Dissertations / Theses on the topic 'Fever Management'

Despite decades of research about educational interventions to correct parents' childhood fever management their knowledge remains poor and practices continue to be based on beliefs about harmful outcomes. The purpose of this thesis was to 1) identify Australian parents' fever management knowledge, attitudes, practices and methods of learning to manage fever and 2) undertake a theoretical exploration of the determinants of parents' intentions to reduce fever using the Theory of Planned Behavior (TPB). Two studies were undertaken: a qualitative study with 15 parents; and survey of 401 Queensland parents with a child aged between 6 months and 5 years. Parents determine childhood fever through behavioural changes they have learnt to associate with fever. Few were aware of the immunological beneficial effects associated with fever and most believed fever harmful causing febrile convulsions and brain damage. To prevent harm they monitored temperatures, used antipyretics, dressed children in light clothing and sponged them with tepid, cool or cold water. Despite believing antipyretics harmful most parents reduced temperatures of 38.3 degrees Celsius ± 0.6 degrees Celsius with antipyretics, alternating two antipyretics when fever was not reduced or returned. In addition to temperature reduction antipyretics were used to reduce distress or general unwellness and pain or discomfort. Multiple factors were used to determine antipyretic dosage including temperature, irritability and illness severity. Over one-third of parents had overdosed their child with too frequent antipyretic administration; more frequently with ibuprofen than paracetamol, 12:1. Fever management information was learnt from numerous sources. Doctors were the most frequently reported followed by personal experience. With the variety of information sources nearly half received conflicting information about how to manage fever increasing concerns and creating uncertainty about how to best care for their child. Despite this many believed they knew how to manage fever. Some parents' practices changed over time as a result of either positive or negative experiences with fever indicating more positive or negative attitudes toward fever. Positive experiences reduced antipyretic and medical service use; negative ones had the adverse effect with increase in antipyretic use including alternating antipyretics and double dosing with one antipyretic. Child medication behaviours also influenced attitudes and practice intentions. Parents of children who readily took antipyretics had more negative attitudes and intended to reduce their child's next fever with antipyretics. Negative attitudes were a significant determinant of fever management intentions. Parents' practices were strongly influenced by their perception that doctors and partners expected them to reduce fever. This expectation from partners is understandable; from doctors it is not and indicates doctors' propensity to recommend reducing fever. There is an urgent need to identify doctors' fever management beliefs and rationales for practice recommendations. Parents also learn to manage fever from nurses and pharmacists; their beliefs and management rationales must also be determined and addressed. There is an urgent need to educate parents about evidence-based fever management and reduce their unnecessary antipyretic use. They must be encouraged to delay antipyretic administration using them to reduce pain rather than fever. Findings from this thesis have identified the determinants of parents' intentions to reduce fever; negative attitudes and normative influences and positive child medication behaviours. Future studies should examine the efficiency and cost effectiveness of fever management educational programs for parents using different presentation methods in multiple settings.

Despite decades of research about educational interventions to correct parents' childhood fever management their knowledge remains poor and practices continue to be based on beliefs about harmful outcomes. The purpose of this thesis was to 1) identify Australian parents' fever management knowledge, attitudes, practices and methods of learning to manage fever and 2) undertake a theoretical exploration of the determinants of parents' intentions to reduce fever using the Theory of Planned Behavior (TPB). Two studies were undertaken: a qualitative study with 15 parents; and survey of 401 Queensland parents with a child aged between 6 months and 5 years. Parents determine childhood fever through behavioural changes they have learnt to associate with fever. Few were aware of the immunological beneficial effects associated with fever and most believed fever harmful causing febrile convulsions and brain damage. To prevent harm they monitored temperatures, used antipyretics, dressed children in light clothing and sponged them with tepid, cool or cold water. Despite believing antipyretics harmful most parents reduced temperatures of 38.3 degrees Celsius ± 0.6 degrees Celsius with antipyretics, alternating two antipyretics when fever was not reduced or returned. In addition to temperature reduction antipyretics were used to reduce distress or general unwellness and pain or discomfort. Multiple factors were used to determine antipyretic dosage including temperature, irritability and illness severity. Over one-third of parents had overdosed their child with too frequent antipyretic administration; more frequently with ibuprofen than paracetamol, 12:1. Fever management information was learnt from numerous sources. Doctors were the most frequently reported followed by personal experience. With the variety of information sources nearly half received conflicting information about how to manage fever increasing concerns and creating uncertainty about how to best care for their child. Despite this many believed they knew how to manage fever. Some parents' practices changed over time as a result of either positive or negative experiences with fever indicating more positive or negative attitudes toward fever. Positive experiences reduced antipyretic and medical service use; negative ones had the adverse effect with increase in antipyretic use including alternating antipyretics and double dosing with one antipyretic. Child medication behaviours also influenced attitudes and practice intentions. Parents of children who readily took antipyretics had more negative attitudes and intended to reduce their child's next fever with antipyretics. Negative attitudes were a significant determinant of fever management intentions. Parents' practices were strongly influenced by their perception that doctors and partners expected them to reduce fever. This expectation from partners is understandable; from doctors it is not and indicates doctors' propensity to recommend reducing fever. There is an urgent need to identify doctors' fever management beliefs and rationales for practice recommendations. Parents also learn to manage fever from nurses and pharmacists; their beliefs and management rationales must also be determined and addressed. There is an urgent need to educate parents about evidence-based fever management and reduce their unnecessary antipyretic use. They must be encouraged to delay antipyretic administration using them to reduce pain rather than fever. Findings from this thesis have identified the determinants of parents' intentions to reduce fever; negative attitudes and normative influences and positive child medication behaviours. Future studies should examine the efficiency and cost effectiveness of fever management educational programs for parents using different presentation methods in multiple settings.

Most families and children have coped with fever at least once in their lifetime regardless of ethnicity or culture. The purpose of this descriptive study was to describe how Afro-American parents' perceive and manage fever in their school age child. Roy's Adaptation model was used to guide this study. A convenient sample of 50 Afro-American parents of children ages 6-12 years was selected for this study. Parents were explained this study and asked to complete the questionnaire, based on their school age child. The data was analyzed using descriptive statistics and chi-square, where applicable. Findings revealed that Afro-American parents, in this study, had misconceptions concerning the beginning of fever, the height of fever, harmful affects of fever and believing that all fevers needed to be treated. Many Afro-American's in this study overtreated fever. All these misconceptions are areas which nurses can provide parents with current information.

This thesis comprised two studies: an exploratory study and a cross-sectional survey, guided by the Theory of Planned Behaviour. It explored parents' and paediatric nurses' knowledge, beliefs and practices about fever management in Vietnam. The research highlights the determinants of parents' and nurses' intentions to manage childhood fever which can be targeted for future interventions to integrate latest evidence-based practices.

This thesis examined malaria test use, adherence and integration into clinical practice for improved pediatric fever management in sub-Saharan African countries and explored Access, Facility Readiness and Clinical Practice bottlenecks to achieve this program goal. Study I examined diagnostic testing rates and its determinants for pediatric fevers across 13 countries in 2009-2012 including Access bottlenecks. Study II evaluated the effect of testing on treatment decisions at the population level in 12 countries in 2010-2012 and explored reasons for varying country results across Access, Facility Readiness and Clinical Practice bottlenecks. Study III explored Facility Readiness and Clinical Practice bottlenecks for using malaria diagnosis for improved pediatric fever management in Mbarara District Uganda. Study IV examined integrated pediatric fever management using RDT and IMCI in Malawi health facilities in 2013-2014 including Facility Readiness and Clinical Practice bottlenecks. Malaria testing of pediatric fevers was low (17%) and inequitable at the outset of new guidelines with febrile children in least poor household more often tested than in poorest (OR: 1.63, 95% CI: 1.39-1.91) (Study I). Significant variability was found in the effect of testing on ACT use across countries (e.g. Uganda OR: 0.84, 95% CI: 0.66-1.06; Mozambique OR: 3.54, 95% CI: 2.33-5.39). Four main themes explained varying results: available diagnostics and medicines; quality of care; care-seeking behavior; and malaria epidemiology (Study II). In Mbarara District Uganda malaria over-treatment for RDT-negative results reportedly occurred and was driven by RDT perceptions, system constraints and provider-client interactions (Study III). In Malawi health facilities, there was common compliance to malaria treatment guidelines in sick child consultations. 72% were tested or referred for malaria diagnosis and 85% with RDT-confirmed malaria were prescribed first-line anti-malarials. Yet integrated pediatric fever management was sub-optimal in terms of other assessments completed and antibiotic targeting. 28% with IMCI-pneumonia were not prescribed any antibiotic and 59% ‘without antibiotic need’ were prescribed any antibiotic. Few eligible clients had respiratory rates counted to identify antibiotic need for IMCI-pneumonia (18%). RDT-negative children had 16.8 (95% CI: 8.6-32.7) times higher antibiotic over-treatment odds compared to positive cases and this effect was conditioned by cough or difficult breathing complaints (Study IV). Thesis findings highlight Access, Facility Readiness and Clinical Practice bottlenecks that need to be addressed to use malaria diagnosis for improved pediatric fever management. Programs must move beyond malaria-focused ‘test and treat’ strategies towards ‘IMCI with testing’ in order to conceptualize RDT as one part of the established algorithm for managing sick children in an integrated manner. RDT should also be viewed as an important entry point for contributing to ongoing health system strengthening efforts.

