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1
Byass, Peter. "Microcomputer support for health care delivery in the Gambia." Thesis, University of Nottingham, 1990. http://eprints.nottingham.ac.uk/12413/.
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Microcomputer support for health care delivery is a relatively new concept in developing countries, despite serious shortages of human expertise. In this light, the concept of microcomputer-based decision support for patient management at the rural health centre level in The Gambia is discussed and developed. Possible methodologies are devised and evaluated, taking into account constraints imposed both by feasibility of hardware for the rural African setting and by appropriate software techniques. Clinical data were collected for a pilot system, which was implemented using a Bayesian methodology, and assessed, with encouraging results. Further sources of data were then considered in order to generalise the pilot system into a prototype, which was implemented on a portable solar-powered microcomputer. The evaluation of this prototype system, and the difficulties involved in undertaking rigorous evaluations of this type of decision aid, are described and discussed. Whilst it is not proven that major health benefits would arise from the widespread introduction of such systems, the results of this preliminary study suggest that this type of approach merits further consideration and development.
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Rosenberg, Anna. "Hand Hygiene Barriers faced byHealth Care Workers in The Gambia: : A Health Belief Model Approach." Thesis, Södertörns högskola, Miljövetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-32255.
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Health care associated infections cause major challenges to the provision of health care. This isdue to the burden placed on individuals, their families, and health services. Hand hygiene actions are cost effective measures towards reducing the spread of health care associated infections and have proven very effective in preventing microbial transmission during patient care. It has beenproven that health care workers hands are the main routes of transmission of health care associated infections. Despite this, hand hygiene is still frequently overlooked by health careworkers especially in settings with limited resources. This paper therefore explores hand hygieneknowledge and behaviours of public and private health care workers in The Gambia with focuson the health belief model. The required information has been gathered from 4 public and 2 private health care facilities through the use of a questionnaire based on the WHO evaluation toolkit. Hand hygiene knowledge of health care workers corresponded with their hand hygiene behaviour. Inadequate hand hygiene performance was noted in many health care workers as wellas limited availability of hand hygiene resources from health care facilities. Private health care facilities provided better hand hygiene opportunities for their health care workers yet neither private nor public health care facilities offered adequate hand hygiene training and feedback on hand hygiene performances to their health care workers.
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Baldeh, Yero H. J. "Information support for district health care planning and decision making in The Gambia : a holistic approach." Thesis, University of Central Lancashire, 1997. http://clok.uclan.ac.uk/21604/.
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This research builds upon a body of previous research on health informatics in developing countries. Early research on this area was motivated by a desire to understand the role of different health informatics applications for an effective and efficient health care delivery in developing countries. These applications range from the use of medical expert systems for clinical diagnosis to epidemiological systems at the central level. None of these looked at health information systems at the district level, especially in relation to the information needs of district health staff. Therefore, this research differs from earlier studies in three aspects. First, it looks at the planning and decision-making processes at the district level and how information support could play a crucial role in these processes. Second, it provides a critical evaluation of the existing vertical reporting systems, and through action-research demonstrates the use of an integrated health information system at the district level. Third, it applies multiple perspectives to analyse the research findings in relation to information support for district health care planning and decision making. These three perspectives are the functional perspective, organisational perspective, and the political perspective. To achieve this, the research: • uses a systemic approach to examine the health care system in The Gambia; • uses action-research to design, develop and implement an integrated district health information system in The Gambia; • uses an interpretive evaluation framework to evaluate the impact of the system development efforts in this research; • uses the theory of contextualism to reflect on the research findings over the three year period. Various themes emerged during the research. These themes would be introduced here as the contributions to knowledge arising from the completion of this research project. These include: • a demonstration of the suitability of using a systemic approach for the design, development and implementation of an integrated information system for district health care planning and decision making; • the development of a conceptual implementation framework suitable for the unique characteristics of developing countries; • a manifestation of the implications of an integrated information system for management development, decentralisation, intersectoral coordination and community participation at the district level; • suggestions for further work especially on the need to evaluate the socio-political impact of this research on the existing political and cultural structures in The Gambia.
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Lamb, W. H. "A prospective study of psycho-motor development in rural West African (Gambian) infants." Thesis, University of Newcastle Upon Tyne, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.380209.
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Sanyang, Edrisa. "Risk factors and injury characteristics among trauma patients in the Gambia." Diss., University of Iowa, 2016. https://ir.uiowa.edu/etd/2270.
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This research focuses on injuries from all mechanisms, with particular focus on road traffic injuries in urban Gambia. Data from trauma registries established in two major trauma hospitals were used to address three aims: 1) examine the general characteristics of injured individuals and their injuries, and identify factors associated with discharge status from the hospital emergency room; 2) identify differences in road-user, collision, vehicle, and driver factors, among individuals hospitalized with a road traffic injury; and 3) examine personal, crash, and injury factors associated with transfer status among road traffic injured (RTI) patients, and identify limitations of the current trauma systems that might be improved for more efficient use of resources.
Data used for this dissertation were from trauma registries established in two major trauma hospitals in The Gambia: Edward Francis Small Teaching Hospital (EFSTH) and Serrekunda General Hospital (SGH). At intake, the treating physicians and nurses completed an accident and emergency ward survey form for injuries from all mechanisms. For admitted road traffic injured patients (admission more than 24 hours), the road traffic injured admission form is completed. Data about risk factors contributing to crashes and injuries were collected from the patients. At hospital discharge, treating physicians used a 19-item questionnaire to collect data on the discharge status and disability at discharge of road traffic injured patients.
Using the trauma registry data from March 1, 2014 to March 31, 2016, we found the leading mechanism of injury was road traffic. For place of occurrence, injuries mostly occur at home and on the road. Assault was higher among young females (19 to 44 years) than males. Males have increased odds for admission and disability due to road traffic injuries. We also found that among admitted road traffic injured patients, injuries to pedestrians, bicyclists, and motorcyclists were higher than other road users. Crashes involved risk factors at person, crash, and environment levels. Head/skull injuries were common, and concussions/brain injuries were higher among pedestrians, bicyclists, and motorcyclists than vehicle occupants. Finally, our results also suggest that vehicle occupants, and professionals/skilled personnel had increased odds of being transferred than directly admitted RTI patients. Fractures/dislocations, and concussions/brain injuries were frequent among transfers. Intravenous fluid was the most frequent treatment administered to patients transferred to the definitive-care hospitals.
This project shows that injuries, especially road traffic, create a large burden of injury in The Gambia and the many contributing factors. It also provides evidence that there are many opportunities to intervene at personal, crash, and environment levels. Additionally, creating trauma registries across the country as well as trauma response system will have a greater impact to reduce burden of road traffic crashes in The Gambia.
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Dawson, Angela Jane Public Health & Community Medicine Faculty of Medicine UNSW. "Learning and curriculum design in community health nurse education: a picture of a journey on the river Gambia." Publisher:University of New South Wales. Public Health & Community Medicine, 2008. http://handle.unsw.edu.au/1959.4/42597.
