Dissertations / Theses: 'Health care fields'

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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.

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Kerr, Karolyn. "The institutionalisation of data quality in the New Zealand health sector." Thesis, University of Auckland, 2006. http://hdl.handle.net/2292/1899.

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This research began a journey towards improved maturity around data quality management in New Zealand health care, where total data quality management is 'business as usual" institutionalised into the daily practices of all those who work in health care. The increasingly information intensive nature of health care demands a proactive and strategic approach to data quality to ensure the right information is available to the right person at the right time in the right format, all in consideration of the rights of the patient to have his/her health data protected and used in an ethical way. The work extends and tests principles to establish good practice and overcome practical barriers. This thesis explores the issues that define and control data quality in the national health data collections and the mechanisms and frameworks that can be developed to achieve and sustain good data quality. The research is interpretive, studying meaning within a social setting. The research provides the structure for learning and potential change through the utilisation of action research. Grounded theory provides the structure for the analysis of qualitative data through inductive coding and constant comparison in the analysis phase of the action research iterative cycle. Participatory observation provided considerable rich data as the researcher was a member of staff within the organisation. Data were also collected at workshops, focus groups, structured meetings and interviews. The development of a Data Quality Evaluation Framework and a national Data quality Improvement Strategy provides clear direction for a holistic and 'whole of health sector' way of viewing data quality, with the ability for organisations to develop and implement local innovations through locally developed strategies and data quality improvement programmes. The researcher utilised the theory of appreciative enquiry (Fry, 2002) to positively encourage change, and to encourage the utilisation of existing organisational knowledge. Simple rules, such as the TDQM process and the data quality dimensions guided the change, leaving room for innovation. The theory of 'complex systems of adjustment' (Champagne, 2002; Stacey, 1993) can be instilled in the organisation to encourage change through the constant interaction of people throughout the organisation.

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Claas, Bianca Muriel. "Self-reported oral health and access to dental care among pregnant women in Wellington : a thesis presented in fulfilment of the requirements for the degree of Master of Public Health at Massey University, Wellington, New Zealand." Massey University, 2009. http://hdl.handle.net/10179/1205.

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Pregnancy can have important effects on oral health and pregnant women are a population group requiring special attention with regard to their oral health and their babies? health. International research shows that oral health care for pregnant women has been inadequate, especially in relation to education and health promotion and there is some evidence of disparities by SES and ethnicity. Improving oral health is one of the health priorities in the New Zealand Health Strategy (Ministry of Health, 2000) and the Ministry of Health (Ministry of Health, 2006a) has recently identified a need for more information on the oral health and behaviour of pre-natal women. The aims of this study were to gain an understanding of pregnant women?s oral health care practices, access to oral health care information and use of dental care services and to identify any difference by ethnicity and socio-economic position. A self-reported questionnaire was completed by 405 pregnant women (55% response rate) who attended antenatal classes in the Wellington region. The questionnaire was broadly divided into four parts: (1) care of the teeth when the woman was not pregnant; (2) care of the teeth and diet during the pregnancy; (3) sources of oral health information during pregnancy and; (4) demographic information . Data were analysed by age, ethnicity, education and income and odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using logistic regression. The majority of women in this survey were pakeha (80.2%), compared to 19.7% „Others? (8.8% Maori, 1.9% Pacific, 8.6% other). Most of the subjects were aged 31-35 years (34.5%), of high SES (household income and education level). Half of the women reported having regular visits to the dentist previous pregnancy while a significant percentage of women saw a dentist basically when they had problems. The usual dental hygiene habits were maintained during pregnancy. However, during pregnancy more than 60% of women reported bleeding gums. Just 32% of women went to see the dentist during pregnancy and less than half had access to oral health information related to pregnancy. „Others? (OR 0.38, 95% CI 0.15-0.91) and low income (OR 0.27, 95% CI 0.10-0.76) groups were significantly less likely to report access to oral health information compared to pakeha and high income groups (respectively). Women who went to see the dentist during pregnancy were more likely to receive information on dental health. However, low income women were more likely to report the need to see a dentist (OR 2.55, CI 1.08-5.99). Information on dental health and access to oral care should be prioritised to low income women, Maori, Pacific and other ethnic groups. Little attention has previously been given to oral health for pregnant women in New Zealand and there is a need to increase awareness of the importance of this area amongst health practitioners particularly Lead Maternity Carers and Plunket and tamariki ora nurses.

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Wenn, Janice. "Kaupapa hauora Māori : ngā whakaaro whakahirahira o ngā kaumātua : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Māori Studies at Te Pumanawa Hauora Research Centre for Māori Health and Development, Massey University, Wellington, Aotearoa/New Zealand." Massey University, 2006. http://hdl.handle.net/10179/995.

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There is a requirement for all services within the New Zealand health system to be accredited with an established quality organisation and to demonstrate an ability to provide a measurable quality service to consumers. For Māori these requirements must make sense in Māori terms. This thesis is based on the view that, for Māori, the concept of health is more effectively expressed as hauora - optimal health and wellbeing for Māori. This thesis makes five contributions to Māori health and Māori health research. First, it identifies a responsive approach to engaging kaumātua effectively in the process of qualitative research. Second, it identifies a fundamental underlying conceptual framework – kaupapa hauora Māori as a means of understanding hauora – expressed in terms derived from kaumātua in Taranaki and Kahungunu. Third, it adapts this conceptual framework into an analytical research framework and then applies it to allow kaupapa hauora Māori (described in terms of worldview, values and ethics) to be identified from a range of data. Fourth, it critically analyses popular models of Māori health – Te Whare Tapa Whā, Te Wheke and Ngā Pou Mana. Finally, it proposes and details post-doctoral research that will translate kaupapa hauora Māori into a quality services framework/tool. “Kaupapa Hauora Māori” is a conceptual framework articulated by kaumātua, and has its origins in te ao Māori, from which the aronga or worldview is developed. The aronga is composed of the kaupapa or values and tikanga or ethics that provide kaumātua with the values base of hauora. These components have been identified by kaumātua and not only inform the concept of KHM but also inform the analytical research framework that is applied to the data. The values have been identified as a core set of values comprising whakapapa, wairua, whenua, whānau, tikanga te reo Māori, tinana, and hinengaro, and the associated tikanga is expressed as behaviour or ethics. These, together, influence the perception and understanding individuals have of their world and of hauora.

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Clendon, Jillian Margaret. "Motherhood and the 'Plunket Book' : a social history : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Auckland, New Zealand." Massey University, 2009. http://hdl.handle.net/10179/826.

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The Well Child/Tamariki Ora Health Book (the Plunket book) is a small booklet given to New Zealand mothers on the birth of a child. It has been used by nurses as a tool to record growth and development from birth to five years since the 1920s. Although use of the book decreases over time, it is frequently kept within the family and handed on from mother to child. Utilising an oral history approach, this study has traced the development of the Plunket book over time and explored the experiences of a group of 34 women and one man who have reflected on their ownership of, or involvement with, Plunket books. The study found that the Plunket book remains an effective clinical tool for mothers and nurses. Mothers have used the book as a tool to link past with present, to maintain kinship ties across generations, to deal with change intergenerationally, and in a manner that contributes to their self-identity as woman and mother. Although mothers were able to use the book to affirm their own knowledge and that of their mothers, a medically dominated discourse persists in the book. The book has also played a role in facilitating the interaction between mother and nurse, providing an opportunity to explore the relationship in detail. The study found that the most successful relationships at any time were those that bordered the division between a professional relationship and a personal one: it was not the information that nurses offered but the interaction and resulting care they provided that was important to the mothers in the study. The study recommends that nurses and other health professionals continue to use the Plunket book as a clinical tool mindful of the fact that the book remains in use beyond the health professional’s immediate involvement with the mother and child, playing an important role in the context of the New Zealand family across generations. Future versions of the book should contain written reference to the strengths and abilities the mother holds as she cares for her child, reaffirming her role and identity as mother not only when her children are younger but as they grow and become parents themselves.

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Nyberg, Roy. "Examining institutional entrepreneurship at early moments : the case of mobile health in England and Finland." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:b9fc5103-d06b-4562-aef8-8746d31c2ea7.

