Dissertations / Theses: '321214 Health and Community Services'

1

Withdrawn, Theodore Reremoana Farquharson. "Factors associated with cognitive ability in middle childhood." Thesis, University of Auckland, 2008. http://hdl.handle.net/2292/2378.

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There has been considerable debate among cognitive psychologists and epidemiologists regarding which determinants of children’s intelligence are most important. Factors such as children’s diet, maternal stress and social support are important for general health and wellbeing, but have received little research attention in longitudinal studies involving cognitive outcomes. Few studies have examined the determinants of intelligence in children born small-for-gestational age (SGA) at term even though these children may be particularly vulnerable to poorer postnatal environments. The aim of this study was to identify factors associated with cognitive ability in middle childhood in New Zealand (NZ) European children and children born SGA. The present research was conducted as part of the Auckland Birthweight Collaborative (ABC) study. Approximately half of the children in this study were born SGA (birthweight<10th percentile) and half were born appropriate-for-gestational age (AGA=birthweight>10th percentile). Information was collected from mothers and children on pregnancy, obstetric, socio-demographic, postnatal and dietary factors when the children were born (n=871), at one year (n=744), 3.5 years (n=550), and 7 years of age (n=591). Cognitive ability was assessed at 7 years using the Wechsler Intelligence Scale for Children – Third Edition. For the total sample, the analyses utilised weighting to allow for the disproportionate sampling of children born SGA. Results showed that SGA and AGA children did not differ in intelligence at 7 years. Factors associated with intelligence included maternal pregnancy factors (e.g. hypertension), socio-demographic factors (e.g. paternal education), and postnatal factors (e.g. maternal social support). In general, the effects of environmental factors did not differ significantly for SGA children compared with AGA children. A number of dietary factors were also found to be significantly and positively associated with intelligence measures including higher intakes of breads and cereals and weekly fish consumption. In contrast, daily margarine consumption was associated with significantly lower intelligence scores, particularly in SGA children, and this is the first study to report this association. iii Dietary and “environmental” factors were stronger predictors of children’s intelligence in middle childhood than “biological” factors, such as infant’s birthweight. Importantly, most of the factors associated with intelligence that were identified in this study are potentially modifiable. Further research is needed to examine whether these factors continue to be associated with cognitive ability in later childhood.

2

Crengle, Suzanne Marie. "The management of children's asthma in primary care : Are there ethnic differences in care?" Thesis, University of Auckland, 2008. http://hdl.handle.net/2292/4957.

