832 resultados para Institute of Urban Indigenous Health


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A visually apparent but scientifically untested outcome of land-use change is homogenization across urban areas, where neighborhoods in different parts of the country have similar patterns of roads, residential lots, commercial areas, and aquatic features. We hypothesize that this homogenization extends to ecological structure and also to ecosystem functions such as carbon dynamics and microclimate, with continental-scale implications. Further, we suggest that understanding urban homogenization will provide the basis for understanding the impacts of urban land-use change from local to continental scales. Here, we show how multi-scale, multidisciplinary datasets from six metropolitan areas that cover the major climatic regions of the US (Phoenix, AZ; Miami, FL; Baltimore, MD; Boston, MA; Minneapolis-St Paul, MN; and Los Angeles, CA) can be used to determine how household and neighborhood characteristics correlate with land-management practices, land-cover composition, and landscape structure and ecosystem functions at local, regional, and continental scales. © The Ecological Society of America.

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Changes in land use, land cover, and land management present some of the greatest potential global environmental challenges of the 21st century. Urbanization, one of the principal drivers of these transformations, is commonly thought to be generating land changes that are increasingly similar. An implication of this multiscale homogenization hypothesis is that the ecosystem structure and function and human behaviors associated with urbanization should be more similar in certain kinds of urbanized locations across biogeophysical gradients than across urbanization gradients in places with similar biogeophysical characteristics. This paper introduces an analytical framework for testing this hypothesis, and applies the framework to the case of residential lawn care. This set of land management behaviors are often assumed--not demonstrated--to exhibit homogeneity. Multivariate analyses are conducted on telephone survey responses from a geographically stratified random sample of homeowners (n = 9,480), equally distributed across six US metropolitan areas. Two behaviors are examined: lawn fertilizing and irrigating. Limited support for strong homogenization is found at two scales (i.e., multi- and single-city; 2 of 36 cases), but significant support is found for homogenization at only one scale (22 cases) or at neither scale (12 cases). These results suggest that US lawn care behaviors are more differentiated in practice than in theory. Thus, even if the biophysical outcomes of urbanization are homogenizing, managing the associated sustainability implications may require a multiscale, differentiated approach because the underlying social practices appear relatively varied. The analytical approach introduced here should also be productive for other facets of urban-ecological homogenization.

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The size, shape, and connectivity of water bodies (lakes, ponds, and wetlands) can have important effects on ecological communities and ecosystem processes, but how these characteristics are influenced by land use and land cover change over broad spatial scales is not known. Intensive alteration of water bodies during urban development, including construction, burial, drainage, and reshaping, may select for certain morphometric characteristics and influence the types of water bodies present in cities. We used a database of over one million water bodies in 100 cities across the conterminous United States to compare the size distributions, connectivity (as intersection with surface flow lines), and shape (as measured by shoreline development factor) of water bodies in different land cover classes. Water bodies in all urban land covers were dominated by lakes and ponds, while reservoirs and wetlands comprised only a small fraction of the sample. In urban land covers, as compared to surrounding undeveloped land, water body size distributions converged on moderate sizes, shapes toward less tortuous shorelines, and the number and area of water bodies that intersected surface flow lines (i.e., streams and rivers) decreased. Potential mechanisms responsible for changing the characteristics of urban water bodies include: preferential removal, physical reshaping or addition of water bodies, and selection of locations for development. The relative contributions of each mechanism likely change as cities grow. The larger size and reduced surface connectivity of urban water bodies may affect the role of internal dynamics and sensitivity to catchment processes. More broadly, these results illustrate the complex nature of urban watersheds and highlight the need to develop a conceptual framework for urban water bodies.