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If you have an idea about applying a proven technology to improve the processes in a new area of society, what does it take to implement it in a way that it has wide impact and endures? This is a relevant question particularly now, at the dawn of the age of 'big data', as information and communication technologies are adopted in many areas to harness the ability to collect, retrieve and analyse large amounts of information, and be made available at the level of individual users. Extraordinarily powerful devices developed in recent years offer much promise, but as many examples, such as Betamax, WAP-technology, HD DVD and netbooks, show that even potent technologies may fail to gain predominance and survive. The concept of institutional entrepreneurship is a useful framework to analyse these complex issues as it embodies a comprehensive analytical perspective, combining attention to the institutional environment as well as to the efforts by interested and re-sourced actors. I use this concept to I investigate the efforts to introduce mobile technology into health care in England and Finland. I employ a distinct research strategy that avoids a retrospective bias, through the collection and analysis of qualitative data before known outcomes, from a wide range of technology, care, regulatory and intermediary organisations. I uncover some of the difficulties to technology adoption and develop arguments about the types of efforts and the impact of context at the early moment stage that contribute to the further development of the concept of institutional entrepreneurship.

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Dodsworth, Caroline. "How can midlife nurses be supported to deliver bedside care in the acute clinical services until retirement? : a thesis presented in partial fulfilment of the degree of Master of Philosophy (Nursing), Massey University, Turitea, Palmerston North, New Zealand." Massey University, 2008. http://hdl.handle.net/10179/902.

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As the baby boomer generation move inexorably towards retirement and the requirement for health care services increases, the supply of nurses available to provide care at the patient bedside is forecast to fall significantly short of demand. This thesis has explored the perspectives of midlife nurses, asking what it would take to keep them in bedside practice until retirement. These nurses have provided insights which offer employers of valuable senior nurses, suggestions for maximising their potential. Through the use of questionnaires and focus groups nurses aged 45 years and over were asked what the employer can do to ensure that they are able to continue to work at the patient bedside until they reach the age of retirement. The results of this research demonstrate a workforce of nurses who are passionate and committed to their profession, but feeling disillusioned and disempowered. The nursing environment has changed over the span of their career and they find the increased workload, together with increasing professional demands, too hard to cope with. They feel they have no control over their workload, their shift patterns, or the expectations of their patients and colleagues. They want their experience to be recognized but they do not want to have to prove competency; they want to have a voice but they are unwilling to pursue postgraduate education to learn how to become visible and emancipated.

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Andrae, Daniela. ""Diabetes? I can live with it" : a qualitative evaluation of a diabetes self-management programme : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Palmerston North, New Zealand." Massey University, 2009. http://hdl.handle.net/10179/1199.

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Self-management programmes provide one form of education for people with diabetes. Evaluations of these programmes allow for a better understanding in regard to their impact and whether outcomes are met. Very little research has used qualitative methods to capture participants’ experiences of these programmes and their perception of psychological outcomes. This is the first qualitative evaluation of the Type 2 Diabetes Self-Management Programme in Whangarei. It has adopted an interpretative-phenomenological approach to explore participants’ experiences of the programme and participants’ perceptions in regard to their self-efficacy and quality of life after attending a course. A sample of 7 participants with diabetes provided data via interviews 4 weeks and 3 months after attending the course. The themes that emerged from the initial interview were separated into three evaluation components. In “6 weeks sounded very long but it was worth the time”, participants discussed enrolment, benefits of the course and suggestions for future participants. In “I know what I need to do and I’m confident to do it”, participants linked the gained knowledge from the course to improvements in their self-efficacy regarding self-management behaviours, education and control of own life. In “Life is good, diabetes is just another thing to handle”, participants reflected on the impact of living with diabetes and changes to their life. An overarching theme of settling into a comfortable routine emerged from the follow-up interview. Participants reflected positively on their course and research participation. The programme was perceived to be beneficial to participants, impacting positively on increasing knowledge, self-efficacy development, behaviour changes and quality of life. The participants maintained these benefits in the short-term. These results are discussed in terms of the need for further research to evaluate if benefits are maintained in the long-term, referral process to the programme, decision-making process in regard to enrolment and impact of a support person attending the programme. Practice implications for the programme are discussed in regard to incorporating a follow-up phone call to participants after they attended a course and offering follow-up sessions with the latest information on diabetes care.

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Engelbrecht, Judith Merrylyn. "Electronic clinical decision support (eCDS) in primary health care: a multiple case study of three New Zealand PHOs : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Information Systems at Massey University, Palmerston North, New Zealand." Massey University, 2009. http://hdl.handle.net/10179/1107.

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Health care providers internationally are facing challenges surrounding the delivery of high quality, cost effective services. The use of integrated electronic information systems is seen by many people working in the health sector as a way to address some of the associated issues. In New Zealand the primary health care sector has been restructured to follow a population based care model and provides services through not-for-profit Primary Health Organisations (PHOs). PHOs, together with their District Health Boards (DHBs), contributing service providers, and local communities, are responsible for the care of their enrolled populations. The Ministry of Health (MoH) is streamlining information sharing in this environment through improvements to computer based information systems (IS). By providing health professionals with improved access to required information within an appropriate time frame, services can be targeted efficiently and effectively and patient health outcomes potentially improved. However, the adoption of IS in health care has been slower than in other industries. Therefore, a thorough knowledge of health care professionals’ attitudes to, and use of, available IS is currently needed to contribute to the development of appropriate systems. This research employs a multiple case study strategy to establish the usage of IS by three New Zealand PHOs and their member primary health care providers (PHPs), with a focus on the role of IS in clinical decision support (CDS). A mixed method approach including semi-structured interviews and postal surveys was used in the study. Firstly, the research develops and applies a survey tool based on an adaptation of an existing framework, for the study of IT sophistication in the organisations. This provides the foundation for an in-depth study of the use of computerised CDS (eCDS) in the PHO environment. Secondly, a conceptual model of eCDS utilisation is presented, illustrating the variation of eCDS use by member general practitioner (GP) practices within individual organisations. Thirdly, five areas of importance for improving eCDS utilisation within PHO’s are identified, contributing information of use to organisations, practitioners, planners, and systems developers. Lastly, the research provides a structure for the study of the domain of eCDS in PHOs by presenting a research approach and information specific for the area.

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Moxon, Alicia M. "The effectiveness of a brief psychoeducational intervention for people with schizophrenia and their families : a dissertation presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Palmerston North, New Zealand." Massey University, 2009. http://hdl.handle.net/10179/1143.

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In an attempt to replicate and extend previous research, the present study conducted a brief psychoeducational intervention through community organisations designed to overcome methodological shortcomings of past studies. The two session intervention (one session with follow-up phone call) sought to establish if a brief community intervention was effective in both improving family members’ knowledge about schizophrenia and various other indicators linked to improved client functioning. People with schizophrenia and their family members (N = 50) were recruited into a controlled trial of a brief educational intervention. Clients and their corresponding key family members were randomly allocated to a treatment group or a wait-list control group. Measures included those reflecting knowledge about schizophrenia, expressed emotion, perceived coping ability, burden of care and distress. Analyses showed that knowledge increased significantly after the intervention and not after the control condition and was maintained at a nine-month follow-up. Family members’ and clients’ expressed emotion ratings significantly decreased from pre- to post-test with changes in total expressed emotion scores improving across treatment by over twice the magnitude compared to the control condition. All gains were maintained at the nine-month follow-up, with continuing improvement seen in family members’ intrusiveness ratings. A similar pattern of findings was reflected on other indices, with significant improvements in burden of care, coping and distress that were more a function of intervention than the control condition. All gains were maintained at the nine-month follow-up. Additionally, assessment of relapse rates at this follow-up interval indicated that no client had relapsed. Overall the results suggested that although knowledge increased as a result of education, the improvements in all indicators other than knowledge appeared to be due to education combined with some non-specific factors. These non-specific factors may have included expectancy effects, setting effects, sampling bias and other possibilities. These issues are considered in terms of implementation of brief programs in supportive community settings and in terms of future research.

