Thèses sur le sujet « Indicators of accessibility »

Adequate public transport infrastructure and services are essential to facilitate access to basic opportunities, such as jobs, healthcare, education, recreation or shopping, especially in low-income cities where the majority of the low-income population have no access to the car. In the context of transport exclusion and urban poverty, access and accessibility metrics can serve as good indicators for the identification of transport-disadvantaged zones or population groups in a city. In Cape Town, accessibility-based planning is being embraced by the authority as a means of addressing the planning defects of the past apartheid regime, which created a city that is spatially fragmented by race and income levels. Among the agenda outlined in its 5-year Integrated Transport Plan of 2013-2018, is the need to develop a highly integrated public transport network in which all households would have equitable access to the public transport system, especially for the majority of the urban poor who reside in the city outskirts far from major economic centres. Although planning efforts are being made to redeem the defects of the past, there is still the need for tools and indicators to understand the current situation, as well as to further aid planning and decision making about land-use and transport. The objective of this research, therefore, is to develop suitable indicators of accessibility, identify possible spatial and socioeconomic drivers of accessibility and evaluate equity in the distribution of accessibility benefits for various population groups in Cape Town. In the study, transport network data of Cape Town are utilised to develop GIS-based indicators of network access and origin accessibility to various opportunities like jobs, healthcare and education, across various modes of travel. An Access Index measures public transport service presence within a zone, based on route and stops availability. The index is used to compare the coverage levels provided by each mode of public transport in the city. Also, an Accessibility Index is proposed, that measures the number of opportunities 'potentially reachable' within a specified 'reasonable’ travel time. A key consideration in measuring accessibility by public transport is the monetary cost of overcoming distance, based on the pricing structure that exists in Cape Town. Equity in accessibility is further evaluated both vertically and horizontally. Vertical equity is evaluated using a proposed Accessibility Loss Index, which analyses the potential implication of affordability and budget restrictions on accessibility, based on the income level of the poor households. GINI type of measures is also proposed to evaluate horizontal equity across the various population groups for various travel modes. To further understand the likely drivers of accessibility, an exploratory OLS regression technique is employed to investigate the relationship between accessibility and a combination of socioeconomic and built environment features of the study area. The study reveals among other things that potential accessibility achievable by car is far higher than that achievable by public transport. The paratransit mode provides the most extensive access coverage, and the highest level of accessibility among all the public transport modes investigated. However, this mode shows to be one of the most expensive options of travel, especially for low-income households who are likely to be restricted by travel monetary budgets. The train turns out to be the most affordable travel option, although the level of accessibility achievable with the train is much lower compared to the paratransit or regular bus. From a vertical equity perspective, the consideration of transport affordability drastically reduces the opportunity space and potential accessibility for the poorest population group compared to the higher income groups. The study further interrogates the distance-based tariff model of public transport services in Cape Town, which it considered to be detrimental to the welfare of poor households, regarding the potential to access essential opportunities. The contribution of this study to the body of research on accessibility is twofold: methodological and contextual. On the methodological dimension, it presents a GIS based approach of modelling accessibility both for the car and for a multimodal public transport system that combines four modes; bus, train, BRT and a minibus taxi (paratransit). It also builds on existing gravity-based potential accessibility measure by incorporating an affordability dimension. The consideration of affordability adds a further layer that enables vertical equity evaluation by judging the potential for destination reachability by the monetary out-of-pocket cost of travel. This approach is considered to be more sensitive to the context of low-income cities like Cape Town, where low-income household’s daily travel decisions are likely to be more guided by monetary cost.

The Internet is an integral part of higher education today. Students, faculty, and staff must have access to the institutional web for essential activities. For persons with disabilities, the web is a double-edged sword. While an accessibly designed website can mitigate or remove barriers, an inaccessible one can make access impossible. If websites that provide necessary information are not accessible, those with disabilities will be unable to independently complete their daily tasks or compete in the modern world. Project GOALS (Gaining Online Accessible Learning through Self-Study) has developed a document outlining a set of four institutional indicators of Web accessibility. Postsecondary institutions can use this document in their efforts to ensure that online content is accessible to all users. This dissertation evaluated the social validity of the document to determine if it was appropriate, understandable, usable, and satisfactory to provide a framework for implementing and promoting institution-wide web accessibility across a variety of demographic markers including job type (administrator, faculty, and technology specialist) and institution type (2- and 4-year). Ninety-seven participants reviewed the document and completed an online survey. All four indicators with their subsequent benchmarks were found to be "good" or "very good" based on the evaluation criteria. Administrators rated the document somewhat lower than faculty or technology specialists. Participants from 2-year schools consistently rated the document higher than their 4-year counterparts. In general, the longer participants had been in their positions, the less favorably they rated the document. The median ratings for all questions of appropriateness, understandability, usefulness, and satisfaction were a 6 or 7 on a 7-point scale across the board. This result would indicate that while different aspects of the indicator document may appeal to different groups, participant ratings across job and institution type show that these criteria achieve acceptable levels that validate the use of the indicators as a tool to assist institutions in their web accessibility efforts. This dissertation utilized the multiple-paper format recommended by the committee.

