Dissertations / Theses on the topic '200202 Evaluation of health outcomes'
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1
Bezerra, Roberto C. R. "Evaluation of the Epidemiologic Impact of a National Primary Health Care Policy on Infant Health Outcomes in Brazil, from 1999 to 2002." Diss., The University of Arizona, 2006. http://hdl.handle.net/10150/194486.
Full textAbstract:
Programa de Saude da Familia-PSF was initially proposed as a novel model of primary health care in Brazil in 1994 as it was implemented in several Brazilian municipalities. This national policy embraces different dimensions of primary care, but has a primary reliance on maternal and child health, especially on the survival of infants, given the unfavorable Brazilian child health scenario. This study has proposed that an improvement on infant health is expected to occur through three major mechanisms: overcoming of socio-cultural and geographical barriers of access to maternal and child health services; integrality of care; and community empowerment. An ecological longitudinal study design was utilized to assess the impact of the policy implementation on municipal indicators of infant health of 1201 municipalities, from 1999 to 2002. A group of municipalities that first implemented PSF in 1999 and were covered continuously from 1999 from 2002 were compared to a group of municipalities that didn't implement this policy within the same time period. This study has found that PSF has had an overall positive impact on infant health. Overall, it might be concluded that PSF implementation has brought an important short-term improvement on municipal indicators of infant health from 1999 to 2002, especially on the infant mortality rate. Such beneficial impact tended to be stronger in socially disadvantaged municipalities, commonly with unfavorable health care scenario. Thus, the expansion of primary health care capacity and overcoming of major gaps within the access to MCH services might explain such beneficial impact of PSF implementation in Brazilian municipalities.
2
Knutson, Sharon Ann 1963. "Critical paths: An evaluation of patient outcomes." Thesis, The University of Arizona, 1990. http://hdl.handle.net/10150/291565.
Full textAbstract:
Managed care has been proposed as a system for decreasing the cost and improving the quality of care to hospitalized patients. Critical paths, which time and sequence nursing and medical interventions, are an integral part of managed care. The purpose of this study was to describe the relationships between use of the critical paths and selected patient outcomes: length of hospital stay, mobility, pain medication regimen, and bowel regimen. A retrospective record review of hospital care for adults, having total hip replacements (n = 30), and total knee replacements (n = 30) suggested that the critical paths were used more intensively with patients having knee replacements. Although significant relationships between the intensity of use of the critical paths and patient outcomes were not found in this study, some of the findings were in the predicted direction.
3
Moucheraud, Corrina. "Evaluation of Strategies and Outcomes in Maternal and Child Health." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:16121157.
Full textAbstract:
Maternal and child mortality, particularly during the neonatal period, are among the most challenging global health issues of this era. This burden disproportionately affects the poorest populations, across and within countries. And although many of these deaths would be avertable, improvements in most countries have been slow. This dissertation explores three main research questions: (1) what is the effect of maternal health on infant outcomes?; (2) what survival gains could be attained through improved interventions, across the continuum of care?; and (3) how do health system characteristics affect the potential impact and cost-effectiveness of such interventions? The first paper uses decision modeling to evaluate how increased use of family planning and of improved intrapartum care could reduce maternal deaths in Nepal—as well as the cost-effectiveness of doing so, and of accompanying interventions to achieve these targets. The second paper estimates the potential impact of administering interventions from the Safe Childbirth Checklist at health facilities in India, and how “real world” implementation might see different results due to health system characteristics. Lastly, the third paper examines child survival outcomes following a maternal death in Ethiopia, using a long-term household-level longitudinal dataset. Together, these papers aim to provide new insights on approaches to reducing the high level of mortality among women and children.Global Health and Population
4
Jadambaa, Amarzaya. "Bullying in Australia: Prevalence, health outcomes, cost outcomes, and economic evaluation of bullying prevention." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/206147/1/Amarzaya_Jadambaa_Thesis.pdf.
Full textAbstract:
Bullying among children and adolescents is a major public health problem. The negative consequences of bullying are not limited to health problems, nor to experiences in childhood and adolescence, and can persist into adulthood. This research found that one in seven Australian children experienced bullying victimisation; bullying victimisation contributes a significant proportion of the burden of disease; a substantial annual cost to Australian society results from bullying; and further investment in bullying prevention is an efficient use of scarce healthcare resources. This thesis makes an important contribution to the field of bullying and the vital role of bullying intervention programmes.
5
Judkins, Daniel Glen 1950. "Head injury outcomes evaluation of a bicycle helmet law for children." Thesis, The University of Arizona, 1998. http://hdl.handle.net/10150/278664.
Full textAbstract:
Background. Bicycle helmets are 85% effective in protecting against head injury. The City of Tucson enacted an ordinance requiring children to wear a helmet. This quasi-experimental, population-based study evaluates this law's effectiveness. Hypotheses. Primary hypothesis: There will be a significant decrease in head injury occurrence in children after the helmet law. Secondary hypothesis H₂: There will be a significant decrease in head injury severity. Secondary hypothesis H₃: There will be a significant decrease in fatality due to head injury. Data collection. Trauma center trauma registry data, the hospital discharge data from other Tucson hospitals, and the medical examiner's case files. Data analysis. Chi square analysis of the proportion of head injury to all bike injuries, pre and post, revealed a significant drop in head injuries, confirming the primary hypothesis. Other analyses revealed a reduction in injury, but not to significant levels. Conclusion. The helmet law is effective.
6
Cunningham, Susan Jane. "Outcomes of orthognathic treatment." Thesis, University College London (University of London), 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.325911.
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7
Simatupang, Rentanida Renata. "Evaluation of Decentralization Outcomes in Indonesia: Analysis of Health and Education Sectors." Digital Archive @ GSU, 2009. http://digitalarchive.gsu.edu/econ_diss/58.
Full textAbstract:
This study examines the performance of decentralized health and education service delivery in Indonesia. Results show that education outcomes improved with decentralization, and that local governments are responding to local needs for education services. Decentralization also brings improvement to health services, as mortality rates and life expectancy are significantly improved with decentralization. However, results indicate that decentralization does not improve availability of health services, as only small percentage of municipalities in Indonesia have access to health facilities. The empirical study on the performance of proliferated municipalities provides similar conclusions to those obtained in the examination of general decentralization performance. Proliferated municipalities experience improvement in education outcomes but not so for health outcomes; these results are consistent with the previous examination. Therefore, from the result of this study, there is no evidence to reject proliferation as it does not hurt health and education service delivery outcomes.
8
Ren, Cizao. "Evaluation of interactive effects between temperature and air pollution on health outcomes." Thesis, Queensland University of Technology, 2007. https://eprints.qut.edu.au/16384/1/Cizao_Ren_Thesis.pdf.
Full textAbstract:
A large number of studies have shown that both temperature and air pollution (eg, particulate
matter and ozone) are associated with health outcomes. So far, it has received limited
attention whether air pollution and temperature interact to affect health outcomes. A few
studies have examined interactive effects between temperature and air pollution, but produced
conflicting results. This thesis aimed to examine whether air pollution (including ozone and
particulate matter) and temperature interacted to affect health outcomes in Brisbane, Australia
and 95 large US communities.
In order to examine the consistency across different cities and different countries, we used
two datasets to examine interactive effects of temperature and air pollution. One dataset was
collected in Brisbane City, Australia, during 1996-2000. The dataset included air pollution
(PM10, ozone and nitrogen dioxide), weather conditions (minimum temperature, maximum
temperature, relative humidity and rainfall) and different health outcomes. Another dataset
was collected from the 95 large US communities, which included air pollution (ozone was
used in the thesis), weather conditions (maximum temperature and dew point temperature)
and mortality (all non-external cause mortality and cardiorespiratory mortality).
Firstly, we used three parallel time-series models to examine whether maximum temperature
modified PM10 effects on cardiovascular hospital admissions (CHA), respiratory hospital
admissions (RHA), cardiovascular emergency visits (CEV), respiratory emergency visits
(REV), cardiovascular mortality (CM) and non-external cause mortality (NECM), at lags of
0-2 days in Brisbane. We used a Poisson generalized additive model (GAM) to fit a bivariate
model to explore joint response surfaces of both maximum temperature and particulate matter
less than 10 μm in diameter (PM10) on individual health outcomes at each lag. Results show
that temperature and PM10 interacted to affect different health outcomes at various lags. Then,
we separately fitted non-stratification and stratification GAM models to quantify the
interactive effects. In the non-stratification model, we examined the interactive effects by
including a pointwise product for both temperature and the pollutant. In the stratification
model, we categorized temperature into two levels using different cut-offs and then included
an interactive term for both pollutant and temperature. Results show that maximum
temperature significantly and positively modified the associations of PM10 with RHA, CEV,
REV, CM and NECM at various lags, but not for CHA.
Then, we used the above Poisson regression models to examine whether PM10 modified the
associations of minimum temperature with CHA, RHA, CEV, REV, CM and NECM at lags
of 0-2 days. In this part, we categorized PM10 into two levels using the mean as cut-off to fit
the stratification model. The results show that PM10 significantly modified the effects of
temperature on CHA, RHA, CM and NECM at various lags. The enhanced adverse
temperature effects were found at higher levels of PM10, but there was no clear evidence for
synergistic effects on CEV and REV at various lags. Three parallel models produced similar
results, which strengthened the validity of these findings.
Thirdly, we examined whether there were the interactive effects between maximum
temperature and ozone on NECM in individual communities between April and October,
1987-2000, using the data of 60 eastern US communities from the National Morbidity,
Mortality, and Air Pollution Study (NMMAPS). We divided these communities into two
regions (northeast and southeast) according to the NMMAPS study. We first used the
bivariate model to examine the joint effects between temperature and ozone on NECM in
each community, and then fit a stratification model in each community by categorizing
temperature into three levels. After that, we used Bayesian meta-analysis to estimate overall
effects across regions and temperature levels from the stratification model. The bivariate
model shows that temperature obviously modified ozone effects in most of the northeast
communities, but the trend was not obviously in the southeast region. Bayesian meta-analysis
shows that in the northeast region, a 10-ppb increment in ozone was associated with 2.2%
(95% posterior interval [PI]: 1.2%, 3.1 %), 3.1% (95% PI: 2.2%, 3.8 %) and 6.2 % (95% PI:
4.8%, 7.6 %) increase in mortality for low, moderate and high temperature levels, respectively,
while in the southeast region, a 10-ppb increment in ozone was associated with 1.1% (95% PI:
-1.1%, 3.2 %), 1.5% (95% PI: 0.2%, 2.8%) and 1.3% (95% PI: -0.3%, 3.0 %) increase in
mortality.