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Whole document restricted until August 2010, see Access Instructions file below for details of how to access the print copy.
Abstract Background Asthma is a common problem in New Zealand, and is associated with significant morbidity and costs to children, their families, and wider society. Previously published New Zealand literature suggested that Māori and Pacific children were less likely than NZ European children to receive asthma medications and elements of asthma education, had poorer knowledge of asthma, and experienced greater morbidity and hospitalisations. However, none of the previous literature had been specifically designed to assess the nature of asthma care in the community, or to specifically answer whether there were ethnic disparities in care. A systematic review of studies published in the international literature that compared asthma management among different ethnic groups drawn from community-based samples was undertaken. The results of this review suggested that minority ethnic group children were less likely to receive elements of asthma medication use, asthma education and self-management (action) plans. Objectives The primary objectives of the study were to: • describe the use of medications, medication delivery systems, asthma education, and self-management plans in primary care for Māori, Pacific, and Other ethnic group children • ascertain whether there were any ethnic disparities in the use of medications, medication delivery systems, asthma education, and self-management plans in primary care after controlling for differences in socio-economic position and other potential confounders. Secondary objectives were to: • describe the asthma-related utilisation of GP, after hours medical care, emergency departments, and hospital admissions among Māori, Pacific, and Other ethnic group children with asthma • ascertain whether differences in medication use, the provision of asthma education, and the provision of self-management plans explained ethnic differences in health service utilisation. Methods A cross-sectional survey was conducted in Auckland, New Zealand. The caregivers of 647 children who were aged 2–14 years, had a diagnosis of asthma or experienced ‘wheeze or whistling in the chest’, and had experienced symptoms in the previous 12 months were identified using random residential address start points and door knocking. Ethnically stratified sampling ratios were used to ensure that approximately equal numbers of children of Māori, Pacific and Other ethnicity were enrolled into the study. A face-to-face interview was conducted with the caregivers of these children. Data was collected about: socio-demographic factors; asthma morbidity; asthma medications and delivery devices; exposure to, and experiences of, asthma education and asthma action plans; and asthma-related health services utilisation. Results In this study, the caregivers of 647 eligible children were invited to participate and 583 completed the interview, giving an overall completion rate of 90.1%. There were no ethnic differences in completion rates. The overall use of inhaled corticosteroid medications had increased since previous New Zealand research was published. Multivariable modelling that adjusted for potential confounders did not identify ethnic differences in the use of inhaled corticosteroids or oral steroids. Some findings about medication delivery mechanisms indicated that care was not consistent with guidelines. About 15% of participants reported they had not received asthma education from a primary care health professional. After adjusting for potential confounders there were no ethnic differences in the likelihood of having received asthma education from a health professional. Among those participants who had received education from a primary care health professional, significantly fewer Māori and Pacific caregivers reported receiving education about asthma triggers, pathophysiology and action plans. Lower proportions of Pacific (77.7%; 95% confidence interval (95%CI) 70.3, 85.1) and Māori (79.8%; 95% CI 73.6, 85.9) caregivers were given information about asthma triggers compared to Other caregivers (89.2%; 95% CI 84.9, 93.6; p=0.01). Fewer Māori (63.6%; 95% CI 55.7, 71.4) and Pacific (68.1%; 95% CI 60.1, 76.1) caregivers reported receiving information about pathophysiology (Other 75.9%; 95% CI 69.5, 82.3; p=0.05). Information about asthma action plans had been given to 22.7% (95% CI 15.5, 29.9) of Pacific and 32.9% (95% CI 25.3, 40.6) of Māori compared to Other participants (36.5%; 95% CI 28.6, 44.3; p=0.04). In addition, fewer Māori (64.2%; 95% CI 56.1, 72.3) and Pacific (68.5%; 95% CI 60.1, 77.0) reported that the information they received was clear and easy to understand (Other 77.9%; 95% CI 71.8, 84.1; p=0.03). About half of those who had received education from a health professional reported receiving further education and, after adjustment for potential confounders, Pacific caregivers were less likely to have been given further education (odds ratio 0.57; 95% confidence interval 0.33, 0.96). A minority of participants (35.3%) had heard about action plans and, after adjustment for potential confounders, Pacific caregivers were less likely to have heard about these plans (odds ratio 0.54; 95% confidence interval 0.33, 0.96). About 10% of the sample was considered to have a current action plan. The mean number of visits to a GP for acute and routine asthma care (excluding after-hours doctors and medical services) in the previous twelve months were significantly higher for Pacific (3.89; CI 3.28, 4.60) and Māori (3.56; CI 3.03, 4.16) children than Other ethnic group children (2.47; CI 2.11, 2.85; p<0.0001). Multivariable modelling of health service utilization outcomes (‘number of GP visits for acute and routine asthma care in the previous twelve months’, ‘high use of hospital emergency departments’, and ‘hospital admissions’) showed that adjustment for potential confounding and asthma management variables reduced, but did not fully explain, ethnic differences in these outcomes. Māori children experienced 22% more GP visits and Pacific children 28% more visits than Other children (p=0.05). Other variables that were significantly associated with a higher number of GP visits were: regular source of care they always used (regression coefficient (RC) 0.24; p<0.01); lower household income (RC 0.31; p=0.004) and having a current action plan (RC 0.38; p=0.006). Increasing age (RC -0.04; p=0.003), a lay source of asthma education (RC -0.41; p=0.001), and higher scores on asthma management scenario (RC -0.03; p=0.05) were all associated with a lower number of GP visits. Pacific (odds ratio (OR) 6.93; 95% CI 2.40, 19.98) and Māori (OR 2.60; 95% CI 0.87, 8.32) children were more likely to have used an emergency department for asthma care in the previous twelve months (p=0.0007). Other variables that had a significant effect on the use of EDs in the multivariable model were: not speaking English in the home (OR 3.72; 95% CI 1.52, 9.09; p=0.004), male sex (OR 2.43; 95% CI 1.15, 5.15; p=0.02), and having a current action plan (OR 7.85; 95% CI 3.49, 17.66; p<0.0001). Increasing age was associated with a reduced likelihood of using EDs (OR 0.90; 95% CI 0.81, 1.00; p=0.05). Hospitalisations were more likely in the Pacific (OR 8.94; 95% CI 2.25, 35.62) and Māori (OR 5.40; 95% CI 1.28, 23.06) ethnic groups (p=0.007). Four other variables had a significant effect on hospital admissions in the multivariable model. Participants who had a low income (OR 3.70; 95% CI 1.49, 9.18; p=0.005), and those who had a current action plan (OR 8.39; 95% CI 3.85, 18.30; p<0.0001) were more likely to have been admitted to hospital in the previous 12 months. Increasing age (OR 0.88; 95% CI 0.80, 0.98; p=0.02) and parental history of asthma (OR 0.39; 95% CI 0.18, 0.85; p=0.02) were associated with reduced likelihood of admission. Conclusions The study is a robust example of cross-sectional design and has high internal validity. The study population is representative of the population of children with asthma in the community. The three ethnic groups are also considered to be representative of those ethnic groups in the community. The study, therefore, has good representativeness and the findings of the study can be generalised to the wider population of children with asthma in the Auckland region. The results suggested that some aspects of pharmacological management were more consistent with guideline recommendations than in the past. However, given the higher burden of disease experienced by Māori and Pacific children, the lack of observed ethnic differences in the use of preventative medications may reflect under treatment relative to need. There are important ethnic differences in the provision of asthma education and action plans. Future approaches to improving care should focus on interventions to assist health professionals to implement guideline recommendations and to monitor ethnic disparities in their practice. Asthma education that is comprehensive, structured and delivered in ways that are effective for the people concerned is needed.