Este estudo visa à criação e aplicação de um índice de acessibilidade de aeroportos que considera vários perfis de usuários (passageiro com e sem bagagem, estrangeiro, idoso e gestante, cadeirante e deficiente visual) que possuem diferentes restrições de mobilidade. O método tem início com uma seleção de indicadores que surgiram da identificação de potenciais problemas que os passageiros podem enfrentar ao acessar o aeroporto. Os indicadores são agrupados de acordo com o modo de transporte disponível para acesso ao aeroporto: táxi, carona, automóvel próprio, automóvel de aluguel, ônibus regional e ônibus especial. Em seguida os indicadores são avaliados através de pesquisas e levantamentos de campo e recebem pontuações de acordo com o seu desempenho. Por fim, os escores dos indicadores são ponderados e um valor final é calculado para cada aeroporto. Para aplicação e avaliação do índice foram selecionados, em São Paulo, os aeroportos Congonhas, Guarulhos e Viracopos; no Rio de Janeiro, Galeão e Santos Dumont, e em Brasília, o aeroporto Juscelino Kubitschek. Em uma escala que vai de zero a um, os aeroportos estudados apresentaram resultados com uma amplitude de 0,16. O maior valor encontrado foi 0,629 para o aeroporto Santos Dumont e o menor valor foi 0,469 para o aeroporto de Guarulhos. Isto evidencia que há muitos aspectos a serem melhorados no que diz respeito à acessibilidade dos aeroportos no Brasil.
This study aims to create an index of accessibility to airports that takes into account several profiles of users (passengers with and without luggage, foreigners, elderly and pregnant women, wheelchair users and visually impaired users) that have different mobility constraints. The method starts with a selection of indicators that emerged from the identification of potential problems that passengers may have when accessing the airport. The indicators are grouped according to the transportations modes available for access the airport: taxi, ride with a third party, own car, rental car, regional bus and shuttle bus. The indicators are then evaluated through surveys and field observations and scored according to their performances. Finally, the scores of the indicators are weighted and an overall score is calculated for each airport. For implementation and evaluation of the index, six important Brazilian airports were selected. In São Paulo, the airports of Congonhas, Guarulhos and Viracopos; in Rio de Janeiro, Galeão and Santos Dumont; and, in Brasília, the airport Juscelino Kubitschek. In a scale that goes from zero to one, the studied airports showed results with an amplitude of 0.16. The highest value was 0.629 for Santos Dumont airport and the lowest value was 0.469, for Guarulhos airport. The results highlight the fact that many aspects must still be improved regarding accessibility to Brazilian airports.

Abdominal aortic aneurysms are the third leading cause of sudden death in men 60 years and over. AAAneurysm Outreach provides free screenings to residents of Louisiana and beyond. Service areas were calculated for each AAAneurysm Outreach screening event location and stroke center. Data provided by the 2010 U.S. Census, the American Community Survey, and the Behavioral Risk Factor Surveillance System were used to describe demographics of the underserved populations and to identify high-risk areas for targeted interventions. Twenty-five percent of age-eligible Louisianans reside outside optimal drive-time-to-screening-event zones but within spatially clustered areas of increased prevalence rates. The maximum drive-time-to-treatment zones excluded 1,395 residents 65 years and over from timely access to emergency medical care. Results revealed limitations in the geographic breadth of the screening program and small disparities in accessibility to emergency healthcare.

En Côte d'Ivoire, la problématique de l'accessibilité aux soins reste entière en raison de l'insuffisance des infrastructures sanitaires et du manque de ressources financières. Aussi, la population a t-elle souvent recours à l'odontologie traditionnelle pour répondre à ses besoins prioritaires de santé. Cependant, l'absence de données factuelles dans un contexte de pluralité de soins constitue un handicap pour la définition d'une politique de santé bucco-dentaire efficiente. L'objectif de la présente étude a été de décrire l'activité des tradipraticiens, puis de déterminer les facteurs influençant le recours et le renoncement aux soins bucco-dentaires des populations. L'étude de type transversale pilote a portée sur un échantillon de 28 tradipraticiens et 927 adultes. Les résultats ont montré que les consultations bucco-dentaires répresentaient le 1/5 de l'ensemble des activités des tradipraticiens. La majorité des tradipraticiens a déclaré prendre en charge les douleurs bucco-dentaires et était disposé à collaborer avec la médecine conventionnelle. Les tradipraticiens ont déclaré être satisfaits des honoraires perçus. Les ressources végétales et minérales étaient principalement utilisées pour la confection des remèdes. S'agissant de l'étude menée auprès des usagers, alors que les adultes non scolarisés avaient recours en majorité aux tradipraticiens, ceux qui disposaient d'une assurance de santé ou qui avaient le niveau d'étude du secondaire ou plus ont consulté préférentiellement le chirurgien-dentiste. Les adultes ayant un niveau d'étude secondaire ou plus ont eu recours à un tradipraticien en raison de sa proximité. Le recours au tradipraticien en raison de l'efficacité des soins a été plus évoqué par les adultes ayant un âge compris entre 30 et 44 ans, par ceux résidant en milieu urbain et par ceux situés à plus de 15 km du cabinet dentaire. Quant au recours au chirurgien-dentiste en raison de la confiance faite aux soins modernes et la propreté des cabinets dentaires, il a été majoritairement le fait d'adultes vivant dans des habitats modernes. Le renoncement aux soins traditionnels en raison de l'automédication a été le plus évoqué par les femmes. Les adultes situés entre 5 et 15 km du cabinet dentaire ont majoritairement renoncé aux soins traditionnels en raison de la non perception de leur nécessité. Le manque de ressources financières a été le plus évoqué par les adultes vivant en milieu urbain pour justifier leur renoncement aux soins modernes. La non perception de la nécessité des soins a été plus évoquée par les adultes situés entre 5 et 15 km du cabinet dentaire pour justifier le renoncement aux soins modernes. Cette étude a mis en évidence la relation entre l'accessibilité aux soins bucco-dentaires et la pauvreté. Ainsi l'amélioration de l'accès aux soins bucco-dentaires doit s'inscrire dans le cadre global de la lutte contre les inégalités sociales, de l'alphabétisation et de l'aménagement du territoire. En outre, l'odontologie traditionnelle doit être valorisée pour venir en aide au système de santé dans un contexte marqué par l'insuffisance des ressources financières

