A survey aimed at assessing the nutritional impact of resettlement of Internally Displaced Persons (IDPs) was conducted in Northern Iraq between July and November 2000. The sample consisted of 301 households in the collective town of Dyana, representing the IDPs, and 282 households in ten villages of Rostey Valley, representing the resettled IDPs. The methodology consisted of structured questionnaires, anthropometry, and measurement of hemoglobin levels of one child under the age five years, one adult mate, and one adult female per household. The prevalence of low height-for-age among the children from the resettled households was 30.6% and among those still in the collective town was 18.9% (p < 0.01). Incidence of diarrhea was more than three times and acute respiratory infection (ARI) was more than seven times among the children in the collective town (p < 0.01). No significant differences existed in acute malnutrition and underweight rates among the children or in adult BMIs between the two populations. Anemia was present among 56.8% of the children in the collective town and among 46.8% of the children in the resettled villages (p < 0.01). When children who had diarrhea and ARI during the two weeks prior to the survey were removed from the analysis, the difference was not statistically significant, suggesting that the higher prevalence rate of anemia in the collective town may be due to higher infection rate. The presence of anemia among both male (42.9%) and female (47.2%) adults was significantly higher among the IDPs in the collective town than among the male (22.5%) and female (28.0%) adults in the resettled villages (p < 0.01). Except for vegetables, all other types of food were available in higher quantities to the resettled households (p < 0.05). Availability of food energy, protein, iron, zinc, thiamin, and folic acid was significantly higher in the resettled villages and availability of calcium, riboflavin, and vitamins C and A was significantly higher in the collective town (p < 0.05). The IDPs in the collective town had better diet diversity (p < 0.05). These results show that the resettled IDPs did not have a superior nutritional status than those still considered IDPs.

The health care reform debate in the United States is defined by the choice between free market reform and a government-administered single payer alternative. Nearly half the population receives access to health care through government directed programs (e.g. Medicare) while the remainder is covered by private insurers. In spite of the current mix of allocation mechanisms advocates on both sides of the debate have argued for the superiority of one form over the other in controlling costs and constraining aggregate demand. Precisely because allocation is the focus of the debate, "health care" is conceived of as a cost incurred by businesses, individuals and/or the government. A miserly attitude prevails. This dissertation aims at developing a new discursive context in which to politicize health care reform. I have used qualitative research techniques to explore the spaces in which health care is produced, allocated and consumed. The concept of the diverse/community economy, developed by J. K Gibson-Graham and the Community Economies Collective, provides us with a language for differentiating the economic landscape. This typology not only allows us to recognize the importance of informal caregivers in the economy of care but also to recognize the different organizational forms, processes of exchange, ethical commitments in health care's "market sector." A common theme has emerged from my interviews with informal care providers, physicians, community based health care institution administrators and alternative practitioners. All of these people spoke of their ethical commitment to care, how the practice of caregiving is deeply affecting. Interviewees recognized that caregiving was at moments a source of profound meaning while, at other times, it was a threat to their emotional and physical wellbeing. This dissertation concludes with an argument for thinking of health care "reform" as a process of development that focuses on the affective intensity of care and the ethical commitment of care providers. The aim of this development project is to produce supportive conditions for caregivers operating in both the formal and informal settings to be ethically engaged subjects.

Women make up a significant minority of the homeless population in the United States. This dissertation examines the social and health characteristics of homeless women, the data having been obtained from the National Health Care for the Homeless Program (HCH), sponsored by the Robert Wood Johnson Foundation and Pew Memorial Trust. This program is designed to provide health care and social services to homeless people in 19 U.S. cities. The data are gleaned from medical and social service records on the entire HCH client population (over 20,000 individuals), and from a supplemental questionnaire completed on a sample of the HCH client's. The findings indicate that there are at least five types of homeless women in the HCH population. The first, and largest group includes the single, significantly mentally impaired women, most closely fitting the stereotype of the "bag lady." Two-thirds of this group are receiving government entitlements, but only one-half are receiving mental health counseling. Release from a mental institution is a reason for homelessness for nearly one-third of these women. The second group of women are the women with dependent children in their care. Only half of these women receive AFDC benefits, but they are in better physical health and are rated as having better chances at employment and finding housing than any other type of women. The very young, single women make up the third, and smallest, group of HCH women. Findings suggest that this group may be the most difficult to reach and to maintain contact with, given their low average number of contacts with the HCH program and the lack of information available in their files. The fourth type includes the women with adult family members but no dependent children. The adult support they were presumed to have appears to be of little benefit in their homeless state. The fifth type of women, single, with no significant mental impairment, no children, and no adult support, are by far the most deviant and addicted of any group. The implications of the findings are significant for both service providers and policy makers. Interventions for homeless women must be tailored to their specific problems, and can be guided by the health and social characteristics found here to be associated with each type of homeless woman.

