledge about the wildlands in order to provide direction for the City of Austin Wildland Division’s environmental education program. The two specific objectives were to (1) Understand factors that influence residents’ knowledge, determine if previous participation in an environmental programs increases their level of knowledge, and to ascertain the effectiveness of different information outlets for increasing residents knowledge about environmental issues pertaining to the Edwards Aquifer and City of Austin’s wildlands and (2) Identify factors that influence residents’ approval or disapproval of land management actions and the alternative recreation activities on the City of Austin’s wildlands. For objective one, it was expected that socio-demographic variables (eg: older, educated, males that live within Austin for a longer period of time) and behavioral variables (eg: previous involvement in environmental organizations), and acquisition of prior information about the wildlands would be positively associated with wildland knowledge. For objective two, it was expected that residents’ management support would be positively associated with the perception that one of the purposes of the wildlands is to protect endangered species, respondents’ positive experiences with the wildlands, pro-environmental behavior, and perceptions that the wildlands increase their property value. It was also expected that approval of wildland management actions would be positively associated with the extent to which residents have been negatively affected by wildlife and their level of concern about wildlife impacts on their property. Also, it was expected that respondents’ approval of vegetation management actions, such as the use of fire, would be negatively associated with the extent to which residents have seen smoke on the wildlands and their level of concern about wildfire. The regression analyses conducted to test the first objective showed positive associations between local newspaper readership and residents’ knowledge about environmental issues and the City of Austin’s wildlands. Previous pro-environmental behavior by residents positively related to their knowledge about environmental issues pertaining to the wildlands. Furthermore, survey respondents who were older, male, and had lived in the City of Austin for a longer time were positively associated with environmental and City of Austin’s wildland knowledge levels. Some strategies for information dissemination about the wildlands include the use of local newspapers and homeowner association newsletters. New City of Austin residents who are younger and live in close proximity to the wildlands are the suggested target audience for initiating a proposed environmental education program. The results of regression analyses conducted to address objective two showed that approval of wildland management actions were positively associated with knowledge about rangelands and negatively associated with the level of concern about being negatively impacted by management actions used by the City of Austin. Results suggest that knowledge about specific environmental benefits associated with the management actions can improve respondents’ support for management actions such as the use of prescribed fire and harvesting overpopulation of deer and hogs. The results of this study should help the City of Austin by providing (1) information about factors that influence residents’ knowledge and suggested information dissemination channels (2) descriptive information about respondents’ environmental knowledge levels, and (3) aid to improve an existing education program for the purpose of increasing support for management actions that are critical for attaining the objectives of the WQPL and BCP.

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No description available.

Objectives: 1. To describe variations in major trauma between rural and urban residents of Ontario in terms of external causes, severities, prehospital care and clinical outcomes. 2. To determine whether prehospital intubation improves survival to hospital discharge among victims of major trauma. Methods: The study involved secondary analyses of data from the Ontario Prehospital Advanced Life Support Study (OPALS). OPALS is the largest study of prehospital emergency medical services conducted worldwide. 1. Rural-urban status of trauma patients was determined using modified Beale Codes. Differences in trauma characteristics and patient care were compared among four geographic groups (Large Metro, Medium Metro, Small Metro, Rural). 2. Patients who were intubated in the field were individually matched with non-intubated patients by patient age, injury severity score category, abbreviated head injury score category, and exact Glasgow coma scores. Cox regression was used to estimate the effect of prehospital intubation on patients' survival to hospital discharge, stratifying on patient matching. Results: 1. Patients in the large metro and rural groups had higher injury severity scores (medial 25, 24, respectively) than the other two groups (median=22). Paramedics generally spent more time in rural and large metro areas (median=37.4, 36.6 minutes respectively) than in medium and small metro (median=32.0, 30.7 minutes respectively) areas. Response times and transport times in rural groups were significantly longer than the other three groups, while scene times in the large metro group were significantly longer compared with the other geographic groups. There were no significant differences in survival rates by geographic group. 2. There were no significantly differences between the intubated and the non-intubated groups by age, sex, Glasgow coma scores, injury severity score, and systolic blood pressure category. Prehospital intubated patients exprienced a 3-fold risk of mortality after adjustment for potential confounders (HR2.9; 95% CI 1.4 to 5.8). Conclusions: 1. While response and transport times for major trauma were longer in rural areas, there were no significant differences in mortality in patients with different rural urban status. 2. Prehosptial intubation showed a negative association with survival among major trauma patients. Further randomized trials are required to invesitigate this clinical issue. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2007-10-24 11:58:53.955