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Gopalakrishnan, Raghavan. "Magnetoencephalography Characterization of Pain Anticipation in Patients with Post-Stroke Thalamic Pain." Cleveland State University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=csu1431519667.

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Lee, Scott S. "Three Field Experiments on Incentives for Health Workers." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17467500.

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The economic study of incentives in firms has traditionally focused on one type of incentive—pecuniary—and one causal mechanism—the direct effect of incentives on effort. This dissertation uses three randomized field experiments to explore non-traditional incentives, and non-traditional incentive effects, in the setting of health care delivery. The first experiment (jointly authored with Nava Ashraf and Oriana Bandiera) addresses an under-appreciated phenomenon: incentives affect not only the effort of agents on the job, but also the selection of agents into the job. We collaborate with the Government of Zambia to experimentally vary the salience of career incentives in a newly created health worker position when recruiting agents nationally. We find that making career incentives salient at the recruitment stage attracts health workers who are more effective at delivering health services, with administrative data showing an improvement in institutional deliveries, child health visits, and immunization rates in the treatment areas. While career incentives attract agents who differ on observables (e.g., they have higher skills and career ambitions), 91% of the performance gap is due to unobservables. The results highlight the importance of incentive design at the recruitment stage for attracting high performers who cannot be identified on observables alone. The second and third experiments examine the use of non-pecuniary incentives in health care. The second experiment (jointly authored with Nava Ashraf and Oriana Bandiera) studies non-monetary awards. Awards may affect behavior through several mechanisms: by conferring employer recognition, by enhancing social visibility, and by facilitating social comparison. In a nationwide health worker training program in Zambia, we design a field experiment to unbundle these mechanisms. We find that employer recognition and social visibility increase performance, while social comparison reduces it, especially for low-ability trainees. These effects appear when treatments are announced and persist through training. The findings are consistent with a model of optimal expectations in which low-ability individuals exert low effort in order to avoid unfavorable information about their relative ability. The results highlight the importance of anticipating the distributional consequences of incentives in settings in which the performance of each worker affects social welfare. The third experiment turns from extrinsic incentives (such as career opportunities and non-monetary awards) to "intrinsic incentives"—that is, incentives that make work more intrinsically rewarding. In the context of a rural health worker program in India, I develop and test a novel, mobile phone-based self-tracking app designed to increase agents' intrinsic returns to effort. At nine months of follow-up, the self-tracking app leads to a 27% increase in performance as measured by the main job task (home visits). Moreover, the app is most effective when it leverages pre-existing intrinsic motivation: it produces a 46% increase in performance in the top tercile of intrinsically motivated workers, but no improvement in the bottom tercile. Evidence from survey and performance data indicates that the treatment effect is mediated primarily by making effort more intrinsically rewarding, and not by other mechanisms such as providing implicit extrinsic incentives. The results suggest the potential for wider use of intrinsic incentives that may increase performance at low cost, when agents are intrinsically motivated.
Health Policy

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Reay, Patricia Allison. "The reorganization of health care in Alberta, change in an organizational field." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp02/NQ60018.pdf.

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Schlieter, Hannes, Martin Juhrisch, Stephan Bögel, and Werner Esswein. "Adapting Enterprise Architectures for Health-Care Networks – Field Report of an Implementation." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-142820.

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Schlieter, Hannes, Martin Juhrisch, Stephan Bögel, and Werner Esswein. "Adapting Enterprise Architectures for Health-Care Networks – Field Report of an Implementation." Technische Universität Dresden, 2010. https://tud.qucosa.de/id/qucosa%3A28019.

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Whitener, Louise M. "Using Hongvivatana's model to evaluate health care access : a field study of adolescent women's access to reproductive health care services in rural Missouri counties /." free to MU campus, to others for purchase, 2000. http://wwwlib.umi.com/cr/mo/fullcit?p9974703.

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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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Lee, Renee Gravios. "Uneasy Tensions in Health Care Delivery in a Rural Appalachian Coal Mining Community: Envisioning Alternative Solutions." Diss., Virginia Tech, 1996. http://hdl.handle.net/10919/30555.

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Research consistently supports that some segments of society are at considerably higher risk for illness and death than the national average. While the existence and extent of poor health outcomes for these "vulnerable populations" are well documented, less research attempts to explain why such inequities persist and how they might be resolved. Thus, many vulnerable individuals fail to get adequate health care. How can health care delivery be improved to better serve those consumers most at risk of poor health? Addressing this issue requires an in-depth understanding of the unique health and social needs of vulnerable consumers and how these needs are being met (or not met) by the health care industry. Based on field research using a variety of methods, this study examined health care delivery to one at-risk population, women in a rural Appalachian coal mining community, with the ultimate goal of envisioning service design and distribution strategies that might better serve disadvantaged populations. Consistent with the change-oriented goal of this research, a feminist approach guided this study. Women's everyday experiences in managing their health needs were explored through an analysis of their health care stories. Health care providers were also interviewed in order to explore both sides of the service encounter dyad. The voices of the women and the providers reveal uneasy tensions in health care delivery and illuminate why the current system does not meet the actual health care needs of the women or their community. A variety of solutions are offered to improve health care delivery.
Ph. D.

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McCray, Janet Patricia. "Towards a conceptual framework for interprofessional practice in the field of learning disability." Thesis, University of Southampton, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.252224.

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Dahl, Andreas, and Kristofer Nylander. "Differences in security between native applications and web based applications in the field of health care." Thesis, Linnéuniversitetet, Institutionen för datavetenskap (DV), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-40397.

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Developing native applications for different platforms with different resolutions and screen sizes is both time consuming and costly. If developers were able to develop one web based application which can be used on multiple platforms, yet retain the same level of security as a native application, they would be able to reduce both development time and costs. In this thesis we will investigate the possibilities of achieving a level of security in a web-based application that can equal that of a native application, as well as how to develop an application that uses the Mina Vårdkontakter (My Healthcare Contacts) framework.

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Cappellaro, Giulia. "Institutional pluralism and organizational change : insights from hybrid organizational forms in the Italian health care field." Thesis, University of Cambridge, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.648682.

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Vincent, Alexander C. "What Do People Entering the Field of Long-Term Care Administration Need to Know?" Miami University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=miami1335559782.

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Johansson, Yvonne. "Tensions in the field of health care : knowledge networks and evidence based practice : an action research approach." Doctoral thesis, Högskolan Kristianstad, Forskningsplattformen för Hälsa i samverkan, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-12488.

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Empirically, this thesis has focused on nine research and development (R&D) networks set up to promote a professional approach to care and strengthen the collaboration between health care sectors in a Swedish health care setting. The research project was embedded in an action research approach intended to encourage network development by means of a dialogical process. The specific research question was: What are the actors‟ perceptions of knowledge networks and how might we account for the networks‟ evolution, role and ways of working? Bourdieu‟s concepts reproduction and symbolic violence were used as analytical tools and were chosen as a way of answering and explaining the empirical story line. Data was collected by use of a multi-method approach consisting of 39 interviews, observations, document review and reflexive notes. The intention was to elicit data that supported both network development and the theoretical explanation to come. It appeared that the networks concerned had several advantages, such as being a forum for internal dialogue and exchange of experiences. In addition, two main patterns emerged: Firstly, most of the participants within the networks were advocates of a linear top-down model of implementation of evidence-based knowledge into practice. Secondly, they experienced inertia in the transfer process. From the collaborative process undertaken it emerged that their linear top-down model of knowledge transfer seemed to be firmly rooted. Theoretically, the thesis contributes to an understanding of why the process of knowledge transfer was considered by the participants within the networks to be a sluggish process. The thesis also contributes to an explanation of why they adhered to the macro-discourse of evidence-based medicine at the expense of involving practitioners outside the networks in horizontal patterns of exchange. It is argued that the networks had a symbolic value and were also a product of and reproduced the evidence-based discourse and the prevailing structures within their field. This contrasted with the role of networks as arenas for generation of local knowledge in the network literature. A major challenge facing health care sectors is that of how to support practitioners in the incorporation of new practices resulting in actual changes.