3

Jewkes, Rachel Katherine. "Meanings of 'community' in community participation in health promotion." Thesis, King's College London (University of London), 1994. https://kclpure.kcl.ac.uk/portal/en/theses/meanings-of-community-in-community-participation-in-health-promotion(b6de367c-b093-4d06-a81b-42bb9746d344).html.

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4

Anderson, Claire Wynn. "Health promotion by community pharmacists." Thesis, King's College London (University of London), 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299776.

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Hariri, Shapour. "Multimedia health promotion in community pharmacy." Thesis, King's College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.301212.

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Tomintz, Melanie Natascha. "Modelling Location of Community Based Health Services." Thesis, University of Leeds, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.494255.

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Beecham, Jennifer Kate. "Community mental health services : resources and costs." Thesis, University of Kent, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.319222.

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Simonson, Toni Lee. "The evaluation of comprehensive community services." Online version, 2000. http://www.uwstout.edu/lib/thesis/2000/2000simonsont.pdf.

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9

Young, Kate. "The organisation of the community health services in Norwich Health District : an evaluation of the community care group scheme." Thesis, University of East Anglia, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.303065.

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Podoba, John E. "Unmet needs for community services among the elderly : impact on health services utilization." Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=85636.

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Seniors 75 years of age and older, the majority of whom live in the community, constitute a segment of the population that is vulnerable to loss of autonomy. Indeed many community dwelling seniors have difficulty performing daily living activities, such as bathing, toileting, walking, preparing meals and housekeeping.
In the setting of a population based cohort study of community-dwelling seniors 75 years of age or older, we examined the effect of unmet needs for community services for activities of daily living (ADL) and instrumental activities of daily living (IADL) on health services utilization. Self-perceived unmet need status was determined using a baseline in-home interview. A total of 839 subjects were recruited from the Greater Montreal Region, Quebec, Canada, using random telephone number dialling.
Health services utilization data were obtained from administrative databases from the Quebec Health Insurance Board (Regie de l'Assurance-Maladie du Quebec - RAMQ). Multivariable negative binomial regression models were used to examine the association between unmet need status and health services utilization during the six month period following the baseline interview.
The results of this study indicate that unmet needs are associated with higher rates of emergency department visits, hospitalization and prescription drug use. No statistically significant association was found between unmet needs and physician utilization among single seniors, although married seniors with unmet needs in activities of daily living had 2.8 times the rate of medical specialist visits as compared to those who reported no unmet ADL needs.
Unmet need for community services among the elderly has implications for the use of more expensive acute and long-term health care services. The results of this research suggest that developing programs to address unmet needs in the elderly population can potentially reduce health services utilization by the elderly.

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Jones, Andrew Peter. "Health service accessability and health outcomes." Thesis, University of East Anglia, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.296338.

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Catchpole, C. P. "Information systems design for the community health services." Thesis, Aston University, 1987. http://publications.aston.ac.uk/10620/.