Opioid abuse has become a global epidemic and is now a huge public health concern here in the US. Non-medicinal use of opioid prescription drugs is at the forefront of the epidemic and considered the "gateway" drug to other illicit opioid use. As opioid prescribing has increased over the last decade in the US, so has opioid-related deaths, surpassing car accidents and suicide as the leading cause of injury-related deaths. Medication assisted treatment (MAT) is fundamental in decreasing opioid abuse overdose and mortality. Therefore, the research study aims to determine if counseling adherence, opioid abstinence, and retention in MATs are influenced by personal characteristics, socio-economic factors, readiness to change, social support, and integrated care. Guided by social cognitive theory, transtheoretical model, and theory of reasoned action, the study will employ a retrospective cohort design utilizing opioid dependent patients from a MAT Program in West Florida. Analysis of three cox regression models indicated for personal factors: an increase in age was associated with patients being more likely to adhere to counseling (p=.001) and retention (p=.034), full-time employment (p=.043) was positively associated with opioid abstinence, whereas part-time employment (p=.037) was positively associated with retention, having insurance (public: p=.000) was positively associated with counseling adherence, opioid abstinence (public: p=.000, private: p=.035) and retention (public: p=.000, private: p=.000). With regards to environmental influences, social support was positively associated with opioid abstinence (p=.022) and integrated care was positively associated with opioid abstinence (p=.027) and retention (p=.000). Examining these factors are necessary to improve treatment adherence and expand MAT programs. Additionally, providing funding is crucial for practitioners to continually create educational intervention strategies to engage patients in treatment, thereby reducing the opioid overdose epidemic. This study extends the literature contributing to understanding personal factors and environmental influences in MATs.

Registered nurses (RNs) are essential to providing care in the healthcare system. To date, research on the relationship between healthcare provider supply and population health has focused on physician supply. This study explored the effect of RN supply on population health outcomes in the U.S. This is a retrospective, cross-sectional study of U.S. counties and county equivalents using national data. Seven population health outcomes (total and disease specific mortalities and low infant birth weight rate) were the response variables. The predictor variable, RN supply, and some control variables were anticipated to have an asynchronous effect on the seven outcome variables in the hypothesized relationship. Therefore, these variables were examined using three different models: contemporaneous; a three-year lagged; and a distributed lag (both contemporaneous and lagged variables). Quadratic terms for RN and physician supply variables were included. Because the Area Health Resource File (AHRF) outcome variables were skewed toward zero and left censored, Tobit regression analyses were used. Data were obtained from 19 states using historical RN Supply data for 1,472 counties, representing 47% of the total target population of 3,108 U.S. counties and county equivalents. Regions with rural populations—the Midwest and Southeast—were overrepresented. Higher RN supply is positively related to higher mortality rates from ischemic heart disease, other cardiovascular disease, and chronic lower respiratory disease in the distributed lag models. Higher RN supply is not significantly related to rates of low infant birth weight, infant mortality, or mortality from cerebrovascular disease in any model. Higher RN supply is positively related to total deaths in the contemporaneous and lagged model. The results suggest a counter-intuitive, but non-linear relationship between RN supply and health outcomes. More research is needed to understand these relationships and policies must be devised to reduce the current and growing future RN shortage.

ABSTRACT How as a new worker could I have become better prepared by my education for child welfare work? What have other new workers experienced through their education that helped prepare them or hindered them? Lastly what are some creative ideas to better prepare new workers, specifically social workers, for the reality of working in child protection? These questions formed the focus of this study, which includes a literature review on new worker readiness and findings from qualitative interviews with new workers which utilizes an insider perspective towards data analysis. The participants in this research had varying experiences as new workers, however similar themes emerged. New workers struggled with power and experienced feelings of hopelessness and helplessness. New workers had difficulty transferring theoretical knowledge from their education into practice and did not feel prepared for the reality of child welfare work. Participants also described how they internalized conflict and the stress of the job. They suggested ways of coping including supportive supervision and a collaborative team environment. Increasing new workers’ confidence was also seen as key to prepare new workers for a child protection position. This research was conducted through a partnership with my fellow MSW researcher Julie Huynh-Lauesen, who coauthored the literature review and conducted a similar, yet separate research study with child welfare managers. Both studies were then compared and contrasted for discussion and future purposes. / Thesis / Master of Social Work (MSW)