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Mitchell, R. Michael. "Comparative impact of selected group input variables on self-assessments of group process skills in interdisciplinary health care teams : a field study." PDXScholar, 1990. https://pdxscholar.library.pdx.edu/open_access_etds/4129.

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During the past two decades interdisciplinary health care teams have come to be considered an integral component in the efficient delivery of health care. Interdisciplinary teams dealing with the increasingly complex problems of patients are now common in many health care settings. The purpose of the present study was to investigate the individual and collective impact of several group process inputs, common to interdisciplinary health care teams, on team members' appraisals of their own group process skills.

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25

Alexandersson, Katrine. "Intensive care : The significance of gender." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-19593.

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Jordan is a developing country which is taking measures to make the situation in the society more equal between males and females. Former research has showed that it, worldwide, sometimes is great differences between the genders in the health care. This thesis illuminates how it is to work in an intensive care unit and if there are differences between male and female intensive care nurses influencing on the provided care. Twenty intensive care nurses from four intensive care units at Jordan University Hospital were included in the study. Both field notes and an observation schedule were used to gather data. The field notes captured the overall experience of working in the intensive care area and were analyzed by thematic content analyze. The observation schedule concentrated on how long time was spent and which activities were performed bedside. Data from the schedule was compared between the units and between male and female intensive care nurses caring for male and female intensive care patients. The field notes showed that even if the units were busy and crowed the silence and calmness were present. Cooperation was essential and trust and knowledge were spread. Often a warm and comfortable feeling surrounded the personnel and they seemed to like it at work. The observation schedule showed that in the medical and surgical intensive care units the intensive care nurses spent more time and performed a greater number of bedside activities compared to the pediatric and main intensive care units. Female intensive care nurses who cared for male intensive care patients performed less bedside activities and when they cared for a female intensive care patient they spent less time bedside compared to the other groups. In all the units and all the groups the most frequent performed activity was to have a look at the equipment, followed by have a look at the patient. The results can however be questioned since it is a small study accomplished by a single researcher, in some few intensive care units at one hospital.
Program: Specialistsjuksköterskeutbildning med inriktning mot intensivvård

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Simson, Zofia. "What about substance abuse? : a minor field study on Namibian substance abuse care." Thesis, Högskolan Väst, Avd för vårdvetenskap på grundnivå, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-5799.

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Holmemo, Ingvild Kiil. "The Relation between Stress, Muscle Activity, and Shoulder/Neck Pain : a Long-Term Field Study on Health Care Workers." Thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for bevegelsesvitenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-13156.

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Background: Shoulder and neck pain (SNP) is one of the main causes for sick-leave, and the high prevalence affects occupations with both high, moderate and low workloads. At present, the knowledge about pain mechanisms in occupations with low physical workload is still limited. The main purpose of this study was to investigate whether perceived work stress during the workday is related to trapezius muscle activity. A second objective was to investiagte whether trapezius activity differs between individuals with long-term SNP. Methods: Twenty-seven female health care workers participated. Surface electromyography (sEMG) was recorded from the trapezius muscle throughout the workday. Simultaneous inclinometer recordings of the thigh was used to identify periods with sitting, standing, and walking. SNP and stress were recorded by visual analogue scale and physical fatigue by Borgs scale every hour throughout the workday. An index for long-term SNP was also calculated. Findings: Two main comparisons were performed: A between group comparison where sEMG in pain-afflicted workers was compared to sEMG recorded from pain-free workers, and an intra-individual comparison where sEMG in periods of high stress was compared to periods of low stress. In the analyses of the sEMG activity pattern, the focus was on median amplitude and rest time defined as activity < 0.5% of the maximal sEMG response. Overall, there was no evidence of a difference in sEMG activity between pain-free and pain-afflicted workers. Neither did sEMG activity differ between periods with high vs. low stress. Interpretation: The current study does not support the hypothesis that SNP is related to stress-induced low level muscle activity. Further research is needed to reveal the relation between stress, muscle activity and SNP, and the mechanisms behind.

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Islam, AKM Saiful. "INTEREST GROUPS IN RESPONSE TO THE OBAMACARE: THE CHANGING ORGANIZATIONAL FIELD OF HEALTH CARE POLICY IN THE UNITED STATES." OpenSIUC, 2017. https://opensiuc.lib.siu.edu/dissertations/1448.

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This dissertation explores the health care policy organizational field in the United States (U.S.) and its changes due to the implementation of the Patient Protection and Affordable Care Act (ACA). In particular, this study provides the interest groups’ role in the ACA’s evolution process. The ACA was enacted in 2010 by the US Congress highlighting some major reform goals, which included, i) expanding states’ Medicaid expansions and health insurance market reforms to allow greater access to health care services for all Americans, ii) regulating health care providers and lowering costs, and iii) ensuring patient and consumer protection. The policy reform impacted the wide range of interest groups who were societal level actors representing the health care provider groups, hospitals, health insurance companies, and pharmaceutical companies, and patients, etc. The ACA emphasized changes in both structure and culture of the health care policy field to ensure greater institutional representation of the federal government in working with various actors in the health care policy field. This study followed two theoretical guidelines, which included 1) the new-institutionalism theory emphasizing the structuration, dependency, and legitimacy factors in actors’ strategies in the health care policy organizational field and 2) Pierre Bourdieu’s perspectives of the field focusing on the cultural, social and political, economic, and symbolic capitals and actors’ habitus or predispositions due to the ACA in the health care policy field. Besides, the federal government, the states, and the roles of the five health care related professional organizations were investigated. These organizations included, 1) The American Medical Association (AMA), 2) The American Hospital Association (AHA), 3) The America’s Health Insurance Plans (AHIP), 4) The Pharmaceutical Research and Manufacturers of America (PhRMA), and 5) The AARP Inc. (a.k.a. American Association for Retired Persons). I studied the testimonies of these organizations at the U.S. House of Representatives and the Senate and their lobbying activities as actors influencing the health care legislative policies. The qualitative analyses of both manifest and latent contents of the ACA’s legislature and testimonies of the interest groups showed how different actors “wanted” the ACA to be and how they won and lost in the legislative process. Further, how the interest groups used various capitals to actuate the ACA implementation? A focus on the state level legislative processes amplified how the ACA’s implementation is primarily reliant on the state level actors. This study aims to expand knowledge in the area of the health care policy change management. Further, the study provides cross-disciplinary knowledge exchange opportunity for other disciplines, such as, management, public policy, and health care administration to understand health care policy processes through sociological lens.

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Wing, Donna Marie. "The use of political strategies for resource acquisition and allocation for home health care a comparative field study of Central Thames, United Kingdom, and Energytown, United States /." Access abstract and link to full text, 1987. http://0-wwwlib.umi.com.library.utulsa.edu/dissertations/fullcit/8712610.

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Heidari, Negina, and Nasim Yavari. "Nurses' experiences of being team leaders for community health workers in the care of tuberculosis patients : A minor field study in South Africa." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-15922.

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South Africa is a country with a high mortality rate because of tuberculosis and increasing cases of multidrug-resistant tuberculosis makes it a global health problem. Tuberculosis is curable and preventable but without proper treatment many of the infected have no chance of survival. Nurses has an essential role as team leaders for the community health workers in the tuberculosis care. The aim of this study is to investigate nurses' experiences of being team leaders for the community health workers in the care of tuberculosis patients. This study is based on semi-structured interviews with seven nurses working as team leaders in the tuberculosis care in different suburbs in Western Cape, South Africa. The nurses experienced that their leadership gets affected by many obstacles in their daily work. A nurse team leadership have a major effect on the quality of care and the community health workers have an essential role by reaching out to the patients in the communities. To develop the cooperation between the nurses and the community health workers, more resources are needed. Therefore a good cooperation is the key to compete against tuberculosis. This study was sponsored by the Swedish Development Cooperation Agency as a Minor Field Study

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Hasan, Md Mahmudul. "Thermal comfort conditions and perception by staff and patients in a Swedish health care center : A measurement and survey field study for summer conditions." Thesis, Högskolan i Gävle, Avdelningen för byggnadsteknik, energisystem och miljövetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-34161.