Stroke is Australia’s second highest cause of death and a leading cause of adult disability (1- 3). Several factors influence morbidity and mortality after ischaemic stroke, including fever, hyperglycaemia and swallowing dysfunction (4-8). Early detection and treatment of these three physiological variables should be a priority (4-8). National and international guidelines (9-13) provide recommendations for the management of fever, hyperglycaemia and swallowing dysfunction following acute stroke; however, only a small proportion of Australians receive evidence-based care (14-18). Prior studies have identified that the distribution alone of guidelines will not change clinician behaviour (19); thus, further research is required to identify effective behaviour change interventions to promote the uptake of guideline recommendations and evidence-based practice. This thesis presents three studies conducted by the candidate as part of the Quality in Acute Stroke Care (QASC) cluster randomised controlled trial (CRCT) conducted from July 2005 to October 2010 in 19 stroke units located in New South Wales (NSW), Australia. The aim of the QASC trial was to develop, implement and evaluate a multifaceted behaviour change intervention to promote stroke guideline recommendations and evidence-based management for fever, hyperglycaemia and swallowing dysfunction within the first three days following hospital admission for acute stroke. The QASC multifaceted behaviour change intervention comprised evidence-based clinical treatment protocols (referred to as the fever (Fe), sugar (S) and swallow (S) [FeSS] protocols), supported by team-building workshops (to identify local barriers to change) and site-based education and support. The QASC trial resulted in significantly improved patient outcomes in intervention stroke units, explained in full later in this thesis (1). As part of the QASC trial, the candidate conducted three studies. Specifically, the aim was to (i) establish monitoring and treatment practices within NSW stroke units for fever hyperglycaemia and swallowing dysfunction prior to the implementation of the QASC intervention; (ii) investigate NSW stroke unit nurse unit managers’ (NUMs) perceptions of self-leadership ability, organisational learning, attitudes and beliefs towards evidence-based practice (EBP), and organisational readiness for change also prior to the implementation of the QASC intervention; and (iii) conduct a process evaluation parallel to the QASC trial to assist in the interpretation of the QASC patient outcome results at the conclusion of the trial.

Magister Public Health - MPH
In Zambia, there had been a large scaling up of new interventions to control malaria since 2003, which included the distribution of rapid diagnostic tests (RDTs), used to immediately determine if someone with symptoms suggestive of malaria actually has malaria; training of health workers in the use of the RDTs; and the prescription of artemisinin-based combination therapy (ACT) to which the malaria parasite is sensitive, rather than the old treatment regime of chloroquine to which the malaria parasite had become resistant. The use of RDTs to confirm the presence of malaria before treating for it with ACT became known as the „test and treat‟ policy. Previously, since the 1960s, in malaria endemic areas such as Zambia, children presenting with fever (the commonest symptom of malaria) without any obvious other cause for the fever, were assumed to have malaria and were hence treated for it with chloroquine. This was known as "presumptive treatment" of malaria. The combination of "presumptive treatment" and the use of a single medication led to the development of high levels of resistance to chloroquine, to the extent that it is now no longer an effective treatment for malaria. Years after the introduction of the "test and treat" policy, it was still unclear to what extent it was being implemented, as there was initial reluctance by health workers to test all children presenting with fever for malaria and if they did test they may not have followed the management guidelines of treating those who test positive with ACT and further investigating those who test negative for the cause of the fever. It seemed that staff had gotten used to the "presumptive treatment" approach to malaria over almost 4 decades and hence were quite reluctant to abandon it. The conflicting guidelines for malaria treatment in children between IMCI and "test and treat‟ has promoted a paradox between presumptive treatment for malaria and "test and treat" approach as IMCI teaches health workers to treat febrile children presumptively for malaria whereas the "test and treat" approach requires them to first make a definitive diagnosis before treating. Hence although the "test and treat" approach was instituted to overcome the problems with presumptive treatment approach it now had to contend with the competing and contradictory influence of the IMCI approach. This study therefore aimed to assess what proportion of children aged five years and younger who presented with fever were managed via the "test and treat" guidelines and which factors were associated with this, in Lusaka District, Zambia. Methodology: A cross sectional analytical study design was used based on a review of medical records. A sample size of 800 medical records of children presenting with fever was selected from 10 out of the 23 health care facilities in Lusaka, using a multistage stratified random sampling technique. Four hundred records were sampled from 2008 records (five years after commencement of the "test and treat" policy) and 400 from 2011 records (eight years after commencement of the "test and treat" policy). Trained data collectors used a data extraction tool to transcribe demographic and clinical data from the medical records in a standardized manner. Data Analysis: Univariate descriptive statistics analysis was performed using measures of central tendency and measures of dispersion to analyze numerical (continuous) variables such as age, weight and body temperature; and using frequencies for categorical variables such as gender, area of residence, RDTs/microscopy malaria tests conducted, received ACT if RDT positive, presence of an ACT treatment chart on the health centre wall and availability of a weighing scale. To determine the relationship between variables, bivariate analysis via the prevalence ratio was conducted. Results: Just over half (55%) of all children with fever were tested for malaria in 2008 and this gratifyingly increased to (73%) in 2011. Overall, the proportion of children correctly and appropriately treated with ACT, which means that those who tested positive for malaria were given ACT, was 85% in 2008 but regrettably dropped to 72% in 2011. Although "presumptive treatment" decreased from 24% in 2008 to 11% in 2011, the proportion of children with fever not tested for malaria, and although not treated for malaria, but left without a definitive diagnosis of their fever being made, remained high but dropping (22% in 2008 and 16% in 2011). Similarly the proportion of children who tested negative for malaria but then did not undergo any further investigation also unfortunately remained very high and rising (57% in 2008 and 89% in 2011). A combination of the above poor clinical management practises resulted in only 38% of children with fever in 2008 and unfortunately dropping to only 33% in 2011 being correctly managed (tested for malaria via RDT or microscopy and treated with ACT if positive, while further investigated for the cause of fever if negative). On preparedness of the health facility to implement the "test and treat" policy, it was noted that only 4 out of 10 health facilities were at least minimally prepared to do so, but paradoxically on bivariate analysis those minimally prepared were less likely (PR 0.62; 95% CI 0.41-0.94) to correctly manage the patients in 2011 than those who were unprepared. A similar paradox occurred for those correctly treated with ACT after testing positive, with facilities which were minimally prepared being less likely to do so (PR 0.28; 95% CI 0.14-0.58) in 2011 than those facilities which were unprepared to implement the "test and treat" policy. However these associations were inconsistent over time, as the associations were not present in 2008. Similarly all other factors such as staff category (doctor, nurse, clinical officer) and type of presenting symptoms besides fever (anorexia, lethargy, pallor) assessed, were not consistently associated with testing for malaria in both 2008 and 2011. The same applied for the other two main outcome variables of 'treated with ACT after test positive for malaria' and 'correctly managed child with fever', in that there were no factors that showed a consistent association with them in both 2008 and 2011. Conclusion: Testing of children with fever for malaria is at a low level but rose between 2008 and 2011. Paradoxically the proportion of those diagnosed with malaria who were correctly treated with ACT dropped between 2008 and 2011, as did the proportion of children with fever who were correctly managed. No factors assessed in this study were found to be consistently associated in both 2008 and 2011 with either testing for malaria, or treating confirmed malaria cases with ACT, or managing patients with fever correctly. Recommendations: In order for health workers to correctly implement the "test and treat" policy, which involves a series of complex steps, they ought to be formally trained to do so, mentored and constructively supervised. Additionally health facilities should be adequately equipped to enable health workers to fully implement the policy. Further studies to assess factors associated with the correct management of malaria via the "test and treat" policy are warranted.