Depuis les années 1960, les villes françaises sont soumises à un processus d'étalement urbain. Cet étalement se traduit par l'émergence d'une catégorie d'espace située à l'interface entre la ville et la campagne : le périurbain. Les caractéristiques sociales, urbanistiques, ou liées aux pratiques spatiales de ses habitants confèrent au périurbain une singularité et une spécificité propres. Il s'agit d'un espace de contradiction qui attire à la fois en raison du cadre de vie plutôt " naturel " qu'il offre aux ménages, mais également en raison de sa proximité avec la ville et des potentialités liées à l'accessibilité à diverses aménités urbaines.Pour comprendre plus finement cet engouement pour le périurbain, cette thèse propose d'explorer la relation individu-environnement résidentiel sous l'angle de la satisfaction que retirent les individus de leur cadre de vie. Il s'agit de mettre en relation une information de nature cognitive avec une information de nature spatiale. En modélisant chacune de ces composantes par l'utilisation d'indicateurs spécifiques, divers modèles statistiques sont mobilisés pour mettre en lumière les attributs spatiaux du cadre de vie susceptibles d'avoir une influence sur la satisfaction des individus.L'approche modélisatrice est centrale dans la démarche suivie. Après voir mené une enquête de satisfaction sur plus d'un millier de ménages vivant dans un secteur périurbain de Besançon, la démarche s'est attelée à construire des indicateurs en vue de caractériser deux types d'aménités de leur environnement résidentiel : le paysage et l'accessibilité aux commerces et services. Chacune de ces aménités est ensuite intégrée dans des modèles statistiques permettant d'évaluer leur contribution dans le degré de satisfaction du ménage.La démarche, essentiellement modélisatrice et exploratoire, offre toutefois des perspectives intéressantes dans le domaine de l'aménagement du territoire et de la planification urbaine. En ayant recours à des modèles simples et reproductibles, il s'agit de d'établir des documents cartographiques décrivant le potentiel de satisfaction à grande échelle.

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Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG
This research is inserted in the context of the importance of the accessibility for the development of metropolitan regions. In this context, is considered that challenges faced by municipalities reach even more complexity when they are inserted in metropolitan regions. This problematic grow worse through factors such as the excessive use of automobiles, as well as the lack of integrated planning and management that prioritize displacements by public transport and that establish balanced guidelines of land use and occupation. Therefore, is research uses indicator to analyze the dynamics of accessibility between municipalities of metropolitan regions. Based on the conceptual and theoretical deepening about the metropolitan context, accessibility and its principles, this work focused on the public transport systems.
Esta pesquisa se insere no contexto da importância da acessibilidade para o desenvolvimento das regiões metropolitanas. Considera-se que os desafios enfrentados pelos municípios atingem ainda maior complexidade quando estes estão inseridos em regiões metropolitanas. Contribuem para o agravamento desta problemática fatores como o uso excessivo de automóveis, bem como a falta de planejamentos e gestões integradas que priorizem deslocamentos por transporte público e que estabeleçam diretrizes equilibradas de uso e ocupação do solo. Sendo assim, esta pesquisa se utiliza de indicadores para analisar a dinâmica da acessibilidade entre municípios de RMs. Baseado no aprofundamento teórico conceitual sobre o contexto metropolitano, a acessibilidade e seus princípios, este trabalho teve como foco os sistemas de transporte público coletivo.

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The present dissertation work in Urban Engineering of the Federal University of São Carlos (UFSCar) aims to define an easy and practical form of evaluating the level of service in public spaces destined to the carriers of physical deficiency (sidewalks and streets passages) through the determination of an index that considers the parameters of higher importance by the point of view of wheelchair users. The index is defined through the identification and the ordinance of variables based on physical and environment characterization of sidewalks related to aspects of quality such as comfort, security and conditions of the environment. The weighing scale of the variables of physical and environment characterization of sidewalks (importance degree) is carried through analysis based on wheelchair users perception, therefore defining the ISPA - Index of Sidewalks and Passages Accessibility, and verifying its functionality through auditor work also performed with wheelchairs users advice in two places of São Carlos city. Through this tool of evaluation, the agencies of road management can evaluate the quality of the public spaces in a total route or specific stretches of the essential displacements for the real participation of the person with locomotion difficulties in society.
O presente trabalho de dissertação do mestrado em Engenharia Urbana da UFSCar - Universidade Federal de São Carlos visa definir uma forma fácil e prática de se avaliar o nível de serviço dos espaços públicos destinados aos portadores de deficiência física (calçadas e travessias de ruas) através da determinação de um índice que considere os parâmetros de maior importância sob o ponto de vista dos usuários de cadeira de rodas (cadeirantes). O índice é definido através da identificação e a ordenação de variáveis de caracterização física e ambiental das calçadas relacionadas aos aspectos de qualidade de conforto, segurança e condições do ambiente. A ponderação das variáveis de caracterização física e ambiental das calçadas (grau de importância) é realizada através de análise da percepção dos cadeirantes, definindo-se, desta forma o IACT Índice de Acessibilidade das Calçadas e Travessias, e verificando sua funcionalidade através de auditoria realizada com auxílio também de cadeirantes selecionados para realizar testes em dois locais da cidade de São Carlos. Através desta ferramenta de avaliação, os órgãos de gestão viária podem avaliar a qualidade dos espaços públicos em uma rota total ou em trechos específicos dos deslocamentos imprescindíveis para a real participação da pessoa com dificuldade de locomoção na sociedade.

L’esclusione sociale può essere descritta come un processo che tende ad emarginare progressivamente degli individui, o gruppi di individui, dal mercato del lavoro o dall’accesso a servizi di diverso genere, ad esempio educativi, sanitari, ecc. I fenomeni che favoriscono ed accrescono l’esclusione sociale possono essere di natura diversa. Sicuramente il reddito gioca un ruolo rilevante, seguito dalla disoccupazione, dequalificazione di aree, condizioni abitative talvolta inadeguate, malasanità o criminalità locale. Già da tempo molte città europee hanno iniziato a sostenere delle politiche volte a promuovere studi qualitativi e quantitativi, che permettano di determinare i meccanismi che generano questi fenomeni di esclusione. Tra questi gioca un ruolo fondamentale la modalità di trasferimento tra le diverse aree urbane. Se un quartiere, una circoscrizione o un Comune, presentano degli evidenti problemi di garanzia del servizio di trasporto pubblico si genereranno degli scompensi che porteranno nel tempo ad un aumento dell’esclusione sociale. L’obiettivo di questa tesi è stato quello di individuare, attraverso l’analisi della rete del servizio di trasporto pubblico locale, le zone territoriali all’interno dell’area della città metropolitana di Bologna con un basso livello di accessibilità, che potrebbe portare allo sviluppo di fenomeni di esclusione sociale. Si è partiti da una attenta analisi dei dati, inquadrando il territorio per la sua morfologia, conformazione e distribuzione della popolazione, in modo da individuare le aree più densamente popolate dove il problema poteva presentarsi. Sono stati utilizzati dati sulla popolazione provenienti da fonti ISTAT e dati GTFS (database contenente linee, percorsi, fermate e tabelle orari) forniti dal gestore del servizio di trasporto pubblico locale TPER.