Child protection workers, who are often graduates of schools of social work, are the frontline professionals who are charged with making determinations about the safety of children, and developing interventions to address these safety concerns. Determining the safety of children is an extremely difficult process due to the complexity of the issues that may exist in any one situation, including the impact of social problems, the complexity of human behaviour, and the need to predict future actions and consequences. On top of these challenges, child protection workers are subject to strict reporting and practice requirements imposed by the government and are required to provide a service mandated by legislation and funded by taxpayers. Given such responsibilities and constraints how does a person get prepared to work in the field of child welfare? The purpose of this research was to explore what child welfare managers think prepares new BSW graduates to enter into the field of child welfare. In particular, how well are BSW graduates currently prepared? Is there a need to improve preparedness, and if so, what could be done to achieve this? Literature provided key but contradictory perspectives in the debate around the preparedness of new workers. However, it is recognized that a partnership between education and child welfare could have beneficial effect on preparedness. Using the approaches of Interpretive Social Science and Critical Social Science, this qualitative research study was designed using semi-structured interviews to generate the data. Data was interpreted and analyzed through the techniques of coding and memo-writing from Grounded Theory. A colleague conducted a separate study of new workers which provided an opportunity to compare and contrast managers perspectives with those of new workers leading to a clearer understanding of preparedness. Overall, new workers are deemed to be prepared in terms of having the knowledge base that is needed to start working in child welfare. However, child welfare managers believe more learning opportunities need to be built into school programs that focus on applying theory to practice, child welfare specific knowledge, and understanding the complexity of mandated work. Field placements in child welfare settings, are considered to be valuable in preparing students prior to employment. Child welfare managers believe that an alliance between education and the field could optimize the readiness of new workers so as to ensure quality service for families in our community. / Thesis / Master of Social Work (MSW)

<p dir="ltr">In the US, dogs are considered members of the family by many people. Dogs may be obtained from multiple sources, but many in the US originate from commercial breeding kennels (CBKs). Prioritizing adult dogs’ welfare while they are housed in these kennels is essential for their well-being not only while residing there, but throughout the rest of their lives in new environments for those who are rehomed after their breeding careers end. However, the research conducted in this population is scarce. Therefore, evaluating dogs’ overall welfare states and factors that may affect them in this population is crucial.</p><p dir="ltr">Maternal factors are one of many that may affect puppies’ welfare states. This topic has never been directly explored in US CBKs and has been understudied in all domestic dogs. Therefore, this dissertation sought to explore associations between maternal factors and puppy welfare indicators, and related topics.</p><p dir="ltr">Chapter 2 aimed to explore changes in indicators of dams’ welfare states (<i>n</i>= 74), such as behavioral responses to a mild stressor and stress-related physiology, throughout the peri-parturient period in 8 CBKs. The changes observed were most likely due to natural biological changes associated with the peri-parturient period, and no worrisome indicators of welfare were detected. Additionally, Chapter 3 sought to investigate the relationship between dams’ levels of fear and stress (<i>n</i>= 90), as indicated by behavior and stress-related physiology, and metrics indicative of their puppies’ welfare states (<i>n</i>= 390), such as behavior, stress-related physiology, and physical health, in 12 CBKs. Findings suggest some associations between dams’ fear and stress and their puppies’ behavioral responses to isolation, physiology, and physical health. To further explore these associations, Chapter 4 examined the relationships between dams’ (<i>n</i>= 79) and puppies’ (<i>n</i>= 291) behavioral responses to novel social and non-social stimuli in 11 CBKs. No significant associations between dams’ and puppies’ responses were discovered, and possible reasons such as kennel management practices, puppies’ mobility and hazard avoidance, and differences between dams’ and puppies’ early life experiences were discussed. Finally, as the type and level of maternal care dams provide may be indicative of their welfare and may also be related to puppy welfare, Chapter 5 aimed to characterize maternal behaviors in a CBK (<i>n</i>= 12) and working dog population focused on detection work (<i>n</i>= 8). This study uncovered common maternal behaviors in each population, such as nursing and licking puppies. It also revealed that the behaviors observed were consistent with those reported for other dog populations, and found that factors such as day, time of day, litter size, and whelping type may influence their expression.</p><p dir="ltr">Overall, results from these studies suggest that there were no worrisome changes in dams’ welfare states throughout the peri-parturient period. Additionally, dams’ levels of fear and stress may affect potential indicators of their puppies’ welfare states, such as stress-related physiology, behavioral responses to stressors, and physical health. Findings highlight the importance of closely monitoring dams throughout the peri-parturient period for consistent displays of fear and stress, and abnormal behaviors. Doing so may not only affect dams’ welfare but that of their puppies as well. Further, the characterization and exploration of factors that may affect maternal care in various populations provides the basis for future work to explore maternal care as a mechanism behind the significant associations between dam and puppy welfare. The results also provide a foundation for breeders and caretakers to monitor maternal care, and make breeding selection and management interventions as needed to best support dam and puppy welfare. Altogether, findings from this research may have salient implications for dam’s welfare states throughout the peri-parturient period, and puppies’ welfare states while housed with their dams and into adulthood.</p>

Boston University. University Professors Program Senior theses.

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