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Dissertations / Theses on the topic 'Hygiene Services'
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Manase, Gift. "Cost recovery for sanitation services : the case of poor urban areas in Zimbabwe." Thesis, University of Southampton, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274072.
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Greene, Joseph Harrison. "Development of a social service program for college health services." CSUSB ScholarWorks, 2001. https://scholarworks.lib.csusb.edu/etd-project/1869.
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The initial development of a social services program in a college health setting is presented, with discussion regarding causes, methods, and outcomes. Both empirical and anecdotal data which were influential in the initial formation of the program are reviewed, in the context of an examination of the research literature relating to this area. The actual development and implementation of the program is followed through its first year of existence. Outcomes are presented in the form of qualitative data analysis and case studies. Discussion of the results and recommendations for both future research and improvements to the program are presented.
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Paulik, Jacklyn Christine. "ENVIRONMENTAL ASSESSMENT GROUP INTERNSHIP: ASBESTOS HAZARD EVALUATION SPECIALIST -- INDUSTRIAL HYGIENE AND SAFETY SERVICES." Miami University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=miami1377076619.
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GAYOUX, MAUGIN CORINE. "Les dechets hospitaliers : reglementation, elimination et risques : etude sur six services pilotes du c.h.u. d'angers." Angers, 1993. http://www.theses.fr/1993ANGE1050.
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Johnson, Bridget A. "Teacher support teams: a school-based strategy for the provision of education support services and health promotion." Thesis, University of the Western Cape, 1997. http://etd.uwc.ac.za/index.php?module=etd&.
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Siu, Wing-ho Joseph, and 蕭永豪. "The privatization of food and environmental hygiene services in Hong Kong: an evaluation and future prospects." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B31966640.
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Siu, Wing-ho Joseph. "The privatization of food and environmental hygiene services in Hong Kong : an evaluation and future prospects /." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk:8888/cgi-bin/hkuto%5Ftoc%5Fpdf?B23294930.
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Ricks, Esmeralda Jennifer. "A holistic healthcare model for higher education campus health services." Thesis, Nelson Mandela Metropolitan University, 2008. http://hdl.handle.net/10948/666.
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Most students are adolescents and young adults, a group characterized by a new-found sense of independence, experimentation with sex and sometimes drugs and a feeling of invincibility (Gayle, Richard, Keeling, Garcia-Tunon, Kilbourne, Narkunas, Ingram, rogers and Curran, 1990:1538). These behavioural, developmental and environmental issues may contribute to premature morbidity, mortality and reduced quality of life for university students (Patrick et al., 1992:260). The ages of staff on the other hand range from young adults to retirement age. The types of health problems that exist among staff who use the campus health service include First Aid treatment on site for injuries on duty and more chronic health problems such as, for example, hypertension and diabetes mellitus. To date there is very little evidence as to whether or not the healthcare needs of students and staff are being met comprehensively or whether the practitioners rendering the service are knowledgeable and complying with the PHC norms and standards developed by the department of Health’s Quality Assurance Directorate. The lack of such empirical data can contribute to misconceptions and hamper the management of public health problems experienced in SA, for example sexually transmitted infections and the transmission of HIV. Thus the purpose of this research was to develop a model that would assist registered nurses employed at a higher education campus health service in the Western Region of the Eastern Cape Province to render a healthcare service relevant to the healthcare needs of the students and staff on campus.
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Takahashi, Masami Branson Bonnie. "A study to determine the outcome of sealants placed by dental hygiene students in a school-based sealant program." Diss., UMK access, 2008.
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Thesis (M.S.)--School of Dentistry. University of Missouri--Kansas City, 2008."A thesis in dental hygiene education." Advisor: Bonnie Branson. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed Aug. 07, 2008. Includes bibliographical references (leaves 53-58). Online version of the print edition.
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Agenbag, Michael Hermanus Albertus. "The management and control of milk hygiene in the informal sector by environmental health services in South Africa." Thesis, Bloemfontein : Central University of Technology, Free State, 2008. http://hdl.handle.net/11462/109.
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Thesis (M. Tech.) -- Central University of Technology, Free State, 2008Local government (LG) is under increasing pressure from the milk industry and consumers regarding their ability and willingness to carry out their mandate with regard to the quality control of milk, especially in the informal sector. The government and the milk industry currently have programmes underway to stimulate economic activities in the informal sector, targeting emerging cattle farmers for the production of milk as part of government’s Accelerated Shared Growth Initiative of South Africa (ASGISA). These initiatives further increase the number of informal milk producers and distributors, which holds a further challenge to regulatory authorities. At the same time, the quality of milk from the informal milk-producing sector poses a serious public health concern. Most of the milk produced and sold by the informal sector is raw (unpasteurised), which does not meet the minimum statutory requirements, and the milking practices applied by the informal sector also do not comply with best practice compliance standards. Local authorities (LAs) are statutorily responsible for registering milking parlours and controlling milk hygiene quality from production stage to purchase stage in order to ensure safe and wholesome dairy products to the consumer. Therefore, LG should play an increasingly important role in ensuring that safe and wholesome milk is produced and distributed to the consumers. All metropolitan municipalities (metros) and district municipalities (DMs) should be authorised by the Ministry of Health to enforce the Foodstuffs, Cosmetics and Disinfectants Act, 1972 (Act 54 of 1972) through their authorised officials – mainly environmental health practitioners (EHPs). Secondly, LG should have specific programmes, systems and resources to register, monitor, evaluate and control milk production and distribution outlets for continued compliance
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Campbell, Desiree. "An evaluation of patient engagement with diabetes out-patient services in an ethically diverse urban area in the UK." Thesis, City, University of London, 2018. http://openaccess.city.ac.uk/21477/.
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Diabetes has been described as an epidemic with a significant global burden of illness. This burden is associated with poorer engagement with services and the cost of managing avoidable complications. One outcome measure of engagement in the national health service (NHS) in the United Kingdom (UK) is attendance at appointments. The cost implications (direct and indirect) of non-attendance are significant, with empirical evidence consistently demonstrating higher than average non-attendance rates for out-patient appointments and education sessions by minority ethnic and socio-economically deprived individuals. A gap was identified whereby a comprehensive understanding of non-attendance which moves beyond clinical and technical aspects such as capacity and demand is still required. This thesis provides a fresh approach and granular understanding of patient engagement which can influence clinical care, service delivery and policy. The main research questions in this thesis were: 1. What are the predictors of out-patient attendance? 2. What are the barriers and enablers to attendance? To answer these questions, a retrospective geo-demographic trend analysis, critical narrative literature review of Community Health Worker (CHW) and peer support interventions and a research study were conducted. The case study is based on a dataset which comprised of 35,597 appointments. Its findings highlighted that factors such as age, gender, ethnicity, local geography and deprivation were significant predictors of out-patient attendance. A critical review of CHW and peer support interventions demonstrated that despite the heterogeneity of programme designs, duration of interventions, follow up and healthcare systems in which they were used, they were assessed to be both clinically and cost effective. There was limited evidence on the sustainability of these interventions due to a lack of longitudinal studies. The research element was conducted in two stages and utilised multi methods (focus groups, semi-structured interviews and questionnaires) to evaluate the barriers and facilitators to attendance. Key findings included the need for effective and on-going education, better alignment of health and social care due to the impact of the wider determinants of health but more interestingly, the influence of family on the concept of ownership for one's health by some individuals whose self-determination is limited by language and health literacy. The relationship between patient activation (knowledge, skills and confidence) and attendance was also evaluated. This evaluation demonstrated that the more activated individuals are, they are significantly more likely to attend appointments. However, to maximise care planning and operational effectiveness, activation should not be assessed in isolation. The findings of this thesis highlighted the influence of individual, organisational and structural factors on patients' engagement with out-patient services and the need for a synergistic approach involving service users, clinicians, organisations and policy makers to minimise patient dis-engagement with healthcare services.
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Richardson, Theresa Marianne Rupke. "The century of the child : the mental hygiene movement and social policy in the United States and Canada." Thesis, University of British Columbia, 1987. http://hdl.handle.net/2429/27518.
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The purpose of this study is to examine the dynamics between professional knowledge and the power to construct social realities. The focus is on the institutions which contributed to mental hygiene as a protocol for public policies directed toward children. The social history of the child in the twentieth century is juxtaposed with shifts in the configurations of private and public institutions in a sociology of mental illness.
The mental hygiene movement created one of the twentieth century's major paradigms. Mental hygiene was conceptualized as the development of a science of promoting mental health and preventing mental illness. The' working premise of the movement was that early life experiences determined adult competence and constituted the root cause of major social problems from crime and dependency to labour unrest and war. The National Committee for Mental Hygiene was established in the United States in 1909 and a second National Committee was established in Canada in 1918. Mental hygienists developed an ideology of child oriented prevention in public health, welfare and educational policies which legitimated public intervention into the private spheres of family relations and child rearing.
The idea of mental hygiene was based on a medical model and as such it was part of the new psychiatry and public health movements of the Progressive Era. As a paradigm mental hygiene fostered the identification of children according to scientific standards. Mental hygiene contributed to the transformation of juvenile delinquency into a psychiatry of maladjustment in childhood. As a positivistic approach to public health, mental hygiene research elaborated criteria to determine age related stages of normal psychological and biological progress.
Mental hygiene was a product of professional researchers and policy makers. The knowledge base of mental hygiene grew with the expansion of higher education in the United States especially in regard to scientific medicine. The medical model was subsequently applied to research in the behavioural and social sciences. Scientific philanthropy provided funds for research, professional education, and the distribution of knowledge. The accumulation of monetary resources by nineteenth century entrepreneurial capitalists, who applied these funds to further the growth of scientific models, were a sustaining factor in twentieth century mental hygiene.
The agents of power described as part of the mental hygiene movement include: 1) the National Committees for Mental Hygiene in the United States and Canada; and, 2) general purpose foundations in Rockefeller related philanthropy and the Commonwealth Fund. By mid-century, the federal, state/provincial and local governments of the United States and Canada had assumed major aspects of the former role of the National Committees and philanthropy in mental health advocacy.
The theoretical foundation of mental hygiene evolved in conjunction with the development of the scientific method as applied to preventive medicine, especially in fields related to psychiatry. Mental hygiene was a primary carrier of the medical model into applied disciplines in the social and health sciences. The professionalization of education, social welfare and psychology, as imbued with mental hygiene, translated technological change into revised concepts of public and private spheres in relationship to family and child life.
The medicalization of human differences limited the potential for radical revisions in social organization. It justified unequal access to political and economic power on the basis of psychological and biological characteristics. The mental hygiene paradigm served to maintain established social configurations in the face of social change. The function of justifying inequalities was especially important in the United States but less so in Canada for reasons of the timing of nation-building, national history, character, and culture.Education, Faculty of
Educational Studies (EDST), Department of
Graduate
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Dusabe, John. "Development and evaluation of an mHealth intervention to improve the uptake of sexual and reproductive health services in Mwanza Tanzania." Thesis, University of Liverpool, 2014. http://livrepository.liverpool.ac.uk/2014371/.
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This thesis documents the development and evaluation of an mHealth intervention for sexual and reproductive health (SRH) referral from drugstores to health facilities in Mwanza Tanzania. SRH is an important factor for human development. Over the last 2 decades, provision and accessibility to SRH services has benefited from international and national health promotion interventions. In developing countries, use of close to community providers (CTC providers), such as village health workers, has been a key component of health promotion. This has been especially true in Tanzania where up to 70% of formal primary health care facilities lack health staff. CTC providers have been promoted through international initiatives such as the World Health Organization’s (WHO) task-shifting initiative. WHO’s recognition of CTC providers ranges from cadres at the grassroots level such as village health workers and drugstores to formal auxiliary providers based in health facilities, such as medical aides and nurses. In Tanzania, drugstores provide a range of SRH services ranging from simple advice on how to use a condom to complex prescriptions of antibiotics for STI treatment. Evidence has shown that drugstores – though more likely to have health-related training than any other informal CTC providers – lack skills necessary for provision of SRH services. This may contribute to poor SRH outcomes, such as increase in prevalence of sexually transmitted infections (STIs)/human immunodeficiency virus (HIV) and antibiotic resistance. Accessing SRH services at the formal health facility level is key to improving these outcomes. To create SRH service linkages and integration between drugstores and health facilities in Mwanza, Tanzania, an intervention that pioneered an mHealth SRH referral from drugstores to health facilities was designed and implemented for 18 months from September 2012 to February 2014. Referral between these two SRH providers using mHealth tools had not been attempted before. The intervention provided an electronic platform accessible to 52 drugstores and 18 health facilities in two districts of Mwanza region. Through a toll-free number and password, drugstores referred patients with SRH conditions to health facilities using the text-messaging feature on their mobile phones. From the platform’s in-built data collection tool, SRH uptake data demonstrated that 38% of patients referred from drugstores accessed HIV, STIs, family planning and maternal health services at the health facility level. A follow-up randomised household survey found that 72% of the participants would accept such type of referral in future, and among those who had ever visited drugstores for SRH services, 15% had heard about the intervention. At the end of the intervention, drugstores and health facilities confirmed that it was beneficial to their SRH service provision and that they would like to continue implementing it. In conclusion, this text messaging intervention pioneered community referral from drugstores to health facilities for SRH treatment by using mobile phones which appeared to be acceptable and effective in Mwanza Tanzania. With the growing use of mobile phones in Africa and the need to provide SRH services beyond the Millennium Development Goals (MDGs) era, mobile phone-based community referral through CTC providers, such as drugstores, could make an important contribution to achieving Universal Health Coverage targets.