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Fundação Oswaldo Cruz. Instituto de Tecnologia em Fármacos/Farmanguinhos. Rio de Janeiro, RJ, Brasil.
O gerenciamento de riscos à qualidade é um processo sistemático de avaliação, controle, comunicação e revisão dos riscos à qualidade, sendo um componente valioso de um sistema da qualidade efetivo e robusto. Visando uma abordagem pró-ativa do monitoramento dos controles existentes e das ações implementadas para o controle dos riscos dos processos produtivos de Bio-Manguinhos, realizou-se um estudo de caso do insumo farmacêutico ativo (IFA) da vacina febre amarela, cujo objetivo foi propor uma metodologia para o monitoramento deste processo produtivo através dos resultados obtidos no gerenciamento de riscos à qualidade. O IFA produzido no Laboratório de Febre Amarela (LAFAM) do Departamento de Vacinas Virais (DEVIR), é obtido a partir da cepa atenuada 17DD do vírus da febre amarela cultivada em ovos embrionados de galinha spf (ovos livres de agentes patogênicos específicos) e este é utilizado na produção da vacina febre amarela, que atualmente encontra-se com a tecnologia 100% brasileira. O LAFAM é uma unidade reconhecida internacionalmente como fabricante da vacina antiamarílica. Devido à sua importância para Bio-Manguinhos, somado à experiência e conhecimento dos especialistas do Instituto no processo, este foi o primeiro IFA a ter uma avaliação de riscos das etapas do processo produtivo através da ferramenta FMEA (Failure Mode and Effect Analysis). Para alcançar o objetivo proposto, utilizou-se a folha de verificação que é uma ferramenta da qualidade, tendo como critério para o monitoramento das atividades, os controles existentes e as ações implementadas para o controle dos riscos com as suas respectivas frequências, que foram definidas de acordo com o nível do modo de falha identificados na avaliação de riscos do processo produtivo. Como resultado do estudo, foram elaboradas 9 folhas de verificação, sendo uma para cada etapa do processo produtivo, além da metodologia para o monitoramento, foram sugeridas propostas de melhoria nos documentos internos (protocolos) usados para o registro do processo produtivo. A utilização da folha de verificação, mesmo na ausência de aplicação desta, demonstrou ser bastante útil na medida em que se tem a necessidade de saber com que frequência certos eventos acontecem? e para obter dados factíveis da efetividade dos controles existentes e das ações implementadas para controlar os riscos dos modos de falhas identificados neste processo. Devem ser realizados estudos futuros para a revisão das folhas de verificação com o objetivo de propor novos monitoramentos e/ou novas ferramentas, ampliando o escopo da metodologia, que venha a abranger efetivamente todas as etapas críticas do processo e que esta possa ser implementada em outros processos produtivos de Bio-Manguinhos que já tenham o seu mapeamento concluído.
The quality risk management is a systematic process of evaluation, control and review of risks that could be related to quality, it is an important component of an effective and robust quality system. Aiming a proactive approach of monitoring, existing controls and implemented actions to control the risks of Bio-Manguinhos’ manufacture processes, were conducted a case study of Active Pharmaceutical Ingredient (API) of yellow fever vaccine. The objective of this study was suggesting a methodology to monitor this process based on the quality risk management results. The API produced in Yellow Fever Lab of Viral Vaccines Department is obtained from 17DD, attenuated strain of yellow fever virus, grown in chicken embryonic SPF eggs (Specifics Pathogens Free) and this API is used on the yellow fever vaccine, that actually is produced by a 100% Brazilian technology. The Yellow Fever Lab is internationally recognized as the lab of vaccine against yellow fever. Due to its importance to Bio-Manguinhos and the experience and knowledge of its staff, this was the first API to have a risk evaluation of the manufacture process based on FMEA (Failure Mode and Effect Analysis) tool. To achieve the proposed objective, the check sheet was used which is a tool having as criteria for monitoring activities, the controls and the actions taken to control the risks with their respective frequencies, that were defined considering the identified fail mode level during the manufactured process risk evaluation. The results of this study allow the elaboration of 9 check sheets, one for each manufacture process step, besides of monitoring methodology, were suggest improvement proposals in the internal documents (forms) that are used to record the manufacture process. The check sheet utilization, even if in the absence of its application, demonstrated that is very useful when we have to know what is the frequency that certain events occurs? And to obtain real data of effectiveness of existent controls and implemented actions to control the risks of fail modes identified during this process. Future studies should be conducted to review the check sheets in order to propose new monitoring and / or new tools, expanding the scope of the methodology, which will effectively cover all critical process steps and that can be applied in other to manufacture processes of Bio-Manguinhos which have already your completed mapping.

La dengue est une infection virale à transmission vectorielle qui sévit principalement dans les milieux urbains de la zone intertropicale. Jadis limitée à l’Asie du Sud-Est et aux Amériques, la maladie s’est progressivement répandue de façon disproportionnée dans toutes les Régions OMS du monde. La situation de la dengue dans la Région africaine reste relativement peu documentée. La maladie touche cependant plusieurs pays ouest-africains dont le Burkina Faso, particulièrement sa capitale Ouagadougou. Cette ville en effet, parallèlement à sa croissance urbaine non planifiée enregistre d’importantes épidémies de dengue ces dernières années. Notre thèse se propose d’évaluer la vulnérabilité face à la dengue de la population de la ville de Ouagadougou. Pour atteindre cet objectif, nous avons opté pour une méthodologie mixte, qui est une combinaison des méthodes quantitative et qualitative. L’approche quantitative a consisté en une comparaison des connaissances, attitudes et pratiques autour de la dengue de trois (3) zones de la ville différentes sur le plan socio-spatial. L’approche qualitative a quant à elle permis d’évaluer la gestion par les autorités sanitaires, des épidémies de dengue survenues dans la ville de Ouagadougou en 2016 et 2017 ainsi que l’impact de cette gestion sur la vulnérabilité de la population
Dengue fever is a vector-borne viral infection that occurs mainly in urban areas of the intertropical zone. Once limited to South-East Asia and the Americas, the disease has gradually spread disproportionately throughout all WHO Regions of the world. The dengue situation in the African Region remains relatively undocumented. However, the disease does affect several West African countries including Burkina Faso, particularly its capital Ouagadougou. This city, in fact, in parallel with its unplanned urban growth, has recorded major dengue epidemics in recent years. Our thesis proposes to assess the vulnerability to dengue fever of the population of the city of Ouagadougou. To achieve this objective, we have opted for a mixed methodology, which is a combination of quantitative and qualitative methods. The quantitative approach consisted of a comparison of knowledge, attitudes and practices around dengue fever in three (3) different socio-spatial areas of the city. The qualitative approach allowed us to evaluate the management by the health authorities of the dengue epidemics that occurred in the city of Ouagadougou in 2016 and 2017 as well as the impact of this management on the vulnerability of the population

Accounting plays a crucial role in the success of any business, but it is particularly vital in the construction industry, a complex field that typically requires the coordination of multiple subcontractors and multiple jobs in any given year. Although small-volume home builders make up 70 percent of the membership of the National Association of Home Builders (NAHB), a trade association of the home building industry, little is known about the accounting practices of these builders. This thesis undertook to study the accounting practices of small-volume home builders. Small-volume home builders were defined as those producing 25 homes or fewer in a given year. A 20-question questionnaire was sent to 750 small-volume home builders, 141 of which responded for a 20-percent response rate. The names were taken from a sampling of an NAHB membership list. Respondents were asked about their accounting practices, including what type of accounting method they used, whether they employed an outside certified public accountant, and what types of accounting software they used. Respondents were asked to give specifics about their accounting system, such as how their chart of accounts was developed and how they viewed different accounting tools. Collected data was run through the data-analysis program SPSS for Windows. The results gave a picture of the accounting practices of these small-volume home builders. There was a fairly even split between cash and accrual methods of accounting. Most owners or managers did their own day-to-day accounting, and most employed an outside CPA. Most used Quickbooks computer software for every accounting function, and most reviewed financial statements monthly. Most respondents were satisfied with their accounting system. Reasons for this satisfaction included ease of use, simplicity, accuracy, and the ability to job cost. On the other hand, dissatisfaction with an accounting system was often tied to expense of software, complexity, and the need for frequent updating of software programs. These responses give an important first look at what kinds of accounting methods small-volume homebuilders are using.

People with disabilities face discrimination around the world. This has a negative impact on society, individuals and the economy. In Saudi Arabia, people with physical disabilities face serious challenges. This research addressed the negative perceptions and attitudes toward disability in Saudi Arabia that resulted in discrimination against people with disabilities, create challenges for them and prevented them from participating in society equally. This mixed- method study investigated the challenges that face the physically disabled in Saudi Arabia in their personal, political, economic and professional paradigms. This research used quantitative and qualitative methods, to reflect the sentiment and impressions of both the disabled and non- disabled populations in Saudi Arabia on the topic of physical disability. There were 14 participants in the interview component of this research and 403 participated in the survey. This research identified the main challenges facing people with disabilities in Saudi Arabia as inaccessible environments, judgmental society, family and self-image, health care services and enforcement of existing laws and regulations. Furthermore, the results highlighted a number of steps needed for people with disabilities to overcome the challenges in their personal and professional lives.

