Tackling health inequalities in primary care: an exploration of GPs’ experience at the frontline

In Scotland, life expectancy and health outcomes are strongly tied to socioeconomic status. Specifically, socioeconomically deprived areas suffer disproportionately from high levels of premature multimorbidity and mortality. To tackle these inequalities in health, challenges in the most deprived areas must be addressed. One avenue that merits attention is the potential role of general medical practitioners (GPs) in helping to address health inequalities, particularly due to their long-term presence in deprived communities, their role in improving patient and population health, and their potential advocacy role on behalf of their patients. GPs can be seen as what Lipsky calls ‘street-level bureaucrats’ due to their considerable autonomy in the decisions they make surrounding individual patient needs, yet practising under the bureaucratic structure of the NHS. While previous research has examined the applicability of Lipsky’s framework to the role of GPs, there has been very little research exploring how GPs negotiate between the multiple identities in their work, how GPs ‘socially construct’ their patients, how GPs view their potential role as ‘advocate’, and what this means in terms of the contribution of GPs to addressing existing inequalities in health. Using semi-structured interviews, this study explored the experience and views of 24 GPs working in some of Scotland’s most deprived practices to understand how they might combat this growing health divide via the mitigation (and potential prevention) of existing health inequalities. Participants were selected based on several criteria including practice deprivation level and their individual involvement in the Deep End project, which is an informal network comprising the 100 most deprived general practices in Scotland. The research focused on understanding GPs’ perceptions of their work including its broader implications, within their practice, the communities within which they practise, and the health system as a whole. The concept of street-level bureaucracy proved to be useful in understanding GPs’ frontline work and how they negotiate dilemmas. However, this research demonstrated the need to look beyond Lipsky’s framework in order to understand how GPs reconcile their multiple identities, including advocate and manager. As a result, the term ‘street-level professional’ is offered to capture more fully the multiple identities which GPs inhabit and to explain how GPs’ elite status positions them to engage in political and policy advocacy. This study also provides evidence that GPs’ social constructions of patients are linked not only to how GPs conceptualise the causes of health inequalities, but also to how they view their role in tackling them. In line with this, the interviews established that many GPs felt they could make a difference through advocacy efforts at individual, community and policy/political levels. Furthermore, the study draws attention to the importance of practitioner-led groups—such as the Deep End project—in supporting GPs’ efforts and providing a platform for their advocacy. Within this study, a range of GPs’ views have been explored based on the sample. While it is unclear how common these views are amongst GPs in general, the study revealed that there is considerable scope for ‘political GPs’ who choose to exercise discretion in their communities and beyond. Consequently, GPs working in deprived areas should be encouraged to use their professional status and political clout not only to strengthen local communities, but also to advocate for policy change that might potentially affect the degree of disadvantage of their patients, and levels of social and health inequalities more generally.

People with psychiatric disabilities, employment, and the Americans with Disabilities Act : turning policy into practice : report from the Center for Mental Health Services ADA Roundtable, January 25-26, 1995 /

"The report ... summarizes the major points of discussion at the meeting as well as integrating other pertinent information"--P. iii.

More Than A Movement: Unpacking Contemporary Anti-Human Trafficking Efforts in Washington, D.C.

Trafficking in persons has attracted seemingly boundless attention over the last two decades and the work aimed at fighting it is best understood when this cause is contextualized against the backdrop of other social forces—economic, social, and cultural—shaping contemporary nonprofit activities. This project argues that the paid and volunteer labor that takes place in metro Washington, D.C., to combat trafficking in persons can be understood as both a movement and an industry. In addition to arguing that anti-trafficking work is part of a nonprofit industrial complex that situates activist and advocacy work firmly inside state and economic institutions, this project is concerned with the ways in which trafficking work and workers conduct their business collectively. As an organizational study, it identifies the key players in the D.C. region focused on this issue and traces their interactions, collaborations, and cooperation. Significantly, this project suggests that despite variations in objectives, methods, priorities, and characterizations of trafficking, thirty organizations in metro D.C. working on this issue “get along” because they are bound by the benign common goal of raising awareness. Awareness, in this context, is best understood as both a cultural anchor facilitating cohesion and as a social currency allowing groups to opt into joint efforts. The dissertation concludes that organizations centralize awareness in their collective activities over more drastic priorities around which consensus would need to be gained. This is a lost opportunity for making sense of the ways that individual bodies—men, women, and children—experience not just trafficking, but the world around them.