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Giné, Garriga Ricard. "Monitoring water, sanitation and hygiene services : developing tools and methods to measure sustainable acces and practice at the local level." Doctoral thesis, Universitat Politècnica de Catalunya, 2015. http://hdl.handle.net/10803/334692.
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Water and sanitation improvements together with good hygiene (WaSH) have well-known positive impacts on human development and poverty alleviation. However, universal access to safe drinking water and basic sanitation remains a huge challenge in many low income countries, where vast numbers of people lack these basic services. To help end this appalling state of affairs, the Millennium Development Goals and other international initiatives have been launched to reduce the proportion of underserved people. These efforts, however, have been hampered by the lack of meaningful indicators to measure coverage and to establish progress towards the goals and targets set out by the international community. From an institutional viewpoint, the competences for many sector-related responsibilities have been delegated to lower administrative levels of government. It has come to be widely accepted that such decentralization process can help to reduce poverty because local governments are assumed to be more knowledgeable about and responsive to the needs of the poor. The sector also calls for greater transparency and accountability. In all, local decision-makers are being increasingly challenged by the need to take informed decisions and give an objective account of their actions, which rely crucially on adequate monitoring and reporting systems. Amongst others, available data may be employed to i) measure progress and performance; ii) improve transparency in budgetary procedures; and iii) allocate resources to deliver services where they are most needed. Today, reliable information on key WaSH-related variables at the local level is often missing, but even when it is available, the uptake and usage of such data by policymakers is, at best, challenging. Limited capacity of recipient governmental bodies, an inadequate monitoring and reporting framework, and lack of data updating mechanisms are common reasons that hamper an adequate appropriation and continued use of the data for planning and monitoring purposes.
In an effort to address the shortcomings cited above, this thesis discusses methodologies for routine data collection and develops tools and processes to support local planning. In doing so, it covers the monitoring cycle of data collection, data analysis and data dissemination. In Chapter 1, an improved approach for data collection is presented. It combines two different information sources: the water point and the household, and thus provides a more complete picture of the context in which the services are delivered. Chapter 2 reviews four different approaches that are commonly adopted for monitoring purposes: i) health impact indicators; ii) the Joint Monitoring Programme; iii) one multidimensional, water-focused composite indicator; and iv) easy-to-use planning indices designed locally on an ad hoc basis. From a policy-making perspective the usefulness of outcomes produced by each approach is discussed. Chapter 3 introduces a variety of policy tools that may be used to promote decision-making: i) composite indices; ii) a small set of simple thematic indicators; and iii) object oriented Bayesian networks (ooBn). Chapter 4 presents different alternatives to enhance data interpretation and disemination, which is crucial to promote evidence-based and equity-oriented planning. Overall, results indicate that accurate and comprehensive data, if adequately collected, exploited and visualized through simple instruments, can serve as the basis for effective targeting and prioritization, both central to sector planning. The actual application and implementation of the proposed monitoring and reporting tools and processes in the real world, however, is to a certain extent elusive; and this has been pointed out as a major weakness of this research. Two specific challenges that remain unaddressed, namely the upgrading of decision support systems, and the design of data updating mechanisms, suggest the way forward.Assegurar l'accés a l'aigua, promoure la higiene i facilitar l'accés al sanejament ajuda a prevenir la transmissió de malalties relacionades amb una deficient provisió d’aquests serveis i reduir el risc d'epidèmies. No obstant, l'accés universal a l'aigua potable i als serveis bàsics de sanejament segueix sent un enorme desafiament en molts països en vies de desenvolupament, on un gran nombre de persones continuen sense tenir cobertes unes necessitats bàsiques. En aquest context, el sector ha vist com es posaven en marxa vàries iniciatives, com els Objectius de Desenvolupament del Mil·lenni, per tal de reduir la proporció de persones desateses. Aquests esforços, però, s'han vist obstaculitzats per la falta d'indicadors fiables alhora d’avaluar el nivell de cobertura i de mesurar els avenços envers les metes i els objectius establerts per la comunitat internacional. En els darrers anys, les competències sectorials s'han delegat a les administracions locals, sota el supòsit de que els processos de descentralització ajudarien a reduir la pobresa en base a un millor coneixement, per part de les autoritats locals, sobre les necessitats reals de la població. Així mateix, també ha anat creixent la demanda de més transparència i una millor rendició de comptes. Per tots aquests motius, cada vegada s’ha anat qüestionant més el fet de que els processos de presa de decisió no es fonamentin en informació actualitzada i basada en evidències, i no depenguin per tant d’un marc adequat que permeti el correcte seguiment, avaluació i la presentació periòdica d'informes. Entre altres coses, la informació disponible s’hauria de poder utilitzar per i) mesurar els avenços i el progrés assolit; ii) millorar la transparència i el control pressupostari; i iii) assignar els recursos disponibles de manera equitativa. Dissortadament, la informació sobre el sector és generalment escassa, però fins i tot quan és accessible, el seu ús per part dels governants és limitat. Amb la voluntat d’abordar aquest accés i ús deficient de la informació, aquesta tesi desenvolupa eines i processos per donar suport a la planificació local dels servies d’aigua i sanejament. En síntesi, es pretén cobrir tot el cicle de la informació, que integra la recollida, l’anàlisi i la seva posterior difusió. En el capítol 1 es presenta una metodologia millorada per a la recopilació de dades. Aquesta combina dues fonts d'informació: el punt d'aigua i la llar; i en conseqüència proporciona una visió més completa del context en què es proveeixen els serveis. El Capítol 2 presenta quatre enfocaments diferents a l’hora d’avaluar el nivell de servei: i) indicadors d'impacte sobre la salut; ii) el Programa Conjunt de Seguiment de la OMS i UNICEF; iii) un indicador agregat multidimensional; i iv) una bateria d’índexs de planificació dissenyats ad hoc per respondre a les necessitats locals. Es discuteix la utilitat de cada alternativa i la seva pertinença des d’una òptica de política pública. El Capítol 3 introdueix varis instruments dissenyats per a promoure la presa de decisions: i) índexs agregats; ii) indicadors temàtics senzills; i iii) les xarxes bayesianes. El Capítol 4 presenta diferents alternatives per millorar la interpretació i disseminació de la informació, que esdevenen activitats necessàries per a promoure una planificació basada en l'evidència i orientada a l'equitat. Per concloure, els resultats indiquen que l’accés a la informació, si aquesta es compila correctament, s’explota i es visualitza a través d’instruments i processos senzills, pot revertir en una correcta priorització d’accions i de grups beneficiaris i, per tant, millorar la planificació sectorial. És cert, però, que l'aplicació real i la posada en pràctica d’aquestes eines i processos no és en cap cas trivial. Es plantegen, en aquest sentit, dos reptes que suggereixen el camí a seguir: la millora dels sistemes de suport a les decisions i el disseny de mecanismes adequats per a l'actualització de dades.
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Hassan, Shaima M. "A qualitative study exploring British Muslim women's experiences of motherhood while engaging with NHS maternity services." Thesis, Liverpool John Moores University, 2017. http://researchonline.ljmu.ac.uk/7412/.
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Women in the UK have access to NHS maternity services and most will attend hospital to give birth in the NHS. Much effort has been undertaken over several decades to improve childbirth and to enhance the experiences of those using NHS maternity services. However, while most women report positive experiences of maternity care, existing evidence suggests that women from ethnic minority groups in the UK have poorer pregnancy outcomes, experience poorer maternity care, are at higher risk of adverse perinatal outcomes and have significantly higher severe maternal morbidity than the resident white women (Puthussery, 2016; Henderson et al, 2013; Puthussery et al., 2010; Straus et al., 2009). Muslim women of child-bearing age make up a significant part of UK society, yet their health needs and their experiences of health services have not been extensively researched. The term ‘Muslim’ is often combined with ethnic group identity, rather than used to refer to people distinguished by beliefs, practices or affiliations. Muslim women commonly observe certain religious and cultural practices during their maternity journey and the little research there is in this area suggests that more could be done from a service provision perspective to support Muslim women through this, spiritually and culturally significant life event (McFadden et al., 2013; Alshawish et al., 2013). This study explores Muslim women’s perceived needs and the factors that influence their health seeking decisions during their transition to motherhood. Using a generic qualitative approach, seven English-speaking first time pregnant Muslim women and a Muslim mother who is second time pregnant but experiencing motherhood as a Muslim for the first time, were interviewed at different stages of their maternity journey (antenatal, post-labour and postnatal); five focus groups were conducted with Muslim mothers; and 12 semi-structured interviews were conducted with healthcare professionals. Thematic analysis of the transcripts revealed that Muslim women: 1) had a unique perspective on motherhood based on Islamic teaching; 2) sourced information from a number of sources, additional to midwives; 3) experienced difficulty expressing their religious requirements when preparing a birth plan; 4) assumed that healthcare professionals would have a negative view of Islam and Islamic birthing practices. While one-to-one interviews revealed that healthcare professionals: 1) varied in their perceptions of Muslim women; 2) had a general awareness of Muslim women’s Islamic practices but not specific to motherhood; 3) sourced cultural and religious information to enhance their understanding of women’s needs and their specific practices; 4) had some challenges when addressing women’s specific religious practices such as fasting; 5) would benefit from cultural/religious competency training that incorporates lived experience and group discussion. The implications for institutions, midwifery practice and further research are outlined. The study concludes that transcultural knowledge and specifically Muslim women’s worldview incorporated into healthcare professional training would enhance the competency and quality of healthcare services.
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Denver, Sara Jane. "Experiences of developing cancer and palliative care services in one community in North West England 1976-2000 : an oral history and documentary reconstruction." Thesis, University of Glasgow, 2014. http://theses.gla.ac.uk/5526/.
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The purpose of this study was to explore how cancer and palliative care services developed in one place and changed in the course of time. Research on how local cancer and palliative care services have developed is limited. A small number of researchers have provided accounts of hospice developments nationally, but they did not explore individual experiences and the micro context in detail. Other studies have examined accounts of developing local cancer support services, but not hospice developments. This research addresses the question - how were cancer and palliative care services developed in Lancaster 1976 ? 2000? Oral history and documentary sources were used to generate data, which was analysed using thematic analysis/constant comparison. Social constructionism offered a fruitful theoretical basis that increased understandings of oral history accounts. A snowball sample recruited a broad group of participants that had been involved with the local cancer and palliative care services in the relevant period. Thirty five interviews were conducted. The study revealed that services developed in the absence of national planning; participants worked to make them respectable, but there was tension at times. Progress was shaped by a combination of individual and social factors. Services evolved outside the National Health Service, yet alongside oncology and were therefore tripartite in character. Elsewhere developments were often fragmented. Many participants were involved in all the local services; they created networks and collaborated to form comprehensive facilities, which were available from diagnosis to the terminal stage of illness. The approaches complemented each other to reveal that at the macro level services were initially flexible. In time they became more structured, as social, historical, economic, professional and political mechanisms in the broader context impacted to shape them; this created some challenges. The study also uncovered aspects of the meaning of compassion. It revealed that compassionate practices challenged the rationality of conventional approaches and shared relativist perspectives because participants found different ways of providing care. All of these findings contributed to new knowledge about the development of local cancer and palliative care services. The study was limited by the historical period, perhaps by the place and because the reconstruction was one interpretation. It is possible there are others.
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Engström, Johanna, and Maria Landström. "Omvårdnadspersonalens kunskaper och följsamhet till basala hygienrutiner: en kvantitativ studie : en kvantitativ studie." Thesis, University of Gävle, Faculty of Health and Occupational Studies, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-6761.