Stress management interventions (SMIs) are increasingly used by organisations across both private and public settings. Such interventions are employed with the expectation that they will be effective in reducing levels of stress in participants and in turn, will provide a return to the organisation by way of increased productivity through performance improvements of those employees whose stress has been reduced. Despite the increasing popularity of SMIs, there exists a lack of evidence on whether they have any effect on the performance of users, and on the relative effectiveness of the components that often make up SMIs. Although the literature addressing SMIs and their effects is increasing, relatively few studies directly compare different techniques, and even fewer employ randomised controlled designs or follow-up measures. The assumed relationship between the reduction of stress and improvement of managerial performance does not appear to have been tested with a randomised controlled trial. The term “stress” as used in this study specifically denotes the concept of “distress” as defined by Selye (1956; 1987). To support this use of the term, the evolution of current terminology in the field of occupational stress is briefly discussed with specific reference to the development and influence in the wider literature of the Yerkes Dodson Law (Yerkes, 1909). The aims of this thesis were to (1) compare the relative effectiveness of two component techniques often used in SMIs (somatic and cognitive techniques) in the reduction of stress, and (2) to examine the effect of the use of these techniques on the performance of managers in their workplace. Study One was a randomised controlled trial assessing the effect of the use of somatic and cognitive stress management interventions on stress and performance in managers. Participants were 112 corporate managers who were randomly assigned to one of two intervention groups (somatic or cognitive technique training) or to a wait list control group. The intervention groups were trained in their respective techniques over a 4 week period in brief (20-30 minute) face-to-face workshop sessions. Participants were provided with recordings of the techniques to assist practice between training sessions. At baseline, stress was assessed using the Occupational Stress Inventory – Revised Edition (OSI-R, Osipow, 1998), and managerial performance was assessed with the Personal Qualities Competency from the Inventory of Management Competencies (IMC, Saville Holdsworth Ltd., 1993). In the case of the IMC, self, colleague, and subordinate assessments were used. On completion of the 4 week intervention, the OSI-R was readministered, and then at week 12 and week 24, follow-up assessments of stress and managerial performance took place. At the week 12 follow-up, MANOVA for the OSI-R showed no significant difference between the somatic and cognitive interventions in their effect on stress, although both interventions did reduce stress relative to the wait list control group, as measured by the OSI-R. A significant intervention effect was also shown (ηp2 = 0.089, p = 0.002) for the combined intervention groups (cognitive and somatic). MANOVA for the Personal Qualities Competency showed a significant intervention effect for the self (ηp2 = 0.077, p = 0.008) and colleague (ηp2 = 0.064, p = 0.013) assessments, and a no significant effect (ηp2 = 0.032, p = 0.063) for the subordinate assessment at the week 12 follow-up point. Unfortunately, withdrawal and attrition reduced the sample size below that required for analysis at the week 24 follow-up point. Study Two was designed as a follow-up qualitative study that aimed to gather information on participants’ perceptions of the effects of the interventions on their stress and performance, and of their reasons for completion or no completion of the SMI. In this study, 14 participants from Study One took part in semi-structured interviews after the final follow-up assessment (week 24) for that study. The interviews were structured to elicit responses concerning participants’ perceptions of the demands of their workplace and their stress, their experience of using the stress management techniques (including perceived benefits or behavioural changes from that use), their reasons for completion or no completion of the intervention, and their own definitions of stress. Several important findings emerged from this study. First, participants described their workplace as characterised by high pressure and demand with rapid change and a perceived lack of personal control. Second, participants who continued to use the techniques they had learned after the formal intervention was completed did so because they perceived personal benefits in terms of their ability to relax and in terms of their perceptions of workload and demand. For those who did not complete the intervention, the predominant reasons reported for no completion were workplace task demands, lack of top management commitment to an intervention of this nature, and lack of personal gain once the techniques had been learned. In relation to defining stress, participants did not have agreement, but rather reported definitions reflecting a multifaceted complex amalgam of physiological, psychological, and emotional aspects. Research such as this is important in terms of its contribution to the general field of occupational stress and its alleviation. It addresses a long-standing need to assess the relative effectiveness of some of the subcomponents commonly employed as part of more complex multifaceted approaches to SMIs, and the effect of the techniques on both stress and performance. This thesis makes several contributions to existing knowledge. First, this thesis clarifies the origin of the Yerkes Dodson Law and its relevance to current stress management thinking. In management texts distress has come to be regarded as too much stress or pressure. This is coupled with the idea that some stress has a positive impact on performance due to an earlier and erroneous interpretation of the Yerkes Dodson Law. Second, Study One provides evidence of the relative effectiveness of two different SMI components in the reduction of individuals’ occupational stress, as well as evidence for the effectiveness of individual focussed SMIs in the reduction of stress in corporate managers. Third, Study One provides evidence for a positive effect on managers’ performance consequent to their use of stress management techniques. This thesis also sheds light on managers’ definitions of stress, and their reasons for completion or no completion of SMIs. In summary, individual focussed (or secondary) SMIs have the potential to reduce stress and to improve performance in corporate managers as perceived by both the individual and others in the workplace.

碩士
國立成功大學
護理學系碩博士班
93
The purpose of this study was to evaluate the effectiveness of a self-developed fever education program which was based on the Information-Motivation-Behavioral Skills Model. The program consists of individualized assessment and discussion with a colored brochure. The experimental design with two-group pre-test/post-test method was used in this study. 　　 　Parents of children aged from 3 months to 6years who visited a pediatric clinician with chief complain of children’s fever in Tainan city during March to April in 2005 were randomly assigned to the experimental (n=67) or control group (n=66). After the pre-test, parents of the experimental group received the fever education program. Then, both of them had been asked to fill out a “management record” to collect their management behaviors for 3 days when children had fever episode and complete the post-test at home. 　　 　Results showed that the scores of fever management information, attitudes, skills and self-efficacy of the parents in the experimental group were significantly higher than those in the control group. Compared with the control group, the temperature of febrile children were significantly higher in the experimental group when the parents used antipyretics via oral or suppository (0.66℃ higher in oral and 0.89℃ higher in suppository use). There were 65.7% of parents in the experimental group used antipyretics to promote comfort for children; however, the majority of parents in the control group used antipyretic to alleviate temperature. There were 52.9% in the control group still using external cooling to manage fever, while only 20% of the experimental group remained unchanged. After fever education intervention, parents of the experimental group were calmer than those of the control group. There were 67% of parents in experimental group used hand to touch children’ skin for evaluating the temperature, while 77% of the control group did more frequent; 70% of the control group parents took children’s temperature within one hour as only 64% of the experimental group did in a 2 to 4 hourly interval. 　 　The theory-based fever education program showed significant improvement on parents’ information of fever management, attitudes, skills, self-efficacy, and altered fever management behaviors effectively as well as decrease parental anxiety. In clinics, health care professionals have the responsibilities to understand parental worries about fever and to teach advanced fever knowledge and skills to dispel parents’ misconceptions about fever and enhanced fever manage ability at home eventually.

碩士
國立高雄大學
運動健康與休閒學系碩士班
100
Dengue fever prevention and control can not relying on a single method to achieve successful control. In this study, the insecticides resistance of the mosquito was investigated, green barrier spray to control adult mosquito test was conducted, meanwhile, the environment friendly pesticides such as Bacillus thuringiensis var. israelensis H-14 (Bti), spinosad, insect growth regulator pyriproxyfen and monomolecule film (AMF) were used to test for the Dengue fever vectors. The results were shown that Aedes aegypti without insecticides resistance to organophosphorus insecticides. Green barrier spray method can effectively reduce the ovitrap indices and eggs number of mosquito to achieve good prevention effect. The results of the larva prevention study found that the larva of Dengue fever vectors did not show insecticides resistance to Bti and spinosad. It was found that the 50% Lethal Concentrations (LC50) of Bti, spinosad and pyriproxyfen to Bora Bora of A. aegypti were respectively 44.9, 4.7 and 0.019 ppb, that is, very low concentration to control the larva of the Bora Bora of A. aegypti effectively. AMF can kill the larva within 72 hours (mortality 100%), and the 50% Lethal Time (LT50) to the pupa of mosquito is 160 minutes of concentration in 1 ml/m2. All pupae were killed until 210 minture. The mixed reagent of pyriproxyfen and Bti (0.001: 4) was used for the test, the mixed solution showed LC50 of 0.354 ppb to Bora Bora of A. aegypti. The mixed solution of pyriproxyfen and spinosad (0.01: 5) was used for the test, the mixed solution showed a LC50 of 0.054 ppb to Bora Bora of A. aegypti. In addition, results of further combination index analysis showed synergism effects of these testing mixtures. Moreover, the residual effects of pyriproxyfen laboratory simulation test (10 and 50 ppb in indoor and outdoor) were evaluated once a week for 9 weeks and no mosquito larvae were found. The results of spinosad laboratory simulation tests (50 and 100 ppb in indoor) were found to have 100% killing effect 4 weeks and 5 weeks after indoor application, respectively. The 24 hours mortality of dengue vector larvae were 100% by mixed reagent (5 ppb pyriproxyfen and 100 ppb Bti or 50 ppb spinosad), and the residual effects of mixed reagent was 4 weeks. The results may be used as a reference for the government in establishing strategies on the integrated vector management of dengue.

碩士
國立成功大學
護理學系碩博士班
96
This study evaluates the effects of interactive fever instruction on improving parents' fever management in a pediatric emergency department. Based on the Information- Motivation-Behavioral Skills Model, an experimental study with pre and post tests was designed to investigate the effects of the interactive education program. This study took place at a pediatric emergency department in southern Taiwan and sampled a total of 67 participants. The participants were parents of children from ages three months to six years who visited the pediatric emergency department due to the concern their child had a fever. The parents were randomly assigned to the experimental (n=33) or control (n=34) group. After treating the child and completing the pre-test, parents of the experimental group received the interactive fever instructions while parents of the control group received only a pamphlet. The interactive fever instructions consisted of an interactive CD and a pamphlet of fever instructions. Three days after receiving the education materials and documenting their fever management all parents completed the post-test. The post-test scores of fever management information, attitudes, skills and self-efficiency of the parents in the experimental group were significantly improved over the pre-test. The experimental group had higher scores in the categories of fever management information, attitudes and skills than the control group. Application of interactive fever instructions in the pediatric emergency department demonstrated the effects of improving parents’ fever information and management behavior at home. This interactive education program could help clinical staff provide fever instruction to improve parents’ fever management ability.