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Thirty years after the concept of primary health care (PHC) was declared the path to health for all, a crisis continues in human resources for health in Africa. This involves the low prioritisation of education and training for primary health care personnel (PHCP) which is crucial to effective practice in severely under-resourced settings. The curriculum required for this education, involving pictures and textual materials, must meet the needs and capacities of the learners so that learning transfer can occur and community health needs are met. This research set out to establish the basis upon which text and pictures should be incorporated into curriculum to address the requirements of community health nurses (CHNs) in The Gambia. A pragmatic, three phased, mixed methodological design was selected for this study. Curricula for African PHCP were first collected and examined using content analysis to determine the rationale for pictures and text. The second phase employed psychometric testing and statistical analysis to establish if learning style preferences for pictures and text were important in Gambian CHN learning. In the final phase, interviews with CHN students explored their preferences for pictures and text and how these preferences should be accommodated in curriculum. The research found that much of the PHCP curriculum analysed was generic, used traditional didactic approaches and focused on written knowledge-based assessment. Learning style preferences were not found to be a consideration and were unidentifiable in this context. Socio-cultural factors significantly impacted upon student CHN learning, but were not adequately addressed in the curriculum materials examined. In addition, CHNs preferred practical learning through primary, multi-sensory experiences. These findings support the conclusion that the localisation of CHN curriculum is required in order to provide a socio-cultural context for learning that is meaningful, rich, interactive and responsive to learner needs. This demands a reconnection with PHC principles of equity and participation which should underpin this curriculum. The thesis argues that an ecological framework better articulates the link between PHCP education and training, practice, and community needs, and should serve to guide curriculum design. Six strategies are identified that could be extended to African PHCP course design.
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Aikins, Moses Kweku Sekyi. "Cost-effectiveness analysis of insecticide-impregnated mosquito nets (bednets) used as a malaria control measure : a study from the Gambia." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1995. http://researchonline.lshtm.ac.uk/682242/.
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Insecticide-impregnated bednets are currently being promoted as one of the promising malaria control methods in endemic regions of most developing countries. Although, much is known about the entomological and epidemiological aspects of treated bednets, little is known about the efficiency of malaria control programmes in general, and bednets in particular. This cost-effectiveness analysis forms part of the evaluation of the Gambian National Insecticide-impregnated Bednet Programme (NIBP). The research was conducted in the rural Gambia where malaria is endemic. An integrated approach to data collection approach (qualitative and quantitative) provided information for the four objectives of the study, namely; 1. to calculate the total NIBP implementation costs (ie' direct and indirect costs); 2. to estimate the number of child (under 10 years) deaths averted in the intervention area; 3. to calculate the resources saved by averting a child death to the health sector and households both direct (ie saved treatment costs, saved preventive expenditures, postponed funeral expenses) and indirect (ie time costs saved by carers and relatives that can be spent on productive activities) and subtract these from the programme costs, to produce net cost-effectiveness ratios and 4. to investigate the effect of impregnated bednets on primary school attendance in terms of days and reasons for absenteeism. The study covered 64 government and non-governmental organization personnel, 179 village dippers, 306 women in groups of 5 8 in focus group discussions, 25 in-depth interviews of men, 134 carers of children, 50 women in random spot observations and 2182 pupils in school attendance study. The main findings of the study were; 1. The annual implementation cost of NIBP was D757,874.72. 2. The implementation and the net cost-effectiveness ratios per child death averted were D4,946.63 and D1,332.31 respectively and, 3 . Impregnated bednets were observed to reduce absenteeism due to ill-health. NIBP was an efficient malaria control method in rural Gambia and saved resources.
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Backebjörk, Vanja, and Emma Lundgren. "Nurses' experiences and challenges while caring for patients with mental disorders in the Gambia : a quantitative cross-sectional study." Thesis, Luleå tekniska universitet, Omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-78922.
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Background: The care for patients with mental disorders have changed and this has led to higher demands on nurses. Research is conducted globally within the subject and studies have shown that nurses enquire more theoretical knowledge and practical training. In the Gambia, nursing education is conducted by five different schools and the country has one psychiatric hospital. Purpose: To explore nurses’ experiences and challenges while caring for patients with mental disorders in the Gambia. Method: The study was conducted using a quantitative cross-sectional design. Result: The result showed that the respondents enquire more education, that the work is challenging and that the majority of respondents have experience of working with patients with mental disorders. Conclusions: There is a need for internal education for nurses on their workplaces and more research within the subject.
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Jech, Martin, Federico Magnani, and Rute Freitas. "Internationalization of a Health Care Organization : An Empirical Study on Gambro." Thesis, Växjö University, School of Management and Economics, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:vxu:diva-1496.
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The international marketer is challenging new factors in the present globalized world. Such marketer has often to solve conflicts resulting from different laws, cultures and societies, and overcome a variety of constraints when entering or establishing foreign markets. Entering and establishing new markets is a complicated process affected by both, external and internal factors. To be successful in new markets, said marketers must formulate market entry strategy with regard to those factors. This paper was written with the purpose to investigate the relationship between relatedness of core business and business regarding the market in question, government policies and regulations, and entry strategy of companies entering the U.S. renal services market. We have carried out the exploratory research based mainly on secondary data obtained from annual reports from 1995 to 2005. The one case study on the Swedish health care company Gambro was conducted in order to formulate hypotheses, which can be proven in prospective research. The whole paper is written in the context of PSE market entry model developed by Anders Pehrsson. Based on the analysis we suggest that if the perception of barriers is low and the relatedness between core business and business regarding market in question is high, companies prefer a non-organic growth when entering the market.
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Nadowska, Agnieszka. "Services Marketing in the Health Care Industry- Elekta in Sweden." Thesis, Högskolan i Gävle, Avdelningen för ekonomi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-15674.
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During the nineteenth and the twentieth centuries, the world has moved from a manufacturing to service-based economy, where the twentieth first century, will be the” century of services”, and will transform into the century of “international services” (Clark and Rajaratnam, 1999).
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Yamuah, Lawrence Kweku. "Healthcare provision in The Gambia : the role of health informatics." Thesis, City University London, 2003. http://openaccess.city.ac.uk/7646/.
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While technological advances in computing and telecommunications are revolutionising the way many organisations work, healthcare systems in The Gambia are very much lagging behind. No proper patient records or filing systems are in place. Delivery of effective healthcare depends on availability of routinely collected, good quality health data to provide useful information that is accessible when and where it is needed. Presently, in The Gambia, there is considerable scope for improvement in relation to such data. Electronic patient record system is long overdue. This research, focuses on the development of a Health Information System (HIS) capable of providing doctors, nurses and other healthcare professionals with quick and easy access to the appropriate information needed to care for their patients. A systems analysis has been undertaken to identify the full need for patient health data, the range of users and the extent of present paper-based provision. From this analysis, a requirements specification has been produced for a proposed health information and administration system (HIAS) to become operational and also successful in terms of efficiency and effectiveness. The requirements specification has taken the form of a series of precise statements of needs, buttressed with a corresponding justification in each case. By assessing what information and communication technology (lCT) is required and feasible, affordable and available in The Gambia, based on the extensive fieldwork involving interviews, observational study and questionnaires, a design specification (the logical and physical framework for the proposed ,IUAS) has also been produced as a precursor to the development of the proposed HIAS prototype. The approach,used will aid any implementor to progress from the proposed system to a fully functional one in an efficient and timely manner. Constraints in the programme of research were such that it was not possible to continue on with a prototype implementation based on this design. Hence it is now for The Gambia government to study and implement the proposed system. Several recommendations have been made in the areas of policies to be implemented, resources needed and training and motivation. In conclusion, the study has demonstrated the value or role of health informatics in the provision of health care in a developing country. It has contributed in the understanding of the complexities of the problems in The Gambia and developing countries, building this understanding in terms of requirements analysis and design specification and in methodological issues.