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Nosokomiala infektioner förekommer världen över och är en stor orsak till sjukdomar och dödlighet. Även i Sverige är nosokomiala infektioner ett problem, både på sjukhus och i andra vårdformer. Basala hygienrutiner är den viktigaste åtgärden för att förebygga uppkomst av infektionssjukdomar. Syftet med denna studie var att undersöka och jämföra hemtjänstens undersköterskor och vårdbiträden, gällande deras kunskaper och följsamhet till basala hygienrutiner, samt deras kunskaper angående den vanligaste smittvägen inom vården. Datainsamlingen gjordes med en enkät som innehöll 22 frågor. Fyra hemtjänstgrupper ingick i studien, där totalt 66 vårdbiträden och 30 undersköterskor inkluderades. Resultatet visade att följsamheten till handtvätt och handdesinfektion efter ett omvårdnadstillfälle var hög, dock var följsamheten till handdesinfektion före ett omvårdnadstillfälle mindre bra. Följsamheten till handskar vid personlig hygien var mycket god, resultatet visade dock att de flesta endast använde plastförkläde/skyddsrock ibland. Många av respondenterna i båda undersökningsgrupperna kände inte till vilka områden som ingår i begreppet basala hygienrutiner, däremot kände många till den vanligaste smittvägen inom vården. Endast en statistisk signifikant skillnad kunde påvisas mellan undersköterskor och vårdbiträden. Slutsatsen var att begreppet basala hygienrutiner måste tydliggöras och att mer information behövs om vid vilka tillfällen händerna ska tvättas eller desinficeras. Ytterligare information behövs även om varför och vid vilka tillfällen plastförkläde eller skyddsrock ska användas.
Nosocomial infections is a big cause of disease and mortality worldwide. In Sweden nosocomial infections also is a big problem, both in hospitals and other care facilities. Hygiene guidelines is the most important measure to prevent infection diseases. The aim of this study was to measure and compare licensed practical nurses and nursing assistants in homemaker services, concerning their knowledge and compliance to hygiene guidelines and their knowledge about the most common way of spread of infection in healthcare. The data collection was conducted with a questionnaire including 22 questions. Four groups in homemaker services were included in the study, totally 66 nursing assistants and 30 licensed practical nurses. The result showed that the compliance to hand washing and hand disinfection after a care opportunity was high, however the result showed that hand disinfection before a care opportunity was less good. The compliance of using gloves was very good in personal hygiene opportunities. The result also showed that most of the respondents only used aprons occasionally. Many of the respondents didn’t know which areas are included in hygiene guidelines, however many had knowledge about the most common way of spread of infection in healthcare. Only one statistical significant distinction was established between nursing assistants and licensed practical nurses. The conclusion showed that hygiene guidelines must be elucidate and that more information is needed about when hands should be washed or disinfected. Further information is also needed about why and in which occasions aprons should be used.
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Jonker, Linda. "The experiences and perceptions of mothers utilizing child health services." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/20294.
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Thesis (MCur)--Stellenbosch University, 2012.ENGLISH ABSTRACT: Member states of the United Nations accepted eight Millennium Development Goals in 2000. Millennium Development Goal number four addresses the improvement of child health. The purpose of goal number four is to decrease the child mortality rate by 60% for the period 1990 to 2015. South Africa is one of twelve countries where the incidence of child mortality increased during this period. Guided by the research question “What are the experiences and perceptions of mothers utilizing child health services”, a study was done. A qualitative, descriptive phenomenological methodology was applied to explore the experiences and perceptions of mothers utilizing child health services for children younger than two years. The goal of this study was to determine the experiences and perceptions of mothers utilizing child health services. The objectives were to explore their experiences and perceptions, with specific reference to the service they receive regarding: - immunization - nutrition assessment - the growth of the child - the growth chart - other underlying illnesses Ethical approval was obtained from Stellenbosch University and various health authorities. Validity was assured by adhering to the principles of trustworthiness, namely credibility, transferability, dependability, and conformability. The population for this study was mothers who utilized ten clinics in a demarcated area of Cape Town for child health services. Purposive sampling was utilized to consciously select three clinics (N =10), and at each of the clinics four mothers were purposively selected to participate. A total of seventeen mothers participated in the study. An interview guide was used to conduct interviews with participants. The researcher conducted and recorded the interviews after obtaining written informed consent from each participant. A field diary was kept for notation of observations. Data analysis involved the transcribing of digitally recorded interviews, the coding of the data, the generating of themes and sub-themes, interpretation and organization of data and the drawing of conclusions. The Modeling Role-Modeling Nursing theory of Erickson, Tomlin and Swain were utilized as conceptual theoretical framework to facilitate application to the broad population. Findings of the study indicated varied experiences. All mothers did not receive information about the RtHB or RTHC. Not all mothers developed a relationship of trust with caregivers or were afforded the respect of becoming part of the child’s health care team. According to the mothers integrated child health care services were not practised. The consequences were missed opportunities in immunization, provision of Vitamin A, absence of growth monitoring, feeding assessment and provision of nutritional advice. Hospitals and private practitioners equally did not provide immunization services or offered holistic care. Simple interventions such as oral rehydration, early recognition and treatment of diseases, immunization, growth monitoring and appropriate nutrition are not diligently offered; that could reduce the incidence of child morbidity and mortality. The following recommendations are made: determine why hospitals do not immunize children. The root causes must be addressed to change practice. Rendering of child services must happen in an integrated approach. Staff must be empowered with skills regarding procurement, in particular regarding vaccines.
AFRIKAANSE OPSOMMING: In 2000 het die lidlande van die Verenigde Volke Organisasie die Millenium Ontwikkelingsdoelwitte aanvaar. Die Millenium Ontwikkelingsdoelwit nommer vier roer die kwessie van kindergesondheid aan. Die strategie om die voorkoms van kindersterftes met 60% te verminder vanaf 1990 tot 2015 is die vierde millenium doelwit. Suid Afrika is een van twaalf lande in die wêreld waar die kindersterftes vir hierdie tydperk toegeneem het. ‘n Studie is gedoen om te bepaal “Wat die ervaring en persepsies van moeders is wat van kindergesondheidsdienste gebruik maak. ‘n Kwalitatiewe, beskrywende, fenomenologiese studie is gedoen,om die ervaring en persepsies van moeders wat kinders jonger as twee jaar na klinieke geneem het, te bepaal. Die doel van die studie was om die ervaring en persepsies van moeders ten opsigte van kindergesondheidsdienste vas te stel. Spesifieke doelwitte was die bepaling van die ervaring en persepsies rondom: - immunisasiedienste - groeimonitering - voedingsvoorligting - die groeikaart - behandeling van siektes Etiese goedkeuring was verkry vanaf die Universiteit van Stellenbosch en die verskeie gesondheidsowerhede. Geldigheid van die studie is verseker deur die beginsels van geloofwaardigheid na te kom naamlik, aaneemlikheid, betroubaarheid, oordraagbaarheid en inskiklikheid. Die bevolking betreffende die studie was moeders wat kliniekdienste gebruik het vir hulle kinders in ‘n spesieke area van Kaapstad, bestaande uit tien klinieke. Drie klinieke (N=10) is doelgerig geselekter vir deelname. Vier moeders is doelgerig by elk van die drie klinieke geselekteer vir deelname. Onderhoude is met sewentien deelnemers gevoer. ‘n Onderhoudsgids is gebruik en die navorser het rekord gehou van waarnemings. Die navorser het onderhoude gevoer en opgeneem na skriftelike toestemming daarvoor van elke deelnemer verkry is. ’n Veldwerkdagboek is gehou van alle waarnemings. Data-analise het behels: digitale opnames wat woordeliks beskryf , tematies ontleed en geïnterpreteer is en volgens temas georganiseer is. Toepassing na die breër populasie is bevorder deur die gebruik van die verpleegteorie van Erickson, Tomlin en Swain. Bevindinge van die studie het getoon dat moeders verskillende ervaringe gehad het. Nie alle moeders het inligting ontvang omtrent die RtHB of RTHC nie. Nie alle moeders het vertroue in die kliniek nie en moeders word nie erken as bepalende faktore in die sorgspan nie. . Volgens die moeders is geïntegreerde gesondheidssorg nie beoefen nie. Die gevolge is dat geleenthede nie benut word om te immuniseer nie, vitamien A te verskaf, groei te kontroleer, voeding te bepaal en voedingsadvies te verskaf. Die voorraadvlakke van entstof word nie oral doeltreffend beheer nie. Hospitale en dokters beoefen nie altyd immunisering en holistiese kindergesondheidsdienste nie. Eenvoudige intervensies, wat die voorkoms van kindermorbiditeit en kindermortaliteit kan bestry, word nie verskaf nie. Voorbeelde van sulke intervensies is mondelinge rehidrasie, vroeë diagnose en behandeling van siektes, immunisering, groeimonitering en geskikte voedingsinligting. Daar word aanbeveel dat daar indringend bepaal word hoekom hospitale nie kinders immuniseer nie en dat die oorsake aangespreek word. Integrasie van dienste by klinieke moet as prioriteit gesien en geïmplimenteer word. Personeel se vaardighede betreffende beheer van voorraad moet verbeter word, veral t.o.v. entstof voorraad.
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Tucker, Helen Jean. "Integrated care : the presence, nature and development of integrated care in community health services in England and Ireland." Thesis, University of Warwick, 2012. http://wrap.warwick.ac.uk/56879/.
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Background: Integrated care is a policy imperative in health and social care services globally, and yet there are reported difficulties in defining, developing and sustaining this way of working. Research Question: This research explores staff views and experiences of the presence, nature and development of integrated care in two programmes of community services. Method: A case study approach was adopted using secondary analysis of qualitative data from staff questionnaires using themed content analysis and pattern matching, with findings triangulated with documentary sources. The study considers the presence and nature of integrated care using the conceptual framework “to what extent integrated care is for everyone (inclusive) and not just for some (exclusive)” as interpreted from the literature. The development of integrated care was explored using systems theory for the management of change in a complex environment. Findings: A meta-analysis of the two case studies demonstrated that integration was present in all 66 services within the two programmes. The nature of integrated care varied and was demonstrated as multiple types (in community hospitals) and processes (in community services). The most frequently reported type was multidisciplinary working. The processes most teams chose to develop were information sharing systems. The development of integration within the case studies was affected by a number of factors, such as commitment and staffing. Conclusion: This study provides new evidence of the presence, nature and development of integration within a wide range of established services spanning all ages. From this and other measures, the extent to which integrated care is presented as “exclusive” can be questioned. These findings have informed the development of a framework of five principles, reflecting whether integrated care is: for everyone, extensive, enduring, can be enabled and essential. The implications and application of this research for policy, service development and training are discussed, and proposals for further research include testing the applicability of this framework and widening this study.
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Townsend, Linda Susan. "The relationships between cognitive appraisal, coping and physical functioning in a work hardening population." W&M ScholarWorks, 1994. https://scholarworks.wm.edu/etd/1539618861.
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This study explored the interactions of cognitive appraisal of pain, cognitive appraisal of function, pain coping strategies and physical functioning in a work hardening population. Using a retrospective design, the medical records of 85 subjects were reviewed for their responses on the following instruments: a 10 cm. Visual Analogue Scale (to measure appraisal of pain), the Spinal Function Sort (to measure appraisal of function); the Coping Strategies Questionnaire (to measure pain coping strategies); a series of objective measures of physical function; and several demographic questions. Pearson product moment correlation and simple regression were used to analyze data. Correlational analyses suggested that a moderate to strong, statistically significant relationship existed between the Spinal Function Sort and most of the objective measures of physical function. The statistically significant, negative relationship between the Coping Strategies Questionnaire's subscale catastrophization was anticipated and supported prior research with this tool. The statistically significant relationships between subjects' appraisals of pain and their functional status were weaker than anticipated and may be attributed to validity problems with the Visual Analogue Scale. Duration since injury as a factor in the maintenance of physical dysfunction was not supported by statistical analyses. The expected positive relationship between the Coping Strategies Questionnaire's coping subscales was not supported by analysis and was consistent with some of the prior research conducted with this instrument. Results from the current study give support to Lazarus' theory of cognitive appraisal as a factor in illness and function.
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Cooper, Diane. "Women's social position and their health : a case study of the social determinants of the health of women in Khayelitsha, Cape Town, South Africa." Doctoral thesis, University of Cape Town, 1995. http://hdl.handle.net/11427/14955.
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Includes bibliographical references.This thesis examines the social determinants of women's health status, health knowledge and knowledge and use of health services in a peri-urban area, using Kbayelitsha in Cape Town, South Africa as a case study. It argues for the importance of women's health as a specific focus, looks at some trends in women's health internationally over the past two decades and reviews the main factors affecting women's health. Some key issues in women's health of special relevance to developing countries such as South Africa are discussed. There is a special focus on newly urbanised women in peri-urban areas. Against this background the results of a community-based survey, preceded by indepth interviews, and conducted amongst 659 women in Kbayelitsha in 1989 and 1990 are presented. Data collected were statistically analysed using unIvariate,, bivariate and multivariate analysis. A number of priority social and health problems are identified: poverty; poor environmental conditions; lack of education, partlcularly skills training appropriate for finding work and the subordinate social status of women. Major health concerns included reproductive tract infections, especially sexually transmitted diseases, infertility, contraceptive use and ante-natal care during pregnancy. There were inadequacies in cervical screening conducted by health services and deficiencies in respondents' knowledge of AIDS. cervical smears and where to obtain various health services . Young, newly urbanised women, living in the poorly serviced and unserviced informal housing areas were partlcularly vulnerable in their socio-economic and health status within a peri-urban African community such as Khayelitsha. They also had poorest health knowledge and least knowledge of where to acquire health services. Some recommended interventions focussing on certain of these areas are suggested. It is argued that changes in the provision of women's health services within a primary health care setting can only be part of the process of improving women's health. Improvements in women's economic status and their social status are fundamental to any initiatives to improve their health status.