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A challenging aspect of modern global development is to provide desired thermal environment for building occupants with optimum consideration of energy and occupants health and satisfaction, both physically and psychologically. The variation of activity level, health condition, needs, clothing habit and staying time of different categories of occupants in hospitals makes it critical where comfort level should be optimized. Now-a-days, tremendous changing on climate makes even more challenging to maintain optimum level of indoor thermal environment at low energy cost. Thermal comfort can be assessed by the well-established PMV- PPD model, and studies on the correlation with AMV ratings from the occupants can help to understand the exact scenario of the thermal comfort. Therefore, this research aims to estimate the thermal comfort level of healthcare occupants, compare PMV-PPD values with AMV for different categories of occupants, and analyze optimum operative temperature for energy savings. A combination of objective measurements and a field study with a semi-structured interview on comfort perception, following ISO-7726, 7730, 8996, 9920, 10551 and ASHARE- 55 regulations, were conducted, where a total number of 56 occupants, including 35 patients, 5 visitors and 16 medical staffs were participated from a health care center of a hospital in Stockholm, Sweden. The data was collected during the summertime. Based on studied thermal environment, both PMV (-1.59 to 1.01) and AMV range (-2 to 1) considering gender, indicated health care center of studied hospital toward slightly cold, where occupants wanted warmer indoor environment. Patients more than 60 years were most sensitive on thermal comfort and overall patients were more sensitive for warm indoor climate than medical staff due to health condition and age. But male respondents were less sensitive than female. PMV and AMV with optimum operative temperature provides the clear idea about optimum thermal environment for the hospitals occupant. Identifying an optimum thermal environment could be a sustainable solution if and only if energy can be reduced.

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Olsson, Sara, and Malin Oskarsson. "How nurses support self-care in patients diagnosed with malaria : A field study at a district hospital in Kenya." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-20462.

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Malaria is a big problem and a major cause of death and illness among children and adults in tropical countries (World Health Organization, 2010). It is the biggest threat for children in Kenya and leads to death in approximately 36,000 children (<5 yrs) every year. When infected with malaria; the patient ends up with some kind of self-care deficit and need access to health care.Research about how nurses can support self-care in patients with malaria is lacking. If no plan for how to take care of a patient with malaria exits, treatment can differ, which in turn can result in poorer outcome for the patient. The aim of the study was to investigate how the nurses at Moi District Hospital in Voi support self-care in patients diagnosed with malaria. The study was carried out with five qualitative semi-structured interviews. Data was analyzed with a deductive content analysis. The result showed that nurses teached and encouraged patients to perform self-care; they identified patient status, they acted for the patient, guided him or her and tried to provide a developmental environment. Teaching was the most common way to support self-care, probably because of lack of recourses.
Program: Sjuksköterskeutbildning

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Viltoft, Clara Dybbroe. "Xenophobia and Intergroup Conflict: An Inquiry Through The Concept of Health A qualitative field study on the perceptions of health among refugees and asylum seekers in Cape Town, South Africa." Thesis, Malmö universitet, Fakulteten för kultur och samhälle (KS), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-21175.

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Motivated by the ongoing and widespread xenophobia in South Africa, this study explores the experiences of health access and the health sector by refugees and asylum seekers so as to understand intergroup relations, and more specifically the tensions between nationals and non-nationals. In achieving this, an ethnographic fieldwork was conducted in Cape Town, South Africa during Spring 2017; semi-structured interviews with refugees and asylum seekers provide the material for analysis to identify key perceptions on health and xenophobia to shed light on what possible peacebuilding initiatives should address. Key themes uncovered that intergroup violence based on nationality is prevailing in the areas and townships where refugees and asylum seekers live side by side with (black) South Africans. The presence of violence and the fear of risk of violence appear to fuel intergroup resentment and hostility. The lack of social well-being of the refugee became apparent in their frustrations in attaining safety in their everyday life. Moreover, it positions them so that they are unable to improve their own situation and attain health, health access, and health rights. Additionally, it found that a major obstacle to the realisation of health is connected to legal documentation as well as perceived competition for scarce health service. Specifically, it uncovered the perception of assumed hostile attitude (or fear hereof) by nationals among refugees and asylum seekers constitute both visible and invisible access barriers to the public health system and social integration. The application of the instrumental group conflict theory to the ethnographic interview material thus showed that to end what I term ‘norms of protracted social conflict rooted in xenophobia’, refugees and asylum seekers access to and treatment in the health sector is integral for their inclusion into society. It can simultaneously foster relations with the locals and, at the same time, allow for an everyday life wherein the individual can participate in and contribute to the South African society.

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Schaepe, Christiane. "And here we are allowed to do it - An ethnographic field study about the role of the palliative care nurses in Uganda." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-24457.

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Palliativ vård – vård i livets slutskede – är inte prioriterat i tredje världen. I Uganda grundades 1993 Hospice Africa Uganda (HAU), ett hospice som var tänkt som modell för andra afrikanska länder. Här utbildas bl a sjuksköterskor som har rätt att skriva ut morfin och andra läkemedel efter en nio månader lång kurs. I den här etnografiska fältstudien används observationer, intervjuer och gruppintervjuer för att undersöka sjuksköterskan roll inom palliativ vård i Uganda. I studien deltar sammanlagt 20 sjuksköterskor som jobbar på HAU, Mulago hospital och studenter i palliativ vård-kursen på HAU. Resultatet visar att sjuksköterskanS roll är mångfacetterad. Utöver förskrivning av läkemedel är deras roll att utföra vården holistisk, där de tar hänsyn till fysisk, psykosocial och andlig smärta. I sitt arbete möter de många utmaningar men de har även möjlighet att förbättra patientens livskvalitet.
Palliative care – end of life care – is not a priority in developing countries. In 1993 Hospice Africa Uganda (HAU) was founded and chosen as a model for other african counties. Among other things nurses are authorised to prescribe morphine and other palliative care drugs after undergoing a nine months clinical palliative care course at HAU. In this ethnographic field study observations, interviews and group interviews are used in order to explore the role of the palliative care nurse specialist in Uganda. In total there are 20 participants involved in this study, who are working at HAU, Mulago hospital and students from the clinical palliative care course. The result of the study reveal that the role of the palliative care nurse specialist is multifaceted. Beyond prescribing drugs their role is to deliver holistic care by taking into consideration the physical, psychosocial and spiritual pain patients and their family can have. They encounter many challenges in their work but they also have the possibility to improve the quality of the patients life.

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Fisch, Mandy. "Interpreting practices in health care : an investigation of differences across trained and untrained interpreters in initial assessment interviews, within the field of Speech-Language and Hearing Therapy." Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/10473.

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Bibliography: leaves 168-181.
Interpreting is an act that has become so customary within the South African context that it has become virtually invisible. Most health care institutions rely on ad hoc interpreting, which involves haphazard interpreting arrangements in which anyone who speaks the patient's language, is called on to interpret. Untrained interpreters are consistently used in clinical practice due to a severe lack of trained interpreters. Despite this, to date little research has been conducted investigating the differences between trained and untrained interpreters. Furthermore, little research has been undertaken on the use of interpreters in the field of Speech-Language and Hearing Therapy. There is much need for interpreters within our profession, as clinicians usually either speak English or Afrikaans, with very little or no knowledge of indigenous South African languages. In this study, differences between trained and untrained interpreters were examined in the initial assessment interview, within the field of Speech-Language and Hearing Therapy.

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Näsman, Per. "Risk, Risk Analysis and Decision-making with Reference to Biostatistics and the Field of Medicine." Doctoral thesis, KTH, Säkerhetsforskning (stängd 20110301), 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-24304.