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Moore, Sophie Elizabeth. "Long term health effects of early malnutrition in the Gambia." Thesis, University of Cambridge, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.621751.
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Weber, Martin Willi. "Infection with the respiratory syncytial virus in the Gambia." Thesis, Open University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.262711.
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Greenaway, Chris. "Humoral response to M. tuberculosis antigens in patients with tuberculosis in the Gambia." Thesis, McGill University, 2003. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=80282.
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New tests to diagnose active tuberculosis (TB) that are simple, rapid and inexpensive, yet sensitive and specific are urgently needed. We assessed the sensitivity and specificity of seven different M. tuberculosis antigens for the diagnosis of active pulmonary TB in The Gambia. Three of the antigens tested were restricted, i.e. absent from BCG and some non-tuberculous mycobacteria (ESAT6, CFP-10 and Rv3871), and four shared, i.e. common to most mycobacteria (38kDa, GLU-S, 19kDa and 14kDa). Sera from 100 patients with active pulmonary TB, 100 household contacts, and 100 healthy neighborhood controls, in the Gambia, were tested by ELISA for antibodies to these 7 antigens. The sensitivity and specificity of both the shared and the restricted antigens were unacceptably low. In countries with high, rates of TB, such as the Gambia, the clinical utility of serologic testing to diagnose active tuberculosis remains limited.
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Hough, Carolyn Ann. "Disruption and development kanyalengs in the Gambia /." Diss., University of Iowa, 2006. http://ir.uiowa.edu/etd/53.
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Wong, Tinadale. "An evaluation of a peer health education programme in The Gambia, West Africa." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1996. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/MQ37824.pdf.
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Donato, Francis A. "Reforming health care through managed care." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1995. http://www.kutztown.edu/library/services/remote_access.asp.
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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1995.Source: Masters Abstracts International, Volume: 45-06, page: 2939. Abstract precedes thesis as [1] preliminary leaf. Typescript. Includes bibliographical references (leaves 91-92).
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Haas, Marion Ruth. "Benefits of health care beyond health: an exploration of non-health outcomes of health care." University of Sydney. Public Health, 2002. http://hdl.handle.net/2123/854.
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Recent interest in identifying and measuring health outcomes represents an advance in our understanding of how health care for individuals should be evaluated. However, the concept of health outcomes has mainly focussed on improvements in health status. Non-health outcomes of health care may also be important to patients. In this thesis, four tasks were undertaken with the aim of identifying non-health outcomes and establishing the extent of their relevance and importance to patients. First, the illness experience literature was reviewed to identify potential non-health outcomes. Seven categories of non-health outcomes were identified: information, being treated with dignity, being able to trust the health care provider, having distress recognised and supported, participating in decision making, legitimation and reassurance. Second, to gain an in-depth understanding of these concepts, topic-specific literature was reviewed and synthesised. Third, in order to confirm how relevant and important the concepts were to patients, a qualitative study was conducted with each of two different groups of health service users. Broadly, patients considered that all the non-health concepts were relevant, although the extent to which they were important varied. Fourth, to test the relative importance of the seven concepts, a Stated Preference Discrete Choice experiment in the context of general practice was conducted. This study showed that most people thought their GP demonstrated behaviour likely to result in the production of non-health outcomes. The results showed that although all the non-health outcomes were, to some extent, preferred by respondents, trust was most important, followed by legitimation and recognition of and support for emotional distress. Once again, these results point to the importance of context in the evaluation of health care from the patient's perspective. While still being perceived as positive aspects of health care, the provision of information and acting autonomously or participating in decisions about their health care were the non-health outcomes considered least important by patients
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Mykhalovskiy, Eric. "Knowing health care / governing health care exploring health services research as social practice /." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0018/NQ56249.pdf.
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Bataineh, Hana. "An Empirical Investigation of Unmet Health Care, Health Care Utilization and Health Outcomes." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/36492.
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This thesis is comprised of three chapters that empirically examine two important areas in health economics: access to health care and health outcomes.
The first chapter explores the impact of health care utilization on unmet health care needs (UHC) using four biennial confidential master files (2001-2010) of the Canadian Community Health Survey and applying an instrumental variables (IV) approach to deal with the endogeneity of health care utilization. The presence of drug insurance and the number of physicians in each health region are used to identify the causal effect. I find a clear and robustly negative relationship between health care use and unmet health care needs; individuals who are more likely to report unmet health care needs are those who use the health care system less frequently. One more visit to a family doctor, specialist or a medical doctor on average, decreases the probability of having unmet health care needs by 7.1, 4.6 and 2.8 percentage points, respectively. Further analysis by sub groups reveals that the impact of health care utilization on UHC is larger for females in comparison to males, rural residents in comparison to urban dwellers and those with low household income rather than high.
The second chapter of this thesis examines whether the presence of the unmet health-care (UHC) needs has an adverse effect on health outcomes using the National Population Health Survey, a nationally representative longitudinal data set spanning 18 years. I pay close attention to the potential endogeneity of this problem. Five direct and indirect measures of health-related outcomes are examined. I find clear and robust evidence that the presence of UHC either two-years previously or anytime in the past, affects negatively the current health of the individual – controlling for a host of other influences. For instance, reporting UHC in the previous cycle reduces the probability of being in excellent or very good health and in good mental health, respectively by 8.1 and 1.2 percentage points; it reduces the HUI3 score by 2.9 percentage points and increases the expected number of medications used by 11%. Further analysis by looking at the effect of UHC when it was due to accessibility reasons, reveal that the effect of UHC because of accessibility reasons on health outcomes is larger than the one of the overall UHC, but the difference is small in general.