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Snyman, J. S. "Effectiveness of the basic antenatal care package in primary health care clinics." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/728.
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Pregnancy challenges the health care system in a unique way in that it involves at least two individuals – the woman and the fetus. The death rates of both pregnant women (maternal mortality) and newborns (perinatal mortality) are often used to indicate the quality of care the health system is providing. In terms of maternal and perinatal outcomes South Africa scores poorly compared to other upper-middle income countries (Penn-Kekana & Blaauw, 2002:14). The high stillbirth rate compared to the neonatal death rate reflects poor quality of antenatal care. Maternal and perinatal mortality is recognised as a problem and as a priority for action in the Millennium Development Goals (Thieren & Beusenberg, 2005:11). The Saving Mothers (Pattinson, 2002: 37-135) and Saving Babies (Pattinson, 2004:4-35) reports describe the causes and avoidable factors of these deaths with recommendations on how to improve care. The quality of care during the antenatal period may impact on the health of the pregnant woman and the outcome of the pregnancy, in particular on the still birth rate. In primary health care services there are many factors which may impact on and influence the quality of antenatal care. For example with the implementation of the comprehensive primary health care services package (Department of Health, 2001a:21-35) changes at clinic level resulted in a large number of primary health care professional nurses having to provide antenatal care, who previously may only have worked with one aspect of the primary health care package such as minor ailments or childcare. Because skills of midwifery or antenatal care, had not been practiced by some of these professional nurses, perhaps since completion of basic training, their level of competence has declined, and they have not been exposed to new developments in the field of midwifery. The practice of primary health care nurses is also influenced by the impact of diseases not specifically related to pregnancy like HIV/AIDS and tuberculosis. The principles of quality antenatal care are known (Chalmers et al. 2001:203) but despite the knowledge about these principles the maternal and perinatal mortality remains high. The Basic Antenatal Care quality improvement package is designed to assist clinical management and decision making in antenatal care. The implementation of the BANC package may influence the quality of antenatal care positively, which in turn may impact on the outcome of pregnancy for the mother and her baby. The aim of this study was to evaluate the effectiveness of the Basic antenatal care (BANC) package to improve the quality of antenatal care at primary health care clinics.
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Isaacs, Anna. "Keeping healthy and accessing primary and preventive health services in Glasgow : the experiences of refugees and asylum seekers from Sub Saharan Africa." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/8971/.
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Background and aims: Recent decades have seen material shifts in global migration flows. Migrants now come to the UK for an increasing number of reasons and from an increasing number of countries. This presents a challenge for health services that must provide care to individuals with a broad range of needs. In particular, there is concern that asylum seekers and refugees (ASRs) are at heightened risk of poor wellbeing and of receiving suboptimal healthcare. Concurrent with these shifts in migration, increasing attention is being paid to noncommunicable diseases (NCDs), which are now the most significant drivers of morbidity and mortality in most regions of the world. In the UK, the burden of NCDs is not evenly distributed, with inequalities related to ethnicity and socioeconomic status shaping an individual’s risk of ill health. Little is known, however, about how diverse migrant groups, including ASRs, conceptualise health and respond to health prevention messaging. Against this backdrop, this thesis aims to understand the health-related experiences of one such group – asylum seekers and refugees (ASRs) from Sub Saharan Africa living in Glasgow Scotland. Specifically, it explores: a) perceptions of health, wellbeing, and illness causation, b) experiences of accessing primary and preventive healthcare, and c) the factors influencing these perceptions and experiences. It also seeks to elucidate professional perspectives on ASR health. Methods: To gain an in depth understanding of ASR health perceptions and experiences, as well as professional perspectives, a focused ethnography was undertaken. This approach utilised four qualitative methods: community engagement, participatory focus groups, semistructured interviews, and go- along interviews. In total 12 primary care and public health professionals were interviewed, and 27 ASRs took part in either a focus group, an interview, or both. The thesis took a theoretically informed approach, seeking to determine whether and how two theories – ‘candidacy’ (Dixon-Woods et al 2005) and ‘structural vulnerability’ (Quesada et al 2011) – might deepen our understanding of ASR health. Results: Candidacy enhanced understanding of how ASRs identified and responded to messages about ‘healthy lifestyles’. ASR participants considered keeping healthy to be an individual responsibility, with diet and exercise highlighted as especially important. At the same time, however, perceptions and experiences of health and wellbeing were shaped by a number of structural influences, which limited the capacity of ASRs to engage in health practices. Therefore, while ASRs considered health to be an individual choice in theory, they did not necessarily feel they had the ability to be healthy in practice. The theory of structural vulnerability proved useful in identifying the wider structural determinants that impacted on an individual’s capacity to respond. There were several important structural influences, including poverty, racism, discrimination, and language barriers. The greatest negative influence, however, and one that compounded all the others, was the asylum process. This diminished individuals’ capacity to identify as candidates for prevention messages, engage in preventive health practices, and/ or access care in an optimal fashion. Conclusions: Efforts to engage ASRs in preventive health programmes and practices must take into account the ways in which the immigration and asylum system acts as a determinant of health, affecting both what it means to be healthy and what capacity individuals have to engage. The NHS, together with non statutory bodies, has a role to play in mitigating some of the vulnerabilities to which ASRs are subject.
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Rademan, Janet Ellen. "The identification of contextually relevant health and well-being information needs for the youth through human-centered co-design." Thesis, Cape Peninsula University of Technology, 2015. http://hdl.handle.net/20.500.11838/2409.
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Thesis (MTech (Design))--Cape Peninsula University of Technology, 2015.Available health and well-being information is limited in communities with insufficient health care resources. This affects the community negatively on multiple levels in which the health and well-being needs of individuals are not satisfied. This research project explored the impact of human centred co-design, using tools such as health and well-being needs questionnaires including a health needs assessment as well as a quality of life scale. The aim was making accurate health and well-being information more accessible to the youth. The target group was Durbanville youth aged between 14 and 18 years. The sample included different ages ( = 15), races (79% White, 21% Coloured) and near equal gender distribution (55% female, 45% male). The sample (N = 33) was comprised of three groups: Group A, B, and C. A Human-Centered Design (HCD) framework was used during the project referring to the following three steps: Hear, Create, and Deliver. During the Hear phase, stories and inspiration from the participants were gathered. Group A (n = 10) completed a health and well-being information needs questionnaire. Group B (n = 15) discussed the topic, and created affinity diagrams. This was how the health and well-being status and information needs were established. During the Create phase; frameworks, opportunities, solutions, and prototypes were developed by the participants. Group B co-designed the concept prototype: a possible mobile application solution for practical access to health and well-being information. Group C (n = 8) provided feedback and input on the concept prototype and created storyboards to visually display scenarios in which they would use the mobile application. This step produced a youth-friendly health and well-being information service concept prototype. During the Deliver phase, the relevant health and well-being information solution was established as a youth-friendly health and well-being mobile application: WeHelp. Also, group A, B, and C were introduced to a similar existing resource named MobieG. Thus, the present study contributed directly to the participants’ health and well-being awareness. The research provided significant health and well-being insights. For example, the youth of Durbanville revealed extremely low scores on the emotional well-being domain. The data collected makes it possible for future researchers to create a practical, youth-friendly, health and well-being information service.
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Plogin, Jérôme. "Démarche qualité en hygiène dans un service de médecine nucléaire." Bordeaux 2, 1998. http://www.theses.fr/1998BOR2P080.
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Mutoro, Antonina Namaemba. "Feeding, care-giving and behaviour characteristics of undernourished children aged between 6 and 24 months in low income areas in Nairobi, Kenya." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/8892/.
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Childhood undernutrition remains a public health problem in slums in Nairobi, yet little is known about current childcare practices, particularly child eating and maternal feeding behavior and their impact on child growth. Treatment options for malnutrition in this setting involve the use of sweet, high energy ready to use foods (RUF), which have the potential to displace home foods, but few studies have assessed this. This thesis therefore aimed to quantify high-risk caring practices in children aged 6-24 months and how these vary with nutrition status. The effects of RUF on meal frequency and eating and feeding behavior were also assessed. The programme of research was underpinned by the following research questions: • What are the commonest modifiable risk factors for undernutrition found in children and how does this pattern vary with nutrition status? • Do ready to use foods displace complementary foods in moderately undernourished children? • Do ready to use foods affect eating and feeding behaviour? Preliminary studies were carried out to test the feasibility of using observations to assess childcare practices. Caregivers of children aged between 6 and 24 months were recruited in Wagha town, a semi urban area in Lahore, Pakistan and in selected slums in Nairobi, Kenya. A structured observation guide was used to collect information on caregiver child interactions during mid-morning meals in Pakistan and lunch time meals in Kenya. A description of childcare practices in the household, specifically dietary practices, feeding behaviour and hygiene practices were assessed by asking the following questions: Who feeds the child? How is the child fed? What is the child fed and how often? What are the hygiene practices of caregivers? Thirty meal observations, 11 in Pakistan and 19 in Kenya, were carried out in homes, while 11 meals were observed in day-care centres in Nairobi. Eating and feeding behaviours varied between cultures. Compared to caregivers in Kenya, caregivers in Pakistan offered more encouragement during meals. In Kenya, encouragement was mainly in response to food refusal and undernourished children were more likely to show aversive eating behaviour. Caregivers would respond to this behaviour by either restraining the child or simply leaving them alone. In day-care centres, laissez faire feeding was common as children were left to feed themselves with little or no assistance. Poor hygiene practices were also common, especially in Kenya where caregivers did not wash their hands before feeding their children. Meal observations were not representative as only one meal could be observed and they were also not practical because of insecurity in the slums. Based on these findings, a cross sectional study carried out in seven health facilities was designed. Caregivers of children aged 6-24 months were recruited from health facilities in two stages. In the first stage, undernourished children (weight for age or weight for length below - 2 Z scores or length for age below -3 Z scores) were quota sampled either from outpatient therapeutic or supplementary feeding programs based on severity and supplementation status between February and August 2015. Undernourished children were recruited from well-baby clinics during growth monitoring. Between July and August 2016 healthy children (weight for age above-2 Z scores) were also recruited from well-baby clinics at the same health facilities. For both groups, child anthropometric measurements were taken and information on sociodemographic, hygiene breastfeeding frequency, meal frequency, dietary diversity, child eating and caregiver feeding behaviour collected using a structured interview guide. Among children receiving ready to use foods, information on child interest in food, food refusal and caregiver force-feeding was also collected for both family meals and ready to use food meals. We recruited 415 children (54.5% female), over half (58.6%) of whom were undernourished. Caregivers and their children came from disadvantaged backgrounds characterized by low parental education. They also lacked access to basic hygiene and sanitation facilities. There was no association between nutrition status and hygiene as nearly all children came from households that lacked piped water (83.6%) and shared toilets (82.9%). Compared to healthy children, undernourished children were more likely not to be breastfeeding (undernourished 11.5%; healthy 5.2% P=0.002) and to receive plated meals at a low frequency (undernourished 12.2%; healthy 26.2% P=0.002). Diets offered were mainly carbohydrate based and there was no association between dietary diversity and nutrition status. Close to one third of children showed low interest in food 25.8% (107) and high food refusal 22.5% (93). Force-feeding was also relatively common 38.5% (155). Compared to healthy children, undernourished children were more likely to show low interest in food (undernourished 34.2%; healthy 14.0% P < 0.001) and high food refusal (undernourished 30.9%; healthy 10.5% P < 0.001); and their mothers were more likely to be anxious about feeding them (undernourished 20.6%; healthy 6.4% P < 0.001). Within the undernourished group, 49.4% had either low interest in food or high food refusal or both. Force-feeding was common in both groups, with a non-significant trend towards more force-feeding in the undernourished infants (undernourished 41.4%; healthy 34.5% P=0.087). Children were more likely to be force-fed if they had low interest in food (odds ratio[95% CI] 3.72 [1.93 to 7.15] P < 0.001) or high food refusal (4.83[2.38 to 9.78] P < 0.001), after controlling for maternal anxiety and child nutrition status. Children appeared to prefer RUF to home foods which is good for treatment compliance, but it may have a negative impact on intake of home foods. Although a single sachet of RUF appeared not to displace family meals in moderately undernourished children, actual energy intake was not measured in this study and these findings are therefore inconclusive. Children in slum areas in Nairobi are exposed to many risk factors which puts them at risk of infection and undernutrition and provision of ready to use foods as a treatment option does not address the underlying problem. There is therefore a need for poverty alleviation strategies which will lead to improved access to hygiene facilities and better environmental conditions. Measures to improve access and utilization of safe nutritious foods as well as mother-child interactions during meals are also required. A better understanding of child care practices and underlying factors that influence them is also required for the design of effective and sustainable interventions in this setting.