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This system is concerned with the design and implementation of a community health information system which fulfils some of the local needs of fourteen nursing and para-medical professions in a district health authority, whilst satisfying the statutory requirements of the NHS Korner steering group for those professions. A national survey of community health computer applications, documented in the form of an applications register, shows the need for such a system. A series of general requirements for an informations systems design methodology are identified, together with specific requirements for this problem situation. A number of existing methodologies are reviewed, but none of these were appropriate for this application. Some existing approaches, tools and techniques are used to define a more suitable methodology. It is unreasonable to rely on one single general methodology for all types of application development. There is a need for pragmatism, adaptation and flexibility. In this research, participation in the development stages by those who will eventually use the system was thought desirable. This was achieved by forming a representative design group. Results would seem to show a highly favourable response from users to this participation which contributed to the overall success of the system implemented. A prototype was developed for the chiropody and school nursing staff groups of Darlington health authority, and evaluations show that a significant number of the problems and objectives of those groups have been successfully addressed; the value of community health information has been increased; and information has been successfully fed back to staff and better utilised.

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Muga, Florence Adhiambo. "Community mental health in Kenya : an improbable dream?" Thesis, University of Bristol, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263918.

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Sun, Xiao Ming. "Health access and health financing in rural China." Thesis, Keele University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263121.

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Amador, Karina, and Natalie Salas. "MENTAL HEALTH SERVICES IN AN EXCLUSIVE LATINO COMMUNITY VERSUS A DIVERSE COMMUNITY." CSUSB ScholarWorks, 2019. https://scholarworks.lib.csusb.edu/etd/878.

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This study examined whether Latino immigrants’ community environment influenced perceptions about the meaning of mental health and accessing mental health services. The two environments analyzed in were an exclusively Latino community (primarily Latino members) and a diverse community (composed of different ethnicities including Latinos). The research method used in this study was a qualitative survey design. A semi-structured interview guideline with questions on the meaning of mental health, mental health services access, and community norms on mental health was utilized with 24 respondents. Responses were then analyzed to find themes. Findings from this study found similarities as well as differences in the two groups in seeking mental health services. Differences were more commonly in the details of the responses rather than in the themes of the responses. The finding will help social workers, who provide a large percentage of mental health services, understand the individual, the barriers, and the importance of social environments in seeking mental health services.

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Goodwin, Simon Christopher. "Community care : the reform of the mental health services?" Thesis, University of Sheffield, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387717.

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Sills, Margaret Vivienne. "Adult perceptions of influences on personal health and change : a study of health educators and non-health educators." Thesis, King's College London (University of London), 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.284803.

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Milner, Susan Joan. "Health in the high street : an evaluation of a community based health promotion projects." Thesis, Northumbria University, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.240622.

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Brazier, John Edward. "Valuing health benefits : the development of a preference-based measure of health for use in the economic evaluation of health care from the SF-36 health survey." Thesis, University of Sheffield, 1997. http://etheses.whiterose.ac.uk/5997/.

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The main aim of the research was to develop a preference-based measure of health from the Short Form-36 (SF-36) Health Survey for valuing health-related quality of life on a 0 to 1 scale in order to calculate Quality adjusted life years (QALYs). Before undertaking the empirical work, reviews were undertaken of the justification for the QALY approach, existing preference-based measures for deriving QALYs and the rationale for looking at the SF-36. The methods of the research were as follows. The SF-36 was reduced and simplified to form a six dimensional health state classification (SF-6D) amenable to valuation. One hundred and sixty five patients, health professionals, managers, and students valued a sample of health states defined by the SF-6D using the visual analogue scale (VAS) and standard gamble (SG) techniques to elicit preferences. There were 1,357 VAS and 1,037 SG health state valuations after adjustment and exclusions for major inconsistencies. Models for predicting median and mean VAS and SG health state values from the SF-6D were estimated from these data by multivariate techniques. A set of additive models were selected on the basis of goodness of fit and parsimony. More complex specifications did not improve the models. Initial applications of algorithms based on these models to five data sets suggested this new preference-based measure retained much of sensitivity of the SF-36 at the milder end of the of the illness spectrum. The preference-based algorithms can be used to transform SF-36 data collected in a clinical trial (with costs) into information suitable for assessing the cost-effectiveness of health care interventions. The adoption of these algorithms has the potential to considerably extend the application of economic evaluation in health care.

20

Ruston, Annmarie. "Implementation of preventive health policies in the field of sexual health : an examination of the influence of health professionals in the implementation of the Health of the NationStrategy-HIV/AIDS and Sexual Health Key Area." Thesis, University of Kent, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310165.

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Ghaly, Marina Adele. "Client outcomes in a community health setting." Thesis, The University of Arizona, 1990. http://hdl.handle.net/10150/277274.