In addition, we examined whether temperature modified ozone effects on cardiovascular
mortality in 95 large US communities between May and October, 1987-2000 using the same
models as the above. We divided the communities into 7 regions according to the NMMAPS
study (Northeast, Industrial Midwest, Upper Midwest, Northwest, Southeast, Southwest and
Southern California). The bivariate model shows that temperature modified ozone effects in
most of the communities in the northern regions (Northeast, Industrial Midwest, Upper
Midwest, Northwest), but such modification was not obvious in the southern regions
(Southeast, Southwest and Southern California). Bayesian meta-analysis shows that
temperature significantly modified ozone effects in the Northeast, Industrial Midwest and
Northwest regions, but not significant in Upper Midwest, Southeast, Southwest and Southern
California. Nationally, temperature marginally positively modified ozone effects on
cardiovascular mortality. A 10-ppb increment in ozone was associated with 0.4% (95%
posterior interval [PI]: -0.2, 0.9 %), 0.3% (95% PI: -0.3%, 1.0%) and 1.6% (95% PI: 4.8%,
7.6%) increase in mortality for low, moderate and high temperature levels, respectively. The
difference of overall effects between high and low temperature levels was 1.3% (95% PI: -
0.4%, 2.9%) in the 95 communities.
Finally, we examined whether ozone modified the association between maximum temperature
and cardiovascular mortality in 60 large eastern US communities during the warmer days,
1987-2000. The communities were divided into the northeast and southeast regions. We
restricted the analyses to the warmer days when temperature was equal to or higher than the
median in each community throughout the study period. We fitted a bivariate model to
explore the joint effects between temperature and ozone on cardiovascular mortality in
individual communities and results show that in general, ozone positively modified the
association between temperature and mortality in the northeast region, but such modification
was not obvious in the southeast region. Because temperature effects on mortality might
partly intermediate by ozone, we divided the dataset into four equal subsets using quartiles as
cut-offs. Then, we fitted a parametric model to examine the associations between temperature
and mortality across different levels of ozone using the subsets. Results show that the higher
the ozone concentrations, the stronger the temperature-mortality associations in the northeast
region. However, such a trend was not obvious in the southeast region.
Overall, this study found strong evidence that temperature and air pollution interacted to
affect health outcomes. PM10 and temperature interacted to affect different health outcomes at
various lags in Brisbane, Australia. Temperature and ozone also interacted to affect NECM
and CM in US communities and such modification varied considerably across different
regions. The symmetric modification between temperature and air pollution was observed in
the study. This implies that it is considerably important to evaluate the interactive effect while
estimating temperature or air pollution effects and further investigate reasons behind the
regional variability.
9
Ren, Cizao. "Evaluation of interactive effects between temperature and air pollution on health outcomes." Queensland University of Technology, 2007. http://eprints.qut.edu.au/16384/.
Full textAbstract:
A large number of studies have shown that both temperature and air pollution (eg, particulate matter and ozone) are associated with health outcomes. So far, it has received limited attention whether air pollution and temperature interact to affect health outcomes. A few studies have examined interactive effects between temperature and air pollution, but produced conflicting results. This thesis aimed to examine whether air pollution (including ozone and particulate matter) and temperature interacted to affect health outcomes in Brisbane, Australia and 95 large US communities. In order to examine the consistency across different cities and different countries, we used two datasets to examine interactive effects of temperature and air pollution. One dataset was collected in Brisbane City, Australia, during 1996-2000. The dataset included air pollution (PM10, ozone and nitrogen dioxide), weather conditions (minimum temperature, maximum temperature, relative humidity and rainfall) and different health outcomes. Another dataset was collected from the 95 large US communities, which included air pollution (ozone was used in the thesis), weather conditions (maximum temperature and dew point temperature) and mortality (all non-external cause mortality and cardiorespiratory mortality). Firstly, we used three parallel time-series models to examine whether maximum temperature modified PM10 effects on cardiovascular hospital admissions (CHA), respiratory hospital admissions (RHA), cardiovascular emergency visits (CEV), respiratory emergency visits (REV), cardiovascular mortality (CM) and non-external cause mortality (NECM), at lags of 0-2 days in Brisbane. We used a Poisson generalized additive model (GAM) to fit a bivariate model to explore joint response surfaces of both maximum temperature and particulate matter less than 10 μm in diameter (PM10) on individual health outcomes at each lag. Results show that temperature and PM10 interacted to affect different health outcomes at various lags. Then, we separately fitted non-stratification and stratification GAM models to quantify the interactive effects. In the non-stratification model, we examined the interactive effects by including a pointwise product for both temperature and the pollutant. In the stratification model, we categorized temperature into two levels using different cut-offs and then included an interactive term for both pollutant and temperature. Results show that maximum temperature significantly and positively modified the associations of PM10 with RHA, CEV, REV, CM and NECM at various lags, but not for CHA. Then, we used the above Poisson regression models to examine whether PM10 modified the associations of minimum temperature with CHA, RHA, CEV, REV, CM and NECM at lags of 0-2 days. In this part, we categorized PM10 into two levels using the mean as cut-off to fit the stratification model. The results show that PM10 significantly modified the effects of temperature on CHA, RHA, CM and NECM at various lags. The enhanced adverse temperature effects were found at higher levels of PM10, but there was no clear evidence for synergistic effects on CEV and REV at various lags. Three parallel models produced similar results, which strengthened the validity of these findings. Thirdly, we examined whether there were the interactive effects between maximum temperature and ozone on NECM in individual communities between April and October, 1987-2000, using the data of 60 eastern US communities from the National Morbidity, Mortality, and Air Pollution Study (NMMAPS). We divided these communities into two regions (northeast and southeast) according to the NMMAPS study. We first used the bivariate model to examine the joint effects between temperature and ozone on NECM in each community, and then fit a stratification model in each community by categorizing temperature into three levels. After that, we used Bayesian meta-analysis to estimate overall effects across regions and temperature levels from the stratification model. The bivariate model shows that temperature obviously modified ozone effects in most of the northeast communities, but the trend was not obviously in the southeast region. Bayesian meta-analysis shows that in the northeast region, a 10-ppb increment in ozone was associated with 2.2% (95% posterior interval [PI]: 1.2%, 3.1 %), 3.1% (95% PI: 2.2%, 3.8 %) and 6.2 % (95% PI: 4.8%, 7.6 %) increase in mortality for low, moderate and high temperature levels, respectively, while in the southeast region, a 10-ppb increment in ozone was associated with 1.1% (95% PI: -1.1%, 3.2 %), 1.5% (95% PI: 0.2%, 2.8%) and 1.3% (95% PI: -0.3%, 3.0 %) increase in mortality. In addition, we examined whether temperature modified ozone effects on cardiovascular mortality in 95 large US communities between May and October, 1987-2000 using the same models as the above. We divided the communities into 7 regions according to the NMMAPS study (Northeast, Industrial Midwest, Upper Midwest, Northwest, Southeast, Southwest and Southern California). The bivariate model shows that temperature modified ozone effects in most of the communities in the northern regions (Northeast, Industrial Midwest, Upper Midwest, Northwest), but such modification was not obvious in the southern regions (Southeast, Southwest and Southern California). Bayesian meta-analysis shows that temperature significantly modified ozone effects in the Northeast, Industrial Midwest and Northwest regions, but not significant in Upper Midwest, Southeast, Southwest and Southern California. Nationally, temperature marginally positively modified ozone effects on cardiovascular mortality. A 10-ppb increment in ozone was associated with 0.4% (95% posterior interval [PI]: -0.2, 0.9 %), 0.3% (95% PI: -0.3%, 1.0%) and 1.6% (95% PI: 4.8%, 7.6%) increase in mortality for low, moderate and high temperature levels, respectively. The difference of overall effects between high and low temperature levels was 1.3% (95% PI: - 0.4%, 2.9%) in the 95 communities. Finally, we examined whether ozone modified the association between maximum temperature and cardiovascular mortality in 60 large eastern US communities during the warmer days, 1987-2000. The communities were divided into the northeast and southeast regions. We restricted the analyses to the warmer days when temperature was equal to or higher than the median in each community throughout the study period. We fitted a bivariate model to explore the joint effects between temperature and ozone on cardiovascular mortality in individual communities and results show that in general, ozone positively modified the association between temperature and mortality in the northeast region, but such modification was not obvious in the southeast region. Because temperature effects on mortality might partly intermediate by ozone, we divided the dataset into four equal subsets using quartiles as cut-offs. Then, we fitted a parametric model to examine the associations between temperature and mortality across different levels of ozone using the subsets. Results show that the higher the ozone concentrations, the stronger the temperature-mortality associations in the northeast region. However, such a trend was not obvious in the southeast region. Overall, this study found strong evidence that temperature and air pollution interacted to affect health outcomes. PM10 and temperature interacted to affect different health outcomes at various lags in Brisbane, Australia. Temperature and ozone also interacted to affect NECM and CM in US communities and such modification varied considerably across different regions. The symmetric modification between temperature and air pollution was observed in the study. This implies that it is considerably important to evaluate the interactive effect while estimating temperature or air pollution effects and further investigate reasons behind the regional variability.
10
Siripol, Samantha. "Health service delivery and health outcomes of at-risk populations." Master's thesis, Canberra, ACT : The Australian National University, 2018. http://hdl.handle.net/1885/154723.
Full textAbstract:
As required by the Master of Philosophy (Applied Epidemiology)
program I completed a field placement in the Strategic
Investment, Data and Evaluation Section in the Indigenous Health
Division, Australian Government Department of Health.
Following the introduction chapter (chapter 1), this thesis
contains three projects, which aimed to: 1) explore the
performance of health organisations providing social and
emotional wellbeing (SEWB) services for Aboriginal and Torres
Strait Islander peoples (chapter 2); 2) analyse the relationships
between health organisations’ cultural safety policies and the
uptake of Medicare Benefits Scheme (MBS) health assessments among
Aboriginal and Torres Strait Islander clients (chapter 3); and 3)
describe and the characteristics of inpatients who acquired vanA
vancomycin-resistant enterococci and compare the characteristics
of inpatients with vanA versus vanB sterile site infections at
the John Hunter and Calvary Mater Newcastle hospitals in
Newcastle, New South Wales (chapter 4).
My first project was a national survey of SEWB service delivery
in 2014-15 using a quantitative questionnaire, administrative
data and qualitative case studies. Service delivery strengths
included accessibility, capability, continuity, appropriateness,
responsiveness and sustainability. Fifteen opportunities to
strengthen SEWB service delivery were identified, including in
the areas of: client access, perceptions and experiences of
service delivery; strengthening the SEWB workforce; and
facilities required to support service delivery. These
opportunities represent potential approaches that could improve
the SEWB of Aboriginal and Torres Strait Islander peoples.
For my second project, I used logistic regression to model
univariate relationships between seven cultural safety policies
and low or high uptake of MBS health assessments in 2014-16 using
existing administrative and service performance data. Data from
174 health organisations showed no associations between cultural
safety policies and health assessment uptake, however this is
likely due to study and data limitations.
In my third project, I conducted two case series analyses. The
first described numbers and proportions of 168 vanA and vanAB
acquisitions in 2013-2015. It also examined potential
contributing environmental exposures and other risk factors that
might lead to infection or colonisation. The second case series
used Wilcoxon rank-sum, Chi-squared or Fisher’s exact tests to
compare morbidity and mortality outcomes between vanA and vanB
for 42 inpatients with laboratory-confirmed sterile site
infections in 2015. No specific environmental exposures or risk
factors that likely contributed to acquisition, and no difference
in morbidity and mortality outcomes between genotypes, were
identified. This may suggest that vanA is endemic to the hospital
environment, highlighting the importance of standard, enhanced
and tailored infection prevention and control precautions.