A NARRATIVE CASE STUDY EXAMINING THE EXPEREINCES OF MEN TEACHING SPECIAL EDUCATION IN THE ELEMENTARY GRADES

Over the past several decades, the landscape of the workplace has changed in many industrialized nations. In the United States this time period has seen the outright elimination or outsourcing of well-paying “blue collar” jobs. The workforce continues to evolve, change, and become more global, and men and women are making nontraditional occupational decisions, whether by choice or necessity. The traditional views of men and women have begun to shift. However, gender assumptions about masculinity have failed to keep pace with the shift. There are approximately 1.8 million elementary grade level teachers in United States public schools; of these, a mere 9% are male. The paucity of male teachers in the elementary grades has been a concern for many years. According to the Bureau of Labor Statistics, roughly 86% of all special education teachers are female. In 2012, 86.2% of all special education teachers were female, and by the following year, the number had dropped to 80.4%. The evidence indicates that more men are embarking on nontraditional career paths. Despite theses changes there is minimal research looking at the experiences of men working as special education teachers My goal in this study was to obtain a better understanding of the influences on and the process by which men make the decision to pursuing a career teaching special education in the elementary grades. The study utilized social role theory (Eagly, 1987), and Stead’s (2014) social constructionist theory as well as Williams’ (1992) glass escalator proposition The findings of this study confirm some of the factors related to career choice, experiences and barriers faced by men in nontraditional careers detailed in the literature. Three themes emerged for each research question: Experiences, advocacy, and benefits. Three themes emerged around the second research question exploring the experiences of men in a female-concentrated profession: The male body, communication, and perception. Three themes arose around the third research question: administration, My Masculinity, and pay. The findings run counter to Williams’ glass escalator proposition, which posits men working in female-concentrated professions are at an advantage. The findings advance support for Buschmeyer’s theory of (2013) alternative masculinity.

MEN WRITING WOMEN: “THE WOMAN QUESTION” AND MALE DISCOURSE OF IRANIAN MODERNITY"

In this dissertation I explore “The Woman Question” in the discourse of Iranian male authors. A pro-modernity group, they placed women’s issues at the heart of their discourse. This dissertation follows the trajectory of the representation of “The Woman Question” as it is reflected in the male discourse over the course of a century. It discusses the production of a literature that was anchored in the idea of reform and concerned itself with issues pertaining to women. These men challenged lifelong patriarchal notions such as veiling, polygamy, gender segregation, and arranged marriages, as well as traditional roles of women and gender relations. This study is defined under the rubrics of “The Woman Question” and “The New Woman,” which I have borrowed from the Victorian and Edwardian debates of similar issues as they provide clearer delineations. Drawing upon debates on sexuality, and gender, this dissertation illustrates the way these men championed women was both progressive and regressive. This study argues that the desire for women’s liberation was couched in male ideology of gender relations. It further illustrates that the advancement of “The Woman Question,” due to its continuous and yet gradual shifting concurrent with each author’s nuanced perception of women’s issues, went through discernible stages that I refer to as observation, causation, remedy, and confusion. The analytical framework for this project is anchored in the “why” and the “how” of the Iranian male authors’ writings on women in addition to “what” was written. This dissertation examines four narrative texts—two in prose and two in poetry—entitled: “Lankaran’s Vizier,” “The Black Shroud,” “‘Arefnameh,” and “Fetneh” written respectively by Akhundzadeh, ‘Eshqi, Iraj Mirza, and Dashti. Chapter one outlines the historical background, methodology, theoretical framework, and literature review. The following chapters examine, the advocacy for companionate marriage and romantic love, women and nationalistic cause, veiling and unveiling, and the emerging figure of the New Iranian Woman as morally depraved.