Este estudo buscou analisar a escolha e a adequação do pré-natal de gestantes que frequentaram o Ambulatório de Pré-Natal do Amparo Maternal (PN-AM), uma maternidade filantrópica da cidade de São Paulo. Os objetivos foram: identificar os motivos da escolha do PN-AM para acompanhamento da gestação; descrever a atenção pré-natal, segundo o intervalo entre as consultas, regularidade da frequência às consultas marcadas e término do acompanhamento da gestação; identificar o motivo da falta nas consultas marcadas e o término do acompanhamento da gestação; verificar a adequação da atenção pré-natal das gestantes; relacionar as variáveis sociodemográficas, obstétricas e local de início com a adequação do pré-natal. Trata-se de um estudo transversal com coleta prospectiva de dados de 301 prontuários de gestantes atendidas de fevereiro a outubro de 2009. Após a análise descritiva, utilizou-se o teste do Qui-quadrado para estudar as associações entre as variáveis; o nível de significância adotado foi 0,05. Os resultados mostraram: 58,5% procuraram diretamente o PN-AM para o início do acompanhamento da gestação e 41,5% transferiram-se espontaneamente de outro serviço de saúde, a maioria de unidade básica de saúde (82,4%); 73% por indicação de familiar, amigos ou conhecidos, 21,6% por experiência anterior; 75,1% iniciaram até 120 dias da gestação; média de 8,3 consultas, 71% compareceram a todas as consultas programadas; 72,4% tiveram intervalo adequado entre as consultas; 29,9% tiveram, pelo menos, uma falta; 35,4% faltaram por motivos pessoais; 81,4% das gestações chegaram a termo; 87,4% de adesão ao serviço; o pré-natal foi adequado para 66,8% das gestantes, segundo o índice de Kessner, modificado por Takeda. Idade, trabalho remunerado, parceiro fixo, local de residência, acompanhante às consultas, local de inicio do pré-natal, tiveram diferença estatisticamente significativa quando associados com adequação do pré-natal da gestante segundo número de seis consultas, início do pré-natal até 120 dias e pelo menos 6 consultas e Índice de Kessner, modificado por Takeda. Trabalho remunerado; local de residência, local de início de pré-natal, paridade, número de gestação e de filhos apresentaram associação com a adequação, segundo a frequência e intervalo entre as consultas no PN-AM. Os achados sugerem aos serviços de saúde o estabelecimento de estratégias que viabilizem o ingresso precoce das gestantes no pré-natal, garantindo vaga e profissionais especializados e, sobretudo, que promovam continuidade do acompanhamento, para que as mulheres não precisem procurar um atendimento longe de suas residências.
This study investigates the choice and adequacy of prenatal care of pregnant women who attended the outpatient department of the Amparo Maternal (PN-AM), a social and philanthropic maternity in São Paulo, Brazil. The objectives were to identify the reasons for the choice of the PN-AM to monitoring pregnancy; to describe the prenatal care, according to the interval between appointments, the frequency of regular appointments and the ending of pregnancy monitoring; to identify the reason for the lack in appointments and the ending of pregnancy monitoring; to verify the adequacy of prenatal care; to relate socio demographic, and obstetric data and place of prenatal beginning with the adequacy of prenatal care. It is a cross-sectional study with prospective data collection of 301 medical records of pregnant women from February to October 2009. After the descriptive analysis it was used the chi-square to study associations between variables, the level of significance was 0.05. The results showed: 58.5% went directly to the PN-AM for the start of monitoring of pregnancy and 41.5% spontaneously transferred from another facility, most basic health unit (82.4%); 73.0% on the advice of family, friends or acquaintances, 21.6% for previous experience, 75.1% initiated until 120 days of pregnancy, an average of 8.3 consultations, 71.0% attended all the scheduled appointments; 72.4% had appropriate interval between visits, 29.9% had at least one missing, 35.4% missed for personal reasons and 81.4% of pregnancies reached term; 87.4% adherence to the service, the prenatal care was adequate for 66.8% of pregnant women according to the Kessner index, modified by Takeda. Age, work, steady partner, place of residence, companion in the consultations, site of initiation of prenatal care had statistically significant when associated with adequacy of prenatal care for pregnant women according to number of six visits, onset of prenatal care until 120 days Kessner index, modified by Takeda. Paid work, place of residence, place of early prenatal care, parity, number of pregnancy and children were associated with the adequacy according to the frequency and interval between visits to the PN-AM. The findings suggest health services for the establishment of strategies that enable the early entry of pregnant women in prenatal care, and ensuring availability of specialists and, especially, to promote continuity of monitoring, so that women do not need to seek care away from their residences.