Finally, the third chapter of this thesis examines the link between social networks and access to health care utilization, focusing particularly on the probability of having a regular family doctor. Unlike previous work that uses cross sectional data, I use panel data from the National Population Health survey to control for unobserved heterogeneity. Access to a regular family doctor is modeled using the dynamic random effects probit model, which makes it possible to explore the dynamics of access to a regular family doctor– for instance, the role played by past access status to a family doctor in predicting current access. In particular, I use the dynamic random effects probit model that controls for both unobserved heterogeneity and for initial conditions effects. I find robust evidence of a highly statistically significant relationship between social capital and the probability of having a regular family doctor. Although the marginal effects are modest, the results from all model specifications show that there is clear evidence that individuals with high levels of tangible, affection, emotional, social interaction, who live with spouse only or with spouse and children are more likely to have a regular family doctor, whereas those living alone are less likely to have a regular family doctor. The results also reveal that past access to a family doctor is an important determinant for both current and future access. The predicted probability of having a regular family doctor is about 18 percentage points (or 20%) higher for individuals who had a family doctor in the previous period, relative to those who did not. In addition, I find that unobserved heterogeneity accounts for about 25% of the variation in accessing a regular family doctor and is significantly correlated with the access to a family doctor over my long panel.
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Wood, David L., and R. Nathawad. "Health Care Transition." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/5155.
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Jawla, Muhammed, Folawiyo S. Olanrewaju, and Megan Quinn. "Factors Influencing Attitude Towards The Use of Mosquito Nets in Households in The Gambia." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/38.
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Malaria is caused by Plasmodium parasites, which are transmitted via the bite of infected female anopheles mosquitoes. There were 217 million cases of malaria worldwide, and about 435,000 malaria related deaths in 2017. WHO Africa region accounted for 92% and 93% of malaria cases and deaths worldwide. According to The Gambia National Malaria Strategic Plan 2013-2020, malaria is a leading cause of morbidity and mortality. The aim of this study was to identify factors influencing attitude towards the use of mosquito nets in households in The Gambia using Demographic and Health Survey (DHS) data. The current study is a secondary data analysis with a, cross-sectional study design. The source of the data for this study is the DHS, which was conducted by the United States Agency for International Development (USAID) together with the Gambia Bureau of Statistics (GBOS) in 2013. The study sample is representative of The Gambian population. The sample size for the study was 5276 subjects. Statistical Analysis System (SAS 9.3) was used for data analysis. Descriptive statistics were generated for the factors been tested. These included area of residence, presence of electricity, indoor residual spraying, highest level of education and wealth index. The outcome variable measured was household use of mosquito nets (Yes/No). Logistic regression analysis was done to determine whether area of residence, wealth index, education level, presence of electricity and indoor residual spraying influence attitude towards use of mosquito nets in households. Stepwise binary logistic regression was used to determine the final model with the most significant predictors. Odds ratios and corresponding confidence intervals were reported. Most of the study participants were poor (46%). Those with no education made up 45.5% of the study population and 58% of dwellings had no indoor residual spraying done in the past year. 76.6% and 59.1% of respondents lived in households that had at least one mosquito net and no electricity supply, respectively. 50.6% of the respondents resided in rural areas. Logistic regression analysis showed that wealth index, indoor residual spraying and area of residence were significant factors (p<0.05) influencing attitude towards use of mosquito nets in households. Indoor residual spraying (OR=2.00; 95% C.I. 1.71-2.36), primary school education (OR=1.1; 95% C.I. 0.94-1.32), middle class wealth index (OR=1.32; 95% C.I. 1.05-1.67) and rural residence (OR=1.29; 95% C.I. 1.01-1.64) are all independent factors that increased likelihood of mosquito net usage in households. Identifying factors that influence the usage of mosquito nets in households, can be useful in developing target interventions to further reduce malaria morbidity and mortality in The Gambia. Knowledge from this study can be used to further strengthen the national malaria strategic plan. To further establish causality and increase strength of association between factors and outcome, a case control or cohort study design will be needed, since that is one of the limitations of a cross sectional study.
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Blanton, Sandra. "Justice in Health Care Access Measuring Attitudes of Health Care Professionals." TopSCHOLAR®, 2000. http://digitalcommons.wku.edu/theses/714.
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To measure attitudes toward justice in access to health care services in managed care plans in a convenience sample of medical professionals at Clark Memorial Hospital in Jeffersonville, Indiana. Methods. A sixteen item, self-administered instrument based on Morreim's four concepts of justice in health care access was administered to 147 health care professionals, representing physicians, allied health, and hospital administration. SPSS was used to analyze the results. Results. The attitudes of the respondents were negative toward managed care. They did not feel that managed care had been a positive development in the United States or that managed care had improved access to preventive care or improved primary care. On the survey instrument, respondents scored highest on the scale measuring fairness to individual patients. Conclusion. In a convenience sample of health care professionals at Clark Memorial Hospital in Jeffersonville, Indiana, equity in distributing access to health care among individual patient needs was found to more closely meet their expectations of justice in health care access. There were no differences found across occupational groups in their responses to the two scales. There were differences in attitudes toward managed care among occupational groups.
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Lymer, Ulla-Britt. "Blood exposure in health care : health care workers' and patients' experiences /." Linköping : Univ, 2004. http://www.bibl.liu.se/liupubl/disp/disp2004/med874s.pdf.
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Haas, Marion. "The benefits of health care beyond health an exploration of non-health outcomes of health care /." Connect to full text, 2002. http://hdl.handle.net/2123/854.
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Thesis (Ph. D.)--University of Sydney, 2002.Includes tables and questionnaires. Title from title screen (viewed Apr. 28, 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Public Health and Community Medicine, Faculty of Medicine. Includes bibliography. Also available in print form.
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Szende, Agota. "Equity in health and health care in Hungary : health status, finance, and delivery of health care." Thesis, University of York, 2003. http://etheses.whiterose.ac.uk/14056/.
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Marshall, Emily Gard. "Universal health care? : access to primary care and missed health care of young adult Canadians." Thesis, University of British Columbia, 2007. http://hdl.handle.net/2429/30948.
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Prevalence of missed health care by life course stage is examined with a critique of the
measure of missed care. Canadians reporting missed care has increased from 4.2% in
1995 to 12.5% in 2001. Research questions: 1. Who reports missed care in Canada? 2.
What are the relationships among life course stages, social support, predisposing,
enabling and need factors to the reporting of missed care? 3. What is the role that life
course stages play in the relationships among social support, predisposing, enabling, and
need factors? 4. What kinds of health care are Canadians reporting they missed? 5. What
reasons are provide for missing care?; and 6. Who accesses primary care and what is the
relationship to reporting missed care? Methods: Analysis was done using the Canadian
Community Health Survey Cycle 2.1. Nested multiple logistic regression models explore
the relationships among variables of interest predicting missed care. Results: Young
adults (18-30) are more likely to report missed care compared to other age groups and
are least likely to have a regular doctor. Social support is most significantly protective
against missed care for young adults. Weak sense of belonging to a local community
and lower income are stronger predictors of missed care for young adults. Young adults
differ from others in the reasons they report for missed care (i.e., more likely to report
cost as a barrier). Discussion: It's not clear if the difference between young adults and
other life course stages is in actual missed care or expectations of primary care. Yet, the
literature on emerging adulthood invites curiosity about how delayed adulthood leaves
them in less stable, financially insecure, socially and institutionally isolated situations
that have subsequent consequences for primary care access. Changes in models of
primary care have led to a decline in comprehensive care and more drop-in clinics; while,
not having a regular doctor is associated with missed care. If patterns of inadequate
primary care access established in young adulthood are perpetuated in later life, this may
foretell undesirable consequences for the health of Canadians. A new model for
measuring unmet health care needs is proposed.Graduate and Postdoctoral Studies
Graduate
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Schultz, Sarah Robinson. "Health coverage without health care unmet mental health care needs among the publicly insured /." Connect to Electronic Thesis (CONTENTdm), 2009. http://worldcat.org/oclc/457147003/viewonline.