To meet the teaching requirements, I presented to my peers on
logic models and confounding. Additional to the program
requirements, I completed an internship in the Ebola Community
Engagement Team at the World Health Organization, Geneva,
Switzerland. Chapters 5 and 6, respectively, reflect on these
experiences.
I highly value the opportunities and the skills, experience and
knowledge in epidemiology, public health research and practice I
developed in the program. I applied my knowledge of logic models,
skills in data analysis and interpretation, and knowledge of the
importance of understanding and accommodating culture and belief
systems when addressing public health issues in my paid
employment in my field placement.
11
Newnham, Elizabeth A. "Informing best practice in mental health : using feedback to improve clinical outcomes." University of Western Australia. School of Psychology, 2009. http://theses.library.uwa.edu.au/adt-WU2010.0096.
Full textAbstract:
[Truncated abstract] Physical healthcare uses a suite of tools for measuring response to treatment. However, reliable systems of regular patient monitoring are rare in mental healthcare. Mental health services often measure a treatment response from pre- to post- therapy, yet measurement between those occasions is less common. This omission is problematic since arguably there is a need for an alarm system in psychotherapy (Andrews & Page, 2005). A substantial minority of patients do not experience reliable change following treatment, and a small proportion deteriorates (Hansen, Lambert, & Forman, 2002; Newnham, Harwood, & Page, 2007). Without monitoring, it is not always possible to know which patients are progressing poorly. Since the publication of Howard and colleagues' (1996) proposal that patient progress be monitored routinely during therapy and the results fed back to clinicians to direct treatment, this monitoring regime has garnered attention in the United States and Europe (Lambert, 2007; Lutz, et al., 2006). Findings in outpatient psychotherapy have demonstrated that providing real-time feedback on patient progress to clinicians and patients significantly improves clinical outcomes for those patients demonstrating a negative response to treatment (Harmon et al., 2007; Lambert et al., 2001; Lambert et al., 2002). What is not yet apparent is how these processes would generalize to inpatient and day patient (i.e. patients attending hospital for a whole day of treatment) psychiatric care. Inpatients often present with greater severity and are treated in an intensive setting. ... Deviations from this expected pattern would highlight possible differences between inpatient and outpatient care. To develop an appropriate system for monitoring patient progress, it was important to first define clinically significant recovery in inpatient psychiatric care, and provide criteria for clinicians to judge outcome in routine practice (Newnham, Harwood, & Page, 2007). Second, a quick and easy-to-administer system of progress monitoring and real-time feedback was developed to enhance treatment decision making (Newnham, Hooke, & Page, 2009). Third, the system was evaluated to determine clinical effectiveness. Using the World Health Organizations Wellbeing Index, a program for monitoring patient progress and providing feedback to clinicians and patients was established at Western Australia's largest private psychiatric service. The sample consisted of 1308 consecutive inpatients and day patients whose primary diagnoses were predominantly depressive (67.7%) and anxiety (25.9%) disorders. Feedback to patients and clinicians was effective in reducing depressive symptoms (F (1,649) = 6.29, p<.05) for those patients at risk of poor outcome, but not effective in improving wellbeing (F (1,569) = 1.14, p>.05). The findings support the use of progress monitoring and feedback in psychiatric care to improve symptom outcomes, but raise questions about changes in wellbeing during psychotherapy. The effectiveness study was conducted as a historical cohort trial, consistent with quality improvement efforts, and replication with a randomized controlled design is warranted. Feedback of progress information appears to be an important process within psychotherapy, and further investigation of the means by which clinicians and patients use that information is necessary.
12
Peltier, Diane. "An evaluation of a foundation’s community-wide initiative to impact mental health outcomes." Diss., Wichita State University, 2011. http://hdl.handle.net/10057/3934.
Full textAbstract:
This exploratory study was focused on mental health, broadly defined, as part of a larger
community assessment research project. The primary goals of this study were to determine how
a mental health initiative impacted the perceived care provided by the mental health-serving
organizations and also to identify promising practices of grantees. Because the goal of this study
was illumination and understanding, as opposed to prediction or causal determination, the data
collected were qualitative, coming from open-ended questions and archival data obtained from
the agencies. Organizations reported many strengths and successes, such as improved client
outcomes, partnerships and collaboration among agencies and community members, as well as
having a committed board, staff, administrators, and volunteers. Challenges for organizations
included measuring outcomes, securing adequate staffing levels, and securing adequate funding.
Overall, mental health-serving organizations reported positive changes in the community, but
could benefit from longer granting periods, capacity building activities, improved client access to
services, greater community awareness and reduced stigma associated with mental illnessDissertation (Ph.D.)--Wichita State University, College of Liberal Arts and Sciences, Dept. of Psychology
13
Haywood, Kirstie Louise. "Health outcomes in ankylosing spondylitis : an evaluation of patient-based and anthropometric measures." Thesis, University of York, 2000. http://etheses.whiterose.ac.uk/9814/.
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Coulibaly, Ibrahima. "EVALUATION OF THE IMPACT OF EDUCATION POLICIES ON STUDENT OUTCOMES AND HEALTH BEHAVIOR." OpenSIUC, 2020. https://opensiuc.lib.siu.edu/dissertations/1771.
Full textAbstract:
AN ABSTRACT OF THE DISSERTATION OFIbrahima Coulibaly, for the Doctor of Philosophy degree in Agricultural Science, presented on March 25, 2020, at Southern Illinois University Carbondale. TITLE: EVALUATION OF THE IMPACT OF EDUCATION POLICIES ON STUDENT OUTCOMES AND HEALTH BEHAVIORMAJOR PROFESSOR: Dr. Jebaraj Asirvatham Two essays in this dissertation examine the impact of education policies on student achievement, and enrollment. The third essay focuses on the association of health communication campaigns along with the targeted social health indicator and health behavior changes. In all chapters, the data are on a yearly time horizon and cover the data obtained from Southern Illinois University of Carbondale archives, Integrated Postsecondary Education Data System (IPEDS), and secondary data survey from the Department of Human Services (DHS) database. Chapter 2 data are from a randomized survey done on Southern Illinois University students to measure students' educational outcomes after getting eBook tablets in a pilot program done by Southern Illinois University in Carbondale. The pilot program started in Fall 2013 and the research work aimed to evaluate if tablets increase students’ achievements. This study investigated the effects of eBook tablets on higher education students' achievements using propensity score matching. This study shows a positive value of eBook tablets distributed to the incoming university students in terms of a cumulative increase of GPA over the total four undergraduate years. Therefore, universities and colleges across the United States could benefit by implementing more student-centered policies using technology like eBook tablets.Chapter 3 studies the impacts of the tuition guarantee program “Truth-in-Tuition” on university enrollments. The data is aggregate at the university levels from 2000-2017. Two universities from the state where policy was in place was compared to two universities from the state where there was no such policy. Date was collected from the National Center for Education Statistics Integrated Postsecondary Education Data System (IPEDS) website. Two nationally ranked universities (Southern Illinois Universities of Carbondale, and Illinois University at Chicago) were chosen from Illinois, and two randomly chosen regional universities (Southeast Missouri State University and Murray State University) from neighboring states (Missouri and Kentucky). A Difference-in-Difference method along with state and regional fixed effects is used. The findings of chapter 2 show that Truth-in-Tuition contributes more to the decline in national research extensive universities than regional universities.Chapter 4 studies the impact of health campaigns along with socio-economic health indicators on Rwandan households. It reports log-odds and likely behavioral changes made post AIDS campaign using logistic regression. This chapter uses the DHS household-level social health determinants such as education and health behavior, along with survey questions related to household health campaigns and health behavior changes after hearing about AIDS from 2005 to 2017. This study’s hypothesis is that health campaigns such brochures, flyers, posters, and newspapers, along with the health social determinants such as household education level, assets, literacy, sex of head of household, and health exposure to AIDS, have a positive impact on household behavior changes towards AIDS. The findings of this study show the interaction of health campaigns such as brochures/poster exposures, along with the educational attainment and household health exposure seems to be big contributors to changes in household behavior after hearing about AIDS in Rwanda.
15
Towers, Isabel Margaret Falcon. "The valuation of health outcomes data from clinical trials for use in economic evaluation." Thesis, University of Sheffield, 2005. http://etheses.whiterose.ac.uk/6075/.
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Dulin, Akilah Joyce. "An evaluation of neighborhood context and health lifestyles implications for obesity outcomes among children /." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2007. https://www.mhsl.uab.edu/dt/2009r/dulin.pdf.
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Bryniarski, Carol Ann. "RETROSPECTIVE CHART AUDIT ON PATIENT OUTCOMES RELATED TO NURSING DIAGNOSES IN A HOME HEALTH SETTING." Thesis, The University of Arizona, 1985. http://hdl.handle.net/10150/275322.
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McGee, Margaret Ann. "Health care outcomes evaluation of total hip arthroplasty patients : comparison of patient and doctor derived data /." Title page, contents and abstract only, 1999. http://web4.library.adelaide.edu.au/theses/09MPM/09mpmm145.pdf.
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Sanders, Danna Lane. "An Evaluation of the Utilization and Outcomes of a Georgia County Board of Health Innovative Worksite Wellness Policy." Digital Archive @ GSU, 2009. http://digitalarchive.gsu.edu/iph_theses/64.
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Introduction: Adult obesity is a significant public health problem, increasing chronic disease and resulting in health and economic implications. The worksite environment provides a setting for comprehensive Worksite Health Promotion programs that can benefit employees and employers. However, the literature identifies barriers to implementation of WHP programs and achievement of positive outcomes. The purpose of this study was to determine if a DeKalb County Board of Health Employee Wellness Policy that provides work breaks during the workday for employees to engage in wellness activities has resulted in actual use of the break and employee perceived benefits. The study also examined barriers to use of the wellness break. Methods: In collaboration with the DeKalb County Board of Health, a cross-sectional study of 187 employees across eight locations was conducted. The survey instrument included both quantitative and qualitative questions and was administered electronically or in person via group administration. Results: Of survey respondents, 74% knew about the Employee Wellness Policy, 57% understood policy guidelines, and 41% had ever used wellness breaks. Respondents most often reported using wellness breaks for physical activity, most often for walking/jogging. A majority of employees using wellness breaks reported positive outcomes including: increased physical activity (64.4%), weight loss (65.2%), increased productivity (79.5%), improved work relationships (86%), increased work morale (64.4%), and increased overall positive outlook (69.9%). Barriers to utilization included: lack of time, lack of knowledge, lack of encouragement from management, and clinical setting. Management employees were significantly more likely to know about the policy and understand policy guidelines compared to non-management employees. Clinical employees were significantly less likely to ever use wellness breaks and less likely to feel their manager supports the policy. Conclusion: Sampled employees participating in wellness breaks perceive health and work-related benefits; however barriers have prevented some employees from utilizing the breaks. Quantitative and qualitative data may inform wellness policy changes for improved utilization and outcomes. Findings related to self-reported employee outcomes provide some support for a discretionary paid work break policy in the workplace.