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BACKGROUND: Little is known about the constraints of optimizing health care for prostate cancer survivors in Alaska primary care. OBJECTIVE: To describe the experiences and attitudes of primary care providers within the Alaska Tribal Health System (ATHS) regarding the care of prostate cancer survivors. DESIGN: In late October 2011, we emailed a 22-item electronic survey to 268 ATHS primary care providers regarding the frequency of Prostate Specific Antigen (PSA) monitoring for a hypothetical prostate cancer survivor; who should be responsible for the patient's life-long prostate cancer surveillance; who should support the patient's emotional and medical needs as a survivor; and providers' level of comfort addressing recurrence monitoring, erectile dysfunction, urinary incontinence, androgen deprivation therapy, and emotional needs. We used simple logistic regression to examine the association between provider characteristics and their responses to the survivorship survey items. RESULTS: Of 221 individuals who were successfully contacted, a total of 114 responded (52% response rate). Most ATHS providers indicated they would order a PSA test every 12 months (69%) and believed that, ideally, the hypothetical patient's primary care provider should be responsible for his life-long prostate cancer surveillance (60%). Most providers reported feeling either "moderately" or "very" comfortable addressing topics such as prostate cancer recurrence (59%), erectile dysfunction (64%), urinary incontinence (63%), and emotional needs (61%) with prostate cancer survivors. These results varied somewhat by provider characteristics including female sex, years in practice, and the number of prostate cancer survivors seen in their practice. CONCLUSIONS: These data suggest that most primary care providers in Alaska are poised to assume the care of prostate cancer survivors locally. However, we also found that large minorities of providers do not feel confident in their ability to manage common issues in prostate cancer survivorship, implying that continued access to specialists with more expert knowledge would be beneficial.

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For optimal solutions in health care, decision makers inevitably must evaluate trade-offs, which call for multi-attribute valuation methods. Researchers have proposed using best-worst scaling (BWS) methods which seek to extract information from respondents by asking them to identify the best and worst items in each choice set. While a companion paper describes the different types of BWS, application and their advantages and downsides, this contribution expounds their relationships with microeconomic theory, which also have implications for statistical inference. This article devotes to the microeconomic foundations of preference measurement, also addressing issues such as scale invariance and scale heterogeneity. Furthermore the paper discusses the basics of preference measurement using rating, ranking and stated choice data in the light of the findings of the preceding section. Moreover the paper gives an introduction to the use of stated choice data and juxtaposes BWS with the microeconomic foundations.

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In Sofia Coppola's 2003 film Lost in Translation, Bill Murray and Scarlett Johansson's characters find themselves culturally stranded and oddly mismatched as an improvised tourist couple in contemporary Tokyo. This is an urban landscape that they cannot comprehend but only temporarily experience, in a fragmented and surreptitious way that allows no possible understanding and categorizations, but offers physical inclusion, emotional participation and momentary embeddedness.

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The recognition that urban groundwater is a potentially valuable resource for potable and industrial uses due to growing pressures on perceived less polluted rural groundwater has led to a requirement to assess the groundwater contamination risk in urban areas from industrial contaminants such as chlorinated solvents. The development of a probabilistic risk based management tool that predicts groundwater quality at potential new urban boreholes is beneficial in determining the best sites for future resource development. The Borehole Optimisation System (BOS) is a custom Geographic Information System (GIs) application that has been developed with the objective of identifying the optimum locations for new abstraction boreholes. BOS can be applied to any aquifer subject to variable contamination risk. The system is described in more detail by Tait et al. [Tait, N.G., Davison, J.J., Whittaker, J.J., Lehame, S.A. Lerner, D.N., 2004a. Borehole Optimisation System (BOS) - a GIs based risk analysis tool for optimising the use of urban groundwater. Environmental Modelling and Software 19, 1111-1124]. This paper applies the BOS model to an urban Permo-Triassic Sandstone aquifer in the city centre of Nottingham, UK. The risk of pollution in potential new boreholes from the industrial chlorinated solvent tetrachloroethene (PCE) was assessed for this region. The risk model was validated against contaminant concentrations from 6 actual field boreholes within the study area. In these studies the model generally underestimated contaminant concentrations. A sensitivity analysis showed that the most responsive model parameters were recharge, effective porosity and contaminant degradation rate. Multiple simulations were undertaken across the study area in order to create surface maps indicating areas of low PCE concentrations, thus indicating the best locations to place new boreholes. Results indicate that northeastern, eastern and central regions have the lowest potential PCE concentrations in abstraction groundwater and therefore are the best sites for locating new boreholes. These locations coincide with aquifer areas that are confined by low permeability Mercia Mudstone deposits. Conversely southern and northwestern areas are unconfined and have shallower depth to groundwater. These areas have the highest potential PCE concentrations. These studies demonstrate the applicability of BOS as a tool for informing decision makers on the development of urban groundwater resources. (c) 2007 Elsevier Ltd. All rights reserved.