碩士
國立臺灣大學
護理學研究所
93
The purpose of this study was to explore the knowledge and practices of nurses on fever management and influencing factors. A descriptive cross-sectional research and purposive sampling was conducted in a medical center. Three hundred and twenty three RNs working in medical wards, surgical wards and adult ICUs completed a set of questionnaires developed by the researcher, which regarding knowledge and practices of nurses on fever management. The data were analyzed by descriptive statistics, t-test, one-way ANOVA, Scheffe’s posterior comparison and Pearson’s product moment correlation. The major results were as following: 1. The numbers of questions about nurses’ knowledge of fever management were 19. The mean score of the knowledge of nurses about fever management was 14.24±2.30. There were 5 questions of scores below 60%, which was not as high as expected. Significant factors associated with knowledge scores were working experience and clinical ladder. Nurses who had more working experience and higher clinical ladder had higher scores. 2. The methods of nurses practicing fever management in sequence were ice pillow, antipyretic agent, and tepid sponge. Physician practices strongly influenced nurses’ intentions to administer antipyretic agents. Nursing education and common sense strongly influenced nurses’ intentions to apply ice pillow and tepid sponge for fever management. Nurses working in medical wards administered antipyretic agent for fever management more than nurses in SICUs. Nurses working in surgical wards applied ice pillow for fever management more than nurses in medical wards; nurses working in MICUs or SICUs applied ice pillow for fever management more than nurses in medical wards. Nurses less studying reference about fever management more often applied ice pillow for fever management. 3. The correlation between nurses’ knowledge and practices on fever management revealed that knowledge of fever management was negatively correlated with applying ice pillow (r=-0.16). Nurses with higher level of knowledge on fever management less applied ice pillow to reduce fever. There were no correlation between nurses’ knowledge and the frequency of antipyretic treatment and tepid sponge. In order to increase the quality of nursing practices on fever management, the results of this research suggest that educational program should be developed, implemented and evaluated, and encourage nurses to pursue higher clinical ladder. It is also recommended to develop the lifelong learning motivation and enforce nurses to update the knowledge of fever management. With accurate knowledge and evidence-based intentions, nurses will practice more positively on fever management.

Malaria is endemic in Uganda. The study attempted to determine how Ugandan caregivers managed home-based care of fever. Structured interviews were conducted with sixty caregivers of children under five. In 15 (25.0%) out of the 60 interviewed households, at least one child had reportedly died from malaria. Caregivers’ decisions were influenced by health education, family members, community leaders and other caregivers. Most caregivers knew about malaria, but lacked knowledge about its danger signs, and about the services of village drug distributors. Most caregivers initiated treatment for fever at home before taking the children to health units. Mosquito nets, indoor residual spraying and other malaria preventive measures were rarely used due to lack of funds. The recommendations include that anti-malaria drugs should always be available and accessible, the services of village drug distributors should be improved, health education should be enhanced, malaria preventive measures should be implemented and sustained.
Health Studies
M.A. (Public Health)

博士
國立成功大學
健康照護科學研究所
104
Background: Most parents do not know the definition of fever, its effect, or its management. This study assesses the long-term effects of simulation-based education on information, motivation, behavioral skills, and behaviors related to parental fever management in Taiwan.Methods: Cluster random sampling was used to recruit parents with children aged from 3-months to 5-years of age who are attending kindergartens in Kaohsiung, Taiwan. A total of 160 parents were randomly assigned into experimental (EP) and control (CP) groups equally. Parents in the EP group received a simulation-based education with fever education brochures while the CP group only received the brochure. Parental fever information (I), motivation (M), behavioral skills (Bs), and management behaviors (Mb) were collected before the first day, on the first day (except management behaviors), at the 6th month, and 12th month marks post-training with a self-developed instrument based on the Information-Motivation- Behavioral Skills (IMB) model. Results: The results of a GEE analysis indicate that the I, M, Bs, and Mb of all participants had improved at the posttest assessment, with the experiment group showing a significantly better improvement over the control group. Conclusion: Simulation-based education was a better strategy for improving parental information about fever management, motivation, behavioral skills, and management behavior than using the brochure alone. We suggest providing community-based education about childhood fever with scenario simulation method to improve parental information and behavioral skills about childhood fever management and the management of child fevers competently at home.

Recent data show that wild Aedes aegypti feed frequently and almost exclusively on humans without ingesting sugar for energy, and egg production is attributed to low concentrations of isoleucine in human blood. However, human blood is reportedly sub-optimal for Ae. aegypti compared with other types of blood. To understand why this species prefers to repeatedly feed on blood that is reproductively sub-optimal, groups of females were provided natural, low-isoleucine human blood, human blood supplemented with isoleucine and natural chick and rodent blood in a series of experiments. Egg production, energy reserves, feeding frequency and blood volume were compared. No differences in egg production were found among females offered low isoleucine blood compared with isoleucine-supplemented human blood, or among those offered chick and rodent blood, contradicting previous reports. When females were maintained on both sugar and blood (a common rearing practice, but unnatural wild behavior), rodent-fed females produced more eggs than human-fed females. Greater energy reserves were found in human-fed mosquitoes. Females ingested smaller meals from human hosts than rodents, yet fed with greater frequency on human blood. A life table study demonstrated greatest survival and fitness with females offered human blood alone. Field survival of Ae. aegypti was investigated. Two age cohorts (3 and 13 days) were released and recaptured in 3 experiments in Puerto Rico and Thailand. Regression analysis demonstrated a greater probability of daily survival for the older cohort. Greater survivorship among older females changes the current view of dengue transmission dynamics. Collapsible black fabric resting boxes were evaluated for surveillance of adult Ae. aegypti over a 10 month period in two regions of Thailand. Thirty percent of total females were collected from two resting boxes in each house. Resting boxes, as a surveillance tool, also decrease sampling time. Satisfactory control of Ae. aegypti was not achieved with deltamethrin impregnated resting boxes placed inside Thai houses. Females were susceptible to topical application, but contact irritancy with deltamethrin-treated fabric was observed. Lambdacyhalothrin treated boxes were more effective. Treated resting boxes place low resistance selection pressure on populations and may be an inexpensive and sustainable control method for Ae. aegypti.