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Dean, Lesa. "Dental Care in Long-Term Care Facilities of Warren County, Kentucky." TopSCHOLAR®, 1986. https://digitalcommons.wku.edu/theses/2252.
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Many physical changes occur as one ages, including changes associated with the oral cavity. A review of the literature suggests that the provision of dental care to institutionalized elderly patients presents problems due to a variety of factors. The purpose of this study is to assess the level or dental care provided to residents of long-term care facilities located in Warren County, Kentucky. In addition, secondary objectives Include the ascertainment of who provides dental care to residents and the amount or in-service dental training made available to staff members of the facility.
Each administrator of the long term care facilities located in Warren County participated in an *interview conducted by the author. During the interview, information was obtained for a 21 item questionnaire concerning the facility, the number and age range or the residents, and types of dental services provided within the facility.
Results obtained from the questionnaire indicated that 77 percent or the residents in long-tern care facilities in Warren County are 70 years of age or older. No significant differences were noted in the types or dental services provided to residents. However, the dental services provided ranged from those that were obtained in a private dental office via transportation or the resident to outside dental facilities to routine oral hygiene measures carried out by staff members employed by the facility.
The findings revealed significant differences in the dental status of the MRDD residents when compared to the nursing home residents. Other findings indicated that none of the long-term care facilities had dental operatories or dental radiographic equipment on the premises.
Additional research would be required in order to address uncertainties discovered in the study. A followup to the questionnaire Interview with the consulting dentists may be included to determine to what capacity and to what extent they are utilized by the facilities. Other recommendations include the utilization of entrance dental examinations to determine if services offered do meet the needs of the residents and periodic dental examinations to aid in detection and thus reduce the prevalence of dental diseases in this population.
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Milne, Jillian. "Reshaping breast care services : a role for dietitians? : uptake and response to dietary intervention in postmenopausal women newly diagnosed with breast cancer." Thesis, University of Southampton, 2009. https://eprints.soton.ac.uk/162659/.
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Breast cancer survival rates have risen dramatically over recent years with many women expected to survive their diagnosis and live long and fruitful lives. As a result ‘cancer survivorship’ has become of interest to health care providers who state that future services must be developed that better meet the long term health needs and expectations of this group. To this end, the role of health behaviour change in the secondary prevention of breast cancer is a popular area of research. To date, however, there are no published investigations into what the likely uptake in health promotion activities would be; an important consideration when developing health services. Over a period of six months between April 2007 and September 2007, all eligible newly diagnosed postmenopausal women with breast cancer from the participating NHS trust were invited to participate in a clinical trial to assess uptake and response in a group healthy eating programme. The primary outcome measures were to assess the proportion of women who enrolled on the healthy eating programme and to identify health behaviours that predicted enrolment. Secondary outcome measures were to assess the change in diet quality; change in weight and to identify health behaviours that predicted attendance at classes. Twenty one percent (21%) of women invited agreed to attend the healthy eating programme and were subsequently randomly assigned to either the healthy eating programme (n=5) or the usual care group (n=6). The results suggest that women newly diagnosed with breast cancer were not interested in attending healthy eating classes at the time of their diagnosis. However, screening rates fell significantly short of the target and therefore these results cannot be generalised to all newly diagnosed postmenopausal women with breast cancer. Further, due to poor recruitment, secondary outcomes could not be assessed. In summary, the study was unable to provide information regarding the likely interest and response to a group health eating programme for newly diagnosed postmenopausal women with breast cancer. The reasons the study was unable to meet its aims was objectives were twofold; firstly the study failed to engage both NHS trusts for which approval was granted and secondly, screening procedures were not carried out as planned in the single remaining NHS trust.
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Newhouse, Janette K. "Patterns of in-home care service use among older adults: a rural-urban comparison." Diss., Virginia Polytechnic Institute and State University, 1985. http://hdl.handle.net/10919/76463.
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This study investigated how patterns of in-home care utilization and predictors of service use differ for older adults based on whether they live in a rural or an urban environment and whether the service is provided from an informal, a formal, or a combination informal/formal source. The specific in-home services under consideration were: checking, continuous supervision, homemaker-household, meal preparation, nursing care, and personal care.
Although the study was comparative in nature, the investigator was particularly interested in identifying patterns of service utilization that might be translated into effective and cost-efficient service delivery strategies for rural communities. The rural elderly population was the focus of this research because older people tend to live disproportionately in rural areas. Further, older rural residents seem to have more objective needs than their urban counterparts while they have access to fewer services.
This study was based on data from the Statewide Survey of Older Virginians, a probability sample of 2,146 noninstitutionalized persons 60 years of age and older. The 87% response rate included 8% of the respondents who participated via an informant.
A multiple regression analysis was performed for each of the eight subsamples into which the total sample was divided. The 20 independent variables were categorized according to Andersen's paradigm for conceptualizing service utilization as either predisposing, enabling, or need variables. The need variables were significant (p < .05) predictors of service use more often than the other categories, with ADL performance emerging as a significant predictor of service use across all subsamples.
Evidence from existing service utilization literature formed the basis for five hypotheses included to focus the study. Results of the hypothesized relationships confirmed the generalization that this body of literature lacks the necessary precision to accurately profile rural and urban service users. Further investigation of utilization patterns of in-home care services was indicated by this research.Ph. D.
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Saidi, Marya. "No place like HOME : specialist Housing services for people with mental health problems, Outcomes, Movements and Experiences." Thesis, London School of Economics and Political Science (University of London), 2013. http://etheses.lse.ac.uk/914/.
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Background: No exact and reliable data exists on the characteristics and needs of people with mental health problems in England living in specialist housing services (SHSs). Aims: To describe the cohort of service users’ with mental illness aged 18 to 65 living in various types of SHSs (care homes, supported housing, and Shared Lives schemes) as well as their housing satisfaction, taking into account their social inclusion, and social networks. Pathways into SHSs were accounted for: delayed discharge, referrals and move-on accommodation where applicable. Method: Semi-structured interviews were conducted - using interview schedules designed for the purpose of this study - with 86 service users and 40 managers of SHSs within 7 areas of England. Analysis: Based on a mixed-methods approach: each interview was coded and string variables were turned into quantifiable ones; anonymised quotes from service users and managers were included in the body of the text. Main analysis is quantitative, with a secondary qualitative study, using framework analysis. Results: Differing support levels influenced service users’ experiences and pathways into SHSs, as well as the outlooks of managers. Analyses revealed several aspects mediating housing satisfaction. Many service users were not very well integrated in the community although managers held different views. Some service users were very much reliant on staff and had small social networks. Discrimination was still persistent and recent policy initiatives, in terms of funding, housing, benefits and employment held a negative impact. Preferences of service users were for the most part not taken into account. Conclusions: Further research is needed with regard to BME groups as well as other SHSs settings like Shared Lives schemes. Data should be more systematically collected and in more detail and barriers to employment should be tackled. Better advocacy and information for service users should be established.
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Polimeni, Anne-Maree, and Anne-Maree Polimeni@dhs vic gov au. "Narrative of women's hospital experiences the impact of powerlessness on personal identity." Swinburne University of Technology, 2004. http://adt.lib.swin.edu.au./public/adt-VSWT20050309.143640.
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Since women dominate the health care system as consumers, it is important to understand how women want to be treated by medical staff, and the factors that contribute to satisfactory hospital experiences. The present research comprised two separate but integrated studies exploring these issues. The first study adopted an
atheoretical approach. Qualitative and quantitative methods were used to examine the
importance of hospital experiences in the lives of women, and the role of power within those experiences. Closed answer items about hospital experiences were completed by 124 women who had had a hospital stay of at least one night. In addition, ten of the women provided open-ended oral and written comments about their hospital
experiences, which were used as the basis of the qualitative data. The majority of the women were satisfied with their hospital stay, but a small group recalled experiences of powerlessness associated with the non-medical aspects of their treatment, such as behaviours on the part of health professionals that influenced participants� sense of control as hospital inpatients. The qualitative data reflected similar issues to the quantitative data and provided �process� information by demonstrating how health professionals� behaviour could contribute to patients� feelings of powerlessness. The results suggested that hospital experiences were a salient part of these women�s lives. The richness of the qualitative data suggested that qualitative methodology would be a productive way to further study this area.
The second study was an extension of the first via in-depth interviews with 19 women who perceived their hospital experiences as life-altering. The interview content and the analysis were based on a narrative approach that used the theoretical framework of McAdams� (1993) Life Story Model of Identity. Using McAdams� methodology enabled the researcher to evaluate how women constructed meaning from their hospital
experiences, and the main issues they faced. The life story interview also proved a useful way to explore issues of loss and self-growth in the face of traumatic hospital experiences. Transcripts of descriptions of positive and negative experiences were analysed according to McAdams� themes of agency (sense of power and control) and communion (relationships with others), and sequences of redemption and
contamination. Redemption sequences involve the storyline moving from a bad, affectively negative life scene, to a good, affectively positive life scene. In a contamination sequence, the narrator describes a change from a good, affectively
positive life scene, to a subsequently bad, affectively negative life scene (McAdams & Bowman, 2001). Participants also rated their experiences according to Hermans� (Hermans & Oles, 1999) list of affects. There was strong agreement between McAdams� coding of agency and
communion and Hermans� agentic and communal indices: the women�s hospital stories strongly emphasised the negative or opposite of McAdams� agentic theme �Self Mastery through Control�, which indicated powerlessness, and Hermans� affects, which involved low self-enhancement. It may be useful for future studies to conceptualise
McAdams� themes as bipolar by incorporating currently coded themes and their reverse; in particular, by expanding ideas of agency to incorporate powerlessness, as this theme was pervasive in women�s hospital experiences. The rating of affects added to the findings as this showed a latent dimension of communion manifested as isolation. The common agency and communion themes were apparent in the two distinct but related aspects of hospitalisation that affect patients� sense of control: the medical condition and the manner in which patients are treated by medical staff. The findings of the main study built on the pilot study by showing how ideas of control and powerlessness can inform better practice. For example, respectful, dignified and fair treatment by health professionals played a part in determining redemption sequences; women also indicated this was how they wanted to be treated. Due to the vulnerability of the �sick role�, disrespectful or offhand treatment by health professionals had particularly distressing effects evident in contamination sequences, such as negative changes to sense of self and attitudes toward the health care system. In some cases, such treatment led to participants� avoiding subsequent interactions with doctors and to sustained feelings of helplessness. The present thesis demonstrates that doctors, nurses
and other health professionals need to allow time to attend to the affective as well as the medical aspects of the encounter. Health professionals need a good bedside manner, compassion, and communication skills, as these characteristics play a part in maintaining female patients� sense of self and their faith in and satisfaction with the health care system.
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Motlagh, Ahmad Reza Dorosty. "Epidemiology of childhood obesity." Thesis, University of Glasgow, 2001. http://theses.gla.ac.uk/1932/.
Full textAbstract:
In recent years awareness of childhood obesity as a clinical and public health problem has increased. However, a number of important issues related to childhood obesity were unclear when this thesis began. The aims of this thesis were as follows: 1. To estimate the prevalence of obesity in British and Iranian children. 2. To assess the strengths and weaknesses of the body mass index (BMI) as a way of identifying obese children/estimating obesity prevalence. 3. To investigate the factors associated with early 'adiposity rebound'. 4. To identify risk factors for obesity in British children. This thesis showed that prevalence of childhood obesity in British and Iranian children was significantly higher than expected and that obesity prevalence in children increased during the 1990s. These results are consistent with reports of increased childhood obesity in the USA, Europe, and some other countries. Using BMI 95th centile as the definition of childhood obesity has moderately high sensitivity and high specificity, though a definition of BMI 92nd centile was shown in this thesis to be optimum. This thesis indicated that the typical age of AR in British children must be sometime between 5-7 years. Further research on the factors associated with timing of AR is recommended. A number of independent risk factors for childhood obesity are identified. Parental obesity, birth weight, fizzy drink consumption, and time spent in the car had the strongest association.
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Kennedy, Christina. "Feeding the family : exploration of mothers' experiences and practice." Thesis, Liverpool John Moores University, 2015. http://researchonline.ljmu.ac.uk/4581/.