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Risk, risk analysis and decision-making are essential aspects of health care andmedicine, for patients as well as for physicians and for society as a whole, andthe concept of risk and risk analysis in decision-making has a long history. Theword risk has many different interpretations and has no commonly accepteddefinition. In this thesis, we shall let risk stand for the combination of randomor uncertain events with negative consequences for human health, life and/orwelfare and/or the environment together with some measures of the likelihoodof such events. We believe this is the dominant concept and understanding ofrisk, the risk being the likelihood or probability of an event followed by somenegative consequences or activities of that event. In this doctoral thesis, we focus on biostatistics, risks and risk analysis in thefield of medicine, a science which has been using methods from the area of riskanalysis for a long time. The seven papers (paper I - paper VII) presented inthis thesis, together with a general introduction to risk, risk analysis anddecision-making, will be used to illustrate and discuss risk analysis as a tool fordecision-making in the field of medicine. From my point a view, risk analysisin the field of medicine aims to reduce pain, raise the quality of life, reduce therisk of adverse events, compare cost efficiency between different treatmentregimes and prolong a healthy life. Based on results presented in the thesis, weconclude that biostatistics, risks and risk analysis used in the field of medicineare valuable methods for evaluation of hypotheses within the health care areaand a good basis for decision-making.

QC 20100901

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Zhang, Wei Hong. "The Strengths and challenges of multicentric European epidemiological projects in the field of reproductive health." Doctoral thesis, Universite Libre de Bruxelles, 2007. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/210700.

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In this dissertation, we base our experience of carrying out participation in 4 EU-funded projects: EUROFETUS (Cost-Effectiveness of ultrasound screening for congenital anomalies); MOMS-B (MOther Mortality and Severe morbidity); PERISTAT(Monitoring and evaluating perinatal health) and EUPHRATES (EUropean Project on obstetric Haemorrhage Reduction: Attitudes, Trial, and Early warning System), an online questionnaire survey for researchers and a literature review, to provide results which will help us to understand the added value and the challenges of the EU collaboration research and the challenges of EU collaboration research in improving the quality and the accessibility of reproductive healthcare.

The EUROFETUS project showed that, despite the fact that the birth prevalence of congenital anomalies has been declining during the last twenty years, they are still a major cause of perinatal mortality and childhood disability in Europe. Congenital heart defects were among the most frequent and the most severe malformations, but were the least diagnosed prenatally. There was large variation between and within countries regarding the proportion of cases diagnosed prenatally and the proportion of cases resulting in termination of pregnancy. From the data available in Eurofetus, such variation might result from the cultural differences underling policy or on ultrasonographer’s expertise, or on differing interpretation of scientific evidence in the design and implementation of screening.

The MOMS-B project allowed population-based comparisons between countries by using the standardised definition that showed the three conditions (pre-eclampsia, postpartum haemorrhage and sepsis) selected to as markers of acute severe maternal morbidity are not rare in Europe. Severe haemorrhage was the most common of severe maternal morbidity condition, but its incidence varied widely between European countries.

The PERISTAT project on the indicators of unfavourable maternal health outcome showed that the maternal mortality ratios (per 100, 000 live births) for early obstetric death ranged from 2.8 to 11.4 across European countries studied. Such variation reflected different resources and systems in place with varying level of ascertainment in addition to difference in the number of maternal deaths.

The EUPHRATES project on a survey of current practice in relation to management of the third stage of labour and the immediate management of postpartum haemorrhage in 14 European countries showed that there were considerable differences in policies for managing the third stage of labour between and within the countries studied.

The online questionnaire survey for researchers showed that almost all researchers were satisfied with their participation in EU-funded project; the main benefits for them were transfer and sharing of experience and knowledge between researchers, but the administrative procedures should be simplified in the future. The description of the process needed to obtain ethical approval for a cluster randomized trial in the EUPHRATES project showed that there was considerable variation in time required and the criteria used amongst 14 European countries, with consequential delay in research and exclusion of one country from the trial.

Overall, we conclude that Community Framework programmes offer new opportunities to connect researchers from all over Europe to share expertise and resources, including computing tools, and make a real contribution to the creation of the European research area. The added value of EU collaborative research is particularly well positioned for improving foetal and maternal health, from the perspective of harmonizing case definitions, collecting the necessary number of cases within a limited period of time, comparing data between regions and countries, meeting the specific needs of the EU and giving a common response to European reproductive health questions. On the other hand, epidemiological data from multiple countries has advanced our understanding of important health-risks and their geographical distributions across Europe and provided the evidence to help people make better decisions about healthcare in the field of reproductive health for the future research.

We focus on reproductive health but believe that this approach could be adapted to other fields when appropriate./Dans cette thèse, nous avons basé notre expérience sur notre participation dans 4 projets européens (EUROFETUS, MOMS-B, PERISTAT et EUPHRATES), un questionnaire en ligne vers les chercheurs, et une revue de la littérature pour fournir les résultats qui nous aideront à comprendre la valeur ajoutée qu’apporte la recherche collaborative et les défis de cette recherche pour l’amélioration de la qualité et de l’accessibilité de la santé reproductive.

Le projet EUROFETUS montre que, en dépit du fait que la prévalence des anomalies congénitales à la naissance diminue depuis une vingtaine d’années, elles restent une cause majeure de mortalité périnatale et de handicaps infantiles. Les malformations cardiaques congénitales sont parmi les plus fréquentes et les plus sévères des malformations, mais aussi les moins diagnostiquées. Il y a de larges différences entre et à l’intérieur des pays concernant la proportion de cas diagnostiqués en prénatal et la proportion de cas résultant en interruption de grossesse. D’après les données disponibles dans EUROFETUS, de telles variations pourraient résulter de politiques de santé différentes, reflétant des divergences culturelles, de variations dans l’expertise des échographistes, ou encore d’interprétations divergentes de preuves scientifiques dans la conception ou la mise en place du screening.

Le projet collaboratif européen sur la Mortalité et la Morbidité Maternelle sévère (MOMB-B) a permis des comparaisons en population entre pays en utilisant une définition standardisée qui a montré que les trois pathologies sélectionnées (pré-éclampsie, hémorragie, sepsis) comme marqueurs de la morbidité maternelle sévère n’étaient pas rares en Europe. L’hémorragie sévère était la pathologie la plus fréquente, mais son incidence variait très fort d’un pays à l’autre.

The PERISTAT project on the indicators of unfavourable maternal health outcome showed that the maternal mortality ratios (per 100, 000 live births) for early obstetric death ranged from 2.8 to 11.4 across European countries studied. Such variation reflected different resources and systems in place with varying level of ascertainment in addition to difference in the number of maternal deaths.

Le projet EUPHRATES, par une enquête de pratique concernant le management de la troisième phase du travail et du management immédiat de l’hémorragie du postpartum dans 14 pays européens, a montré qu’il y avait des différences considérables dans les pratiques entre et à l’intérieur des pays en Europe.

Le questionnaire en ligne auprès des chercheurs a montré que la plupart étaient satisfaits de leur participation à des projets européens, les principaux bénéfices étaient le transfert et le partage d’expériences et de connaissances entre chercheurs mais que les procédures administratives devraient être simplifiées dans le futur. La description de l’utilisation des comités d’éthique dans l’essai EUPHRATES a montré de très grandes divergences.

En général, nous concluons que les programmes-cadres européens offrent de nouvelles opportunités aux chercheurs européens de partager l’expertise et les moyens, en ce compris les outils informatiques et contribuent à la création d’un espace européen de la recherche. La valeur ajoutée de la recherche collaborative est particulièrement importante pour améliorer la santé fœtale et maternelle par l’harmonisation de la définition des cas, la collecte du nombre nécessaire de cas dans une période déterminée, la comparaison des données entre les régions et pays, pour rencontrer les besoins spécifiques de l’Union Européenne et donner une réponse commune aux questions de santé reproductive en Europe. D’autre part, les données épidémiologiques de nombreux pays ont fait avancer notre compréhension de risques importants de santé maternelle et leur distribution géographique à travers l’Europe et apporté la preuve de la nécessité d’aider les gens à prendre la meilleure décision en ce qui concerne les soins en santé reproductive pour de futures recherches.

Nous nous sommes concentrés sur la santé reproductive mais nous croyons que cette approche pourrait être adaptée à d’autres domaines.

Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished

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Fröberg, Emmeli, and Anna Rolandsson. "A qualitative study about nurses' experiences of working and caring in a Palestine refugee camp in Jordan and methodological reflections while conducting a study within this field." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-18676.