(inter)FACE: A Study of Black Families Advocating for their Children’s Education

Black students are consistently overrepresented in categories of academic underachievement. Parent engagement has long been touted as an effective strategy for improving the educational outcomes of Black children. However, most parent engagement research reflects deficit based perspectives frame Black parents as problems that must be fixed or mitigated before they can positively contribute to their children’s education. Consequently, parent engagement research and frameworks ignore the perspectives of Black parents and the assets they use to participate effectively in parent engagement. In this case study, I draw on individual and focus group interview data, documents, and observations, to examine how fifteen Black families, collectively known as FACE: 1) define and participate in parental engagement, 2) experience barriers to and opportunities for engagement, and 3) experience benefits of engagement for their children and their own personal development. Guided by Black Feminist and Critical Race Theories, I show how Black families in this study used a myriad of engagement strategies to improve their children’s educational experiences which were invisible to schools and how they used school-sanctioned engagement activities to meet their own objectives. Ultimately, I argue that school-centered parent engagement frameworks and models are ineffective for empowering Black families and accounting for the essential ways that these families contribute to the well-being of their children. Based on my findings, I discuss implications for theory, practice and policy, and research, and make recommendations for a more family-centered approach to parent engagement.

Whose health, whose care, whose say? Some comments on public involvement in new NHS commissioning arrangements

Recent health policy in England has demanded greater involvement of patients and the public in the commissioning of health and social care services. Public involvement is seen as a means of driving up service quality, reducing health inequalities and achieving value in commissioning decisions. This paper presents a summary and analysis of the forms that public involvement in commissioning are to take, along with empirical analysis from a qualitative study of service-user involvement. It is argued that the diversity of constituencies covered by the notion of ‘public involvement’, and the breadth of aims that public involvement is expected to achieve, require careful disaggregation. Public involvement in commissioning may encompass a variety of interest groups, whose inputs may include population needs assessment, evaluation of service quality, advocacy of the interests of a particular patient group or service, or a combination of all of these. Each of these roles may be legitimate, but there are significant tensions between them. The extent to which the structures for public involvement proposed recognize these possible tensions is arguably limited. Notably, new Local Involvement Networks (LINks), which will feed into commissioning decisions, are set as the arbiters of these different interests, a demanding role which will require considerable skill, tenacity and robustness if it is to be fulfilled effectively.

La Teoría General del Derecho como asignatura necesaria en el plan de estudios de la carrera de abogacía

Las ramas jurídicas son estudiadas por el estudiante de Abogacía en asignaturas separadas a lo largo de la carrera. Ahora bien, es necesaria una asignatura al final de la misma que reúna a todas las ramas del Derecho estudiadas separadamente. Es decir, una visión de síntesis de todas las ramas del mundo jurídico. Esa asignatura necesaria es la Teoría General del Derecho. La misma aporta la noción de “unidad” del fenómeno jurídico, es decir, la comprensión del Derecho como “sistema jurídico”. Permite al estudiante avanzado la reflexión superadora de las particularidades de cada rama del Derecho y el enfoque de lo “común” y lo “abarcativo” de todo el fenómeno jurídico. La asignatura debe constituirse en el camino para que el alumno avanzado de Derecho logre autónomamente la comprensión y reflexión de: la noción de unidad del Derecho, la finalidad del Derecho, la idea de cambio en el Derecho, la noción de complejidad pura del Derecho, la noción de rama jurídica, la noción de autonomía de las ramas, la crisis de las respuestas que brindan las ramas jurídicas tradicionales, y el replanteo sobre la necesidad de surgimiento de nuevas ramas jurídicas.

Objeção da consciência e aborto previsto em lei : vivências em um serviço público de saúde

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Enfermagem, Programa de Pós-Graduação em Enfermagem, 2015.