碩士
國立台北護理學院
護理研究所
98
Due to the fear of complications caused by fever, parents may have improper management to their child with a fever. Previous studies called this phenomenon as “fever phobia”, and found the parents' beliefs and management regarding fever were different in various races. The purpose of this study was to investigate the fever knowledge and management of the native and the immigrant mothers with an infant in Taiwan. A convenience sampling was used to recruit mothers with less than 1 year-old baby from Taiwan, mainland China and Vietnam. These mothers responded a questionnaire and the data were analyzed by descriptive statistics and Chi-square tests. The result related to knowledge showed that most mothers defined a fever as temperature between 37.5℃ and 38℃ and a high fever as temperature between 38.5℃ and 39℃. Around 79% of mothers thought the body temperature would be raised constantly if not giving any medicine. They were concerned about the complications of fever such as brain damage, seizure, dehydration, coma and death. More than half of mothers from mainland China and Vietnam did not realize that fever could strengthen the ability of babies to resist bacterial infection. In the case of fever management, all mothers treated babies with seeing a doctor, drinking more water or breast milk, removing clothes, taking a sponge bath or a tepid water bath and giving the antipyretics. Furthermore, more than 80% of mothers from Taiwan chose to observe their babies at home. In contrast, a small part of mothers used improper management to their febrile babies. For example, Taiwanese mothers usually gave a sponge bath, a bath with cold water, and a diluted sports drink, honey water or glucose water to their febrile baby. Mothers from mainland China preferred to reduce the body temperature of babies by wiping with alcohol. In Vietnam, a unique fever treatment was to feed the baby with lemon water adding salt. Siu-gian ritual and Fu-Shui were exclusively used as the fever management in Taiwan and mainland China groups. As for medicine, acetaminophen and ibuprofen, mainly coming from clinics and hospitals, were two common uses for relieving fever. More than 60% of mothers followed the doctor’s prescription. The majority of mothers in the three ethnic groups showed to give their babies antipyretic when their body temperature was higher than 38℃. However, 27.9% of mothers (mostly mainland China and Vietnam) still treated their babies whose body temperature was less than 38℃ with antipyretic. The results of the study can help the health professionals to be aware of the similarities and the differences of fever knowledge and management in these three ethnic groups. Besides, this study showed that the sources of knowledge related to fever mainly were from physicians and nurses. Therefore, it is important that the health professionals should reduce the fever phobia through the health education, and avoid the injuries from the mother’s improper management.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are auto-immune conditions associated with prior exposure to Group A streptococcus (GAS). ARF is an acute condition associated with fever and joint, brain, skin and heart inflammation. RHD is its chronic sequela and is characterised by permanent heart valve damage which can, in turn, lead to heart failure and an increased risk of endocarditis and stroke. To avoid such complications interventions may be required to repair or replace damaged valves. ARF and RHD are preventable diseases rarely encountered in mainstream Australia. However, Aboriginal Australian and Torres Strait Islander peoples have amongst the highest reported rates of ARF/RHD in the world with significant morbidity and mortality. This thesis comprises complementary projects and articles that can inform the community and health service response to prevention, diagnosis and management of ARF/RHD with a particular focus on Indigenous Australians. Prevention: Three systematic reviews are presented that examine strategies to improve primary and secondary prevention of ARF/RHD. High quality studies are often lacking and much of the evidence informing strategies to prevent ARF/RHD is limited or absent. Available evidence indicates primordial prevention via improvements in social, economic and environmental conditions is key. While primary prevention may be achieved through improved diagnosis and early treatment of GAS pharyngitis, implementation can be difficult and research into the development of a GAS vaccine remains crucial. Effective secondary prevention of ARF/RHD is possible with long-acting benzathine penicillin (LAB). Nonetheless, delivery of LAB is highly variable and frequently poor. Further work is needed to enhance health care systems to maximize uptake of LAB and to identify more effective formulations or delivery devices for administration. Diagnosis: The utility of screening for RHD via echocardiography (heart ultrasound) to detect early disease is topical as this may facilitate early administration of secondary prophylaxis thereby limiting disease progression. A review of the feasibility of implementing RHD screening in Australia is presented and a number of limiting factors are highlighted. These include a lack of an agreed case definition and a limited understanding of the significance, natural history and potential treatment of early and subclinical RHD. Further, the delivery of secondary prevention is often suboptimal and the impact of additional cases on health services, and the psychosocial health of patients and families, can be substantial. The refinement of a screening-based case definition for RHD, and particularly the significance of minor heart valve abnormalities, was informed by the Rheumatic Fever Follow-up Study (RhFFUS). Children with prior Borderline RHD (defined under World Heart Federation (WHF) criteria) were up to nine times more likely to experience ARF compared with children with a normal echocardiogram. Their risk of having progressive valve damage was also significantly greater and 1 in 6 developed Definite RHD. In contrast, children with less severe valve abnormalities not satisfying criteria for Borderline RHD were at no greater risk of ARF or echocardiographic progression of valvular lesions. These results provide cogent evidence that, in some children, valvular changes consistent with Borderline RHD detected on screening echocardiograms represent the earliest stage of Definite RHD. Such children may benefit from secondary prophylaxis or enhanced surveillance through regular echocardiographic monitoring to assess for progression of disease. Moreover, these results lend support to the validity of WHF criteria that distinguish Borderline RHD from other minor echocardiographic changes, as it is only in the former group that there is a greater risk of ARF and valvular lesion progression. Nonetheless, the fact that individuals with minor echocardiographic changes not satisfying criteria for Borderline RHD still had an increased risk of developing Definite RHD suggests that such individuals should be initially monitored with echocardiography to ensure they do not progress. Management: The final component of this thesis comprises two papers that describe projects that were undertaken to inform potential improvements in the management of ARF/RHD. The first compared the quality of care provided to patients in the Kimberley and far north Queensland where differing models of care were operating. This highlighted more severe disease in the Kimberley and greater specialist follow-up and prescription and receipt of secondary prophylaxis in far north Queensland. This supported an association between far north Queensland's single-provider model of care and centralised RHD control programme and improved patient care, potentially fewer cases of severe disease, and reduced need for surgical and other interventions. Since this study was completed, a centralized RHD control and management programme has been implemented in the Kimberley. The second project related to the use of prophylactic antibiotics to prevent bacteremia, and potentially infective endocarditis (IE), in patients with RHD undergoing high-risk procedures. While this is recommended for Indigenous patients with RHD under Australian guidelines, American guidelines were recently amended to recommend prophylaxis only in people with prosthetic valves and not in those with "native-valve" RHD. A review of infective endocarditis cases in northern Australia was undertaken to determine whether native valve RHD was associated with an increased risk of IE. Results of this study showed that those with native valve RHD were at increased risk of IE (RR 58) compared to individuals without native valve RHD. Interestingly, the risk of IE in non-Indigenous patients with RHD was found to be 3.7 times higher than in Indigenous Australians with RHD. This study led to recommendations to broaden current Australian guidelines so as to offer prophylactic antibiotics to all persons with RHD undergoing procedures associated with a high risk of bacteraemia. In conclusion, this thesis provides a number of new insights to address existing knowledge gaps regarding prevention, diagnosis and management of ARF/RHD. It is hoped that continued work on developing a GAS vaccine will eventually deliver an effective and safe method of primary prevention. In the interim the continued focus on early and accurate diagnosis of ARF/RHD and best-practice management (particularly improving uptake of secondary prophylaxis) should be pursued. Overarching these health initiatives must be a commitment to improving the socioeconomic and environmental status of Aboriginal Australian and Torres Strait Islander peoples living in remote communities as a means of effecting ARF/RHD primordial prevention.

High prevalence of childhood disease and low use of health facilities are reported for developing countries. In this study factors affecting the incidence of fever, cough and diarrhea and the factors predicting health facility use in rural DRC were analyzed. This study uses the data collected by the World Bank household survey in 2007 from eight health districts. In the districts, clusters were randomly selected for inclusion, and then a systematic selection of households was performed until the targeted number of children was reached. Data on health status of 5860 children during the previous two weeks were collected from 4838 households Bivariate analysis using Pearson chi-square was performed to identify potential determinants of childhood diseases. For cough and fever, multinomial logistic equation has been used to explain the choice of healthcare providers in comparison to the health center, the facility being promoted in DRC Percent of children who suffered from fever, cough and diarrhea were 46.2%, 33.3%, and 21.2% respectively. Age of the child, household size, and health district location were important in affecting the incidence of childhood diseases, while number of children under-five in the household and number of individuals per room were important in explaining the incidence of fever and diarrhea respectively. Health facility use was relatively low (47% for fever, and 35% for cough), but it was not as bad as reported by earlier studies. Income, education, cost of care, quality of care, type of symptom, hospital bed and geographic location were predictors of health facility use for fever and cough. The use of Oral Rehydration Salt for diarrhea was affected by income, age of the child and population density Children whose mothers believed cost of care was affordable were 52.2% and 43.8% less likely not to seek help (OR = 0.478 and 0.562) for fever and cough respectively. For hospital visit versus health center use, children from poorest households were 42.1% and 81.0% less likely to visit hospitals compared to the children from the least poor households (OR = 0.579 and 0.190). The findings may be used to encourage higher level of use of health centers
acase@tulane.edu

My placement for the Master of Philosophy in Applied Epidemiology (MAE) degree was with the Zoonoses, Foodborne and Emerging Infectious Diseases section (ZoFE), within the Office of Health Protection, Australian Government Department of Health. This placement has allowed me to apply the skills and knowledge of the epidemiology of infectious diseases acquired throughout my degree. I focused on the following four core projects. My review of the National Enhanced Listeriosis Surveillance System (NELSS) found that it had been invaluable in listeriosis surveillance in Australia since 2010. It has been used not only to detect clusters and outbreaks but has also assisted in the identification and investigation of possible sources of these outbreaks. NELSS is viewed as valuable with a high level of acceptability by the users of the system, despite limitations including a lack of understanding of system capabilities, duplication of data entry and the system not storing all available data. This review highlights the effectiveness of enhanced surveillance for a foodborne disease, though improvements are needed. In 2013 I was part of a team that investigated an outbreak of foodborne gastroenteritis linked to a buffet meal served at a Canberra restaurant. The cohort study and environmental and laboratory investigations suggested that a breakdown in cleanliness, temperature control and food handling practices resulted in contamination of the buffet food. Our investigation resulted in public health actions, such as repairs to the kitchen of the implicated restaurant, staff training and the development of food business management plans, to limit the potential for such an outbreak to occur in the future. As there is no reliable treatment for Australian Bat lyssavirus (ABLV) or rabies virus infection upon the onset of symptoms, treatment must occur as either pre or post-exposure prophylaxis. The National Human Rabies Immunoglobulin Database records information of people who have received Human Rabies Immunoglobulin (HRIg) in Australia as part of post-exposure prophylaxis treatment. Between 1 January 2010 and 31 December 2013, 3,003 individuals received HRIg for potential exposures to ABLV or rabies virus. A third received HRIg due to potential exposures to ABLV occurring in Australia. The current messaging for the risks of ABLV infection from bats in Australia should be reviewed and revised to ensure that it is appropriately targeted and effective. Two thirds of people received HRIg for potential exposures to the rabies virus overseas. Most occurred in Indonesia and most due to exposure to monkeys. We need to continue to warn of the risk of potential exposure to rabies virus when travelling overseas, particularly to Indonesia. Q fever is a zoonosis that has a wide range of reservoirs in Australia. In humans the disease can manifest as either acute febrile illness or chronic illness that may affect the heart or liver. The Australian Government funded the National Q fever Management Program (NQFMP) from 2000 to 2006, which provided screening and vaccination for target high risk groups. We found notified Q fever cases were predominately male, aged 40 to 59 years, who resided in Queensland or New South Wales. Interestingly the age of notified Q fever cases and the proportion of cases that were female both increased over time. It may be time to re-evaluate the at-risk groups recommended for Q fever vaccination as per the Australian Immunisation Handbook. Additionally, there may be a place for an agreed and consistent enhanced dataset for collection at the jurisdictional level or at the national level to better understand the epidemiology of Q fever in Australia.