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Shao, Jung-Hua. "Evaluation of health-related outcomes following a self-management program for older people with heart failure." Thesis, Queensland University of Technology, 2008. https://eprints.qut.edu.au/20702/1/Jung-Hua_Shao_Thesis.pdf.
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Background. Heart failure (HF) which is a chronic, disabling disorder is mainly found in older people and is one of the leading causes of hospitalisation and readmission around the world. Unfortunately, the mortality and morbidity rates for HF remain high. HF is a complex combination of symptoms which are related to an inadequate perfusion of the body tissues caused by fluid and sodium retention. Hence, enhancing HF patients’ self-efficacy to change their behaviours to perform fluid & sodium control is one of the most important issues for the management of HF. A self-management program has the potential to raise self-efficacy and self-care which is a method to improve health for those with chronic illness and to decrease patients’ health service utilisation and also to enhance these patients’ health status. Aim. The study aims to examine the effectiveness of a self-management program, based on self-efficacy theory, in older people with heart failure in Taiwan. Methods. An experimental design was used to examine the effectiveness of a self-management program on diet and fluid control among HF patients. A total of 93 subjects from two medical centres in Taiwan were randomly assigned to the intervention and control groups. In order to examine the effectiveness of self-management, data were collected at baseline, week 4, and week 12 using the following instruments: self-efficacy for salt and fluid control, HF self-management behaviour, HF related symptoms, and body weight. Moreover, health service utilisation and patient’s evaluation of care received were collected on all patients for the 12 weeks prior to commencing the study and for the 12 week study period. Demographic and disease information was also collected including age, gender, marital state, education, and New York Heart Association (NYHA) functional classification. A structured, individualized self-management training program created by the investigator was implemented for the intervention group through home visits and telephone follow-ups. This program emphasized self-monitoring of diet control and body weight for the self-management of heart failure. The purpose was to improve patients’ self-efficacy in their diet control behaviour. The “diet control” in this study focussed on sodium and fluid restriction. Outcome measures were analysed using the Statistical Package for the Social Sciences (SPSS) 15.0 version, and the level of significance (á) was set at 0.05 for statistical analysis. Results. There were differences for older Taiwanese HF patients’ self-efficacy for salt and fluid control, self-management behaviour, and HF related symptoms for participants who received a self-management intervention compared to those who did not. However, there were no significant differences between the two groups in weight and health serves utilization (p>.001). Conclusion. The self-management program had a positive impact on the improvement of self-efficacy for salt and fluid control, HF related self-management behaviours and symptoms in older Taiwanese with HF. This program may bridge the gap between theory and practice. Health care providers need to provide older people in Taiwan with HF the appropriate skills for self-managing their condition and thereby promoting their health status. These patients with HF and their caregivers have to receive individualized education that emphasizes self-efficacy in the self-management of their disease, thus improving their quality of life.
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Shao, Jung-Hua. "Evaluation of health-related outcomes following a self-management program for older people with heart failure." Queensland University of Technology, 2008. http://eprints.qut.edu.au/20702/.
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Background. Heart failure (HF) which is a chronic, disabling disorder is mainly found in older people and is one of the leading causes of hospitalisation and readmission around the world. Unfortunately, the mortality and morbidity rates for HF remain high. HF is a complex combination of symptoms which are related to an inadequate perfusion of the body tissues caused by fluid and sodium retention. Hence, enhancing HF patients’ self-efficacy to change their behaviours to perform fluid & sodium control is one of the most important issues for the management of HF. A self-management program has the potential to raise self-efficacy and self-care which is a method to improve health for those with chronic illness and to decrease patients’ health service utilisation and also to enhance these patients’ health status. Aim. The study aims to examine the effectiveness of a self-management program, based on self-efficacy theory, in older people with heart failure in Taiwan. Methods. An experimental design was used to examine the effectiveness of a self-management program on diet and fluid control among HF patients. A total of 93 subjects from two medical centres in Taiwan were randomly assigned to the intervention and control groups. In order to examine the effectiveness of self-management, data were collected at baseline, week 4, and week 12 using the following instruments: self-efficacy for salt and fluid control, HF self-management behaviour, HF related symptoms, and body weight. Moreover, health service utilisation and patient’s evaluation of care received were collected on all patients for the 12 weeks prior to commencing the study and for the 12 week study period. Demographic and disease information was also collected including age, gender, marital state, education, and New York Heart Association (NYHA) functional classification. A structured, individualized self-management training program created by the investigator was implemented for the intervention group through home visits and telephone follow-ups. This program emphasized self-monitoring of diet control and body weight for the self-management of heart failure. The purpose was to improve patients’ self-efficacy in their diet control behaviour. The “diet control” in this study focussed on sodium and fluid restriction. Outcome measures were analysed using the Statistical Package for the Social Sciences (SPSS) 15.0 version, and the level of significance (á) was set at 0.05 for statistical analysis. Results. There were differences for older Taiwanese HF patients’ self-efficacy for salt and fluid control, self-management behaviour, and HF related symptoms for participants who received a self-management intervention compared to those who did not. However, there were no significant differences between the two groups in weight and health serves utilization (p>.001). Conclusion. The self-management program had a positive impact on the improvement of self-efficacy for salt and fluid control, HF related self-management behaviours and symptoms in older Taiwanese with HF. This program may bridge the gap between theory and practice. Health care providers need to provide older people in Taiwan with HF the appropriate skills for self-managing their condition and thereby promoting their health status. These patients with HF and their caregivers have to receive individualized education that emphasizes self-efficacy in the self-management of their disease, thus improving their quality of life.
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Jetty, Prasad. "Endovascular versus open repair of abdominal aortic aneurysms: A population-based evaluation of outcomes and resource utilization in Ontario." Thesis, University of Ottawa (Canada), 2009. http://hdl.handle.net/10393/28074.
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Objective. Two large randomized trials that compared elective EndoVascular Aneurysm Repair (EVAR) with open repair for non-ruptured abdominal aortic aneurysms (AAA) have demonstrated similar long-term mortality rates but increased costs associated with EVAR. Despite these data, the use of EVAR continues to increase in North America. There are currently very limited population-based adjusted data looking at long-term outcomes and resource utilization.
Methods. All patients who underwent elective AAA repair between April 2002 and March 2007 in Ontario were identified using data from hospital discharge abstracts. ICD-10-CA and Canadian Classification of health Interventions (CCI) codes were used in a validated algorithm to identify patients who underwent either EVAR or open repair of non-ruptured AAAs. Pre-operative co-morbidities were measured using the Charlson co-morbidity index. Risk stratification into quintiles was performed using propensity score analysis.
Results. Overall, 6461 patients underwent treatment of non-ruptured AAAs (N: EVAR 888; open 5573). Patients undergoing EVAR were older and had more comorbidities. The adjusted 30-day mortality was significantly lower in the EVAR group (adjusted OR= 0.34 [0.20-0.59]). The adjusted all-cause long-term mortality was similar in both groups (OR= 0.95 [0.81-1.05]). After adjustment for significant confounders, rates of imaging studies and both urgent and vascular readmissions were statistically higher in the EVAR group. However, the EVAR group had significantly shorter length of stay for the index hospitalization, all subsequent hospitalizations, and the intensive care unit. Discharge to a nursing home or other chronic care facility after the index procedure was also lower in the EVAR group (OR= 0.55 [0.41-0.0.74]). The durability of the repair of EVAR vs. open techniques as indicated by the rate of repeat interventions following the index procedure for EVAR (OR= 1.3 [0.98-1.75]) did not reach statistical significance.
Conclusion. After adjusting for pre-operative risk factors, there was no difference in long-term mortality between EVAR and open repair in Ontario. The significantly lower 30-day mortality rate in EVAR patients was not sustained over longer-term follow-up. Although the utilization of imaging studies and hospitalizations was significantly higher in the EVAR group, patients undergoing open repair spent more days in hospital (including readmissions), more time in ICU, and were more likely discharged to a chronic care facility.
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Costa, Gabriel Weber. "The effects of Brazil’s family health strategy on educational outcomes." reponame:Repositório Institucional do FGV, 2018. http://hdl.handle.net/10438/23978.
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We aim to evaluate the effects of Brazil’s Family Health Strategy (FHS), a large-scale community-based health intervention, on educational outcomes during primary and secondary education.We use student-level data and adopt a differences-in-differences approach that explores timing of program implementation across municipalities and students’ year and location of birth to estimate FHS effects on enrollment flow, school delay, and Mathematics and Portuguese performance. Results suggest that FHS implementation is associated with an increased probability that students stay in school after age 7 and a decreased probability that students are delayed by two or more grades, although the latter seems to fade after age 12. Estimates for student performance indicate that the program decreases test scores, although these estimates could be affected by compositional changes in treatment and control groups. We also find evidence that program effects are stronger when time of exposition is increased, which is consistent with the FHS continuous expansion over time and with previous research.
Este trabalho tem como objetivo avaliar os efeitos da Estratégia Saúde da Família (FHS), uma intervenção de saúde de larga escala implementada ao nível comunitário no Brasil, sobre resultados educacionais durante a educação básica. Utilizando dados de alunos, é adotada uma estratégia de diferenças em diferenças que explora variações no tempo de implementação da FHS nos municípios brasileiros e informações sobre ano e localidade de nascimento de cada aluno para se estimar os efeitos do programa sobre fluxo escolar, atraso escolar e desempenho em matemática e língua portuguesa. Os resultados sugerem que a implementação da FHS está associada com uma maior probabilidade de que os alunos permaneçam na escola após os 7 anos de idade e uma menor probabilidade de que os alunos estejam atrasados por duas ou mais séries, apesar de esse último parecer se dissipar após os 12 anos de idade. Estimativas para desempenho dos alunos indicam que a FHS diminui as notas durante o quinto ano, entretanto esses resultados podem ser afetados por mudanças na composição nos grupos de tratamento e controle. Também são encontradas evidências de que os efeitos do programa são maiores quando o tempo de exposição é maior, o que é consistente com a expansão da FHS ao longo do tempo e com resultados de pesquisas anteriores.
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Tsarouhas, Afroditi. "Understanding organizational context for the evaluation of training outcomes: A multi-site case study in the community mental health sector." Thesis, University of Ottawa (Canada), 2004. http://hdl.handle.net/10393/26786.
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The evaluation of training models has evolved from Kirkpatrick's (1959) four level model and Brinkerhoff's (1987) six stages of effective human resource development to Guskey's (2000) five critical levels of professional development. This evolution responds to the changing needs of organizations. Analyses of organizational contexts is gaining in importance given that these analyses point to the specific aspects of organizations which require attention to enhance the likelihood that training outcomes will be successfully implemented (Bennett, Lehman & Forst, 1999).
The study formally tests the factors outlined in the third level (organizational support and change) of Guskey's (2000) model. These factors make up the conceptual framework in order to explore and assess the contextual congruence of organizational context to determine whether the current context is conducive to the successful implementation of training outcomes. The study further examines the applicability of Guskey's (2000) third level factors outside educational settings as well as other relevant factors that may not have been considered. Guskey's (2000) third level factors are partially tested to ascertain whether they are adaptable within the community mental health sector. (Abstract shortened by UMI.)