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A descriptive design was used to describe five client outcome scales as potential measures of quality care in home health care: discharge status, client satisfaction, medication adherence, general symptom distress and caregiver strain. The conceptual model used necessitated three separate samples: a discharged sample of 20 clients, an active client sample of 14 subjects and a caregiver sample of three subjects for a total of 37 subjects. Structured interviews and questionnaires were used; descriptive statistics were applied to scores. The most notable indicator of quality of care, the medication adherence scale, showed all clients taking medications as prescribed. The primary reason for discharge showed that the client could manage without further services. Clients reported that they were somewhat satisfied or very satisfied with services. Caregivers reported a low perceived level of stress. The scales measuring discharge status and symptom distress need further investigation to determine if they are true indicators of the concept of quality care.

22

Lam, Yik-tsz. "To evaluate the mobile clinic for the elderly a preliminary study on the referrals /." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk/hkuto/record.jsp?B23339883.

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Montgomery, Scott Mackay. "The relationship of unemployment with health and health behaviour in young men." Thesis, City University London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.336792.

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Koo, Sun Tien-lun Catherine. "The impact of health care policies on the health status of the population of Hong Kong /." Hong Kong : University of Hong Kong, 1987. http://sunzi.lib.hku.hk/hkuto/record.jsp?B14016989.

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Hennessy, Deborah. "Mothers and health visitors." Thesis, University of Southampton, 1985. https://eprints.soton.ac.uk/402124/.

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Al-Issa, Birgitta. "User participation in English and Canadian community mental health services." Thesis, Lancaster University, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.282605.

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Bjorn, Agnes Marie. "Community health assessment and nursing care needs of the elderly." Thesis, University of Manchester, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.237239.

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Rogers, Philip John. "Patient medication records by community pharmacy." Thesis, University of Bath, 1993. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.357290.

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Blignault, Suzette Martha. "Audit of community pharmacy activities." Thesis, Nelson Mandela Metropolitan University, 2010. http://hdl.handle.net/10948/1533.

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In South Africa the pharmacy profession has experienced a number of changes around the turn of the century such as the introduction of the National Drug Policy (NDP), pharmacy ownership and price regulation. With this the role and earnings of the pharmacy profession, as well as to what extent the pharmacist adds value to the profession and society, are being questioned. Community pharmacists are thus faced with the challenge to prove that the value that they add to society is meaningful. Therefore, the aim of the study was to document community pharmacy availability and activities in South Africa and based on this to quantify the perceived value that the community pharmacist adds to society through the delivery of pharmaceutical services and pharmaceutical care. In order to determine the pharmacist’s true value added two surveys were conducted in 2006; an original pharmacist survey and a general public survey. The results obtained were verified by a follow–up pharmacist survey in 2009 to confirm or reject the results obtained in the original survey. The study was representative of both the community pharmacies and the general public in South Africa and was primarily quantitative in design and analysis. More than half of the responding pharmacies (63.16%) were open seven days a week. The average hours of service per day ranged from 10 hours (Monday to Friday) through to 6.45 hours on Saturdays and 3 hours on Sundays. Pharmacists continuously upgraded their professional knowledge. More than three quarters of pharmacies had the necessary equipment available to perform the services investigated in the study. The general public was not aware of all the services provided by pharmacists and as a result, depending on the service, many people did not make use of these services. The general public that made use of services delivered by community pharmacies mainly perceived the services delivered to be of good quality. The main barrier to practicing pharmaceutical care was indicated by pharmacists as not receiving payment for the advice given followed by pharmaceutical care being time consuming, and that there was not enough time to talk to patients. The general public indicated that they found it difficult to ask questions in pharmacies because other patients could hear what was discussed, or other patients had to wait longer if they asked something, and pharmacy staff being too busy. The results of the original pharmacist and the general public survey were confirmed by the results of the follow-up survey with the exception of dispensing prescription medicine (8 minutes 28 seconds), OTC medicine (7 minutes 23 seconds), counselling of prescription medicine (8 minutes 51 seconds) and OTC medicine (8 minutes) which on average took longer to conduct than in the previous analysis. The study highlighted the value added to the wellness and quality of life of the community of South Africa through the delivery of pharmaceutical care and pharmaceutical services by community pharmacy staff, and proved that pharmacists are committed to the provision of pharmaceutical care and pharmaceutical services.

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MoyseÌs, Simone Tetu. "The impact of health promotion policies in schools on oral health in Curitiba, Brazil." Thesis, University College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.313826.

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Ziglio, Erio. "Uncertainty and innovation in health policy : the Canadian and Norwegian approaches to health promotion." Thesis, University of Edinburgh, 1985. http://hdl.handle.net/1842/19439.