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Mboto, Clement Ibi. "Studies on Human Immunodeficiency Virus and hepatitus C virus coinfection in the Gambia." Thesis, Kingston University, 2005. http://eprints.kingston.ac.uk/20370/.
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Co-infection with Hepatitis C Virus (HCV) is a common occurrence in Human Immunodeficiency Virus (HIV)-positive patients and an increasing cause of morbidity and mortality. Little is known however of the burden or the natural history of these infections or their interactions in most parts of sub-Saharan Africa, where both viruses are endemic. In this study a total of 1500 people aged 11 months to 76 years referred to the serology unit of Royal Victoria Teaching Hospital between the months of July to December 2003 were evaluated for anti-HIV, anti-HCV and CD4+ T-cell count and compared with the subjects' socio-demographic and risk factors. HIV and HIV/ HCV seropositive persons who consented to a follow-up study were age and sex matched with HIV and HCV seronegative control subjects and followed for 18 months with biannual monitoring of trends in CD4 count against a possible HIV or HCV seroconversion of the seronegative control subjects. The overall prevalence of antibodies to HIV and HCV was 6.7% (101/1500) (Cl, 5.6-8.2) and 2.1% (31/1500) (95 % CI, 1.4-2.9) respectively. HIV rates in asymptomatic adults were 3.6 %( 43/1189) (OR: 0.16; Cl: 0.13-0.28) and 1.0 %( 12/1189 (OR: 0.16; Cl: 0.08-0.34) for HCV. HIV/HCV co-infections rate was 0.6% among all the subjects sampled and 8.6% in HIV positive persons. The HIV rate in this study is twice the UNAIDS/WHO estimate for the country and twice the numbers of women than men were infected with HIV at a comparatively younger age, while males 55 years and over had higher HIV rates than those below 35. HCV and HIV/HCV coinfection was more commonly associated with males than females. This study showed that Hepatitis C serotype 2 is the most prevalent type in the country and was predominantly associated with HIV-1, and suggests that HCV serotype 2 spread earlier than serotypes 1 and 3. The mean CD4 count of apparently healthy males and females was 489/μl and 496/μl respectively, while the mean CD4 count at diagnosis (CD4dx) of HIV, and HIV/HCV persons was 310 cells/μl and 306 cells/μl respectively. Only about half of the apparently healthy population had CD4 counts of 500 cells and over (51 %), while 1.1 % (15/1377) had counts below 200 cells per microlitre for no explained reasons. HN/HCV co-infected person recorded a lower CD4 count at diagnosis than HIV alone infected persons and also a more significant decline in CD4+ than HIV infected alone persons. The study shows that high HIV rates were independent of the educational status of the individual, while history of sexually transmitted diseases, high income earning and involvements in polygamous marriages were all significant risk factors for HIV, HCV and HIV/HCV co-infection. Female circumcision, knowledge and use of condoms, blood oath, histories of blood transfusion and wife inheritance were not associated with HIV or HCV transmission. The study found an HIV incidence rate of 1.4% (4/288) during the 18 months follow-up period and identified Sexually Transmitted Diseases (STDs) as the associated risk factor. There is need for a new CD4+ staging in the country based on the population within the country and the initiation of a large scale longitudinal study to elucidate the risk factors associated with HCV in the country. The study has provided baseline data on CD4 and its trends in co-infected persons and also a baseline on the distribution and epidemiological pattern and associated risk factors of co-infection between HIV and HCV in the country. It has also determined the incidence of HIV and its associated risk factors in the country. The study has therefore contributed to our understanding of the natural history of these infections and provided an important frame work for possible intervention.
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Al-Yaemni, Asmaa Abdullah. "Does universal health care system in Saudi Arabia achieve equity in health and health care?" Thesis, University of Liverpool, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.526777.
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Damore, Deborah Rose. "H.H.S.C. Spiritual Health Care Centre, integrated spiritual health care graduate academic programme." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0015/MQ55440.pdf.
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Claassens, Mareli Misha. "Responsibility in health care." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/4280.
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Chou, Caroline. "Selfies for Health Care." Scholarship @ Claremont, 2019. https://scholarship.claremont.edu/cmc_theses/2277.
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Presently, self-tracking applications are used to help patients with chronic illness management. For example, applications ask users to track mood through online diaries or snap photos of their food content in order to analyze patterns correlated to their chronic disease. Although these health care applications are on the market today, there still exists a fundamental challenge in motivating participants to consistently update and enter information. Therefore, the focus of this thesis is on reducing the fatigue from using these applications. Pulling from user social media data will almost completely eliminate the capture burden placed on participants, since users will only have to continue to use social media as they regularly do.
Instead of analyzing manually inputted data, patterns can be found between social media data and chronic diseases. A Microsoft Research team found indicators in public user Twitter data associated with the onset of a depressive episode. They were able to create a predictor tool, predicting the onset of a depressive episode, with 70 percent accuracy. Using this research alongside expert feedback, our aim is to design an interface used by both clinician and patient that will provide them with a timeline marking spikes in Twitter indicators correlated to a patient’s depressive episode.
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Ling, Meng-Chun. "Senior health care system." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2785.
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Senior Health Care System (SHCS) is created for users to enter participants' conditions and store information in a central database. When users are ready for quarterly assessments the system generates a simple summary that can be reviewed, modified, and saved as part of the summary assessments, which are required by Federal and California law.
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Polaha, Jodi. "Primary Care Behavioral Health." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6676.
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Snyder, Hannah. "Health Care Customer Creativity." Doctoral thesis, Linköpings universitet, Logistik- och kvalitetsutveckling, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-125723.