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A mother's practice of feeding the family is viewed as risk behaviour in published health literature where the dominant research interest lies in its pathogenic potential in the aetiology of Child Obesity. Mothers’ 'participative knowledge' of their practice, which is their lived experience as known and given meaning by them, is absent from this literature. The aim of the thesis is to address this gap in knowledge and reflect upon its significance for health promotion. The exploration of mothers’ family feeding practices was conducted by means of a Co-operative Inquiry (Heron, 1996) which I adapted as a community participatory research study with a core group of 13 volunteer mothers. This community of mothers from a former mining community in the NW of England became in time my co-researchers in the investigation of what feeding the family entailed and meant for them. There are two phases of the inquiry. In Phase 1, methods were developed to enable mothers to collect data and to engage in reflection and dialogue so as to describe and explain their practice. In Phase 2, the Inquiry process was directed towards empowering mothers to engage in transformative experiential learning. Findings at the end of Phase 1 highlighted that the mothers’ routine practices often exposed their children to risk factors linked to childhood obesity. It also identified that their reality and lived experience systematically exposed mothers to social injustice that had the potential to undermine their health. At the end of Phase 2 however, new insights into the potential meaning of their practice, led the mothers to make changes in family feeding; and to transform an alienating environment into an empowering experience of true community. The author reflects and discusses the inquiry and its findings by drawing upon theories of knowledge, practice and health; and empirical evidence of risk factors in health inequalities. This study extends the body of knowledge about family feeding with insights into the participative reality of mothers’ practice. The Author recommends health research should embrace new theoretical frameworks for inquiry with mothers to develop a more socially just knowledge of their practice that can empower both mothers and community.
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Milton, Beth. "A longitudinal study of Liverpool schoolchildren's experiences of smoking aged 9-11." Thesis, Liverpool John Moores University, 2002. http://researchonline.ljmu.ac.uk/5005/.
Full textAbstract:
Smoking is the greatest avoidable cause of premature death in Britain today, particularly among the poorest people in society. Most smokers take up the habit during childhood, and the age at which children begin to smoke is falling over time. Although patterns of regular smoking are often established during the teenage years, rates of experimentation with cigarettes peak during preadolescence. Despite this, in the UK there has been little longitudinal research into the process of smoking uptake during preadolescence, and this research fills that significant gap. The Liverpool Longitudinal Study of Smoking (LLSS) is a unique longitudinal study that has tracked a cohort of approximately 250 children during their early years at primary school. This thesis continues and develops the LLSS by exploring the cohort's experiences of smoking during preadolescence in order to understand how children's early smoking careers develop between the ages of 9 and 11. Baseline quantitative and qualitative data collected at age 9 (in 1999) were compared with data collected at age 10 (in 2000) and at age 11 (in 2001) in order to identify key elements of change. These data were analysed longitudinally using a multiple case study approach that identified the individual trajectories of five children during preadolescence. A cross-case comparative method was then used to identify and explain the relationship between views, intentions and behaviour, and how these were shaped by the social context in which the children lived. The themes that emerged from the case studies were then explored and developed in the context of data generated by the whole cohort. Statistical analysis revealed that smoking by best friends, fathers and brothers, together with knowing someone with a smoking-related disease, at age 9 predicted smoking by age 11. The discourses that the children used to talk about smoking uptake emphasised the role of parents at age 9, but by age 11 the cohort suggested that friends were the key influence on smoking onset. Each year, anxiety about being bullied into smoking by older children also emerged as a key concern for this age group. In addition, the analysis revealed that preadolescents appropriate adult discourses around the use of smoking as a coping strategy. The use of these discourses was patterned by socioeconomic status. Children who lived in deprived areas suggested that both adults and children might smoke to counter stress and to relieve boredom. However, some of the girls living in relatively affluent areas perceived that adults smoke to control their weight. The study also considered the implications of these discourses for differential rates of smoking uptake at primary school. A key finding of this phase of the LLSS is that preadolescents construct smoking as an adult behaviour, and therefore some children smoke in order to negotiate status in anticipation of the transition to adolescence and as a strategy of resistance to the exercise of adult power. The reduction of rates of smoking among children and young people is central to the government's tobacco control strategy, and this research has significant implications for the development of both interventions and policy.
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Daosodsai, Paiboon. "Assessment of substance misuse among Thai school students : developing an assessment tool and baseline data." Thesis, Liverpool John Moores University, 2000. http://researchonline.ljmu.ac.uk/5067/.
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James, Janet. "Preventing childhood obesity : a school-based intervention trial - CHOPPS - the Christchurch Obesity Prevention Programme in Schools." Thesis, University of Southampton, 2013. https://eprints.soton.ac.uk/385141/.
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Werner, Jennifer Eilleen. "Barriers to initiation and continuation of vision care among diabetics." CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2259.
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Lombard-Latune, Rémi. "Innover pour les services d’assainissement en zone tropicale : approche technique par filtres plantés de végétaux et accompagnement par modélisation participative." Thesis, Lyon, 2019. http://www.theses.fr/2019LYSE1035/document.
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Les Objectifs de Développement Durable visent d'ici 2030 un « accès pour tous à des services d'assainissement et d'hygiène adéquats, en mettant fin à la défécation à l'air libre ». Un service d'assainissement peut-être défini par ses composantes techniques et sociales, et leurs interactions. Dans l'optique de proposer des pistes d'améliorations des services d'assainissement en zone tropicale, les travaux de cette thèse ont porté à la fois sur des infrastructures de traitement et sur l'implication de l'ensemble des acteurs dans la définition du service. L'analyse croisée des contextes des départements d'outre-mer (DOM) français et du Sénégal a permis d'identifier des contraintes qui pèsent sur le secteur de l'assainissement en zone tropicale. Du point de vue des infrastructures de traitement, ces contraintes nous ont amenées à proposer des procédés issus de la famille des Filtres Plantés de Végétaux (FPV) comme solutions à priori pertinentes. Cette thèse présente leurs adaptations à la zone tropicale, en détaillant les choix retenus pour le dimensionnement, la conception des filtres et le choix des végétaux. Une centaine de campagnes de suivi ont été réalisées sur 7 stations pilotes en tailles réelles, à travers les 5 DOM. Les résultats montrent que malgré une plus grande compacité, le dimensionnement proposé permet de conserver des niveaux de traitement au moins comparables à ceux observés en climat tempéré. Compte tenu des contraintes climatiques et organisationnelles en milieu tropical, une analyse de leur résilience à des perturbations et de leur fiabilité de traitement a été réalisée par une étude statistique sur les données produites par l'autosurveillance réglementaire. Elle montre que les FPV sont également plus fiables que les procédés de traitement conventionnel les plus répandus pour les petites collectivités. Ce qui s'explique à la fois par la barrière physique que représente ces procédés de cultures fixées sur support fin ainsi que par des besoins en entretien plus réduits. Le deuxième axe de recherche part du constat d'un manque de concertation entre acteurs au moment de la planification de l'assainissement, étape qui préside à la construction du système d'assainissement. En particulier, les utilisateurs, leurs besoins et leurs contraintes sont très peu et mal pris en compte. La modélisation d'accompagnement pourrait permettre de créer à la fois un support (le modèle) permettant de discuter des choix techniques et de leurs conséquences, ainsi que le cadre dans lequel les différents acteurs pourraient échanger leurs points de vue et trouver un consensus soutenable. Un processus de modélisation d'accompagnement a été conçu et mis en place sur la planification de l'assainissement dans 2 zones (urbaine et rurale) du Sénégal. Il nécessitait, pour proposer des scénarios viables, d'intégrer une part non négligeable de connaissances expertes. Centré sur les populations, ce processus a permis la création d'un premier modèle générique sur l'accès à l'assainissement qui prend la forme d'un jeu de rôle. La pertinence de tels outils dans la caractérisation des besoins des usagers a été évaluée. Par ailleurs, l'attention a été portée sur l'acceptation par les usagers du service proposé et sa traduction en volonté de contributionSustainable Develoment Goals aim by 2030, to « achieve access to adequate and equitable sanitation and hygiene for all and end open defecation », by « using safely managed sanitation services ». Sanitation service can be defined by its technical and social components, and their interactions. This thesis focuses on both treatment infrastructures and involvement of all the stakeholders into service definition. Cross analysis of French Overseas Territories (FOT) and Senegal contexts, has identified common constraints that weigh on sanitation sector in tropical areas. From treatment infrastructure point of view, these constraints lead to suggest treatment wetlands systems and particularly French vertical-flow treatment wetland (FS-VFTW) to easier sludge managment, as a relevant solution. Their adaptation for tropical climate is the subjet of the first axis of our work. It aimed at defining their adaptation in terms of design, plant choices and defining the treatment wetlands type to implement according to outlet requirements. A hundred of 24h sampling campains were performed on 7 full scale demonstration plants, accross the 5 FOTs. Results show that despite more compacity, the proposed design allows maintaining performances at least similar to those observed in temperate climate. Due to climatic and organizational constraints inn tropical climate, a statistical analysis has been done to point out the resilience and reliability of the systems based on regulatory selfmonitoring data. It highlights the fact that FS-VFTWs are more reliable than most of the conventional treatment processes when applied for small size communities. Their physical barrier (filter) and their lower maintenance requirement explain this observation. The second axis of our research is based on an observed lack of consultation between stakeholders during the sanitation planning phase, which is responsible for the construction of the sanitation system. In particular, the users, their needs and their constraints are poorly and badly taken into account. Companion modeling approach could create both a support (the model) for discussing technical choices, as well as the framework within which the stakeholders could exchange points of view and find a sustainable consensus. Such a process has been developed and implemented for sanitation planning in 2 areas (urban and rural) of Senegal. Focused on household population, this process has led to create a generic model for sanitation access, embodied as a role playing game, which include a significant part of expert knowledge. The relevance of such tools in the characterization of user needs has been evaluated. In addition, attention was paid to users' acceptance of the proposed service and its translation into a willingness to contribute
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Mcguire-Wolfe, Christine Michelle. "Practices and Factors Influencing Sharps Use and Safety in a Suburban FIre Department and Among Emergency Medical Services Personnel." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4541.
Full textAbstract:
Needlestick injuries (NSIs) are a recognized risk for occupationally-related transmission of bloodborne pathogens (BBP). The occurrence of NSIs and BBP exposures among firefighters (FFs) and emergency medical services (EMS) personnel has been documented.
The purposes of this study were: 1) to define the problem of NSI among FFs and EMS personnel in a suburban fire department (FD) and identify practices and factors that influence sharps use and safety; 2) design and implement and intervention to promote safer sharps device usage; and 3) to measure the effectiveness of the intervention among FFs and EMS personnel.
A multi-phase, mixed methods approach was used that included a diagnosis phase that utilized a mixed methods exploratory design, an intervention period, and a quantitative evaluation phase that used a before and after evaluation design. In the diagnosis phase, data regarding sharps device practices were obtained through a count of discarded sharps devices. Qualitative data regarding sharps practices and factors which influenced those practice were obtained via focus groups. The PRECEDE/PROCEED model (PPM) was used as the theoretical framework for assessment, planning, implementation, and evaluation of an intervention to increase the occurrence of safer sharps device behaviors and decrease the frequency of riskier sharps device behaviors. The evaluation phase included a post-intervention sharps count and a post-intervention survey to assess changes in sharps practices and the impact of the intervention.
During the baseline sharps count, 2743 sharps devices were counted and classified according to pre-established categories of safer or risky behaviors for NSI. Altered safety devices on IV stylets were the highest count for unsafe behaviors (n=105), followed by recapped traditional needles (n= 53). A statistically significant increase in risky behaviors was observed in discarded sharps from engines, as opposed to ambulances, among all sharps devices combined (p=0.000) and IV stylets (p=0.000). When comparing advanced life support (ALS) medications to all other medications, a statistically significant increase in unsafe behaviors occurred among all sharps devices combined (p=0.000) and prefilled syringes (p=0.000). Input from eight focus groups of firefighters allowed for identification of multiple themes which guided the development of an intervention.
The intervention included distribution of a hands-on training kit and booklet, expansion of an existing required BBP training, and posters to increase awareness regarding NSI prevention.
In the evaluation phase, a total of 2178 sharps devices were counted and classified in a post-intervention sharps count. Altered safety devices on IV stylets were the highest count of unsafe behaviors (n=50). Recapped traditional needles were the second highest count of unsafe behaviors (n=27), but experienced an 18.7% drop in frequency when compared to baseline. When comparing riskier behaviors to the pre-intervention baseline sharps count, statistically significant decreases in risky behaviors were observed in all sharps devices combined ( 2=25.71, p=0.000), IV stylets (2=16.87, p=0.000), and traditional needles (=5.07, p=0.024).
A post-intervention survey, consisting of 15 Likert scale questions, was returned by 165 out of 383 active field personnel (41.3%). Results indicated high frequencies of strongly agree and somewhat agree responses regarding risk perception; the importance of using safer needle devices; the impact of the intervention on safer needle practices and sharps safety awareness.
Critical predisposing, reinforcing, enabling, and environmental factors which influenced sharps device practices were identified. This study identified factors and practices which influenced unsafe sharps device behaviors. Due to the statistically significant decreases in risky behavior in the post-intervention sharps count and the positive responses in the post-intervention survey, it can be concluded that the intervention did positively impact sharps device behavior and reduced the risk of NSI. The implications of the study are numerous and include a need to explore these practices and factors at other fire departments and EMS agencies, address gaps in regulations; promote research targeting FFs and EMS personnel in regard to NSI, and promote a nationwide effort to prevent NSI among emergency responders.