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Harrison, Stephen Robert. "Government and the management of health services." Thesis, University of Bristol, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.385665.

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Grainger, Roger. "Implicit religion and health care." Thesis, University of Cambridge, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316645.

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Waters, Elizabeth. "Measuring child health and wellbeing." Thesis, University of Oxford, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.270153.

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Maclean, John Ross. "Telemedicine in remote health care." Thesis, University of Aberdeen, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.264331.

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This thesis offers a review of the historical development of telemedicine services in remote health care. It addresses the professional concerns in practising medicine in isolated conditions, and the advances in telecommunications technology since the telephone was invented. It also examines the application of telemedicine in remote environments across the world, such as in indigenous communities, remote industrial work sites and at scientific bases in Antarctica. At its most exotic, a review is offered of the health care for space crews. The literature review highlights a number of concerns about the state of the art knowledge on remote health care services. These concerns are the minimal training requirements of individuals who act as health care practitioners in the remote environment, the additional training requirement upon the advising medical practitioner, and the design of a system for the collection of clinical information from the patient. In response to the above a two year study was conducted. Quantitative and qualitative observation of remote health care consultations was undertaken. The environments studied were simulation cases occurring in the UK and Antarctica, and real cases presenting on oil installations in the North Sea. The study results answer the original concerns about the training levels, data collection and communications components of a remote health care service. In addition, they offer valuable input towards the design of a telemedicine model for remote health care. The telemedicine model is presented as a framework upon which future developments in the field of telemedicine may be approached.

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Tatar, Fahreddin. "Privatisation and Turkish health policy." Thesis, University of Nottingham, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.356998.

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Appleton, Jane Victoria. "An examination of health visitors' professional judgements and use of formal guidelines to identify health needs and prioritise families requiring extra health visiting support." Thesis, King's College London (University of London), 2002. https://kclpure.kcl.ac.uk/portal/en/theses/an-examination-of-health-visitors-professional-judgements-and-use-of-formal-guidelines-to-identify-health-needs-and-prioritise-families-requiring-extra-health-visiting-support(ca51ddec-dab0-4f85-b817-da01454eece4).html.

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Waddington, Catriona Jane. "Health economics in an irrational world - the view from a regional health administration in Ghana." Thesis, University of Liverpool, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.317275.

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Saramunee, Kritsanee. "General public views on community pharmacy services in public health." Thesis, Liverpool John Moores University, 2013. http://researchonline.ljmu.ac.uk/6170/.

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Community pharmacists are increasingly providing public health services in response to government policies. Published literature regarding the views of the general public related to pharmacy public health services, although important in ensuring uptake of these services, was limited. This study series aim to explore the general public's perspective on how to maximise the appropriate utilisation of community pharmacy services for improving public health. A large study comprising four sequential phases was designed and conducted in Sefton borough. Initially, to gather background information, focus group discussions (FGDs) and semi-structured interviews were undertaken with the general public and key stakeholders. The second phase involved the development and testing of a questionnaire extracted from the qualitative findings and a literature review. The questionnaire focused upon seven pharmacy public health services related to cardiovascular risks as well as views on factors influencing pharmacy use and advertising/promotion techniques. Geodemographic concepts, widely recognised in public health, were also included to identify potential benefits to pharmacy practice research. Next, a large scale survey was administered among the general public using eight survey modes, to additionally evaluate the range of methods available/for gathering public views. Finally, survey findings were evaluated by representatives of survey respondents using a FGD. Results indicated that, although stakeholders considered that community pharmacy can make an extensive contribution in supporting public health, pharmacy public health services are used at a relatively low level by the general public and awareness of services is also low. Survey respondents indicated a willingness to use services in the future. Important factors influencing pharmacy use include loyalty, location and convenient accessibility. Appropriate promotional campaigns are a key facilitator to help raise the public's awareness. The findings will help the profession to increase uptake of pharmacy public health services. The variety of survey modes used proved beneficial in obtaining diverse population demographics, with street survey being the optimal technique, however, the potential for social desirability bias must be considered with this and other interviewer-assisted approaches. MOSAIC™ as a geodemographic tool is potentially useful in helping to target services for specific groups and is recommended for use in further research.

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Bond, Christine M. "Prescribing in community pharmacy : barriers and opportunities." Thesis, University of Aberdeen, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.294204.