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Crafting and stimulating service innovation is considered a main research priority and remains a challenge for service providers. One suggested component of stimulating service innovation is customer creativity. Customers who adapt, modify and transform services or products to better suit themselves are increasingly being recognized as a source of competitive value and innovation. It has been proposed that understanding and supporting the customer’s value creating practices is the key to creating and sustaining value over time in health care. Health services directly address a customer’s well-being and have a significant impact on his or her quality of life. In these types of services, the service outcome is highly dependent on the activities of the individual customer. Health care services often require customers to participate extensively, over long periods of time, with limited support and control. Health services also stretch far beyond the particular service setting into the customer’s daily life. While research, policy, and legislation have all emphasized the active role of health care customers, such customers have traditionally had few opportunities to design their health care services. Nevertheless, health care customers solve health-related problems and engage in self-care and medical decision-making on a day-to-day basis, although this creativity is often unknown to the service provider. To understand how health care customers can enable service innovation, this thesis seeks to conceptualize and investigate the concept of customer creativity in health care. The thesis focuses on customer creativity, not only as an outcome, but also as a dynamic and contextualized process that can be enhanced. The thesis combines insights from health care research with service and innovation research to provide build a framework for health care customer creativity. Building on five papers, the research develops an understanding for health care customer creativity. The individual papers are based on systematic literature reviews as well as empirical data in the form of customers’ ideas for service innovation collected through diaries. The results of the thesis suggest that despite the negative nature of the service, health care customers are creative. Given the opportunity, health care customers can provide creative ideas and solutions on a multitude of aspects, both within and outside the health care setting. This provides the potential to view the health care experience through the customers’ eyes and take part in their creativity in spheres where the service providers have not traditionally had any access. This thesis contributes to the literature by providing a framework for health care customer creativity that recognizes the concept as a complex interplay of factors operating at the individual, contextual, and situational levels. The proposed framework specifies the health care specific factors upon which customer creativity depends, with the intention of positing potential research directions and developing an enriched theory of health care customer creativity.
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Ahmed, Rukhsana. "Assessing the role of cultural differences on health care receivers' perceptions of health care providers' cultural competence in health care interactions." Ohio : Ohio University, 2007. http://www.ohiolink.edu/etd/view.cgi?ohiou1178244318.
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Bumgarner, D., K. Owens, J. Correll, W. T. Dalton, and Jodi Polaha. "Primary Behavioral Health Care in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/6597.
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Florini, Marita A. "Primary care providers' perception of care coordination needs and strategies in adult primary care practice." Thesis, State University of New York at Binghamton, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3630859.
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Problem: Medical and nursing literature poorly identify primary care providers' (PCP) relationship to care coordination (CC). Primary care providers' education, experience, and perspective, contribute to: (a) assessments of patient's care coordination needs, and (b) variability in behavior to address needs. Dissimilar approaches to CC by PCPs affect work relationships and office flow.
Purpose: To pre-pilot a new tool describing PCPs' knowledge, perception, and behavior regarding CC. Methods: Primary care physicians, nurse practitioners, and physician assistants were surveyed.
Analysis: Frequencies and percentages provided sample characteristics. Descriptive statistics analyzed provider responses within and between groups. Narratives were analyzed for themes. Tool refinement is suggested however, the tool does describe PCPs and CC activities.
Significance: A tool was developed to evaluate areas of CC activity performed by PCPs. Information from surveys of PCPs can illuminate behaviors that lead to improved work flow, efficiency, and patient outcomes. Doctors of Nursing Practice who are PCPs contribute to primary care CC through leadership, experience, and descriptive evidence.
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Babaie, M. H. "Inequities in health and health care between provinces of Iran : promoting equitable health care resource allocation." Thesis, University of Salford, 2014. http://usir.salford.ac.uk/30807/.
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Investigation of the influence of public expenditure on health lends support to the opinion that equitable distribution of financial resources would help to reduce inequities in health. This thesis set out to establish inequities in access to health care and health outcomes across the provinces of Iran and explore equitable resource allocation models to contribute to the reduction of health inequities. Inequities were measured based on the relationship between a range of health indicators and socioeconomic status in the provinces. Information on mortality, morbidity, and socioeconomic factors were taken respectively from the Death Registration System, Health Profile in Iran (2003), and Iran's 2006 census. There were significant relationships between mortality and socioeconomic indicators across the provinces, with the larger rates of mortality in the worst-off provinces. Coronary risk factors (diabetes, high serum cholesterol) were significantly associated with socioeconomic factors; with higher prevalence of the risk factors in the well-off provinces. There were also significant relationships between access to health services (hospital delivery and vaccination) and socioeconomic status; with lower access in the worst-off provinces. The resource allocation models based on population size and age/sex structure changed the health expenditure in favour of the well-off provinces to contribute to the reduction of inequities in morbidities. However, models based on mortality and deprivation changed the expenditure towards the worst-off provinces, in order to bridge the inequities in mortality and access to health services. Equity targets set, based on a combination of age/sex, mortality, and deprivation, indicated that nineteen provinces had received a share of expenditure higher than the equity target, with the largest in Mazanderan and seven provinces received a share lower than the target, with the largest in Tehran. A five-year plan was developed to move the expenditure from the hyper-financed provinces to the under- financed ones.
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Farrell, Kathy, and University of Lethbridge Faculty of Education. "Health care professionals' perceptions of health promotion." Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Education, 1996, 1996. http://hdl.handle.net/10133/34.
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The concept of health promotion is an alternative and emerging orientation. Here the belief is that all people have strengths and are capable of determining their own needs, finding their own answers, and solving their own problems. Most health care professional have been educated in the medical model of health. In this model,
the health care professional, especially the physician, plays an active part as an expert on disease; the patient or client has essentially a passive role, and the disease rather than the person is the focus. The role of health care professionals in health promotion is an important one and will continue to expand with the new focus of the province of Alberta's health system. The focus of that system, and other health systems in Canada and abroad, is increasingly upon health promotion rather than disease treatment. The purpose of this study was to determine the perceptions of a variety of health care professionals working in the community and in the hospital setting relating to health promotion. The study takes a non-experimental approach utilizing a descriptive design. All professional staff including registered nurses, occupational therapists, recreational therapists, physiotherapists, respiratory therapists, social workers, dental workers, nutritionists, speech-language pathologists, and physicians working in Palliser Health Authority were asked to participate in the survey. Two hundred and thirteen staff responded to a questionnaire desgined to reflect their perceptions on the importance of health promotion, determinants of health, principles of health promotion, and skills and knowledge of health promotion. Staff were also asked to identify health promotion activities occuring at their work site, possible barriers to health promotion, and what was needed regarding training and support. Some of the major findings include: 1) Staff perceive health promotion to be an important part of their job. However staff working in the community perceive health promotion to be more important than those working in the hospital. Physicians were the least positive about questions pertaining to the importance of health promotion. 2) Staff perceive that the purpose of health promotion is to strengthen peoples' control over their health, but responses also indicate uncertainty concerning how control is to be defined and effected. 3) When asked to identify health promotion activities at their work site, the majority of staff pointed to the provision of information to individuals and groups. Community development was listed by very few staff. 4) When staff were asked to identify barriers to health promotion they identified the following in the order: lack of resources, old attitudes about health and health promotion, lack of support from the organization and doctors, lack of knowledge/education, and lack of communication between health care workers.v, 101 leaves : ill. ; 28 cm.
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Liebe-Harkort, Carola. "Oral Health Care and Humanitarian Health Praxis." Thesis, Röda Korsets Högskola, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-2276.