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Jordan is a developing country and there are ten Palestine refugee camps throughout Jordansince the Arab-Israel conflict in 1948 and the Arab-Israel war in 1967. The camps are run byUnited Nation Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)which is the main provider of health care in the camp. Today, the fourth generation ofrefugees lives in the camps which are extremely overpopulated. The social and economicconditions in the camps are poor. The nurses' workload in the Health care centre in the campis getting harder and UNRWA's resources are getting strained due to funding shortfalls. Weasked ourselves the question: How do the nurses experience providing care for the patientswith limited resources? The aim of this study is to elucidate the nurses' experiences ofworking and caring in a Palestine refugee camp in Jordan and also to describe challengeswhile conducting a qualitative study within this field. Qualitative data were collected byperforming interviews with an open ended question with nurses who are working in one of theHealth care centres in the largest Palestine refugee camp in Jordan. Methodologicalreflections were made out of our experiences while conducting the study. The nurses talkedabout providing good care for the patients and their satisfaction when caring. They alsoreflected over the resources in the Health care centre. Since the Palestine refugee camp is thenurses' home and workplace, a place where they have their professional and private life, itseems that there is a very strong connection between the nurse and the patient.

Program: Sjuksköterskeutbildning

Uppsatsnivå: C

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Andersson, Mikael, and Josefine Johansson. ""Where I come from cannot make me who I want to be” : A Minor Field Study in the townships of Cape Town." Thesis, Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-4502.

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Aims: The purpose of this thesis is to describe peer educators’ experiences from the training given to them by The Leadership South Programme. The aim is also to describe the participants’ perceived self-empowerment and perceptions about their own learning and experiences of being a peer educator. The study also aims to explore how peer educators share their skills with others. Methods: Grounded Theory is the method used for the research presented in this thesis. The data collection was done by open-ended questionnaires followed by qualitative interviews. Results: The results show that the peer educators who participated in our study show increased self-esteem and motivation. The training has also given them increased knowledge in communicating, listening and facilitating others. Furthermore peer educators experienced increased self-awareness and learned how to motivate and support their peers and share information.
Mål: Denna uppsats syftar till att undersöka hur ungdomar, som har genomgått Leadership South’s program, upplever utbildningen. Syftet är också att analysera deltagarnas upplevda känsla av egenmakt, så kallad empowerment, och uppfattningar om deras eget lärande och erfarenheter av att vara en fadder (peer educator). Slutligen vill vi också undersöka hur respondenterna agerar för att dela med sig av sina erfarenheter. Metod: Grundad teori är den metod som använts i forskningen som presenteras i denna uppsats. Datainsamlingen genomfördes med hjälp av en enkät med öppna frågor följd av en kvalitativ intervju. Resultat: Resultatet visar att de ungdomar som deltagit i vår undersökning har stärkts genom ökad självkänsla och ökad motivation. Utbildningen har också gett dem ökade kunskaper i kommunikation, att lyssna och att facilitera andra. Vidare har ungdomarna, genom ökad självkännedom, lärt sig att motivera och stötta sina kamrater och tillsammans dela och sprida information.

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Öhman, Ann. "Profession on the move : Changing conditions and gendered development in physiotherapy." Doctoral thesis, Umeå universitet, Epidemiologi och folkhälsovetenskap, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-7519.

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Physiotherapy in Sweden has developed from a practical, hands-on, assistant job predominantly taught at college level to a university-based academic discipline emphasising evidence-based practice and research. Women are in majority although an increasing number of men have entered the profession. Women and men physiotherapists tend to undertake different career paths. The overall aim of the present thesis was to use a gender perspective to describe and analyse attitudes to the professional role, health care work and the development of the profession among actors engaged in physiotherapy education. A questionnaire was distributed in 1997 to all Swedish physiotherapy students in the second semester of the education (n=273). The same cohort was investigated in 1999 at the completion of the education. The response rate was 93 percent at both occasions. For an international comparison, the same questionnaire was distributed in 1997 and in 1999 to a group of Canadian physiotherapy students in their first and last semesters (n=60). Qualitative research interviews were conducted with 8 novices in physiotherapy and with 14 women educators in academia. Five focus group discussions with clinical supervisors were conducted (10 women and 5 men). Methods used were Grounded theory, factor analysis, logistic regression and path analysis. Feminist theories and Bourdieu's theory of culture constituted a theoretical framework Four ideal types were identified among the novices representing attitudes to the professional role. The Treater and The Supervisor were attitudes found among the women, whereas The Coach and The Entrepreneur were attitudes among the men. Type of health care facility was important for their positioning in the organisational hierarchy. Swedish students favour future employment in private practice. Sports medicine clinics and fitness centres are health care facilities highly endorsed, as is health promotion. Neither care of elderly nor hospital work are preferable fields of practice. Research is not favoured. Men students are more likely to have chosen the profession because of their interest in physical activity and sports. They are also more likely to prefer owning a private clinic and working with alternative approaches such as fitness training in sports medicine clinics. Women students are more likely to prefer an employment in private practice. The Canadian men students favour private practice whereas the women prefer the public sector of health care. The academic educators experience a gap between theory and practice which causes conflicting messages to students. Competing professions, emergent societal change and a conservative clinical practice constitute threats to the profession. The uniqueness of professional competency, theoretical development and new arenas such as home rehabilitation, consulting and research constitute a vision for future development of the profession. Masculinity is highly valued for status and power whereas femininity symbolises empathy and caring. The clinical supervisors update their theoretical knowledge base through supervision of students, but claim that students lack hands-on skills. Stress at work, unequal power relations in the hierarchy and restructuring of health care are factors that influence work satisfaction negatively. To conclude, gendered habitus, different symbolic capital and different attitudes towards health care work and development of the profession were found in the sub-fields of physiotherapy.
digitalisering@umu

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Masler, Daniel. "The Self of the Field and the Work of Donnel Stern." Antioch University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1420152283.

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Von, Wuhlisch Friderike Schmidt. "How can health literacy and client recall/memory of clinical information be maximised in the field of Speech-Language Pathology? : an exploratory study of clients and therapists in the Western Cape." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/2937.

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Includes abstract.
Includes bibliographical references (leaves [157]-178).
The aims of this study were to (a) explore health literacy and information recall/memory of clients receiving Speech-Language Pathology treatment in Cape Town, and (b) to explore ways of maximising these factors in clients with dysphagia, voice disorders (including laryngectomies) and cleft lip and/or palate.

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Breman, Anna. "The economics of altruism, paternalism and self-control." Doctoral thesis, Stockholm : Economic Research Institute (EFI), Stockholm School of Economics, 2006. http://www2.hhs.se/EFI/summary/698.htm.

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Whiting, Susan E. "A qualitative study investigating the potential for collaborative relationships between clinical psychologists and self-help groups in the field of mental health, and comparing clinical psychologists' views about self-help groups with self-help group members' views about the professional care system." Thesis, Open University, 1996. http://oro.open.ac.uk/57653/.

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This study explores the potential for collaborative relationships between clinical psychologists and self-help group members in the field of mental health, comparing the views of each group in relation to the other and their preferred relationships. The participant group comprised: (a) 16 clinical psychologists working in adult mental health services, twelve with previous contact with self-help groups and four without any previous contact and (b) fourteen self-help group members from various self-help groups for adults experiencing personal or emotional difficulties. Face to face interviews were conducted using semi-structured interview schedules. These were designed for each group to understand in-depth their views in relation to the other and about entering into collaborative relationships. Grounded theory and thematic analysis were used to analyse the interviews. Both groups perceived benefits from a collaboration but envisaged problematic relationships. Tension emerged as a major issue and was expressed in various ways. Three major dimensions of tension were similarity versus difference, power versus equality and resources versus deprivation. Managing the resulting tensions poses threats for both groups in collaborative relationships, particularly to their identity. Findings suggest that both groups need to find ways of managing their genuine differences without introducing threats into the relationship or preventing the full potential of collaborative relationships from being realised. The study's findings are critically evaluated and directions for future research in the field are discussed. Implications for clinical practice are addressed.