碩士
中臺科技大學
文教事業經營研究所
98
The purpose of this study was to investigate the managerial strategies for preschools coping with the trend in declining birth rate. The instrument was a self–designed questionnaire based on related references and the suggestions of educational experts and the directors in preschools. Through the results of analysis, the managerial strategies for preschools under the trend in declining birth rate were discussed. This study focused on the preschools from three counties and one city in central Taiwan in 2009, and one-third of 757 preschools were selected. There were 756 early childhood educators from 252 preschools as target participants. The questionnaires were statistically analyzed through the uses of SPSS12.0 software and Pearson’s product-moment correlation. The findings are listed as follows: 1. Among the managerial strategies for preschools under the trend in the declining birth date, the knowledge of “interpersonal communication” is most frequently used in administrative measures taken by the early childhood educators. 2. Among the managerial strategies for preschools under the trend in the declining birth date, the knowledge of “adaptive instruction” is most frequently used in teaching measures taken by the early childhood educators. 3. Partial differences are found in preschool managerial strategies among the early childhood educators by different background variables. They are: (1) Partially significant differences exist in preschool managerial strategies among the early childhood educators by different ages. (2) Significant differences exist in preschool managerial strategies among the early childhood educators by different academic levels. (3) Significant differences exist in preschool managerial strategies among the early childhood educators by different positions. (4) Significant differences exist in preschool managerial strategies among the early childhood educators by different preschool sizes. (5) Significant differences exist in preschool managerial strategies among the early childhood educators by different preschool locations. 4. Partial differences are found in teaching managerial strategies among the early childhood educators by different background variables. They are: (1) Significant differences exist in teaching managerial strategies among the early childhood educators by different ages. (2) Significant differences exist in teaching managerial strategies among the early childhood educators by different academic levels. (3) Significant differences exist in teaching managerial strategies among the early childhood educators by different positions. (4) No significant differences exist in teaching managerial strategies among the early childhood educators by different preschool sizes. (5) Significant differences exist in teaching managerial strategies among the early childhood educators by different preschool locations. 5. Positive correlations are found between the preschool managerial strategies and the teaching managerial strategies adopted by the early childhood educators in response to declining birth rates. 6. Significant correlations are found in the interaction of preschool managerial strategies used by the early childhood educators by different ages with those by different positions. 7. Significant correlations are found in the interaction of teaching managerial strategies used by the early childhood educators by different ages with those by different positions. 8. Significant correlations are found in the interaction of preschool managerial strategies used by the early childhood educators by different sizes with those by different locations. 9. No significant correlations are found in the interaction of teaching managerial strategies used by the early childhood educators by different sizes with those by different locations.

碩士
淡江大學
教育政策與領導研究所碩士班
95
The purposes of this study are to explore how kindergartens are being impacted and what strategies can be taken under the trend of fewer children (thereafter, TFC). By using kindergartens located in Taipei as my research sample, I gain the following major findings. First, the impact of the TFC on kindergarten practitioners can be classified as 12 categories, in which ‘promoting competitive among kindergartens’ is being recognized as the most serious one and ‘leaving classroom and teaching equipment idle’ as the least. The extent to which kindergarten practitioners are affected by the TFC falls between least and middle, and private kindergartens are adversely affected more than public ones. Second, my findings demonstrate that ‘pursuing differentiation and innovation’ is recognized as the most important strategy under the TFC and ‘diversifying operations’ as the least. A further comparison shows that ‘diversifying operations’ is the only strategy which presents significant difference between private and public kindergartens in the importance of operating strategy facing the TFC. Third, my survey in the operating strategy shows that ‘pursuing differentiation and innovation’ is the most popular strategy used at the present time and ‘diversifying operations’ is the least. A further study shows that kindergartens in Taipei City make more efforts than those in Taipei County in differentiation and innovation, and private kindergartens are better than public kindergartens in terms of ‘pursuing differentiation and innovation,’ ‘diversifying operations,’ ‘improving teaching qualify,’ and ‘reducing cost.’ Last, ‘resources integration’ and ‘marketing orientation’ are the most important strategies recommended by the present study to reduce the impact of the TFC. Furthermore, this study recommends that improving interchange of teachers among different faculties is the top priority of action which should be taken in the ‘resources integration’ strategy, and working together with local citizens to promote their recognition is the top action which should be taken in the ‘market orientation’ strategy.

碩士
國立東華大學
教育行政與管理學系
101
This study adopts a certain elementary school in Yilan County as the study subject, collecting data in the manner of conducting interviews and observation. It involves six participants and is aimed at understanding the management strategies of the case school to deal with the trend of fewer children. Based on the records of interview and observation as well as the information of school background, this study encodes and analyzes the collected data. Moreover, this study adopts triangulation to improve its reliability and validity. Afterwards, it concludes the study result as follows: 1. The number of students in the case school is decreasing annually due to the trend of fewer children, the decline of communities in the neighborhood and the competition of neighboring fellow schools. 2. The trend of fewer children seems to have a great impact on the case school in terms of“the crisis of school termination/ amalgamation due to insufficient new students,”“thelack of school facilities due to funding shortage,” and “low competitiveness due to insufficient students.” 3. Facing the trend of fewer children and the decline of communities, the case school proposes five measures to address these issues: “strive for promising management qualifications such as mutual school district, free school district, and grand school district,” “shuttle bus delivery,”“free after-school academic assistance and school clubs,”“devoted teachers,”and“multiple subsidies.” 4. School administrations value the communication and negotiation with teachers to improve the quality of teaching as well as administration. 5. School teachers devote themselves to caring for students in a comprehensive manner to win the trust of parents. 6. Bridge the gap between school and parents with the help of teachers to build up the positive images of school. 7. Encourage teachers to pursue further studies to foster their expertise and to benefittheir students. 8. Develop diverse learning strategies and allow students to grow, to learn, to develop,and to realize their dreams. 9. The leader empowers the school staff to work in groups so that they may have active,positive, and profound viewpoints. 10. The school emphasizes the importance of managing performance to strive for the participation of social resources.

碩士
國立臺南大學
經營與管理高階經營碩士在職專班(EMBA)
107
In view of the sharp decline in population fertility, strictly become the global trend, Taiwan has become one of the lowest fertility countries, in response to the changes and lack of labor and manpower structure caused by the child-giving, and the resulting national competitiveness decline, family structure and care and many other problems, the phenomenon of child-son has been listed as an issue of national security , In line with Taiwan's prepared nature, the relevant government ministries have stepped up planning of various measures to encourage fertility and related supporting measures to increase fertility and promote the rational growth of the population. However, the results have not yet been demonstrated , Fertility is still not effectively rising. The decline of the fertility rate of Taiwan's population and the appearance of a small-child pattern in the social structure will affect the direction of school operations. This study analyzes the causes of the population's small-childization, summarizes the impact of the population's sub-generation on the educational development of schools, and needs to run schools from the perspectives of school management strategy, teacher-student concept, strategic alliance, fitness teaching, small class system and integrated educational resources. In this way, it should effectively mitigate the impact of child-rearing on the development of school education. Managerial implications and further research suggestions are discussed.

碩士
國立彰化師範大學
工業教育與技術學系
101
The purpose of this research is to explore the efficiency of Senior High School and Vocational High School under the influences of Trend of Fewer Children and 12-year Compulsory Education as well as to construct the Senior High and Vocational High School Management indicator and analyze the importance. In order to achieve the purpose, this research includes 3 approaches. First, the researcher gathered and analyzed the structures of School Management Indicators through reviewing the literatures. Second, the researcher adopted the expert validity and the third one, Delphi Method. There are 15 experts invited as the Delphi Method committees to evaluate the contents of schools’ indicator and importance by encountering Trend of Fewer Children and 12-year Compulsory Education anonymously. The committees comprise 3 profession relevant college scholars, 3 Senior High School principals, 3 Vocational High School principals, 3 Senior High School directors and 3 Vocational High School directors. By observing the research processes, the study has the following results; the Senior High Schools and Vocational High Schools’ indicator of confronting Trend of Fewer Children and 12-year Compulsory Education have 7 aspects, 25 items, and 81 sub-items, which consist of 30 “important” ones and 51 “extremely important.” ones . In summary, the study concludes some suggestions for references in School management of responding to Trend of Fewer Children and 12-year Compulsory Education.

碩士
康寧大學
企業管理研究所
103
This study aimed to explore the improvement of school visibility through “ecological education” used by schools as a blueprint for teaching and the ”green school” as the innovative management strategy for campus hardware and software building under the existing trend of fewer children. The research results are expected to serve as coping strategies for schools suffering from the trend of fewer children, thereby achieving the goal of sustainable development. The questionnaire survey of “The Impact of Ecological Education and Green School Management Strategies on School Visibility, Parent Satisfaction, and Willingness of School Attendance under the Trend of Fewer Children” was adopted as the research tool in this study. The contents consist of four parts: “basic information”, “the impact of the trend of fewer children on schools”, “ecological education and green school strategies on school visibility and parent satisfaction”, and “willingness of school attendance”. A sampling survey was conducted on schoolteachers teaching different grades. A total of 247 valid questionnaire copies were recovered, accounting for the recovery rate of 90.1%. The main research methods include reliability and validity analysis, descriptive statistical analysis, ANOVA, regression analysis, etc. Findings show that ecological education and green school management strategies indeed had an impact on school visibility, parent satisfaction, and willingness of school attendance. Finally, effective recommendations on the education environment were put forth.