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Background: Oral and dental diseases is a major part of the global disease burden. Poor oral health has a significant impact on the general well-being of people. In contrast with prior decades high rates of oral diseases may be found in low- and middle income countries. Populations that are particularly vulnerable are more likely to develop poor oral health. As a consequence of human distress related to war, poverty and natural disasters the accomplishments of humanitarian aid organizations has a direct impact on people´s health and well-being. Purpose: The aim of the present study is to examine the International Red Cross and Red Crescent Movement as well as Doctors without borders concerning documents and guidelines on oral health. A further aim is to explore the knowledge of oral health related topics of delegates from the International Federation of the Red Cross and Red Crescent Societies (IFRC). Method: The study is designed as a literature review and a questionnaire survey. Results: Within the International Red Cross and Red Crescent Movement and Doctors Without Borders there are a limited number of guidelines on oral health and they are rarely mentioned in the same documents as non-communicable diseases (NCDs). The responses of the study revealed that the participants generally have a limited knowledge about measures on oral health in the IFRC. Conclusion: Both the literature review and the questionnaire survey study confirms that there is an absence of clear and specific guidelines on oral health care related activities within IFRC.Bakgrund: Mun- och tandsjukdomar utgör en stor del av den globala sjukdomsbördan. Dålig mun- och tandhälsa har en stark påverkan på det allmänna välbefinnandet. I motsats till tidigare, ses idag höga frekvenser av karies även i låg- och medelinkomstländer. Populationer vilka befinner sig i extra utsatta kontexter löper större risk att utveckla dålig munhälsa. Som en följd av mänskligt lidande i form av händelser relaterade till krig, fattigdom och naturkatastrofer har aktiviteter utförda av humanitära hjälporganisationer en direkt inverkan på hälsa och välbefinnande. Syfte: Syftet med föreliggande studie är att studera dokument och riktlinjer rörande munhälsa inom Internationella Röda korset och Röda halvmånen och Läkare utan gränser. Ett ytterligare syfte är att undersöka kunskapen om hälsorelaterade frågor kring munhälsa hos delegater från Internationella federationen för Röda Korset och Röda Halvmånen (IFRC). Metod: Studien är utförd som en litteratur-sammanställning och som en enkätundersökning. Resultat: Inom Internationella Röda korset och Röda halvmånen samt Läkare utan gränser återfinns begränsat antal riktlinjer rörande oral hälsa vilka dock sällan nämns i samma dokument som icke-smittsamma sjukdomar (NCDs). Av enkätsvaren i studien framgår det att de medverkande generellt har en begränsad kunskap kring åtgärder rörande munhälsa inom IFRC. Konklusion: Deltagarna i denna studie bekräftar resultaten i litteraturstudien om en avsaknad av tydliga och konkreta riktlinjer för munhygienrelaterade aktiviteter inom IFRC.
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Hill, Philip Campbell. "Evaluation of a T-cell assay for mycobacterium tuberculosis infection in the Gambia." Thesis, University of Auckland, 2005. http://hdl.handle.net/2292/5539.
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New generation T cell assays offer hope in the diagnosis of Mycobacterium tuberculosis infection and disease. We assessed the ELISPOT assay using cross-sectional and longitudinal studies and a natural gradient of M. tuberculosis exposure by sleeping proximity to a tuberculosis (TB) case in The Gambia. Two antigens, ESAT-6 and CFP-10 (EC), were compared to purified protein derivative (PPD) by ELISPOT and to the PPD skin test in 735 TB contacts. All three tests responded to the exposure gradient, the PPD skin test most dramatically. Inter-test comparison showed that the EC ELISPOT provided improved specificity in the diagnosis of M. tuberculosis infection, but at the cost of some sensitivity. Increasing discordance, particularly between PPD ELISPOT and PPD skin test results, down the exposure gradient to 105 community controls was identified. In 693 children, the EC ELISPOT was slightly less sensitive than the PPD skin test in the diagnosis of M. tuberculosis infection from recent exposure; neither test was confounded by prior BCG vaccination, even in the very young. A fusion protein of EC compared favourably with their respective peptides by ELISPOT assay in 488 TB contacts, a combined test result offered improved sensitivity. Quantitative ELISPOT and PPD-skin test responses were assessed in 1052 TB case contacts, according to an ELISPOT response to EC. Only the ELISPOT count was sensitive to the exposure gradient (p=0.009), revealing a positive dose-response relationship. In the longitudinal assessment, both ELISPOT and PPD skin test conversion occurred over time. PPD skin test reversion occurred in 10% of individuals after 18 months, ELISPOT reversion occurred in 39% at 3 months. In conclusion: the EC ELISPOT offers increased specificity in the diagnosis of M. tuberculosis infection in The Gambia, at the cost of some sensitivity; the PPD skin test appears to be down-regulated in the community; neither test is confounded by prior BCG vaccination; a fusion protein in combination with EC peptides offers optimal ELISPOT sensitivity; the quantitative ELISPOT response in specific-antigen-positive TB case contacts reflects the infectious load of M. tuberculosis; and significant early reversion of the ELISPOT test suggests it is unreliable in M. tuberculosis dormancy.
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Cremer, Mary Ellen. "Voluntary giving for rural health care: the Sweet Grass County Health Care Foundation." Thesis, Montana State University, 1991. http://etd.lib.montana.edu/etd/1991/cremer/CremerM1991.pdf.
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The purpose of this thesis is to identify factors influencing community support for rural hospitals. Hospitals in rural areas are liable to experience unfavorable financial situations in the near future. Data from a specific fund drive were utilized to develop a model of voluntary giving that may be helpful in predicting the success or failure of other similar drives for the purpose of providing support to these hospitals. Results indicate that voluntary giving is consistent with economic utility maximization theory.
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Benzarti, Emna. "Home Health Care Operations Management : Applying the districting approach to Home Health Care." Phd thesis, Ecole Centrale Paris, 2012. http://tel.archives-ouvertes.fr/tel-00718914.
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Within the framework of economic constraints and demographic changes which the health care sector is confronted to, the Home Health Care (HHC) which has been created sixty years ago, has known an important growth during this last decade. The main objective of this alternative to the traditional hospitalization consists in solving the problem of hospitals' capacity saturation by allowing earlier discharge of patients from hospital or by avoiding their admission while improving or maintaining the medical, psychological and social welfare of these patients. In this thesis, we are interested in the operations management within the HHC structures. In the first part of this thesis, we develop a qualitative analysis of the operations management in the HHC context. More specifically, we identify the complexity factors that operations management has to face up within this type of structures. For each complexity factor, we discuss how it can affect the organization of the care delivery. These factors pertain to the diversity of the services proposed, the location of care delivery, the uncertainty sources, etc. Thereafter, we survey operations management based models proposed in the literature within the HHC context. Based on this literature review, we identify several emerging issues, relevant from an organizational point of view, that have not been studied in the literature and thus represent unexplored opportunities for operations management researchers. In the second part of this thesis, we are interested in the partitioning of the area where the HCC structure operates into districts. This districting approach fits the policies of improvement of the quality of care delivered to patients and the working conditions of care givers as well as costs' reduction. We begin by proposing a classification of the different criteria that may be considered in the districting problem. We then propose two mathematical formulations for the HHC districting problem for which we consider criteria such as the workload balance, compactness, compatibility and indivisibility of basic units. After that, we present a numerical analysis of the computational experiments carried out on randomly generated instances to validate these two models. We also present two possible exploitations of these models and propose two extensions to these basic formulations. After formulating the problem with a static approach, we also develop a dynamic extension which allows the integration of the different variations that can be observed within the activities of an HHC structure from period to period. We then introduce a new partitioning criterion that concerns the continuity of care evaluated on the basis of two sub-criteria. Depending on the preferences of the decision-makers concerning the sub-criteria related to the continuity of care in the districting problem, we then distinguish three scenarios for which we propose the associated mathematical formulations.