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This thesis describes the history of community pharmacy, and the current climate which has identified an extended role, particularly for 'over-the-counter' advice in response to symptoms and the reclassification of medicines. An electric methodology has been used to define current community pharmacy practice in Scotland, and to assess the attitudes of community pharmacists and GPs to an extended community pharmacy role. Attitudes of community pharmacists to medicines reclassification have been assessed nationally, and implications quantified. Clinical pharmacy guidelines for the treatment of dyspepsia have been developed and evaluated. A range of opinion formers have been interviewed to identify the different agenda which have contributed to medicines reclassification. Most of the more innovative tasks proposed are not yet commonly practised in Scotland. However most community pharmacists favour the extended role and the reclassification of medicines. Reclassification has little financial advantage for the community pharmacist, but would benefit the patient and the NHS. GPs were generally supportive of the extended role of the community pharmacist and the reclassification of medicines with a few caveats. These could be overcome by clinical pharmacy guidelines, which we demonstrated to have utility, patient acceptability and an educational value. Representatives of the medical and pharmaceutical professions, the government, the industry and the patient, revealed three agendas which have all influenced medicines reclassification. The government wish to shift the costs from the NHS to the patient. The industry wish to find additional markets and the pharmaceutical profession need a new paradigm to replace their largely redundant technical dispensing role. It is concluded that it is an opportune time for the community pharmacists to extend their professional role.

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Getliffe, Kathryn Anne. "Encrustation of urinary catheters in community patients." Thesis, University of Surrey, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.314816.

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Smith, Felicity Julia. "The contribution of community pharmacists to primary health care in London." Thesis, Queen Mary, University of London, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.389618.

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Oluyole, Alexander Bolarinwa. "Community involvement and needs assessment in primary health care in Nigeria." Thesis, Keele University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261479.

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Fandi, M. M. "The impact of retirement migration on health care demand and resource allocation in Lancaster Health District." Thesis, Lancaster University, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.372537.

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Chambers, Derek W. "A qualitative study of nurse's health beliefs and how these impact on their health education practices." Thesis, University of Huddersfield, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.327148.

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Abstract:

This study investigates the ways in which nurses socially construct their health value systems and the ways in which they interpret their nursing practices. On the basis of the contradictions uncovered by the research, a new approach to health education is suggested, structured around a Lived Experience Model of Health Education the core of which is an intensified reflective practice. The model seeks to build the capacity for critical practice, closely integrating theory and practice, into nurses' modes of constructing a lay ideology based on their clinical and personal experience. Herein lies a fundamental difference between this model and other health education models, which have tended to be too narrowly focused on the individual and as a result have perpetuated a victim blaming ideology. The thesis begins with a desk study of the British dimension of a coming international crisis in the funding of public health, to which the general response has been a shift away from state support for bio-medically dominated health systems to systems based on the central concepts of health promotion and health education. The desk study argues that in Britain this has become as much an ideological issue as a practical one, with liberal notions of free market individualism prominent in public policy, and relevant sociological findings played down. Before embarking on the field study, the thesis considers whether or not a Health Locus of Control study might give enough insight into the basis for nurses' health education practices to explain why many nurses seem resistant to change, and therefore why perhaps they have had so little effect on patterns of social morbidity. This was rejected partly because of the methodological problems uncovered in a range of prior Locus of Control studies, but mainly because the method offers no way of engaging with sociologically identified inequities in morbidity and mortality rates. Nor was it felt that standard quantitative methods of research would enable the study to explore the complex ideological issues involved in nurses' social constructions of health. The decision was taken to employ a methodology based around qualitative interviews using the method of hierarchical focusing, which allows the interviewer to probe seamlessly matters at different levels of generality and specificity. In the field work study the general ideological tendency revealed in the desk study is shown to have a marked effect on nurses' constructions of their roles as health practitioners. The subjects, a group of experienced nurses, were asked a number of questions concerning their views of what constituted good and poor health and the causes for this. When the transcripts of the interview recordings were analysed using content analysis, it was clear that much of what was said was logocentric and heavily influenced by bio-medical discourse in spite of the subjects talking freely about holistic nursing. In fact there were contradictory and anomalous messages throughout the transcripts, so it was decided to subject these to a form of discourse analysis which revealed the existence of two opposing value positions held without any feeling of contradiction by a number of respondents: a holistic view - the public account, and a victim-blaming view - the private account. In order to gauge the effect of such views on nursing practice a further group of experienced nurses was given a series of nursing vignettes to analyse. The results showed that there appear to be two types of nurses: a reflexive group that is able to take on the complex issues involved in caring in the postmodern context and one, much the larger group, whose members have failed to resolve the contradictions in the prevailing ideology, who tend to fall back on victim-blaming and on bio-medical perspectives. Of course, this needs much more research to establish as a general pattern. However, there was enough clear evidence of ideological influences blocking the development of nurses' understanding and health practices to suggest the need for a new way of working with trainee nurses, much more sharply aimed at the development of critical consciousness in the practice situation. All the lessons of the research have been incorporated in the design of the new model.