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In the first article we assessed the utilization of home care by the elderly in Brazil after implementation of the Family Health Strategy (FHS). Data were derived from a crosssectional study in a southern city in Brazil. Using the Chi-square test and a logistic regression with different levels of determination, we tested the hypothesis that the FHS increased the utilization of home care compared with utilization under the Traditional Primary Health Care (TPHC) system. We interviewed 1593 residents aged 60 years and older. Home care utilization under the FHS was 2.7 times the rate of utilization under the TPHC (95% confidence interval=1.5, 4.7; P=.001), and utilization increased among the older group, the less educated, those with history of hospitalization, and those with functional limitations. Improvement in access to care resulted in greater utilization of home care. Our findings have policy implications that include expanding the coverage of the FHS throughout big cities where coverage is limited. These findings are important because the population is aging and the family strategy operates in poorer areas; thus, it can promote equity in access to home health care among the elderly. In the second article the objective was to assess factors associated with home health care for the elderly and its characteristics based on different care models, the Family Health Strategy and Traditional primary care. It also describes the forms of access, the professionals who provide the care, the elderly satisfaction and health status after receiving care. Poisson regression model was used for estimating crude and adjusted prevalence ratios, their related 95% confidence intervals and p-values (Wald test). Home health care was statistically associated with prior history of stroke, signs of dementia and disability in activities of daily living. The family was requested 75% of home care visits. Medical doctors provided most of the care in Traditional primary care settings while nursing staff provided most care within the Family Health strategy. Approximately 78% of the elderly received care within 24 hours after the request and 95% of them positively evaluated the care received. Two thirds of the elderly reported improved health status after receiving home care. The variables associated with home health care were consistent with vulnerability indicators included in the Brazilian National Health Policy for the Elderly, reinforcing the role of this strategy for promoting equitable health care to elderly population. Users satisfaction and the positive impact on their health status support home as a setting for providing care. The objective of the third article was to review the literature in search for tools and indicators proposed for the study of quality assessment of care for the elderly at home. Nineteen articles were selected for inclusion in the analysis. Two instruments are highlighted in the study of quality home care: the Outcome and Assessment Information Set and the Minimum Data Set - Home Care. The hospitalization rate, functional capacity and pain control indicators were used in both instruments to assess quality. This review may help the discussion about the relevance in the development of specific instruments and appropriate indicators to assess home care provided in primary health care, mainly due to the expansion and consolidation of family health strategy.
A Politica Nacional de Saude da Pessoa Idosa preconiza a manutencao do idoso na comunidade, com o apoio dos familiares e o estabelecimento de uma rede social de ajuda. Portanto, o modelo assistencial dos servicos de atencao basica a saude precisa adequar-se a esta nova demanda, identificando precocemente idosos em situacao de fragilidade e resgatando o domicilio como ambiente terapeutico. O objetivo desta tese foi avaliar o desempenho dos servicos de atencao basica no atendimento domiciliar aos idosos, os fatores associados e as caracteristicas do acesso, segundo os modelos de atencao estrategia Saude da Familia e Tradicional. Os dados foram coletados através de um estudo transversal realizado em Bage, no Rio Grande do Sul, no ano de 2008. Um total de 1.593 idosos com 60 anos ou mais de idade responderam ao questionário aplicado por entrevistadores no proprio domicilio. Nas areas cobertas pelas equipes Saude da Familia a utilizacao de assistencia domiciliar foi 2,7 vezes maior comparadas com as areas sob responsabilidade da atencao basica Tradicional (IC95% 1,5-4,7; p=0,001). A utilizacao de assistencia domiciliar foi maior entre os idosos mais velhos, com menor escolaridade, com historia de hospitalizacao no ultimo ano, historia previa de derrame, sinais de demencia e incapacidade para as atividades da vida diaria. O fato da estrategia Saude da Familia operar em areas de maior vulnerabilidade social sugere uma maior equidade no acesso a assistencia domiciliar entre os idosos. Nestas areas, a maior prevalencia de idosos com renda per capita de ate um salario minimo e sem acesso a plano de saude indica que a Saude da Familia permitiu diminuir a desigualdade financeira no acesso aos cuidados domiciliares. As variaveis associadas a utilizacao de assistencia domiciliar reiteram os indicadores de fragilidade destacados na Politica Nacional de Saude da Pessoa Idosa. Estes achados devem servir de estimulo a expansão da cobertura da Saude da Familia nos grandes centros urbanos, locais onde a cobertura ainda e limitada. A familia teve papel central e foi responsavel por 75% das solicitações de cuidado. Nas areas da atencao Tradicional, os medicos responderam pela maior promocao de cuidados, enquanto, nas areas da estrategia Saude da Familia, destacou-se a participacao da equipe de enfermagem. Independente do modelo de atencao, aproximadamente 78% das solicitacoes foram atendidas em ate 24 horas e 95% dos usuarios avaliaram positivamente o cuidado recebido. Dois tercos dos idosos referiram melhora nas condicoes de saude apos atendimento. As avaliacoes positivas realizadas por idosos e familiares, e o impacto na situacao de saude reforcam o domicilio como ambiente terapeutico. A tese tambem contem uma revisao da literatura sobre instrumentos e indicadores utilizados para avaliar a qualidade da assistencia domiciliar. Entre os dezenove artigos que preencheram os criterios de inclusao, a maioria foi realizada na America do Norte e na Europa. Os principais indicadores de qualidade utilizados referem-se a mudancas na capacidade funcional entre a admissao e a alta domiciliar, internacao hospitalar no periodo e as taxas de vacinacao.

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With the aim of subsidizing students with disabilities and reduced mobility in achieving equality, equity of opportunity and space in academic society in their total or partial university experience, presented himself, as objective of our research, the creation of an evaluation instrument that has as result an indicator of the level of accessibility of the university academic centers of Higher Education Institutions (IES), having as a case study the Center of Legal Sciences (CCJ) of the Federal University of Paraíba (UFPB). The developed instrument measured the accessibility of the academic structure that configures university academic centers based on technical and instrumental parameters that make up the dimensions: architectural, communicational; methodological; instrumental; programmatic and attitudinal. As a result, a global indicator was presented – Indicator A6 – which testifies to how accessible the academic university center under study, contributing to the management, mobilization, debate and evaluation of the institutional actors, in view of the importance of promoting accessibility as an empowerment for admission, permanence and completion of higher education of those historically marginalized.
Com a finalidade de subsidiar os discentes com deficiência e mobilidade reduzida no alcance da igualdade, equidade de oportunidade e espaço na sociedade acadêmica em sua total ou parcial vivência universitária, apresentou-se, como objetivo de pesquisa, a criação de um instrumento de avaliação que tem por resultado um indicador do nível de acessibilidade dos centros acadêmicos universitários das Instituições de Ensino Superior (IES), tendo, como estudo de caso, o Centro de Ciências Jurídicas (CCJ) da Universidade Federal da Paraíba (UFPB). O instrumento desenvolvido mensurou a acessibilidade da estrutura acadêmica que configura os centros acadêmicos universitários com base em parâmetros técnicos e instrumentais que compõem as dimensões: arquitetônica; comunicacional; metodológica; instrumental; programática e atitudinal. Como resultado, foi apresentado um indicador global – Indicador A6 – que atesta o quão acessível está o centro acadêmico universitário em estudo, contribuindo para a gestão, mobilização, debate e avaliação dos atores institucionais, frente à importância de se promover a acessibilidade como empoderador para o ingresso, permanência e conclusão do ensino superior daqueles historicamente marginalizados.