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Noyes, Jane. "Evaluation of health and social care provision for ventilator-dependent children in the UK : costs and outcomes." Thesis, University of York, 2004. http://etheses.whiterose.ac.uk/9852/.
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Asper, Karizza B. "Improving Outcomes on Weight Loss and Adherence Through Evaluation of Follow-up Visits in a Structured Weight Management Program." Thesis, Grand Canyon University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10639148.
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The focus of this project was to determine if a relationship existed between weight loss as a result of follow-up visits and adherence as a result of follow-up visits in patients with BMI >26 kg/m2 enrolled in the weight loss program during 12 weeks of treatment. The project was based on two clinical questions which include: In patients with BMI >26 kg/m 2, how do follow-up visits affect weight loss during 12 weeks of treatment? In patients with BMI >26 kg/m2, how do follow-up visits affect adherence during 12 weeks of treatment? The practice improvement project utilized a quantitative methodology with a correlational design. The primary investigator’s clinical questions were tested using two-way mixed analysis of variance (ANOVA) (within-subjects and between-subjects) and one-way ANOVA. The location of the project was at a weight loss clinic located in Southern California, and 156 patients’ charts were used for retrospective chart reviews and a sample of 156 participants answered the MOS-SAS (short version) questionnaire. The theoretical underpinnings for the practice improvement project included the Health belief model and Integrated theory of health behavior change. The results of the project concluded that weekly follow-up visits had significant impact on weight loss, specifically, in the first six weeks of the program. Results also showed weekly follow-up visits (M = 4.51, SD = .317, n = 91) produced significantly greater levels of adherence compared to bimonthly follow-up visits (M = 3.69, SD = .480, n = 61) during 12 weeks of treatment. The future nursing, practice, and research implications of the study include focusing on strong implementation of weekly follow-up visits, additional contact support, integrating weight loss teaching sessions, and determining perceived barriers to exercise adherence.
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Mosquera, Méndez Paola Andrea. "Evaluation of a primary health care strategy implemented in a market-oriented health system : the case of Bogota, Colombia." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-86996.
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Introduction: Despite Colombia having adopted a health system based on an insurance market, Bogota in 2004, as part of a left-wing government (elected for first time in the city), decided to implement a Primary Health Care (PHC) strategy to improve quality of life, level of population health and reduce health inequities. The PHC strategy has been implemented through the HomeHealth program by three consecutive governments over the last eight years in the context of continuous political tension stemming from differences between national and district health policies. This thesis is an attempt to provide a better understanding of the overall experience of implementing a PHC strategy in the context of a market-oriented health care system. The research aimed to evaluate results of the PHC strategy through the intervention of the Home Health program and to identify factors that have enabled or limited the on-going PHC implementation process in Bogota. Methods: This study used a combination of quantitative and qualitative methods. A descriptive analysis was performed to assess direct results of the PHC strategy in terms of progress in the Home Health program coverage and increases in health personnel ratios reaching out to poor and vulnerable groups in Bogota. A cross sectional analysis was carried out to evaluate qualities of the delivery of PHC services through the attainment of PHC essential dimensions in the network of first-level public health care facilities. An ecological analysis was performed to estimate the contribution of the PHC strategy, through the Home Health program, to improve child health outcomes and to reduce health inequalities. A qualitative multiple case study was conducted to identify contextual factors that have enabled or limited the on-going PHC implementation process in Bogota. Results: The descriptive analysis showed a notable initial increase and rapid expansion in the development of the PHC strategy between 2004 and 2007, followed by a period of slower growth and stagnation between 2007 and 2010. The cross-sectional analysis suggested that the Home Health program could be helping to improve the performance of first-level public health care facilities. Ratings assigned to PHC dimensions by different participants pointed out the need to strengthen family focus, community orientation, financial resources distribution, and accessibility. The ecological analysis showed that localities with high PHC coverage had a lower risk of under-five mortality, infant mortality and acute malnutrition as well as a higher probability of being vaccinated than low PHC coverage localities. The belonging to a high-coverage locality was significantly associated with risk reductions of under-five mortality (13.8%) and infant mortality by pneumonia (37.5%) as well as increases in the probability of being vaccinated for DPT (4.9%). Concentration curves and concentration indices indicated inequality reductions in all child indicators betwen 2003 and 2007. In 2007 (period after implementation), the PHC strategy was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-five mortality (24%), infant mortality rate (19%), acute malnutrition (7%) and DPT vaccination coverage (20%). The main facilitators of the results achieved so far by the PHC strategy were all related to the commitment and good will of actors at different levels. Longterm political commitment, support by local mayors and hospital managers, organized communities historically active in the process of social participation, as well as extramural work carried out by community health workers and health care teams were highly valued. Barriers to the implementation included the structure of the national health system itself, lack of a stable funding source, unsatisfactory working conditions, lack of competencies among health workers regarding family focus and community orientation, and limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation. Conclusion: Despite adverse contextual conditions and limitations imposed by the Colombian health system itself, Bogota’s initiative of a PHC strategy has helped to improve the performance of first-level public health care facilities in the essential dimensions of PHC and has also contributed to improvement of child health outcomes and reduction of health inequalities associated with socioeconomic and living conditions. Significant efforts are required to overcome the market approach of the national health system. Structural changes to social policies at the national and district level are needed if the PHC strategy is expected to achieve its full potential. Specific interventions must be designed to have well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.
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O'Gorman, Patricia M. "Economic evaluation of arthroplasty choice for femoral neck fractures." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/98419/1/Patricia_O%27Gorman_Thesis.pdf.
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This thesis examined the cost-effectiveness of different types of arthroplasty and fixation methods used to treat femoral neck fractures in the Australian health system. Using a decision analytic model, the study measured the costs and health outcomes associated with different treatment options to determine which prostheses led to cost-effective care.
Cemented fixation of prostheses was found to be more cost-effective than uncemented fixation. The cost-effectiveness of different arthroplasties varied with age and whether QALYs or revision surgeries were the health outcome assessed.
The results support recommendations that cemented prostheses be used for femoral neck fractures. Further research into defining population groups, collecting preference based values of health states and costs would be beneficial to inform further research into this area.
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Madiba, Thomas Khomotjo. "Evaluation of dental emergency outcomes of the Oral Health Fitness Classification of the South African Military Health Service (SAMHS) in Gauteng - South Africa." Diss., University of Pretoria, 2012. http://hdl.handle.net/2263/30881.
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Background: The South African National Defence Force (SANDF) like other Defence Forces of the world, conducts medical classification on their members. This medical classification has, as one of the components, an Oral Health Fitness (OHF) classification which is done according to North Atlantic Treaty Organisation (NATO) standards. The aim of the Oral Health Fitness classification is to standardize dental readiness, assess oral health, prioritize dental care, minimize the number of dental emergencies (DE), and emphasize the importance of good oral health to all active duty and reserve forces. Medical classification is conducted by the South African Military Health Services (SAMHS). Aim: The aim of the study was to evaluate the dental emergency outcomes of the Oral Health Fitness classification of the SAMHS in Area Military Health Unit Gauteng (AMHU GT), South Africa Objectives: To determine dental emergency rate for the SAMHS, analyse the dental emergencies and to make recommendations regarding dental emergencies to the SAMHS Methods: A cross-sectional retrospective record analyses of members of the SANDF that received an OHF classification of 1 and 2 in AMHU GT in 2009. The AMHU GT members were followed up for a year to determine if they developed dental emergencies. Data analysis included frequency tables, chi-square tests and logistic regression analysis. The level of significance was set at p<0.05. Results: The dental emergency rate for AMHU Gauteng was 307/1000 per year. The type of dental emergencies were: 58.5% dental restorations, 13% extractions and related complications, 4.3% crown and bridge, 3.9% emergency root canals, 9.9% recementations, 3.6% denture related problems while other emergencies were 6.8%. Patients were more likely to experience a dental emergency if they were white, female, of OHF 2 classification and older than fifty years of age. Conversely they were least likely to experience a dental emergency if they were black, male, of OHF 1 classification and in the age group 31-40. Conclusion: The dental emergency rate of 307/1000 per year for the SANDF is high compared to military health units from other countries and it was influenced by race, age and gender. The types of dental emergencies were mainly preventable.Dissertation (MChD)--University of Pretoria, 2012.
Community Dentistry
Unrestricted
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COTTINI, ELENA. "Human Capital Accumulation and the Labour Market: Applications Using Evaluation Methods." Doctoral thesis, Università Cattolica del Sacro Cuore, 2007. http://hdl.handle.net/10280/112.
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Human capital accumulation and its effect on labour market outcomes have been in the focus of economic research for decades. Traditionally the economic literature suggests that there might exist several forms of human capital, where human capital represents the knowledge, skills and health embodied in individuals. Skills and knowledge are largely acquired through education and experience but may also reflect, in part, innate abilities. In addition, some aspects of motivation and behaviour, as well as attributes such as the physical, emotional and mental health of individuals are also considered as human capital. These activities are referred to as human capital because people cannot be separated from their knowledge, skills and health, in the way they are separated from their physical and capital assets. Human capital accumulation is an important determinant of individuals' earning capacity and employment prospects, therefore plays an important role in determining the level and distribution of income in society. Moreover, the costs of these investments include direct outlays on market goods and the opportunity cost of the time that must be withdrawn from competing uses. Apart from direct investments in human capital people could also invest in constructing a network of relationships for example to find a job. Until now all these aspects have been studied separately, in this thesis I try to reconcile them.
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Bittner, Olin J. "Designing a Data-Tracking System for a Private Therapeutic Day School." Antioch University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1448896028.
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Khutan, Ranjit. "Demonstrating effectiveness : competing discourses in the use and evaluation of applied theatre that contributes to improved health outcomes for prisoners." Thesis, University of Manchester, 2015. https://www.research.manchester.ac.uk/portal/en/theses/demonstrating-effectiveness-competing-discourses-in-the-use-and-evaluation-of-applied-theatre-that-contributes-to-improved-health-outcomes-for-prisoners(0288f5a2-69ac-48ab-bbe7-b3bbe5b73daf).html.
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This thesis explores the ways in which applied theatre practitioners and companies evaluate their practice that contributes to improved health outcomes for prisoners in the UK. By examining the discourses around evaluation, and specifically how and what influences these, this thesis aims to offer a deeper understanding of the approaches used to evaluate applied theatre work and the wider socio-political influence on the evaluation of applied theatre practice. This research is driven by a personal desire to understand the contributions and effectiveness of applied theatre in prisons and how understanding around effectiveness between practitioners from the arts, health and criminal justice sector can be enhanced. The research questions that drive this enquiry are threefold: how is applied theatre planned and implemented in prisons when it contributes to improved health outcomes for prisoners; how and to what extent are theatre companies influenced by national policy in the arts, health, and the criminal justice sector when they evaluate their practice; and what approaches and methods do applied theatre companies use to evaluate their interventions in prisons and how do they communicate these to others. The ontological and epistemological positions held in this study stem from a critical realist position. Adopting a Critical Discourse Analysis approach offered by Norman Fairclough, and supplementing this with Michel Foucault's work and philosophy around power/knowledge, allowed for the exploration of broader discourses and concepts. Focussing on work carried out in prisons by five theatre companies in the UK during the New Labour government period 1997-2010, this thesis charts the impact of policy on evaluation, and critically discusses and examines how evaluation is reported through their evaluation reports and in interviews with company staff. I present the analysis and discussion in successive detail using Fairclough's approach that focuses on the identification of discourses at the macro, meso and micro level. Through the metaphor of the prison bar, I shed light on the macro policy level evaluation discourses that restrict the work of applied theatre practitioners through the explicit drive for measurement, evidence and proving worth (discourses that create a bar for applied theatre practitioners). At the meso practice level I examine these discourses through the notion of power/knowledge and authority, present in the evaluation documents produced by these companies and outline how companies uphold policy directives and maintain the status quo whilst simultaneously questioning the dominant discourse of what counts as evidence (discourses that push at the bars that policy has created); and finally, at the micro level I explore the discourses expressed by applied theatre practitioners, outlining their rejection of the positivist dominated evaluation policy discourse and the approaches that can demonstrate the outcomes of their work (discourses that set the bar for future practice). I conclude this thesis with a summary of these discourses, demonstrating how an understanding of these may assist in the future evaluation of practice, as well as collaborative work that aims to improve the health and wellbeing of prisoners.