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Bash, Camille Rose. "The influence of community support services in reducing potentially preventable readmissions." Thesis, Walden University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3602920.

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Abstract:

Recently, the Centers for Medicare and Medicaid Services (CMS) ranked all hospitals based on Medicare readmission rates for heart attacks, heart failure, and pneumonia. CMS offered subsidies to hospitals ranked in the 4th quartile to develop community support services to reduce the problem of potentially preventable readmissions (PPRs). CMS cited 4 of the 5 hospitals in Prince George's County in the 4th quartile. The purpose of this quantitative research study was to investigate the relationship between community support services and the reduction of PPRs in Prince George's County. The Evans and Stoddart field model of health and well-being guided this study with support from Bertalannffy's general systems theory. This study sought to relate community support services to PPRs in Prince George's County in contrast to other Maryland counties. To evaluate relationships between community support services and the reduction of PPAs, secondary data were provided by CMS in conjunction with the Robert Wood Johnson Foundation and the University of Wisconsin. The data included 26 behavioral community support factors from 53,229 Medicare paid claims in Maryland residents from July 1, 2008 to June 30, 2011. Lack of diabetes screening is a community support factor within quality of care. Using multiple regressions, there was a statistically significant relationship found between diabetic screenings and pneumonia readmission rate. The implication for social change is that reimbursement of key screening recommendations to CMS, local government, and hospitals in Prince George's County may reduce readmission rates, thereby positively affecting patients, improving community health, and decreasing health care costs in Prince George's County.

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Chang, Pei-Jen. "Factors influencing occupational health nursing practice." Thesis, King's College London (University of London), 1994. https://kclpure.kcl.ac.uk/portal/en/theses/factors-influencing-occupational-health-nursing-practice(117dd5b4-81ff-45dd-8966-3ea83809c449).html.

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Hunter, Duncan James Webb. "Assessing health care need for prostatectomy." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1995. http://researchonline.lshtm.ac.uk/682257/.

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This thesis describes a study that estimated the health care need for prostatectomy in a typical district of 250,000, among men who have both the appropriate indications for treatment and who would choose treatment if offered. It established the appropriate indications for prostatectomy using a literature review and a nominal group type consensus panel consisting of 6 urologists and 3 general practitioners. These were expressed in terms of different combinations of type of retention, type and severity of symptoms, and level of comorbidity. A 2-stage community survey of 2000 men aged 55 and over randomly selected from 8 general practices, using postal questionnaires, was conducted in North West Thames health region. The surveys collected information about: (1) self-reported frequency and severity of lower urinary tract symptoms; (2) the impact of these symptoms on daily activities and on health status; (3) the advice-seeking behaviour of men with symptoms and consequent action of GPs and urologists; and (4) patient preference for treatment. These results were combined to estimate the number of prostatectomies required in a typical district. The overall response rate was 66% (initial survey=78%, follow-up survey=84%). 20% of men reported moderate or severe lower urinary tract symptoms. Of these, 28% found their symptoms to be a medium or big problem and that, depending on the activity, between 9% and 39% experienced interference with their daily activities. Health status, as measured by either the Nottingham Health Profile or the SF-36, worsened as symptom severity increased. Forty five per cent of men with symptoms had seen their general practitioner for their symptoms. Of these, 62% were referred on to a urologist, of which the majority (71 %) were offered, and accepted surgery. When presented with details and information on the risks and benefits of prostatectomy, a substantial proportion (22%) of men with lower urinary tract symptoms, reported that they would probably, or definitely, refuse treatment, while a 47% of men were unsure. The estimate of required number of prostatectomies in a district with a population of 250,000 ranged from 225 to 4329 depending on the level of appropriateness, symptom severity and preference adopted. The decision about which estimate to use in purchasing prostatectomy for lower urinary tract symptoms must be made by local authorities.

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Jeffery, Roger. "Health and the State in India." Thesis, University of Edinburgh, 1985. http://hdl.handle.net/1842/24023.

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Sturt, Jacqueline Alys. "Implementation of self-efficacy theory into health promotion practice in primary health care : an action research approach." Thesis, Bucks New University, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251328.

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Dissertations / Theses on the topic '321214 Health and Community Services'

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