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This paper reports on the qualitative findings from a comparative study of public health and lifestyles in South East England and Northern France, regions with similar geographic and economic characteristics. Data from health surveys showed that both countries had an increasing BMI with age, particularly in Northern France. This was despite the finding that the percentage eating fresh fruit and vegetable at least five days a week in Northern France increased with age (from well over 50% to over 90%) compared to around 50% to around 75% in South East England. Qualitative data on health inequalities and how they could be addressed were gathered by focus groups sampling from five tiers using the Townsend Index for comparability (14 in England with 106 participants overall; 13 in France with 143 participants). Both had about two thirds women participants, with a preponderance of middle aged and older people. There was a striking difference in the salience of diet between the two countries; in the French data it was raised only 14 times, whereas in England there were 165 occurrences, and these were often distinguished by their use of narrative. Older respondents contrasted the pressures on families today and the expense of fresh fruit and vegetables with their own childhood or childrearing, when cheap meals could be created using skills which have now been lost. These data therefore provide further evidence that providing food is a moral activity.

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This paper addresses the potential of public water operations in achieving developmental goals such as the Millennium Development Goals, and argues that the public sector has a comparative advantage in developing water services. The global importance of the public sector in urban water supply is examined through a review of current practice in the world's largest cities, including operational presence and distribution and ongoing trends. Empirical evidence shows that, in transition and developing countries, public operators are capable of undergoing successful reform. One explanatory factor is proposed to be the creation through the public sphere of highly interconnected networks among stakeholders. Such accountability networks act as vehicles for the generation and distribution of public knowledge among stakeholders, which in turn inform rational decision making on the reform and management of operations.

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Background: Personal health records were implemented with adults with learning disabilities (AWLD) to try to improve their health-care. Materials and Method: Forty GP practices were randomized to the Personal Health Profile (PHP) implementation or control group. Two hundred and one AWLD were interviewed at baseline and 163 followed up after 12 months intervention (PHP group). AWLD and carers of AWLD were employed as research interviewers. AWLD were full research participants. Results: Annual consultation rates in the intervention and control groups at baseline were low (2.3 and 2.6 visits respectively). A slightly greater increase occurred over the year in the intervention group 0.6 ()0.4 to 1.6) visits ⁄ year compared with controls. AWLD in PHP group reported more health problems at follow-up 0.9 (0.0 to 1.8). AWLD liked their PHP (92%) but only 63% AWLD and 55% carers reported PHP usage. Carers had high turnover (34%). Conclusions: No significant outcomes were achieved by the intervention.

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Objective: To explore general practitioners' perceptions of the effects of their profession and training on their attitudes to illness in themselves and colleagues. Design: Qualitative study using focus groups and indepth interviews. Setting: Primary care in Northern Ireland. Participants: 27 general practitioners, including six recently appointed principals and six who also practised occupational medicine part time. Main outcome measures: Participants' views about their own and colleagues' health. Results: Participants were concerned about the current level of illness within the profession. They described their need to portray a healthy image to both patients and colleagues. This hindered acknowledgement of personal illness and engaging in health screening. Embarrassment in adopting the role of a patient and concerns about confidentiality also influenced their reactions to personal illness. Doctors' attitudes can impede their access to appropriate health care for themselves, their families, and their colleagues. A sense of conscience towards patients and colleagues and the working arrangements of the practice were cited as reasons for working through illness and expecting colleagues to do likewise. Conclusions: General practitioners perceive that their professional position and training adversely influence their attitudes to illness in themselves and their colleagues. Organisational changes within general practice, including revalidation, must take account of barriers experienced by general practitioners in accessing health care. Medical education and culture should strive to promote appropriate self care among doctors.

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The Perceived Health Competence Scale (PHCS) is a measure of self-efficacy regarding general healthrelated behaviour. This brief paper examines the psychometric properties of the PHCS in a UK context. Questionnaires containing the PHCS, the SF-36 and questions about perceived health needs were posted to 486 patients randomly selected from a GP practice list. Complete questionnaires were returned by 320 patients. Analyses of these responses provide strong evidence for the validity of the PHCS in this setting. Consequently, we conclude that the PHCS is a useful addition to measures of global self-efficacy and measures of self-efficacy regarding specific behaviours in the toolkit of health psychologists. This range of self-efficacy assessment tools will ensure that psychologists can match the level of specificity of the measure of expectancy beliefs to the level of specificity of the outcome of interest.