Северо-Монгольская горная лесостепь, переходная зона между тайгой и открытой степью, имеет богатый животный и растительный мир. Для сельского хозяйства это самая продуктивная часть страны и имеет плотность населения выше средней по Монголии. Древостои светлой тайги, в которых преобладает лиственница (Larix sibirica Ledeb.), представляют основу монгольских продуктивных лесов и поставляются все больше в соответствии с растущим спросом на деловую древесину и дрова. В лесах Монгольской горной лесостепной зоны и таежной зоны наблюдается, особенно с конца прошлого века, заметное сокращение площади леса. Основными факторами этого сдвига растительности являются изменения в землепользовании, частота пожаров, появление вредителей и изменение климата. На видовой состав, прирост и структуру древостоев оказывают сильное влияние различные природные и антропогенные режимы воздействия и климатические факторы. Понимание влияния климатических факторов на эти воздействия и экологическое влияние от воздействий на древостои и их реакцию с точки зрения структуры, прироста и обновлений необходимо для развития экологически и регионально соответствующих программ ведения лесного хозяйства. Частые, интенсивные, обширные воздействия, прежде всего лесозаготовки и лесные пожары, способствовали появлению сукцессионных лесов (Betula platyphylla Sukaczev), в которых преобладает береза. Несмотря на предпринимаемые усилия по созданию альтернативных подходов к управлению лесами в Монголии существует недостаток знаний о влиянии основных факторов и воздействий на структуру лесов и лесной растительности и недостаточная мощность. Одной из областей с традиционно сильным землепользованием является аймак Селенги, расположенный к северу от Улан-Батора. В 2009 году Монгольский Университет естественных наук в Дархане и группа лесопользователей в исследовательском районе Альтансумбэр создали исследуемые площади и провели экспериментальные опыты выборочной рубки. Эта инициатива в области была поддержана в рамках проекта UNFAO «Укрепление потенциала и институциональное развитие для совместного управления природными ресурсами и сохранения лесов в лесных районах Монголии» (GCP / MON / 002 / NET), финансируемого правительством Нидерланды. Большинство исследуемых площадей имеет размер 2500 м². Исследовательский район Альтансумбэр расположен к западу от Дархана и является ярким примером монгольской горной лесостепной зоны. Исследовательский район Бугант расположен к востоку от Дархана в западных горах Хенти и является частью густой таежной зоны. Изучалось влияние климатических факторов и выборочной вырубки на рост и структуру поврежденных от пожара березовых и лиственничных древостоев светлой тайги в исследовательском районе Алтансумбэр (горная лесостепная зона, северные склоны). В исследовательском районе Бугант (таежная зона, южные и восточные склоны) изучено влияние климатических факторов на прирост березы и проведено сравнение с результатами Алтансумбэр. Различия в отношении повреждений от пожара между березой и сосной (Pinus sylvestris L.) оценивались отдельно. Во всех исследованных древостоях обоих исследуемых районов были обнаружены признаки лесных пожаров, и большинство древостоев также показали признаки предыдущих мелкомасштабных лесозаготовок. Посредством дендрохронологических методов были рассмотрены отношения климата и роста и проведен анализ экстремальных годов. В районе исследований Алтансумбэр непространственная и пространственная структура леса была проанализирована как до, так и непосредственно после прореживания и после трех лет. Анализы произведены в форме анализа прореживания с использованием L-функции и радиальной функции распределения. Влияние снижения конкуренции на прирост остальных деревьев было описано и проанализировано с помощью линейных смешанных моделей. Подрост был зафиксирован на всех площадях в Алтансумбэр в 2012 и в Бугант в 2011 году и возобновился на некоторых площадях в Бугант в 2013 году. Для обоих видов, лиственницы и березы, осадки во время позднего лета и ранней осени предыдущего года и непосредственно перед началом вегетационного периода текущего года были решающим климатическим фактором, определяющим рост деревьев. Анализ экстремальных годов сильного и слабого роста показал значительное сходство между обоими видами. Достаточные осадки перед началом вегетационного периода были для роста молодых деревьев важнее, чем для старых. В более сухой и высококонтинентальной горной лесостепной зоне (Алтансумбэр) по сравнению с более влажной таежной зоной (Бугант) связь между осадками и ростом березы была более выраженной. Признаки повреждения насекомыми были найдены только в Бугант (таежная зона). Все хронологии берез показали высокую чувствительность к более высоким температурам, как правило, весной, и взаимосвязь между временным возникновением негативного соотношения температуры и роста и направления склона. На северных склонах в Алтансумбэр статистические отрицательные соотношения температуры и роста березы произошли в мае. На южных склонах в Буганте это отрицательное соотношение возникло раньше по времени, в апреле. Это отрицательное соотношение температуры и роста в хронологии лиственницы в Алтансумбэр не было установлено. В обоих исследуемых районах среднегодовые показатели роста хвойных пород были выше, чем у березы. Наблюдаемое различие в отношении показателей роста и чувствительности к весенним температурам может быть связано с различной защитной способностью березы и хвойных пород от очень распространенных низкоинтенсивных поверхностных пожаров, которые имеют свой пиковый сезон весной и частично управляются климатическими факторами. Количество видимых поврежденных огнем берез с тонкой корой в Буганте было более, чем в восемь раз выше, чем сосны с толстой корой из того же древостоя. В древостоях, где береза смешана со светлыми хвойными породами, малоинтенсивный режим пожаров имеет более негативное и длительное влияния на рост берез, чем на рост хвойных пород с толстой корой. С другой стороны, разрушение древостоя интенсивными пожарами или сокращение площади вследствие повторяющейся интенсивной вырубки может благоприятствовать преобладанию березы из-за ее способности прорастания – поросль от пня. Характеристики структуры леса и реакции на воздействия изучались исключительно в исследовательском районе Алтансумбэр и могли быть связаны с процессами сукцессии, пожарами и нерегулируемыми вырубками. Агрегированное размещение деревьев было подтверждено для всех лиственничных древостоев и большинства березовых древостоев в Алтансумбэр до выборочной рубки. Вследствие прорастания береза часто встречается агрегировано в очень узких, небольших группах. Лиственница, напротив, появилась в более свободных кластерах, где деревья распределены на более дальнем расстоянии. Вследствие того, что березы имеют меньшую продолжительность жизни и интенсивнее конкурируют друг с другом, у березовых древостоев имеется способность развиваться к случайному размещению деревьев раньше, чем у лиственничных древостоев. Конкуренция сыграла значительную роль в исследуемых древостоях светлой тайги. В исследовательском районе Алтансумбэр соотношение между конкуренцией и ростом оценивалось до, непосредственно после и через три года после прореживания. Прореживания проводились с различной интенсивностью (5,4% - 52,4% площадь сечения). Основными критериями отбора деревьев для рубки были относительно низкое состояние здоровья и способность к росту, на что указывало повреждения ствола и развитие кроны, форма ствола, а также расстояние между отдельными деревьями. Этот отбор привел в значительной мере к низовому прореживанию. Как и ожидалось, прореживание способствовало регулярному размещению деревьев. Тем не менее, дальнейший рост новых стволов привело к тому, что распределение деревьев древостоя менялось обратно в направлении агрегированного. Прирост был в значительной степени вызван ослаблением конкуренции как результат прореживания, и ответ прироста был действительным в абсолютном и относительном выражении. Относительное увеличение прироста по сравнению с периодом до прореживания было немного выше для березы, чем для лиственницы, несмотря на сравнительно поздний средний возраст древостоев на момент прореживания в 2009 году, особенно для березы. Данные были полученны из анализа годичных колец деревьев ( средний возраст лиственница: 22-61 год, березы - 44-68 лет). Основываясь на региональных данных недавней национальной инвентаризации лесов (MPNFI) как норме, количество подроста во всех древостоях в Алтансумбэр относительно низко, тогда как число подроста в Бугант выше среднего. В целом результаты показали, что более методическая стратегия управления лесами является возможной с научной точки зрения. Вместе с тем местное управление лесами должно служить многофункциональным целям регионального лесопользования. Потенциал лесов обеспечивать такие экосистемные услуги, как защита водного режима и почвы, постоянный растительный покров, биоразнообразие, внесение вклада в снижение негативных последствий изменения климата должен быть гарантирован. Это, принимая во внимание длительное изменение климата, усиление воздействий и развитие требований общества, особенно сложно. Основная цель лесоводства должна заключаться в повышении устойчивости и жизнестойкости лесных экосистем к различным воздействиям и одновременно делать возможным использование древостоев. Две модели использования представляются возможными: промышленное производство изделий из дерева (в основном из лиственницы и сосны) или производство энергии на базе древесины (в основном береза), заготовка дров. Плотные древостои светлой тайги, отведенные под производственные леса, могут быть подвергнуты прореживанию или выборочной рубке от одного до двух раз в первые 50-60 лет. в соответствии с вышеназванными критериями. При выборочной рубке в форме небольших групп (Femel) в этих древостоях происходит способствование регенерации и переход в окончательное пользование. Подсадка подроста должна рассматриваться только в том случае, если желаемая регенерация недостаточна или если древостой должен быть изменен на другой древесный состав. Часть сукцессивных березовых древостоев рядом с поселениями могла бы управляться как низкоствольный лес для получения дров. Директивы лесоводства должны принимать во внимание различные специфические экологические и климатические условия, различный возраст древостоев, цели в области лесоводства и реалистические варианты управления. Управленческие меры должны быть усилены путем национального и регионального управления лесами. Рекомендуется также анализировать экономическую эффективность лесохозяйственных операций, таких, как различные системы заготовки древесины. Результаты и выводы проекта охватывают лишь относительно короткие временные рамки. Необходимо продолжить наблюдение долгосрочного влияния выборочной рубки, особенно с точки зрения стабильности древостоя, почвы и спорадической вечной мерзлоты.