L’objectif de la thèse était de développer un indicateur mesurant l’accessibilité spatiale des premiers soins (nommé Index of Spatial Accessibility : ISA) pour les femmes enceintes, à partir de sources de données collectant des informations en routine. Ce travail a pour vocation de mettre en évidence les limites des indicateurs existants tout en apportant des améliorations. Une attention particulière a consisté à étudier l’impact de l’effet des contours administratifs (ou effet de bord), la limite pointée dans de nombreuses études portant sur l’accès aux soins. L’indicateur d’accessibilité aux professionnels de santé que nous avons développé a pour objectif de mettre en évidence les disparités spatiales à une échelle géographique fine afin d’identifier les zones géographiques dans lesquelles il faudrait intervenir en priorité. Ce travail s’est concentré tout d’abord sur les professionnels de santé intervenant dans le suivi de la grossesse : médecins généralistes, sages-femmes et gynécologues. Les résultats mettent en évidence qu’en combinant la disponibilité avec la proximité des soins, les besoins en matière de santé et la mobilité, l’ISA permet de fournir une meilleure mesure d’accessibilité. L’ISA a été construit afin de pouvoir interroger l’accès aux soins pour d’autres pathologies ou d’autres populations. L’analyse de l’impact de l’effet de bord met en évidence que : 1) la moyenne et l'écart-type sont légèrement inférieurs avec effet de bord que sans, quel que soit le type des professionnels de santé ; 2) La variation d’ISA est plus marquée pour les sages-femmes et les gynécologues, et pour les zones rurales. Nous avons également menée une étude pilote sur le recours aux soins des femmes enceinte, à partir des données SNIIRAM afin d’étudier la relation entre le recours aux soins et l’indicateur ISA
This paper developed an improved indicator: the Index of Spatial Accessibility (ISA) to measure geographical healthcare accessibility at the census blocks level, and seeks to assess the effect of edge on the accuracy of defining healthcare provider access by comparing healthcare provider accessibility accounting or not for the edge effect, in a real-world application. The indicator of accessibility to health professionals developed aims to highlight spatial disparities measured at a fine geographical scale and to identify area where actions are needed in priority. This work focused first of all on the health professionals involved in the follow-up of the pregnancy: general practitioners, midwives and gynecologists. The main finding is that by combining availability with proximity to services, health needs and mobility, and by calculating at the smallest feasible geographical scale, ISA provides a better measure of accessibility. ISA was conceived so that we could question the access to care for other pathologies and other populations. When we compare the variation of ISA with and without edge effect, we found that (1) mean and standard deviation are slightly below when offer and demand outside are taken in to account, whichever health professionals considered; 2) the variation of ISA is higher for midwives and gynecologists, and for rural areas. In addition, we also conducted a pilot study on the health use of pregnant women, using SNIIRAM data to examine the relationship between use of care and the ISA indicator

Construit à partir d'une expérience dans un programme de recherche-action en Guinée Maritime, le présent travail met en lumière la nécessité d'actualiser les mesures classiques et macroéconomiques du développement humain, sur lesquelles se basent les politiques de développement qui sont menées en milieu rural africain. Une analyse géohistorique met en évidence une accélération contemporaine des changements géographiques, économiques, politiques et sociaux : la connexion des sociétés étudiées à un monde globalisé s'accroît, par la monétarisation des échanges et leur vulnérabilité augmente face à l'instabilité des prix. Localement, dans les villages, le manque de bien-être (pauvreté) et l'accroissement des inégalités économiques témoignent que les ménages ne fonctionnent pas de manière satisfaisante au quotidien : leur accès aux ressources, aux biens et aux services d'utilité publique sont des problèmes récurrents. La construction d'indicateurs « autochtones » d'accessibilité, réalisée au moyen de méthodes qualitatives et quantitatives, permet de rendre compte des difficultés d'accès des ménages et de leurs communautés villageoises pour accomplir leurs fonctionnements. D'un côté, celles-ci concernent la mise en oeuvre des mobilités nécessaires et donc la construction des espaces de circulation à plusieurs échelles. De l'autre, elles se traduisent par un accès aux ressources insuffisant pour améliorer leur niveau et leurs conditions de vie ainsi que leurs fonctionnements sociaux. Au final, l'ensemble de ces indicateurs d'accessibilité représentent de bons indicateurs du bien-être, du changement économique et social, ainsi que des inégalités et du fonctionnement social.