South Carolina State Plan on Aging 2017-2021

The Lieutenant Governor’s Office on Aging hereby submits the Federal Fiscal Year 2017 – 2021 State Plan on Aging for the State of South Carolina to the Assistant Secretary on Aging of the United States Department of Health and Human Services. The plan is effective for the period of October 1, 2016 through September 30, 2020. This document lays out a long-term strategic blueprint that focuses on how the state will modernize its service delivery system, while expanding the service options available for older South Carolinians, adults with disabilities, and their families. It also sets goals for consumer choice, and person centered and self-directed services. It addresses marketing, outreach, and advocacy issues, as well as the development of initiatives geared toward promoting evidence-based, consumer-directed, and community-based long-term services and supports.

ONGs feministas : conquistas e resultados no âmbito da lei maria da penha

Dissertação (mestrado)—Universidade de Brasília, Instituto de Ciência Política, Programa de Pós-Graduação em Ciência Política, 2010.

Cultural and gender politics in Australian education, the rise of edu-capitalism and the 'fragile project' of critical educational research

This paper draws on research by Australians on Australian education to explore the tension between being critical and being marginalised. In it, I examine how research is positioned in the changing field of education in relation to government, society and the economy in the context of the rise of edu-capitalism globally. I then explore the policy shifts framing the cultural and gender politics of the research/policy problematic in Australia from the perspective of policy critique, policy service and policy advocacy. I consider how the global reconfiguring and reframing of higher education is impacting on the nature and institutional base of educational research, and it’s gendered implications. Finally, I argue that critical educational research is what makes educational research distinctive and also ‘makes a difference’ within a democratic society.

Development of mental health first aid guidelines for panic attacks: a Delphi study

BACKGROUND: Panic attacks are common, and while they are not life-threatening events, they can lead to the development of panic disorder and agoraphobia. Appropriate help at the time that a panic attack occurs may decrease the fear associated with the attack and reduce the risk of developing an anxiety disorder. However, few people have the knowledge and skills required to assist. Simple first aid guidelines may help members of the public to offer help to people who experience panic attacks.

METHODS: The Delphi method was used to reach consensus in a panel of experts. Experts included 50 professionals and 6 people who had experience of panic attacks and were active in mental health advocacy. Statements about how to assist someone who is having a panic attack were sourced through a systematic search of both professional and lay literature. These statements were rated for importance as first aid guidelines by the expert and consumer panels and guidelines were written using the items most consistently endorsed.

RESULTS: Of 144 statements presented to the panels, 27 were accepted. These statements were used to develop the guidelines appended to this paper.

CONCLUSION: There are a number of actions which are considered to be useful for members of the public to do if they encounter someone who is having a panic attack. These guidelines will be useful in revision of curricula of mental health first aid programs. They can also be used by members of the public who want immediate information about how to assist someone who is experiencing panic attacks.

Impact assessment: from theory to practice

Foreign aid is intended to be a major contributor to poverty reduction. However, significant questions arise as to the capacity for development funding to contribute to human development, through service provision, through advocacy, through actions and interventions that change power relations, change the social and institutional arrangements that reinforce inequality, threaten or reproduce well-being, and prevent the fulfillment of human rights. In conjunction with questions about what aid “does,” there is equal focus on how it does it. Questions of efficiency, effectiveness, transparency, accountability, social license to operate, relevance, and many others are all embedded in contemporary aid discourse and practice. The aim of this volume was to contribute to a critical understanding of Impact Assessment (IA) clearly informed by contemporary development theory and practice. There is a significantly increasing push for impact assessment, across the whole aid architecture. This is exacerbated by a much stronger focus on value for money, and accountability – to taxpayers specifically in the context of public funds, and donors in an increasingly competitive NGO environment. As was noted by many authors, since the GFC, a significant number of donor governments have reduced or are considering funding reduction for bilateral aid agencies and their contributions to multilateral aid agencies. At the same time they imposed a more stringent and rigorous requirement focusing on “aid-for-trade” and “value-for-money” strategies. There is a drive to ensure the positive impacts of the grant or loan in a sustainable manner.