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Maimela, Eric. "Evaluation of tuberculosis treatment outcomes and the determinants of treatment failures in the Eastern Cape Province, 2003-2005." Diss., Pretoria: [s.n.], 2009. http://upetd.up.ac.za/thesis/available/etd-11262009-001135/.
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McMillan, Carolyn Vivienne. "A psychometric evaluation of measures of quality of life and related health outcomes in adults with growth hormone deficiency." Thesis, Royal Holloway, University of London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251666.
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Chan, Raymond. "A long-term evaluation of the impact of rehabilitation in home (RIO) program on health outcomes in older adults." Thesis, Queensland University of Technology, 2008. https://eprints.qut.edu.au/16623/1/Raymond_Chan_Thesis.pdf.
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Background:
Older adults experience health deconditioning during hospitalization. There are many facets of care impacting on older adults' health characteristics and their self confidence in managing their health. The aim of this follow-up study is to examine the long term effect of comprehensive discharge planning and nursing in-home follow-up for older adults (over 65 year old) incorporating physiotherapy exercise strategies on health characteristics. No published studies were located that had examined the impact of a comprehensive discharge program on the functional status and psychosocial among older frail adults at 12 months post-discharge.
Design and methodology:
Rehabilitation in Older People (RIO program) is a randomised controlled trial which evaluates the intervention of a comprehensive discharge program, exercise program incorporating nursing follow up. Participants of the RIO study were randomly allocated into usual care control group and an intervention group. The intervention group received a comprehensive training from an advanced practice gerontic nurse (APGN) and exercise strategies by physiotherapists. The APGN visited the participants in their home 48 hours post discharge, followed by telephone follow-up at 4, 8, 12 and 24 weeks. This study followed-up this cohort at 12 month via telephone interviews to evaluate their functional ability, quality of life, psychosocial characteristics and the levels of self-efficacy. The General Self-efficacy Scale (GSE) was used to measure their self-efficacy.
Results:
There is no difference between the demographic and health characteristics between the control and intervention group. There are significant difference in their functional ability, psychosocial health, measured by the tools mentioned above at 4 weeks (p < 0.05), 12 weeks (p < 0.05), and 24 weeks (p < 0.05), but not at 52 weeks. The possible reason could be due to lack of telephone follow up. Moreover, the levels of self-efficacy in this sample have been found to correlate with the functional ability and psychosocial at 12 months after discharge from an acute hospital.
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Chan, Raymond. "A long-term evaluation of the impact of rehabilitation in home (RIO) program on health outcomes in older adults." Queensland University of Technology, 2008. http://eprints.qut.edu.au/16623/.
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Background: Older adults experience health deconditioning during hospitalization. There are many facets of care impacting on older adults' health characteristics and their self confidence in managing their health. The aim of this follow-up study is to examine the long term effect of comprehensive discharge planning and nursing in-home follow-up for older adults (over 65 year old) incorporating physiotherapy exercise strategies on health characteristics. No published studies were located that had examined the impact of a comprehensive discharge program on the functional status and psychosocial among older frail adults at 12 months post-discharge. Design and methodology: Rehabilitation in Older People (RIO program) is a randomised controlled trial which evaluates the intervention of a comprehensive discharge program, exercise program incorporating nursing follow up. Participants of the RIO study were randomly allocated into usual care control group and an intervention group. The intervention group received a comprehensive training from an advanced practice gerontic nurse (APGN) and exercise strategies by physiotherapists. The APGN visited the participants in their home 48 hours post discharge, followed by telephone follow-up at 4, 8, 12 and 24 weeks. This study followed-up this cohort at 12 month via telephone interviews to evaluate their functional ability, quality of life, psychosocial characteristics and the levels of self-efficacy. The General Self-efficacy Scale (GSE) was used to measure their self-efficacy. Results: There is no difference between the demographic and health characteristics between the control and intervention group. There are significant difference in their functional ability, psychosocial health, measured by the tools mentioned above at 4 weeks (p < 0.05), 12 weeks (p < 0.05), and 24 weeks (p < 0.05), but not at 52 weeks. The possible reason could be due to lack of telephone follow up. Moreover, the levels of self-efficacy in this sample have been found to correlate with the functional ability and psychosocial at 12 months after discharge from an acute hospital.
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Feeling, Nicole. "An Evaluation of HRV and Emotion Regulation as Moderators of the Relation between Traumatic Events and Physical and Mental Health Outcomes." The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1565644829014341.
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Esgin, Tuguy. "Evaluation of acceptance and efficiency of exercise for Indigenous Australians to benefit physiological, anthropometric and metabolic syndrome outcomes." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2017. https://ro.ecu.edu.au/theses/2003.
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The proposed study will provide an increased understanding in a much-understudied area of how the Australian Indigenous community perceives physical activity and the beneficial effects for improving health outcomes.
The PhD will be made up of three studies:
1) To design an exercise prescription that is culturally appropriate and specifically addresses the major Indigenous health issues around metabolic syndrome.
The first will be a cross sectional study that surveys the motivators and barriers to physical activity within the Perth Noongar community. The results of this study will be used to enhance the intervention section of the PhD. It will provide a more accurate and the best means of ensuring not only a greater uptake, but also ways of developing positive lifelong physical activity habits.
2) Determining the amount of physical activity taking place within the Noongar community.
Utilising the Global Physical Activity Questionnaire to measure the amount of physical activity and sedentary rates within the Indigenous community.
3) Evaluate the compliance and effectiveness of the developed intervention to inform future exercise therapy programmes for this population.
The second study will be a randomised control trial looking at the physiological responses to a combination of aerobic and anabolic (resistance) exercise. The significance of this aspect of the PhD will be to capture and record physiological and quality of life measures some not previous recorded in the Indigenous community. This will inform policy relation to the most appropriate targets for eliciting successful behaviour change to improve health in Indigenous and non-Indigenous populations
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Underhill, Andrea T. "Gender differences in traumatic brain injury outcomes survival, functional independence, and employment status /." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2008p/underhill.pdf.
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Luengo-Fernandez, Ramon. "Resource costs, health outcomes and cost-effectiveness in stroke care : evidence from the Oxford Vascular Study." Thesis, University of Oxford, 2009. http://ora.ox.ac.uk/objects/uuid:a5012d51-6794-48a7-bb78-4e5166e8cfdf.
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Introduction: Cerebrovascular events are a major cause of mortality, disability and healthcare resource use. Despite this, there is a lack of reliable information on their costs and outcomes, particularly related to transient ischaemic attacks (TIA) and minor stroke. Such information is vital to inform decisions about local and national service provision, and to provide reliable estimates for use in cost-effectiveness analyses. Aims This thesis estimates the costs and outcomes of stroke and TIA using data from a population-based study undertaken in a population of over 91,000 individuals in Oxfordshire (the Oxford Vascular Study – OXVASC). In addition, the thesis aims to estimate the short-term cost-effectiveness of two secondary stroke prevention programmes evaluated in a study nested within OXVASC. Methods: Using multiple methods of case ascertainment, 1,282 patients were identified as having suffered a stroke or TIA, of which 1,199 (723 stroke and 476 TIA) patients consented to the study. Follow-up of patients took place at 1, 6, 12 and 24 months, with data collected on patients’ disability, medication usage, living arrangements, and quality of life. Healthcare resource use information was derived from hospital and primary care records, and priced using published unit costs. Findings: Stroke patients had higher case-fatality rates than TIA patients (15% vs. 1%; p<0.001), with 5-year life expectancy being one year longer for TIA patients. For stroke and TIA survivors, the risk of disability remained higher, at around 30% at each of the four follow-ups, than at baseline (17%; p<0.001 for all follow-ups). After standardising for age and gender, average quality of life for stroke and TIA patients combined was significantly lower than English population norms (p<0.001 for all follow-ups). However, when quality of life was compared to population norms by event type, quality of life differences between TIA patients and English population norms no longer remained statistically significant. Important predictors of quality of life included event severity, baseline disability and recurrent vascular events. Total costs were considerably higher 1-year after the initial stroke or TIA than for the year preceding it and, except for day cases, increases were observed for all resource-use categories. Five years after the index event, stroke patients incurred costs of £16,923 (95% CI: 15,149 to 18,858) per patient, significantly higher than those incurred by TIA patients, at £13,904 (95% CI: 11,488 to 16,657; p=0.019). In multivariate analyses, event severity was found to be a significant predictor of inpatient care resource use and costs, as were the presence of recurrent vascular events, especially stroke and coronary events. For non-hospitalised patients, results showed that urgent outpatient specialist assessment and treatment reduced the 90-day risk of fatal or disabling stroke (0.4% vs. 5%, p<0.001) compared with less urgent assessment and treatment. In terms of resource usage, patients who were assessed and treated urgently had lower recurrent stroke hospitalisation (2% vs. 8%; p=0.001), and reduced overall number of days in hospital (average reduction of 4 days; p=0.017). These reductions in hospital resource usage generated savings of £643 per patient assessed and treated urgently in an outpatient clinic (p=0.028). Conclusion: Despite the impact of stroke on death, disability and healthcare resource use, there is a lack of reliable information on costs and outcomes, especially for TIA and minor stroke. Through the use of a population-based study, the gold-standard study design when assessing the incidence and outcomes of TIA and stroke, this thesis provides healthcare decision makers and researchers with a wealth of data on the resource use patterns, costs and outcomes of TIA and stroke patients, and their main predictors.
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Bennett, Paul J. "An investigation into the health related outcomes of surgery performed by Fellows of the Australian College of Podiatric Surgeons." Thesis, Queensland University of Technology, 1999. https://eprints.qut.edu.au/36746/1/36746_Digitised%20Thesis.pdf.
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Health care providers in the United States, United Kingdom and Australia debate the need for expanding the role of podiatrists' to include the surgical care of foot problems. Paradoxically, during a twelve month period from July 1995 to June 1996, Fellows of the Australian College of Podiatric Surgeons (FACPS) performed over 1,500 individual surgical operations on approximately 785 Australians.