碩士
國立成功大學
體育健康育與休閒研究所
96
Recently, significant attention has been paid gradually to the issue on the barrier-free environment. However, the previous studies, thus far, in regard to barrier-free environment have primarily focused on public buildings. There seem to have been no studies on evaluation and assessment tools for sports and recreational facilities. Many studies have shown that swimming is one of the most popular activities for people with disabilities and the elderly. In order to provide a better understanding of the level of accessibility and obstacles faced by them, the purpose of the present study, therefore, was to establish the first instrument measuring swimming pool environment and to examine the accessibility of swimming pools in Kaohsiung city. A self-designed checklist revised through expert validation and a pilot study was used to examine the accessible level of swimming pools. Fourteen governmental swimming pools and eight private swimming pools in Kaohsiung city were investigated with the convenient sampling method. The conclusions and suggestions in the current study include: 1.A graded scale classified according to a variety of levels and different types of impairments was designed in the self-designed checklist, which was more effective in reflecting the standard of barrier-free facilities and in providing more information for the future users. In addition, the classification in the checklist was based on four priorities as accessibility examination and improvement, and thus it can be used as a reference for further analysis and modification. 2.The findings indicated that governmental swimming pools have better performances on the total accessibility levels than private swimming pools in Kaohsiung city, especially among those basic architectural facilities such as restrooms, fitting rooms and shower rooms. Nevertheless, both governmental and private swimming pools have a severe deficiency in the swim-related assistant facilities. To provide a greater accessible and safer barrier-free environment of swimming pools, there is an urgent need to improve facilities such as assistant entry into the water and facilitators in the water. 3.By classifying accessibilities with the evaluation indicators, three basic architecture-related indicators fulfilled the first and second level of requirements in the vast majority of governmental swimming pools. But in the private swimming pools, the three indicators only fulfilled the accessible requirements below the third level. Furthermore, in the swim-related indicator, accessibilities of both governmental and private swimming pools merely attained the third or the lowest level of requirements. Therefore, specific legislations and instructions measuring accessibility of sports and recreation facilities were needed in the future.

Dissertação de Mestrado Integrado em Engenharia Civil apresentada à Faculdade de Ciências e Tecnologia
The study of urban accessibility is an important factor in urban and transportation planning, which can be used as an instrument of public policies. This concept involves the interaction of a point of origin with multiple destinations, namely various types of equipment, and requires all pertinent information on the spatial distribution of the later (health equiment, education, entertainment, etc.).The present dissertation studies cycling accessibility in the city of Coimbra. Given the well-known importance of sustainable development, triggered by ecological and sustainability concerns, together with public health problems and urban quality of life in general, it is essential to encourage this and other soft (or active) modes of transports given their social, environmental and economic advantages. In order to assess the potential of Coimbra for the use of soft modes of transportation, four accessibility indicators were constructed. These indicators were calculated based on the vision of accessibility as disutility, using human effort as impedance to the various types of equipment, and taking into account that Coimbra is a hilly city. In the analysis, the location of urban facilities in Coimbra and its streets network were considered, and calculations were carried out in the ArcGIS GIS environment.The results were presented in colored map format, according to the accessibility of each location in the city. The analysis of the maps reveals that both centrality and hilliness influence the cycling accessibility of Coimbra. It was also possible to understand the reasons why there exist relatively central zones with lower (worst) values of accessibility. Finally, some suggestions are made to encourage the use of the bicycle.
O estudo da acessibilidade em meio urbano é um fator importante no planeamento urbano e dos transportes, que pode ser usado como instrumento de políticas públicas. Este conceito envolve a interação de um ponto de origem com múltiplos pontos de destino, refentes aos vários tipos de equipamentos, sendo necessária toda a informação pertinente da distribuição espacial dos últimos (equipamentos de saúde, educação, entretenimento etc.).A presente dissertação estuda a acessibilidade ciclável na cidade de Coimbra. Dada a conhecida importância de um desenvolvimento sustentável, potenciada por preocupações ecológicas e de sustentabilidade, juntamente com os problemas de saúde pública e qualidade de vida urbana em geral, é essencial fomentar o uso deste e de outros modos de transportes suaves (ou ativos), dadas as suas vantagens sociais, ambientais e económicas. Assim, de forma a conseguir avaliar o potencial de Coimbra para uso destes modos suaves, procedeu-se à construção de quatro indicadores de acessibilidade. Estes indicadores foram calculados com base na visão da acessibilidade como desutilidade, usando o esforço humano como impedância aos vários tipos de equipamentos, e tendo em conta o facto de ser esta ser uma cidade declivosa. Na análise considerou-se a rede viária e a localização dos equipamentos, tendo sido efetuada toda a gestão da informação espacial, bem como os cálculos num ambiente SIG, o ArcGIS. Os resultados obtidos foram apresentados em formato de mapas coloridos, conforme a acessibilidade de cada localização na cidade. A análise desses mapas revela que tanto a centralidade como a declivosidade da cidade têm influência sobre a acessibilidade ciclável. Foi também possível perceber as razões pelas quais existem zonas relativamente centrais com menores (piores) valores de acessibilidade. Por fim, são feitas algumas sugestões que podem fomentar o uso da bicicleta.

Dissertation submitted in partial fulfilment of the requirements for the degree of Master of Science in Geospatial Technologies
Accessibility to different services in cities has been studied as form of analysing equity, especially in urban settings. Green spaces are one of these services; they have known benefits on the wellbeing of the urban residents. This work intends to determine if the variation in accessibility to urban green spaces is affected by the distribution of socio-economic variables such as income, and how these affect the green equity in a city. Green spaces have been categorised into different functional levels based on their size and accessibility and equity has been analysed, taking into consideration income, density, migrant populations and age-based variables. The analysis conducted involved a network-based service area analysis as well as spatial and statistical analysis using ArcGIS, GeoDa and R. The case study selected was the city of Barcelona (Spain). The results of the analysis reject the hypothesis of inequity in accessibility at functional levels based on the variables studied although some spatial associations exist.