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Wright, Caradee Yael, and n/a. "UVR exposure of NZ schoolchildren." University of Otago. Dunedin School of Medicine, 2007. http://adt.otago.ac.nz./public/adt-NZDU20070817.093312.
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Excess exposure to solar ultraviolet radiation (UVR) is the only readily modifiable skin cancer risk factor, and childhood exposure is implicated in melanoma aetiology. To assist the design and evaluation of child sun protection interventions in the school and community context, this first comprehensive study used electronic monitors to record time-stamped, second-by-second UVR exposure of 325 children (from 28 randomly selected New Zealand primary schools) who kept a diary record of concurrent activities and sun-protective practices and completed a sun-related knowledge, attitudes and usual behaviours questionnaire. School principals and Health promoters (HPs) were interviewed about school and community sun protection efforts.
Using the Haddon matrix and Ottawa Charter of Health Promotion to guide research, four potential domains of influence were identified: the physical and social environments, protective products, and host (child). Two key outcomes identified were child UVR exposure and sun-protective practices. A path model was developed where potential influences on these outcomes included school, community, host factors (demographics, skin type, sun-related attitudes, and sun-related knowledge), and pattern of concurrent outdoor activity. Seven specific hypotheses were defined to investigate the effects of host, school and community factors on UVR exposure, sun-protective practices, and sun-related knowledge, attitudes and behaviours.
To test for the effects of host factors, day of the week and activity on UVR exposure and sun-protective practices, linear mixed models containing these factors and interactions between Year level-sex, activity-Year level and activity-sex, accounting for clustering within schools and allowing for repeated measures, were applied. Logistic regression with a random school effect was used to assess differences in scored student questionnaire items. Structural equation modelling was implemented to consider associations between sun-related knowledge, attitudes and behaviours, and other explanatory factors for variations in UVR exposure and sun-protective practices.
Three of the seven specific hypotheses were supported. There were statistically significant differences in UVR exposure by sex, skin type, day of the week and activity, and sex-activity and Year level-activity interactions. Passive pursuits were associated with the highest UVR exposure rates compared to outdoor active, travel and unclassified pursuits.
There were statistically significant differences in sun-protective practices by sex, ethnicity and skin type, and sex-activity and Year level-activity interactions. Girls tended to have higher sun protection scores than boys, but were more likely to sunbathe and use sunscreen. Children identifying with Pacific Island ethnicities had higher scores than children with other ethnicities, and children with Fitzpatrick skin types I and II had higher scores than children with skin types III, IV and V.
School and community factors were not associated with UVR exposure, sun-protective practices, sun-related knowledge, attitudes and behaviours, but school and HPs� scores were relatively high, reflecting the significant time and effort spent promoting youth sun protection.
Trends for Year level indicated that whereas child sun-related knowledge increased with Year level, attitudes and behaviours supportive of sun protection declined. When considering sun-related knowledge, attitudes and behaviours simultaneously, knowledge was only significantly associated with behaviours when mediated by attitudes. The study findings have implications for child sun protection interventions.
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Manona, Wellman Wela. "Impact of health, water and sanitation services on improving the quality of life of poor communities." Thesis, Stellenbosch : Stellenbosch University, 2004. http://hdl.handle.net/10019.1/49987.
Full textAbstract:
Thesis (PhD)--Stellenbosch University, 2004.ENGLISH ABSTRACT: Good health is a major imperative for social, economic and personal development, thus an important dimension of quality of life. Quality of life, in turn, is significantly influenced by access to the goods and services provided by the State. Access to infrastructure and services such as water and sanitation, has direct effects on health. Thus, the delivery of health, water and sanitation services should ensure improved access to basic needs, enhance the health profile of poor communities and their access to employment opportunities. Safe clean water supplies and adequate sanitation services therefore are among the major determinants of health. Health-related services such as water and sanitation should ensure a certain average life expectancy and eliminate mass disease and ill health. Mindful of the fact that there are many factors that determine the quality of life, the aim of the study was to investigate the impact of health, water and sanitation services in improving the quality of life among poor communities. To do this, this study adopted a comparative qualitative analysis approach between poorly serviced and adequately serviced areas. Subsequent to the findings, this study espouses constructive suggestions and recommendations that could act as guidance to community development agencies' strategies in amelioration of the quality of life among poverty-stricken communities. The research was based on a narrow model of services (health, water and sanitation services) that have impact on improving the quality of life among poor communities. The empirical findings of this study indicate these services to be insufficient to draw conclusive findings in other aspects of the survey. The research was conducted in a sample of 573 households in 6 communities in the Eastern Cape and Western Cape Provinces in South Africa. The sample comprised 3 communities in the category classified as poorly serviced with health, water and sanitation services, and 3 communities that were regarded as adequately provided with these services. The data was gathered by means of structured questionnaires, administered by the researcher with the assistance of a trained field worker. Additional, the data was gathered by means of a semi-structured, open-ended interview with a Sister-in-Charge of a clinic in the rural villages. The interaction between variables on the improvement of the quality of life were explored by means of basic statistics, which made it possible to assess the effects of independent and dependent variables. The results of data analysis provided support for the proposition contained in the premise of the study that although the provision of health, safe clean water and adequate sanitation services lead to improvement in the standard of living, their impact alone does not incorporate all the attributes that enhance quality of life as suggested by mainstream schools of thought in the health sector. Poverty-related factors also have to be taken into account. As such, the findings of this study have shown that poverty, combined with poor public health conditions, inadequate nutrition, overcrowded poor quality housing, lack of accessible drinking water and sanitation, renders communities vulnerable to ill health. Given the poor socio-economic conditions prevalent in the communities under investigation, it was not surprising that tuberculosis was most prevalent in all areas. In line with the premise of this study, there were instances that povertyrelated factors such as income, housing and nutrition had significant influences with regard to improvement in the quality of life. It became evident therefore that in certain instances, health, water, and sanitation services alone are not sufficient to make conclusive findings. Thus, the impact of povertyrelated factors such as income, housing and nutrition necessitate expansion of factors that impact on the quality of life to include their influence.
AFRIKAANSE OPSOMMING: Goeie gesondheid is 'n belangrike vereiste vir sosiale, ekonomiese en persoonlike ontwikkeling, en dus ook 'n wesenlike aspek van 'n goeie lewensgehalte. Toegang tot goedere en dienste wat deur die staat voorsien word, het ook 'n beduidende invloed op lewensgehalte. Boonop het die toegang tot infrastruktuur en dienste soos water en sanitasie 'n direkte invloed op gesondheid. Die lewering van gesondheids, water- en sanitasiedienste verseker dus die bevrediging van basiese behoeftes, onderwyl arm gemeenskappe se gesondheidsprofiel en daarmee saam hul toegang tot werksgeleenthede verbeter word. Toegang tot veilige en skoon waterbronne en voldoende sanitasiedienste is gevolglik van die belangrikste gesondheidsbepalers. Gesondheidsverwante dienste soos water en sanitasie verseker 'n sekere gemiddelde lewensverwagting, en verminder die moontlikheid van wydverspreide siektetoestande. Met inagneming van die feit dat lewensgehalte deur talle faktore beïnvloed kan word, was die doel van hierdie studie om ondersoek in te stel na die invloed van gesondheids, water- en sanitasiedienste op die verbetering van lewensgehalte in arm gemeenskappe. Gevolglik is 'n vergelykende analise tussen areas met swak dienslewering en areas met bevredigende dienslewering uitgevoer. Op grond van die bevindinge word sekere voorstelle en aanbevelings gemaak wat kan dien as riglyne vir ontwikkelingsagentskappe ter bevordering van die lewensgehalte in arm gemeenskappe. Die navorsing was gegrond op 'n beperkte model van dienste (gesondheids, water- en sanitasiedienste) wat die verbetering van lewensgehalte in arm gemeenskappe beïnvloed. Die empiriese bevindinge van die studie toon aan dat hierdie dienste onvoldoende is om as basis te dien vir beslissende uitsprake oor ander aspekte van die opname. Die studie het 'n steekproef van 573 huishoudings in 6 gemeenskappe in die provinsies van die Oos-Kaap en Wes-Kaap in Suid-Afrika ingesluit. Die steekproef het bestaan uit 3 gemeenskappe met swak gesondheids, water en sanitasiedienste, en 3 gemeenskappe waar sulke dienste op 'n bevredigende vlak voorsien word. 'n Gestruktureerde vraelys is gebruik om die navorsingsinligting in te samel, wat deur die navorser en 'n opgeleide veldwerker toegedien is. Bykomende inligting is bekom deur 'n semigestruktureerde onderhoud met die verpleeghoof van 'n kliniek in 'n landelike gemeenskap. Die invloed van die verskillende veranderlikes op lewensgehalte is deur middel van basiese statistiese analise geëvalueer. Die resultate van die data-analise verleen 'n mate van steun vir die premis van die studie dat hoewel die voorsiening van gesondheid, veilige, skoon water en voldoende sanitasie tot 'n beter lewenstandaard kan lei, die uitwerking daarvan as sodanig nie alle vereistes insluit vir 'n beter lewenstaard nie, soos voorgestaan deur hoofstroom denkskole in die gesondheidsektor. Faktore wat met armoede verband hou moet ook in ag geneem word. Die studie se bevindinge dui dus daarop dat armoede, tesame met swak openbare gesondheidstoestande, onvoldoende voeding, gebrekkige behuising en swak water- en sanitasiegeriewe gemeenskappe meer kwesbaar maak. Weens die swak sosio-ekonomiese toestande in die gemeenskappe in die steekproef, is gevind dat tuberkulose wydverspreid voorkom. Alhoewel die studie se hipotese met betrekking tot verskeie aspekte bevestig is, was daar ook gevalle waar armoede-verwante faktore soos inkomste, behuising en voeding 'n beduidende rol gespeel het. Dit het dus geblyk dat gesondheids, water- en sanitasiedienste nie in alle gevalle voldoende is om swak lewensgehalte te verklaar nie. Dus sal die faktore wat op lewens kwaliteit 'n impak maak, uitgebrei moet word om vir die invloed van armoede-verwante faktore soos inkomste, behuising en voeding voorsiening te maak.
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Taylor, Charlotte. "A socio-ecological perspective on the 'Food Dudes' healthy eating programme." Thesis, University of Worcester, 2017. http://eprints.worc.ac.uk/6393/.
Full textAbstract:
In response to poor levels of fruit and vegetable consumption in children across the UK, numerous interventions have been developed in schools in an attempt to encourage children to meet the recommended five a day. This programme of research examined the potential of a school-based healthy eating intervention, the Food Dudes programme, to increase children’s fruit and vegetable consumption in the long-term, at both school and at home, in 15 schools across the West Midlands. In contrast to previous studies that focused on the internal validity of the intervention, the programme of research utilised a socio-ecological approach to explore the wider contextual factors involved in behaviour change, beyond discussion of efficacy. Evidence from the six outputs indicated that the Programme was: effective in increasing fruit and vegetable consumption in the short-term only; more effective for children who consumed school-provided lunches than those provided from home (output 3); did not result in any decreases in high fat and/or sugar foods (output 4), not able to transfer to the home environment (output 5); and difficult to implement as part of the school day (output 6). Sustaining healthy eating behaviours beyond the intervention was a key challenge. Whilst interventions such as Food Dudes may work at the intrapersonal level of an ecological system, issues of sustainability arise from the intervention’s inability to extend or function beyond individual level behaviour change. The ecological approach on children’s’ eating behaviour offers an alternative theoretical approach to explain the effectiveness of interventions such as Food Dudes, and as a basis for proposing alternative intervention strategies.
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Young, Mairi Anne. "Optimising the role of the dental health support worker in Childsmile Practice : a comparative Realist approach." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/8111/.