Few prospective investigations of podiatric surgeon outcomes have been conducted, none of which have taken place in Australia. More particularly, no studies have used valid psychometric instruments to measure the effects of care provided on patients' "health related quality of life". The research contained in this thesis deals with the conceptualisation, development and validation of a new health status instrument: the Foot Health Status Questionnaire. This instrument has been developed with the specific intent of investigating the impact of FACPS on patients' health related quality of life.
One hundred and forty-two subjects treated by eleven Fellows for orthopaedic, neurological or integumentary systems diseases of the foot were recruited into a six month long quasi-experimental repeated measures (time series) study. The study identified that the vast majority of subjects (more than 92%) who underwent foot surgery experienced significant improvements' in a range of health related quality of life dimensions and indicated that they would undergo their procedure again. In particular, a MANCOVA analysis demonstrated that subjects' reported reduced levels of foot pain, increased levels of physical function, improved general foot health perception and footwear related quality of life, up to six months after their respective operations.
Adverse effects of surgery identified in this study include a significant short-term functional disability for subjects' undergoing orthopaedic correction of foot problems and, in the immediate post operative phase, a significant reduction in social function for all three groups of subjects'. Generic measures of General Health and Vitality, as captured by the Short Form 36 health status instrument, were unaffected by Fellows treatment. This study did not identify any significant short to medium term morbid outcomes.
Assessment of patients' satisfaction with surgery one, three and six months postoperatively reflected a general under-reporting of the beneficial effects of foot surgery. These findings support the premise that; specific health related quality of life measures provide significant explanatory power about the outcomes of care compared with the more traditional approach of evaluating patient satisfaction with surgery.
In summary, it has been recommended that podiatrists, like other health care professionals, use recognised methods to determine whether their care meets professional standards and to generate evidence to prove that it does. This research contributes to meeting this important public health need.
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Campbell, Megan Michelle. "The adaptation of the 'Clinical Outcomes in Routine Evaluation-Outcome Measure' (CORE-OM) from English into a valid Xhosa measure of distress." Thesis, Rhodes University, 2013. http://hdl.handle.net/10962/d1001538.
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In South Africa access to mental healthcare resources is restricted for a number of reasons including language barriers that prevent suitable communication between mental healthcare professionals and African language speaking South Africans. The translation of psychometric tools into African languages has been identified as one method in improving access to psychological services for African language speakers. The Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) has demonstrated its clinical utility within the United Kingdom (UK) National Healthcare Service (NHS) as a standardised psychotherapy outcome measure that evaluates the degree of psychological distress individuals present with at the start of psychotherapy treatment, and the degree of change that has been effected at the termination of therapy. A measure like the CORE-OM holds valuable clinical utility for the South African context. This thesis argues that the availability of a valid Xhosa version of the CORE-OM would allow for improved access to psychotherapy resources for Xhosa speaking individuals, and allow for the evaluation of the effectiveness of psychotherapy interventions conducted in Xhosa. The CORE-OM developers have provided a translation design and set of guidelines to standardise the translation of the CORE-OM into different languages. However this thesis argues that these guidelines are incomplete. Instead International Test Commission (ITC) guidelines are recommended as a culturally sensitive method to supplement current CORE-OM translation guidelines, in order to generate a valid Xhosa measure of distress. A mixed methods approach is applied which first investigates the construct equivalence and bias of the CORE-OM English version within a South African student population sample, both qualitatively and quantitatively, in order to establish the degree of adaptation required to generate a valid Xhosa version of distress. Next the CORE-OM English version is translated into Xhosa using the five-stage translation design prescribed by the CORE System Trust, supplemented by ITC guidelines. All changes made to the CORE-OM during translation into Xhosa are documented. The CORE-OM Xhosa version is then investigated for reliability and validity. This investigation reveals low internal reliability within the subjective wellbeing domain indicating that these items are less meaningful as depictions of distress within the Xhosa language. A reduced version of the CORE-OM demonstrates strong psychometric properties as a valid Xhosa measure of distress.
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Mugoya, Isaac. "Retrospective descriptive evaluation of empiric carbapenem-sparing regimens versus carbapenem use in non-intensive care patients at a district hospital in South Africa." University of Western Cape, 2021. http://hdl.handle.net/11394/8228.
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Magister Pharmaceuticae - MPharmAntimicrobial resistance is a global concern associated with increased morbidity and mortality. It has been estimated that, by 2050, the continuous escalation of antimicrobial resistance, globally, will result in more deaths per year, compared to cancer and diabetes. The direct and indirect impact of ineffective antibiotics, and therefore, antimicrobial resistance, will be hardest felt by low and middle-income countries, as the financial burden will be too great to manage. Carbapenems are considered the last line of antimicrobials to treat multidrug-resistant bacterial infections. They are the preferred choice to treat infections, presenting with extended-spectrum beta-lactamases (ESBL) producing Enterobacteriacea. Various strains of bacteria that have become resistant, due to the selective pressure, as a result of carbapenem over use, are referred to as Carbapenem-resistant Enterobacteriaceae (CRE).
2022
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Munro, Louise Ellen. "The development and evaluation of a culturally affirmative counselling model for deaf clients in Australia." Thesis, Queensland University of Technology, 2010. https://eprints.qut.edu.au/46997/1/Louise_Munro_Thesis.pdf.
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In Australia, there is only one, newly established, dedicated mental health service catering specifically for the signing *Deaf community. It is staffed by four part-time hearing professionals and based in Brisbane. There are currently no Deaf psychologists or psychiatrists and there is no valid or reliable empirical evidence on outcomes for Deaf people accessing specialised or mainstream mental health services. Further compounding these issues, is the fact that there are no sign language versions of the most common standardised mental health or psychological instruments available to clinicians in Australia. Contemporary counselling literature is acknowledging the role of the therapeutic alliance and the impact of 'common factors' on therapeutic outcomes. However, these issues are complicated by the relationship between the Deaf client and the hearing therapist being a cross-cultural exchange. The disability model of deafness is contentious and few professionals in Australia have the requisite knowledge and understanding of deafness from a cultural perspective to attend to the therapeutic relationship with this in mind. Consequently, Deaf people are severely disadvantaged by the current lack of services, resources and skilled professionals in the field of deafness and psychology in this country. The primary aim of the following program of research has been to propose a model for culturally affirmative service delivery and to provide clinicians with tools to evaluate the effect of their therapeutic work with Deaf people seeking mental health treatment. The research document is presented as a thesis by publication and comprises four specific objectives formulated in response to the lack of existing services and resources. The first objective was to explore the use of social constructionist counselling techniques and a reflecting team with Deaf clients, hearing therapists and an interpreter. Following the establishment of a pilot counselling clinic, indepth semi-structured interviews were conducted with two long-term clients following the one year pilot of this service. These interviews generated recommendations for the development of a new 'enriched' model of counselling to be implemented and evaluated in later stages of the research program. The second objective was to identify appropriate psychometric measures that could be translated into Australian Sign Language (Auslan) for research into efficacy, effectiveness and counselling outcomes. Two instruments were identified as potentially suitable; the Outcome Rating Scale (ORS), a measure of global functioning, and the Session Rating Scale (SRS), a measure of therapeutic alliance. A specialised team of bi-lingual and bi-cultural interpreters, native signers and the primary researcher for this thesis, produced the ORS-Auslan and the SRS-Auslan in DVD format, using the translation and back-translation process. The third objective was to establish the validity and reliability of these new Auslan measures based on normative data from the Deaf community. Data from the ORS-Auslan was collected from one clinical and one non-clinical sample of Deaf people. Statistical analyses revealed that the ORS-Auslan is reliable, valid and adequately distinguishes between clinical and non-clinical presentations. Furthermore, construct validity has been established using a yet to be validated sign language version of the Depression, Anxiety and Stress Scale-21 items (DASS-21), providing a platform for further research using the DASS-21 with Deaf people. The fourth objective was to evaluate counselling outcomes following the implementation of an enriched counselling service, based on the findings generated by the first objective, and using the newly translated Auslan measures. A second university counselling clinic was established and implemented over the course of one year. Practice-based evidence guided the research and the ORS-Auslan and the SRS-Auslan were administered at every session and provided outcome data on Deaf clients' global functioning. Data from six clients over the course of ten months indicated that this culturally affirmative model was an effective approach for these six clients. This is the first time that outcome data have been collected in Australia using valid and reliable Auslan measures to establish preliminary evidence for the effectiveness of any therapeutic intervention for clinical work with adult, signing Deaf clients. The research generated by this thesis contributes theoretical knowledge, professional development and practical resources that can be used by a variety of mental health clinicians in the context of mental health service delivery to Deaf clients in Australia.
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Nygren, Peggy. "Exploring the Effects of Multi-Level Protective and Risk Factors on Child and Parenting Outcomes in Families Participating in Healthy Start/Healthy Families Oregon (HS/HFO)." PDXScholar, 2013. https://pdxscholar.library.pdx.edu/open_access_etds/1513.
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While many studies focus on the links between multiple risk factors and negative outcomes such as child maltreatment, less is known about the influence of protective factors in the face of risks. The theoretical base of this study was a social ecological model of interactive influences including individual parent, family, and neighborhood level factors to predict outcomes. Protective Factor Index (PFI) and Risk Factor Index (RFI) predictors were developed to explore potential multi-level protective factor buffering effects on key child development and parenting outcomes. Participants were first time mothers enrolled in a randomized controlled study of the Healthy Start/ Healthy Families Oregon (HS/HFO) home visitation program (treatment group) who completed a follow-up phone survey at the child’s 12 month birthday (n = 405). Families were offered HS/HFO services prenatally after meeting risk screening eligibility criteria on the New Baby Questionnaire (NBQ). Program mothers having received at least one home visit (n = 248) were included in the final analyses. Families had an average of 3.1 (SD = 1.2) NBQ risk factors at enrollment and 83% reported having trouble paying for basic needs. Families received an average of 16 home visits in the first 6 months of the program. Thirty-one percent of mothers were aged 19 or younger, 60% were White and Non-Hispanic, 31% were Hispanic, and 9% were another race/ethnicity. Hierarchical regression models with main effects (RFI, PFI, race) and an interaction term (RFI X PFI) were developed to predict eight outcomes. Interaction effects models were not significant. Five RFI main effects were significant: higher RFI scores were associated with greater likelihood of child welfare involvement, greater parenting stress, less favorable scores on child health and well-being, lower parent responsiveness and ii acceptance, and less supportive learning environments. One PFI main effect was significant: higher PFI scores predicted lower parenting stress. A trend level result showed higher PFI scores were associated with less child welfare involvement. Race was significant in two models: White/Non-Hispanic families were more likely to have a home visitor report child welfare involvement and had more frequent parent-child activities compared to other race/ethnicity families. Unpacking the results with separate single risk factor (12 items) and protective factor (10 items) regression models followed. Results showed parent’s prior family history of maltreatment and younger maternal age predicted child welfare involvement (home visitor report), while protection was seen for those with access to housing support. Social support and family functioning protectors were linked to lower parenting stress, while maternal depression showed the opposite finding. Better scores on a child health and well-being measure were seen with higher neighborhood cohesion and greater participation in HS/HFO; in contrast, neighborhood violence and frequent mobility were linked to worse scores. Developmentally supportive home environments were seen for families participating in additional parent support programs, in which the mother had greater knowledge of infant milestones and behavior, and if the family had access to housing supports. Unemployment proved to be associated with less enriched home environments. In summary, there was no support for the cumulative PFI in buffering risk for negative outcomes in this model. The RFI was also a more robust predictor of outcomes compared to the PFI in the main effects models. Overall, study findings provide some evidence for the utility of specific protective factors, as well as cumulative and specific single risk factors, for screening families for effectively targeting services and guiding the conceptual development of program and evaluation formats.