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Marine, Marjorie Butler. "Marketing health care services for a preventive health care agency : a categorical study." Virtual Press, 1987. http://liblink.bsu.edu/uhtbin/catkey/530368.
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The purpose of the study was to determine the needs of one marketing segment of clients seen in a contraceptive clinic in the Midwest. The marketing segment targeted for study was women with positive Pap smears. A comparison group of women with negative Pap smears was sampled from the same clinic during the time frame July 1, 1982, to July 1, 1984.Nine research questions were investigated. Responses have been reported relative to the following questions:1. Does the incidence of positive Pap smears depend on the presence of cervical infection a woman may have?2. Does the incidence of positive Pap smears depend on whether or not a woman smokes?3. Does the incidence of positive Pap smears depend on the type of contraceptive (pill or barrier) used by a woman?4. Does the incidence of positive Pap smears depend number of abortions experienced by a woman?5. Does the incidence of positive Pap smears depend on the number of pregnancies experienced by a woman?6. Does the incidence of positive Pap smears depend on whether the woman is white or black?7. Does the incidence of positive Pap age of the woman?8. Does the incidence of positive Pap smears depend on the smears depend on whether the woman is married or not?9. Does the incidence of positive Pap smears depend on the educational status of the woman?Five conclusions were drawn from findings of the study and were confined to the population for the study, clients of the selected clinic:1. Women with positive Pap smears are more likely to have infections than women with negative Pap smears.2. Women who have had abortions are more likely to have positive Pap smears.3. The incidence of positive Pap smears is associated with pregnancies; that is women with one or more pregnancies are more likely to have positive Pap smears.4. A higher proportion of black women have positive Pap smears than white women.5. Women with less education have more positive Pap smears than women with higher levels of education.Department of Educational Administration and Supervision
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Keum, Clara Binnara. "Analysis of road traffic crashes and injury severity of pedestrian victims in the Gambia." Thesis, University of Iowa, 2016. https://ir.uiowa.edu/etd/2097.
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The Gambia is the smallest country in mainland Africa. Along with the rapid urbanization rate, motorization has increased rapidly as well, contributing to an increased number of road traffic crashes. Road traffic crashes are the 4th leading cause of in-patient deaths in adults in the Gambia and currently are a significant public health problem. This study utilized the Gambia Traffic Force’s data registry to become the first epidemiological study on road traffic injuries in the Gambia as well as the first to analyze the Gambia’s traffic data registry on a national level. Reported crashes from October 1st, 2014 to June 30, 2015 were converted from the paper-based data registry into an electronic database and analyzed statistically, and the location data were geocoded and plotted on the Gambian map. The results of this study showed that crashes involving pedestrian victims and crashes that occurred on unpaved roads were more likely to be associated with outcomes that were fatal or serious. When multiple vehicles were involved in a crash, the involvement of motorcycles and bicycles were more likely to lead to a fatal or serious injury. The mapped data showed that towards the center of each district, the number of crashes increased as pedestrian and vehicle density increased, but that injury severity outcomes were generally minor or none. In contrast, as pedestrian and vehicle density decreased, crash frequency decreased as well, but injury outcomes were more likely to be severe or fatal. The findings of the study also helped in identifying areas in policy and education that need improvement.
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Engelmark, Andersson Anna. "Nurses experience of working with health promotion among adults at the community health centers in The Gambia- a qualitative interview study." Thesis, Mittuniversitetet, Avdelningen för omvårdnad, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-31128.
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Lundqvist, Pontus, and Anton Mathson. "Oral Health Care in Home Care Service – Personnels’ Perspective." Thesis, Umeå universitet, Tandläkarutbildning, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-97909.
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Elderly nowadays stay longer in their own home. This raises the standards on home care service to contribute to the maintenance of elderly’s general and oral health. Our objective is therefore to explore attitudes about how home care workers view oral health care and the importance of good oral health for elderly clients. 8 subjects (22 to 61 years of age) were selected for the study working in home care service, which all gave their informed consent. Semi-structured interviews were performed, recorded and transcribed verbatim before evaluation, using qualitative content analysis. From the interviews, a result of total 19 categories and 41 subcategories were assigned which were the bases for the 10 evolved themes. The four themes best representing the study’s purpose are more thoroughly described. At a low level of abstraction attitudes such as reminding the clients to brush their teeth and importance of practical help with oral hygiene are expressed as important. Difficulties occur in forms of lack of accessibility to the oral cavity and the client’s unwillingness to co-operate. The participants also require better contact with dental services. On the emotional level, feelings such as alienation, powerlessness and fear of breaking the client’s integrity occur along with feelings of distantness and lack of interest. This leading to a conclusion of a low level of awareness together with lack of knowledge about oral care and oral health is seen among personnel in home care service, while the personnel themselves are requesting more knowledge and better contact with dental health care services.
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Baker, Timothy Alan. "Oregon Primary Care Physicians' Support for Health Care Reform." PDXScholar, 1994. https://pdxscholar.library.pdx.edu/open_access_etds/4755.
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This dissertation studies Oregon primary care physicians' attitudes toward health care reform. Two models of reform are examined: one, health care rationing such as that proposed by the Oregon Health Plan (OHP); and, two, support for national health insurance (NHI).
This work examines the necessity for changing the present health care system, traced from the early origins of the medical profession to the present day health care "crisis." The high cost of health care is examined and an overview of the OHP is provided, including citations from John Kitzhaber, M.D., author of the plan.
Overall, Oregon primary care physicians overwhelmingly supported health care rationing policies. Just under 75 percent of the physicians expressed support for health care rationing policies such as that proposed by the Oregon Health Plan. However, just under 48 percent of the same physicians expressed support for national health insurance (NHI). Internal medicine physicians were most supportive of health care rationing policies and OB/GYN physicians were least supportive. Conversely, pediatricians were most supportive of NHI and OB/GYN physicians were least supportive.
Regression analyses explained 11.5 percent of variation in support for health care rationing policies and 20.9 percent of their support for national health insurance (NHI).
While strong support measures were found for health reform such as that proposed by the Oregon Health Plan (OHP), no similar measures of support for NHI emerged. Almost universal support for health care reform such as the OHP was found among primary care physicians across the state, however similar patterns were not found for NHI. It appears from the research's findings that attempts to change the health care system that include the physician's ability to ration care would be more successful than a more systematic change such as would occur under a national health insurance program.
This dissertation points out that physicians represent strong supporting forces and/or opposing forces for health care reform. Their attitudes toward such reform must be considered if successful change is to occur in the U.S. health care system.