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Background: Childsmile, the national oral health improvement programme for children in Scotland, aims to reduce oral health inequalities and improve access to dental services. Childsmile is delivered, in part, by a new category of lay or community-based worker known as a Dental Health Support Worker (DHSW) who supports families to improve oral health behaviours and attend a dental practice. Findings from Childsmile’s national process evaluation indicated there was widespread variation in delivery of the DHSW role and additional research was required to further understand and develop programme theory for the DHSW role; and clarify areas of variation which were adaptive and which were a risk to the programme meeting its desired objectives. Aims: The overarching aim was to gain further understanding of which factors and variants (contextual and those associated with programme delivery) impact on effectiveness of the DHSW role within Childsmile Practice. This research is a component study of the national Childsmile evaluation strategy. Findings will be fed back to the Childsmile programme to optimise delivery of the role and to enable future evaluation of the role’s impact. Methods: Learning and evidence generation was triangulated from two phases of research, comprising three component studies. Phase 1 comprised the sensitising study and comparative case studies: both provided learning from within Childsmile. The sensitising study was designed as a scoping exercise using qualitative data collection methods. The aim was to establish existing programme theory and explicate delivery of the DHSW role, while uncovering deviation (from programme theory) and variation within and between NHS boards. Findings were used to design three comparative case studies, comprising one DHSW and key stakeholders involved in delivery of the role from three NHS boards. The comparative case studies employed qualitative data collection methods; and were designed to address the overarching aim, and explore the casual links between context, delivery, and outcomes in delivery of the role using Realist-inspired analysis. Phase 2 comprised a Realist Review to provide learning from out with Childsmile. The aim was to gain an understanding of which components of child health interventions, delivered by lay health workers to parents, could influence ‘child health parenting behaviours’. Findings and Conclusions: Findings indicated that in terms of motivational readiness to engage with positive oral health parenting behaviours (POHPBs) there were three types of families referred to the DHSW for support: low, moderate, and high-risk. It was established that to address programme aims DHSWs ought to support moderate-high risk families, yet DHSWs only had capacity to support low-moderate risk families. Findings demonstrated that the Public Health Nurses/Health Visitors were best placed to triage families according to their needs and motivational readiness. The peer-ness of the DHSW role was found to positively influence parental engagement with the programme and facilitate person-centred support. However, an embedded ‘sweetie culture’ and health damaging environments were found to negatively impact on parents’ self-efficacy and perceived locus of control to engage with POHPBs. Learning indicated that: delivery over a prolonged period of time; incorporation of the programme into the Early Years Pathway and GIRFEC policy; and recent changes to the Children and Young Person (Scotland) Act (2014), served to embed Childsmile within the NHS boards and facilitated stakeholder buy-in, which positively impacted on delivery of the role. From the learning derived within and out with Childsmile the recommendations for the DHSW role included: (1) DHSW support should move away from a primarily information provision and facilitation of families into dental practice role, and incorporate socio-emotional and person-centred support; (2) The DHSW role should be redefined to support moderate-high risk families; and interpretation and application of referral criteria should be addressed to ensure continuity with who is referred for support; and (3) Programme theory for the DHSW role should be refined and future evaluative effort should concentrate on assessing impact.
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Al, Darwish Mohammed S. "Dental caries, oral health and life style variables among school children in Qatar." Thesis, University of Gloucestershire, 2014. http://eprints.glos.ac.uk/940/.
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Background: Effective delivery of dental services must be based on reliable information regarding the prevalence and severity of disease in the target population. Evaluation of the various factors known to influence the severity and progression of disease is essential for health policy makers to promote oral health resources and address oral health needs. Objective: The overall aim of this research is to describe the situation of dental caries and investigate the associations of level of oral health knowledge, teeth irregularity, BMI and other life style variables (TV viewing, internet use, passive smoking and dietary habits) with dental caries, including the impact of socio-demographic factors amongst school children in Qatar. Materials and methods: A cross-sectional study was conducted in Qatar from October 2011 to March 2012. A total of 2,113 children aged 12-14 years were randomly selected from 16 schools from different areas. Clinical examination was conducted by three calibrated examiners using World Health Organization criteria for diagnosing dental caries. Teeth irregularity was determined clinically according to a method described by Björk et al (1964). A pre-tested and structured questionnaire was used to assess oral health knowledge and life style data. Data analyses were performed. Results: The mean decayed, missing and filled teeth index values was 4.62 (±3.2), 4.79 (±3.5), and 5.5 (±3.7), respectively, for the 12, 13 and 14 year old children. The caries prevalence was 85%. The mandibular incisors and canines were least likely to be affected by dental caries, while maxillary and mandibular molars were the most frequently attacked by dental caries. Of the total sample, only one quarter reported a high level of oral health knowledge. There were more incidences of teeth crowding (44.1%) than teeth spacing (9.5%). The overall prevalence of underweight, overweight, and obesity was 5%, 10%, and 5% respectively. Almost half of the children spent > two hours watching television and 46% spent > two hours using internet. Approximately 35.8% of children had exposure to passive smoking. Concerning dietary habits, 99.4% of children consumed sugar containing snacks in between meals. Approximately 65% consumed sugar containing snacks within one hour of bed time. Almost 49.1% skipped eating breakfast regularly and 22.7% skipped eating lunch regularly. Around 83.8% consumed diary snacks in between meals. Overall, 74.2% drank tea in-between meals and 80.1% chewed gum in-between meals. All variables were affected by socio-demographic factors, but significant differences were found in female children in that they were more at risk to dental caries than male children. Also, children who resided in semi-urban areas were more at risk to dental caries than children who resided in urban areas. The occurrence of dental caries is significantly associated with the level of oral health knowledge, teeth irregularity, and other life style variables. Conclusion: The need to reduce sedentary behaviors and to promote a more active and healthy lifestyle is becoming increasingly essential in Qatar. Implementation of a community-based preventive oral health programs on a healthy diet and practices of adequate oral hygiene should be promoted in schools through integration into the school curriculum and services to combat the growing problem of dental caries.
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Caruth, Fran. "The health of Canadian women in the workforce : a comparison between homemaker women, workforce women and workforce men based on the 1979 Canada health survey." Thesis, University of British Columbia, 1987. http://hdl.handle.net/2429/26181.
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In the past twenty-five years there has been a marked increase in the number of women in the paid labour force, especially among women with young children. Time studies have shown that when a woman has a young family plus a position in the paid labour force, she works a very long day and has little time for recreational or leisure pursuits.
This thesis therefore poses the following questions:
1. Do women who participate in the paid labour force report poorer health status than their counterparts who are homemakers?
2. Do women who participate in the paid labour force exhibit lifestyle patterns significantly different from their homemaker counterparts?
3. Do women in the paid labour force exhibit health care utilization patterns significantly different from their homemaker counterparts?
and 4. Do women's lifestyles, reported health status and health care
utilization patterns differ from those of their male counterparts in the paid labour force?
Data from the 1978-79 Canada Health Survey (C.H.S.), which had asked a wide cross-section of Canadians about their lifestyle, health status and use of the health care system, were used to explore these questions. A model was then developed for this study which linked health risk behaviours, health status and health care related behaviours, and which used the variables available in the C.H.S. data base. Multiple Classification Analyses were carried out to determine the best predictors of women's health risk behaviours, health status and health care related behaviours. The three study groups were then standardized using the top two predictors and the rates of the various states and behaviours were compared.
First, in the prediction of women's health risk behaviours, the demographic variables included in the model were not effective as only 3-4% of the variance in the scores could be explained. Secondly, in the prediction of health status scores, the composite health risk scores developed for each subject plus the demographic variables were able to explain 4 - 11% of the variation. Thirdly, in the prediction of women's health care related behaviours the composite health risk scores, the health status scores and the demographic variables were together able to explain 14 - 27% of the variance.
When the standardized rates for high health risk behaviours were compared, there were significant differences between the three groups but no group was consistently better or worse than any other. The men's group however, consistently reported better health and less use of the health care system. The women's groups reported similar health states but women in the paid labour force reported a higher use of medications and fewer days in hospital.
The C.H.S. was designed to address issues which affect the whole population. The questions therefore, were not always sufficiently specific to describe the special circumstances of women, especially for example in their childbearing and nurturing years. The rapidly changing social and economic circumstances of women and their families, as women enter the paid labour force, plus the need for more information on their health risk behaviours - what these behaviours are, and what predisposes women to engage in them - point to the need for more research focused specifically on this section of the population.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Gordon, Roberta June. "Pregnant women's perception and application of health promotion messages at community health centres." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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Studies have shown that pregnant women do understand and value information of their unborn child. However, those providing health promotion services often focus on medical procedures and health education messages, ignoring the cultural, socio-economic and psychological dimensions that impact on women's health. This research aimed to look at a specific component of health promotion, i.e. health promotion messages shared with pregnant women attending Stellenbosch and Klapmuts Community Health Centre Antenatal Health Promotion Programme and their perceptions of how they apply messages in their daily lives.
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Moth, Richard Robert. "'The Business End' : perspectives on mental distress in the context of neoliberal restructuring of community mental health services." Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/5274/.
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Contemporary neoliberal reconfigurations of statutory mental health services involve significant organisational changes. Based on findings from twelve months fieldwork within a community mental health team, the thesis examines the effects of this new service landscape on the way conceptualisations of mental distress are utilised and articulated. The thesis combines critical realist epistemology and reflexive ethnographic method to produce a contextually situated understanding of the field capturing the dynamic relationships between concepts, agents and the context of action. This draws on and extends Rhodes’ ‘pentimento’ (1993) as a conceptual framework for understanding mental health practice. It argues the mental health team is a ‘differentially sedimented structural institution’ in which practitioners and service users navigate a field of contradictions defined by four strata: the custodial system of the asylum; the biomedical treatment system of the hospital; community care within the Keynesian welfare state; and neoliberal welfare reconfigurations. These are conceptualised as ideological positions that coexist within practitioners as alternative modes of thinking and operate in a relationship of mutual tension. Practice should be understood as a process shaped by mechanisms at different levels of scale from micro to macro, and involving movement between these overlapping and co-existing strata of historically sedimented meaning.
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Hanly, Teia. "The women's health initiative study: impact on the prescribing of hormone replacement therapy in a defined South African population." Thesis, Nelson Mandela Metropolitan University, 2006. http://hdl.handle.net/10948/519.
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Context: The Women’s Health Initiative (WHI) study, published in July 2002, had a significant impact on the prescribing of hormone replacement therapy (HRT). The controversy surrounding the findings, however, has led to much uncertainty regarding the prescription of HRT. Aims and Objectives: The aim of this study is to determine both the initial and the continued impact of the WHI study on the prescribing of HRT in a defined South African population and to determine whether HRT was appropriately individualised based on recommendations published subsequent to the WHI study. Setting: Claims data from a Managed Healthcare Organisation (MHO) that administers for a number of medical aid schemes in South Africa. Method: A retrospective drug utilisation review (DUR) was conducted to identify HRT-related prescribing patterns in the defined populations. The time-frame of the dataset included January 2002, to assess prescribing patterns prior to the publication of the WHI study, January 2003 to determine the initial impact of the WHI study, and January 2005 to assess the continued impact. An extensive, additional dataset of all the HRT users in the defined populations was utilised to conduct a sub-group analysis and determine whether HRT had been appropriately individualised. Key Findings: The percentage of patients in the dataset using HRT decreased from 30.05 percent in January 2002 to 28.30 percent in January 2003 and to 23.24 percent in January 2005, with the latter decrease reaching statistical significance. Although sex hormones and modulators (G03) of the genital system were the most frequently prescribed drug class in all three years of the study period, the prescribing frequency decreased significantly from 10.40 percent in January 2002 to 9.32 percent in January 2003 and 7.44 percent in January 2005. The most noteworthy change in the prescribing of HRT was a 3.95 percent decrease in the prescribing of conjugated equine estrogen (CEE), with a corresponding 2.53 percent increase in the prescribing of estradiol between January 2002 and January 2003. However, less pronounced changes were observed in the prescribing frequencies of other types of HRT, including medroxyprogesterone and estrogen (the HRT type investigated in the estrogen plus progestin phase of the WHI study). Patients initiating HRT post-WHI publication were generally found to be in the younger menopausal age categories (40 to 49 years). These patients were more likely to have been initiated on HRT types other than those investigated in the WHI study and were at a higher risk for disease states for which HRT use is beneficial, such as osteoporosis. Patients discontinuing HRT post-WHI publication were generally found to be in the older menopausal age categories (60 to 69 years), were more likely to have been combined HRT users (although not necessarily the type investigated in the WHI study) and were at a higher risk for disease states for which HRT use is considered harmful or has an uncertain effect, such as diseases affecting the cardiovascular system. Conclusion: It can be concluded that the WHI study did have an impact on the prescribing of HRT in the defined South African population of this study, but that the impact was considerably less than the impact reported in global studies. It was also determined that HRT was appropriately individualised according to recommendations made subsequent to publication of the WHI study.
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Omagari, Lynda Lee. "Depression among the elderly." CSUSB ScholarWorks, 2008. https://scholarworks.lib.csusb.edu/etd-project/3336.
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This study will examine depression among the elderly in an assisted living facility. The main problem in depression in the elderly is the lack of diagnosis and treatment. Left untreated it affects the elderly person's overall well-being and may eventually lead to their mortality.
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Woods, Ginger Lee. "Post Traumatic Stress Symptoms and Critical Incident Stress Debriefing (CISD) in Emergency Medical Services (EMS) Personnel." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etd/2035.
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EMS personnel were examined for Post Traumatic Stress symptoms and the usefulness of Critical Incident Stress Debriefing (CISD) using the Los Angeles Symptom Checklist (LASC) and a demographics questionnaire. This study revealed that women in this group show higher PTSD symptoms than male coworkers. Level of Training (LOT) of the EMS provider did not demonstrate a significant difference in whether a provider developed PTSD. EMS personnel receiving debriefing actually suffered greater levels of PTSD than those that did not receive debriefing. And 16% of EMS providers in this study suffered from PTSD, while approximately 20% suffered from partial PTSD or PTSS. The results suggest that there are high levels of PTSD within the EMS community, especially in women. This study also suggests that CISD does not help with PTSD symptoms and may actually worsen them.