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Mavranezouli, Ifigeneia. "The derivation of a preference-based measure for people with common mental health problems from the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM)." Thesis, University of Sheffield, 2014. http://etheses.whiterose.ac.uk/6724/.
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Background: Generic preference-based measures (PBMs), such as the EQ-5D and SF-6D, are widely used for the estimation of Quality Adjusted Life Years in cost-utility analyses of healthcare interventions. However, their relevance in some disease areas, including mental health, has been questioned. Objective of the thesis: To derive a PBM specific to mental health problems from an existing condition-specific measure (CSM) Methods: A systematic literature review was conducted to identify an appropriate CSM for the derivation of a health state classification. Derivation of the new measure was achieved using novel methodology developed for this purpose, due to the high correlation across the items of the original CSM. Selected health states were valued by members of the public. Regression analysis was employed to predict utility values for all states of the health state classification. Psychometric and qualitative assessments evaluated the performance of the new PBM compared with generic PBMs and the original CSM. Results: The Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) was selected as the basis for the derivation of the new PBM. Application of novel methodology based primarily on Rasch analysis resulted in the development of CORE-6D, a health state classification that consists of a 5-item emotional component and a physical item. Rasch analysis was used to select plausible health states for valuation. A highly predictive regression model was used to attach utility values to all CORE-6D health states. The new PBM has shown promising results regarding its psychometric properties compared with generic PBMs and suffers from little loss of information relative to the original measure, CORE-OM. Further research needs to validate these findings. Conclusion: The CORE-6D preference-based index will enable cost-utility analysis of mental health interventions using existing and prospective CORE-OM datasets. The new methodology for deriving PBMs from existing instruments can be useful for the derivation of PBMs from other instruments with highly correlated dimensions.
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Araujo, Rogério Olmedija de. "Avaliação da qualidade de vida de pacientes com hanseníase: uso do dermatology life quality index e do medical outcomes study 36." Universidade Federal do Amazonas, 2010. http://tede.ufam.edu.br/handle/tede/2776.
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Previous issue date: 2010-11-19Leprosy is a chronic infectious disease caused by ycobacterium leprae, Bacillus acid-resistant, with tropism for Schwann cells and skin. Although curable disease still presents a major public health problem in Brazil, with its higher morbidity due to nervous injury due to permanent physical disabilities and deformities, which significantly impair quality of life of patients. Objective: To assess the quality of life of leprosy patients at diagnosis and at discharge using the Dermatology Life Quality Index (DLQI) and the Medical Outcomes Study 36 (SF-36). Methodology: descriptive study, a prospective study that evaluated 57 patients with confirmed diagnosis of leprosy, and these were classified according to their operational diagnosis (multibacillary and paucibacillary), all being subjected to questionnaires DLQI and SF-36. Results: There was a predominance of the disease in males (59.6%) and multibacillary cases (35.1% in early treatment and 31.6% at the end of tramaneto). It was found that multibacillary patients as compared to paucibacillary had higher sensory changes (p value 0.002), worse quality of life index measured by DLQI (p = 0.04) and worse quality of life in the physical domain as measured by SF- 36 (p = 0.026). Conclusions: leprosy causes damage to quality of life of sufferers, especially those diagnosed as multibacillary
A Hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae, bacilo álcoolácido resistente, com tropismo pela célula de Schwann e pele. Apesar de curável a doença ainda se caracteriza como um grande problema de saúde pública no Brasil, sendo sua maior morbidade associada ao acometimento nervoso devido às incapacidades físicas e deformidades permanentes, que comprometem significativamente a qualidade de vida dos pacientes. Objetivo: avaliar a qualidade de vida de pacientes de hanseníase recém diagnosticados e no momento da alta por meio do Dermatology Life Quality Index (DLQI) e o Medical Outcomes Study 36 (SF-36). Metodologia: estudo transversal, descritivo, prospectivo, que avaliou 57 sujeitos com diagnóstico confirmado de hanseníase, e estes foram classificados de acordo com o seu diagnóstico operacional (multibacilar e paucibacilar), sendo todos submetidos aos questionários DLQI e SF-36. Resultados: encontrou-se predominância da doença no sexo masculino (59,6%) , bem como de casos multibacilares (35,1% em início de tratamento e 31,6% em término de tratamento). Verificou-se que pacientes multibacilares quando comparados aos paucibacilares apresentaram maiores alterações sensoriais (p valor 0.002), pior índice de qualidade de vida mensurado pelo DLQI (p=0,04), e pior qualidade de vida no domínio aspecto físico medido pelo SF-36 (p=0,026). Conclusões: a hanseníase causa prejuízos a qualidade de vida de seus portadores, principalmente aqueles diagnosticados como multibacilares
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Malik, Samreen Mohammad. "A systemic Review: Are Outcomes of Aortic Valve Repair ‘A Beneficial alternative’ for patients with Aortic Valve Insufficiency?" Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-93368.
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IntroductionThe young adult patients with aortic valve insufficiency undergo aortic valve replacement (AVR) and are forced to take anticoagulation medications for the rest of life due to prosthetic valve. This leads to many post-operative complications and drastic outcomes. Whereas, the in-vogue alternative of aortic valve repair (AVr) is available and a lot more beneficial as well.Especially considering the surgeon’s skills for selected repair procedure, selectively chosen patient with mild to moderate grades of aortic valve insufficiency and no significant comorbidities present for at least five (5) years or longer time. AimThe aim of this study was to affirm ‘if all kind of outcomes of aortic valve repair are beneficial alternative to aortic valve replacement (AVR) for the patients suffering from aortic valve insufficiency for at least five (5) years or longer time. Material and MethodsInternet search using standard key words of ‘Aortic Valve Repair and Outcomes’ was used to find both white literature (officially published literature) and grey literature (unpublished or ongoing study/literature) with human, adult, English language and studies published after January 1st 2007 as limitations. Inclusion criteria was adult patients with aortic insufficiency with aortic valve repair as intervention with outcomes at least greater than five (5) years were considered. All the data was extracted using Microsoft excel for windows and was analyzed using GraphPad Prisma. Results20 studies comprising of 5369 patients were included in this systemic review, which included 2 randomized control trails, 7 clinical prospective studies, 8 retrospective studies and 3 observational studies. ConclusionThis study suggests that aortic valve repair is a beneficial alternative available for younger adults suffering from aortic valve insufficiency in longer time.
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Nolte, Sandra, and sandra nolte@mh org au. "Approaches to the measurement of outcomes of chronic disease self-management interventions using a self-report inventory." RMIT University. Global Studies, Social Science & Planning, 2008. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20080822.151606.
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Background Health education programs that are aimed at improving individuals' skills to self-manage are increasingly recognised as a critical component of chronic disease management. Despite the apparent need for such interventions, current studies show inconsistent results regarding program effectiveness, with meta-analyses indicating only marginal effects for some disease groups. A closer examination of these studies however suggests that the magnitude and inconsistency of the findings may be related to the types of outcomes that were assessed rather than specific disease groups. Where self-report measures were used, results tended to be smaller and inconsistent. It is therefore possible that current studies do not adequately reflect program effects because self-report outcomes have a high risk to be confounded by a range of potential biases. Objective The aim of this thesis was to identify and quantify the potential influence of biases in the measurement of change in chronic disease self-management interventions using self-report. Methods The research design targeted the processes that individuals undergo when filling out questionnaires and whether this has an influence on their self-report outcomes. This was achieved by developing a three-group research design. The Health Education Impact Questionnaire (heiQ) was used to collect outcomes data. While pretest questionnaires were identical across groups, three questionnaire versions were randomly distributed at posttest. One of the groups filled out traditional posttest questions (n=331), whereas the other two groups were asked to provide data in addition to posttest questions, with one group providing transition questions (n=304) and one providing retrospective pretest data (n=314). Resulting datasets were further examined for possible confounding effects through response shift and social desirability bias. Through the random allocation of the heiQs it was ensured that data were not influenced by potential intra-group effects. Results The thesis revealed that the design of the posttest questionnaire significantly influenced people's ratings of their posttest levels. In particular, when participants were asked to provide ratings of their retrospective pretest levels in addition to their posttest levels, the latter scores were significantly higher than those of participants who did not perform this additional task. Subsequent analyses however suggested that these differences could neither be explained by response shift nor by social desirability bias. Conclusions This research has provided important insight into the measurement of outcomes of chronic disease self-management interventions. While the threat to the validity of traditional pretest-posttest data due to confounding effects through response shift and social desirability biases could not be supported, the thesis has highlighted that the cognitive task that subjects are asked to perform when providing data at posttest significantly influenced their self-reported outcomes. Given that previous research has predominantly focused on other aspects of validity - such as applying control group designs to circumvent common threats to internal and external validity - this study suggests that more attention must be paid to the design of questionnaires. The thesis concludes that further research, in particular into the influence of cognitive tasks on obtained scores, is important to improve the interpretation of self-report outcomes data derived from participants of self-management interventions.
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McFerran, Ethna. "Health economic evaluation of alternatives to current surveillance in colorectal adenoma at risk of colorectal cancer." Thesis, Queen's University Belfast, 2018. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.766286.
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The thesis provides a comprehensive overview of key issues affecting practice, policy and patients, in current efforts for colorectal cancer (CRC) disease control. The global burden of CRC is expected to increase by 60% to more than 2.2 million new cases and 1.1 million deaths by 2030. CRC incidence and mortality rates vary up to 10-fold worldwide, which is thought to reflect variation in lifestyles, especially diet. Better primary prevention, and more effective early detection, in screening and surveillance, are needed to reduce the number of patients with CRC in future1. The risk factors for CRC development include genetic, behavioural, environmental and socio-economic factors. Changes to surveillance, which offer non-invasive testing and provide primary prevention interventions represent promising opportunities to improve outcomes and personalise care in those at risk of CRC. By systematic review of the literature, I highlight the gaps in comparative effectiveness analyses of post-polypectomy surveillance. Using micro-simulation methods I assess the role of non-invasive, faecal immunochemical testing in surveillance programmes, to optimise post-polypectomy surveillance programmes, and in an accompanying sub-study, I explore the value of adding an adjunct diet and lifestyle intervention. The acceptability of such revisions is exposed to patient preference evaluation by discrete choice experiment methods. These preferences are accompanied by evidence generated from the prospective evaluation of the health literacy, numeracy, sedentary behaviour levels, body mass index (BMI) and information provision about cancer risk factors, to highlight the potential opportunities for personalisation and optimisation of surveillance. Additional analysis examines the optimisation of a screening programme facing colonoscopy constraints, highlighting the attendant potential to reduce costs and save lives within current capacity.