South Africa is experiencing a financial skills shortage with a severe shortage of accountants and chartered accountants in particular. The aim of this study was to measure accessibility of public higher education in South Africa, in general and specifically relating to accountancy programmes with special emphasis on chartered accountancy programmes in South Africa, by making use of selected accessibility indicators. Although some of these indicators have been used to measure accessibility of higher education in general both locally and internationally, they are not often used to measure accessibility of a programme for a particular profession such as accountancy or chartered accountancy. This study aimed to fill this gap by measuring the selected accessibility indicators and providing subsequent rankings of the four public universities selected for this study. The results can be used by institutions that offer accountancy and chartered accountancy programmes as well as the South African Institute of Chartered Accountants, as the profession’s Education and Training Quality Assurance body, to evaluate the accessibility of accountancy as well as chartered accountancy programmes.
Financial Accounting
M. Compt. (Applied Accountancy)

O presente trabalho procura analisar a evolução da rede rodoviária na ilha da Madeira entre 1955 e 2015, desde o prelúdio, ao auge e estagnação do investimento na expansão da rede rodoviária e, deste modo, perceber de que forma o investimento e consequente evolução da rede se repercutiu numa melhoria das acessibilidades, na ocupação do território, distribuição da população e, consequentemente, na mudança dos padrões de mobilidade. Para isso, é feita uma breve incursão histórica à evolução da rede rodoviária regional, ao desenvolvimento do transporte terrestre e ao investimento nas infraestruturas rodoviárias e, posteriormente, perceber o impacto da mesma na mudança dos padrões de mobilidade e no desenvolvimento económico e social da região. O estudo assenta numa reconstituição, a partir de cartografia histórica da rede rodoviária da ilha da Madeira, baseado num modelo SIG, que permite quantificar as transformações da rede rodoviária e acessibilidades na região ao longo dos últimos 60 anos. As transformações da rede rodoviária ao longo deste período tiveram um impacto direto na melhoria das acessibilidades, competitividade e coesão económica e social, bem como na organização e estruturação do território. Em apenas 60 anos a ilha da Madeira transformou-se. Foram eliminadas barreiras físicas, findou-se o isolamento e, atualmente, é possível deslocar-se desde a capital madeisense até o concelho mais noroeste da ilha em apenas 51 minutos, verificando-se uma grande diferença, em comparação com os cerca de 165 minutos dos anos 50 do século XX.
The present work is aimed to analyze the evolution of the road network of Madeira between 1955 and 2015, from the onset of its investments to expand Madeira's roads connections, to its peak and its stagnation. Based on these analyses, it’s possible understand how these investments and the consequent evolution of the network were reflected in an improvement in the accessibility, occupation of the territory and distribution of the population and, consequently, in the change of mobility patterns. To take this into account, this essay/ thesis has a brief historic incursion into the evolution of the regional road network and the development of road transport and road infrastructures, while at the same time, realizing its impact on the changing patterns of mobility and the economic and social development of a region. On the basis of this study was a reconstruction based on the historical cartography of the Madeira island road network, endured by GIS model that allows us to quantify the transformations of the road networks and accessibility in the region during the last 60 years. The transformations of the road networks throughout this period had a direct impact on the improvement of accessibility, competitiveness and economic and social cohesion, as well as on the organization and structuring of the territory, in only 60 years the island of Madeira was transformed. Physical barriers have been eliminated, and isolation has ended, and it is now possible to go from the city of Funchal to the northwestern place of the island (Porto Moniz) in just 51 minutes, compared to about 165 minutes that we needed in the 1950s.

Bibliography: leaves 203-219.
219 leaves : ill. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Concerned with the contribution of commonsense understandings of disease to social differentials in health outcomes. Argues that understandings in part reflect the social circumstances of an individual and mediate preventive activities and use of services, thereby influencing health outcomes. These are examined using the specific health outcomes of tooth loss and tooth decay.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2000

Inequalities in levels of health between regions within a country are frequently regarded as a problem. Zimbabwe is characterised by poor and unequal conditions of health (both the state of people’s health and health services). The health system of the country shows severe spatial inequalities that are manifested at provincial, district and even local levels. This research therefore examines and analyses the spatial inequalities and temporal variation of health conditions in Zimbabwe. Composite indices were used to determine the people’s state of health in Zimbabwe. Administrative districts were ranked according to the level of people’s state of health. Cluster analysis was also performed to demarcate administrative districts according the level of health service provision. Districts with minimum difference were demarcated in a single cluster. Clusters were delineated using data on patterns of diseases and health and such clusters were used to demarcate the country’s spatial health system according to the Adapted Epidemiological Transition Model. This was used to evaluate the applicability of the model to Zimbabwe. It emerged from the research that generally the country’s health conditions are poor and the health system is characterised by severe spatial inequalities. Some districts are experiencing poor health service provision and serious health challenges and are still in the age of pestilence and famine but others have good health service provision as well as highly developed health conditions and are in the age degenerative diseases of the epidemiological transition model. It further emerged that the country’s health has been evolving with signs of improvement since the 1990s. Recommendations were made regarding possible adjustment to previous strategies and policies used in Zimbabwe, for the development of the health system of the country. New strategies were also recommended for the improvement of the health system of the country. Some proposals are made for further research on the spatial development of health in the country.
Geography
D. Litt et. Phil. (Geography)

Indiana University-Purdue University Indianapolis (IUPUI)
A significant body of literature has accumulated in the last decade that provides evidence of the growing health care disparities among racial and ethnic groups in the United States. The literature suggests that Black adults share a disproportionate burden in death, disability, and disease. In 2002, the Institute of Medicine report, Unequal Treatment, showed that racial-ethnic disparities in health cannot be entirely attributed to problems of health care access, clinical performance, or patients’ personal characteristics. Many studies have shown that institutional and individual level discrimination that Blacks face in the health care system impacts their health status. This study used secondary data analysis to examine how primary care experience impacts self-reported health status and health care utilization among Black adults. Data were from the Medical Expenditure Panel Survey (MEPS) implemented by the Agency for Healthcare Research and Quality (AHRQ). Specifically, MEPS Panel 10 (2005-2006) and Panel 11 (2006-2007) data were used in the analyses. The final sample comprised of N=15,295 respondents ages 18 and over. Logistic regression analyses were carried out using Stata Statistical Software, version 11. The study results reflect the disparities among Blacks and Whites on self-reported health and health care utilization. Blacks were 15% less likely to report good health status compared to Whites and had 0.11 less expected office-based doctor visits. Respondents who had better primary care experience had 0.05 times higher expected office-based doctor visits than respondents who did not have good primary care experience. Health care Social Workers should advocate for structural changes in health policy that will take into account the historical marginalization and contemporary inequities that continue to encompass the lives of many Black Americans.