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Fleck, Kenneth. "Finding the shadows in the mirror of experience an ontological study of the global co-worker : a thesis submitted to Auckland University of Technology in fulfilment of the requirements for the degree of Master of Philosophy, 2008." Click here to access this resource online, 2008. http://hdl.handle.net/10292/468.

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This study explores the phenomenon of a personal exploratory field visit to HIV programmes in Malawi and how that informs my future plans to work cross-culturally with HIV. I use hermeneutic phenomenology with the guidance of Heidegger and Gadamer, and draw on Ackermann, Hill, Maluleke, Moltmann, and Thielicke for theological direction. This study analyses how personal formation takes place and how the meaning of that experience can inform future cross-cultural interaction. The data of this study is drawn from a range of people interviewing ‘me’. This includes a pre and post interview in relation to my three week exploratory visit to Malawi, and recorded daily reflections during the visit. Upon return I was interviewed about my experience by ten people from the following areas: nursing, counselling, development, theology, business, medicine, clergy, an Expatriate Malawian, and a women working from a Maori paradigm. These interviews focused on my experience with questions framed from the interviewer’s specialty area. The transcripts become further data for my study. The findings of this thesis suggest that people wishing to work cross-culturally need to understand their motivation for their work, and understand who they are before entering a foreign land. This transformative journey also needs to continue as part of the process of working with people because we can only be effective with change if we are listening and hearing the other’s perspective. It is in being open to this difference between persons that we continue to find ourselves. While perhaps we have a tendency to want to make everybody like us, we can only grow into our full potential in relationship with truly different others. Tensions I experienced demonstrate that there is a complex need to understand how the context controls how HIV is perceived. This requires uncovering some of the deeper issues of HIV and culture, and knowing how to conceptualise these in both positive and informative ways. This thesis asks four key questions for the global-co-worker to work through before embarking on cross-cultural mission: 1. How do you know you should go?; 2. How are you going to make a difference?; 3. Who are you going to be?; and 4. What will sustain your involvement? My own experience has drawn me into a deeper awareness of the need for a vital connectedness of faith, hope and love underpinning the everydayness of such an experience.

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Скиба, Ольга Олександрівна, and Olha Oleksandrivna Skyba. "Публічне управління у сфері громадського здоров’я України в умовах реформи системи охорони здоров’я." Master's thesis, СумДПУ імені А. С. Макаренка, 2020. http://repository.sspu.edu.ua/handle/123456789/11334.

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Проаналізовано адміністративно-правові аспекти публічного управління в сфері охорони здоров’я. Охарактеризовано адміністративно-правові основи розвитку національної системи охорони здоров’я в умовах реформування галузі. Розкрито організаційно-правові засади організації охорони здоров’я в умовах поширення коронавірусу COVID-19. Охарактеризована структура та динаміка захворюваності дорослого населення Сумської області. Здійснено аналіз демографічних показників та стану здоров’я дорослого населення Сумської області.
The administrative and legal aspects of public administration in the field of health care are analyzed. The administrative and legal bases of development of the national health care system in the conditions of reforming the branch are described. The organizational and legal principles of the organization of health care in the context of the spread of coronavirus COVID-19 are revealed. The structure and dynamics of morbidity of the adult population of Sumy region are characterized. The analysis of demographic indicators and the state of health of the adult population of Sumy region is carried out.

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Shimoguiri, Ana Flávia Dias Tanaka [UNESP]. "Contribuições da psicanálise de Freud e Lacan e do materialismo histórico para a terapia ocupacional: uma clínica do desejo e do carecimento na saúde coletiva." Universidade Estadual Paulista (UNESP), 2016. http://hdl.handle.net/11449/134320.

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Made available in DSpace on 2016-02-24T12:35:19Z (GMT). No. of bitstreams: 1 shimoguiri_afdt_me_assis.pdf: 802484 bytes, checksum: 2ce37ef670f73194709c005324fff133 (MD5) Previous issue date: 2016-02-04
Nosso objetivo principal foi pensar as práticas em Terapia Ocupacional à luz da análise paradigmática postulada por Costa-Rosa, que define o Paradigma Psicossocial como um passo além da Reforma Psiquiátrica brasileira. A partir da práxis clínica e institucional, tentamos fundamentar uma modalidade de terapia ocupacional na qual a psicanálise do campo de Freud e Lacan e o Materialismo Histórico são os referenciais teóricos técnicos e éticos políticos. Especificamos o enfoque desta reflexão no campo da Saúde Coletiva, na Atenção Psicossocial. Partimos do Dispositivo Intercessor, como um novo Modo de Produção de subjetividade e conhecimento. De natureza transdisciplinar, o Dispositivo Intercessor parte, principalmente, da psicanálise e do Materialismo Histórico – bem como de inspirações da Análise Institucional francesa e da Filosofia da Diferença – para definir dois momentos de produção radicalmente diferentes: o momento da práxis clínica junto aos “sujeitos do tratamento” e da práxis institucional junto ao “coletivo de trabalho”; e o momento da reflexão teórica, produzida a posteriori, sobre o processo de produção realizado no primeiro momento. Nossas reflexões pretendem demonstrar que (re)inventar a clínica na Terapia Ocupacional no contexto do Paradigma Psicossocial é tão possível quanto eticamente necessário. Na terapia ocupacional psicossocial, a saúde e a subjetividade são tomadas em sua continuidade moebiana e as dimensões subjetiva e social são indissociáveis. O sujeito, conforme concebido pela psicanálise, está entre homens e entre significantes, o referente de ação será o sujeito do inconsciente e o principal ‘meio’ de trabalho será a palavra e o fazer humano, considerado pelo Materialismo Histórico como a atividade vital do processo de humanização, em que ao fazer o homem faz a si mesmo. Com revoluções discursivas, avessas ao Discurso do Mestre e da Universidade, nos posicionamos no Discurso da Histérica e no Discurso do Analista, na ética do desejo. Assim é possível recuperar o aspecto simbólico-criativo-desejante das atividades, pensadas como dispositivos clínicos capazes de proporcionar equacionamentos de certos impasses nos processamentos específicos da subjetivação. Nesse modo de relação do sujeito com seu fazer, com o significante, e com os outros, há possibilidades transferenciais mais simbólicas e menos imaginárias, menos alienantes. E, sobretudo, a produção de subjetividades singularizadas, por definição, subversivas ao instituído social dominante. Somente assim será possível caminhar na direção de suplantar as velhas terapêuticas ocupacionais alienantes pertencentes ao Paradigma Psiquiátrico Hospitalocêntrico Medicalizador, não por acaso sintônico com o Modo Capitalista de Produção.
Our main objective was to reflect about Occupational Therapy´s practices in the light of the paradigmatic analysis postulated by Costa-Rosa, who defines the Psychosocial Paradigm as a step beyond the Brazilian Psychiatric Reform. From a clinical and institutional praxis, we have attempted to found a modality of occupational therapy in which Freud and Lacan’s psychoanalysis and the historical materialism are the technical theoretical and ethical political references. We specify the focus of this reflection in the field of Collective Health, in the Psychosocial Care. We start from the Intercessor Device as a new Mode of Production of subjectivity and knowledge. Of transdisciplinary nature, the Intercessor Device originates mainly from psychoanalysis and Historical Materialism – as well as from inspirations of the french Institutional Analysis and Philosophy of Difference – to define two radically different moments of production: that of clinical praxis together with the “subjects of treatment” and of institutional praxis with the “collective of work”; and the moment of theoretical reflection, produced a posteriori, on the production process carried out along the first moment. Our reflections intend to demonstrate that (re)inventing the clinic in Occupational Therapy in the context of Psychosocial Paradigm is both possible and ethically necessary. In the psychosocial Occupational Therapy the health and the subjectivity are taken in their mobius continuity, so the subjective and social dimensions are inseparable. The subject, as conceived by psychoanalysis, is among men and between signifiers, the referent of action will be the unconscious's subject and the main means of work will be the word and the human´s doing, considered by historical materialism as the vital activity of the humanization process in which the man do to make himself. With averse discursive revolutions to Discourse of the Master and Discourse of the University, we choose the Discourse of the Hysteric and the Discourse of Analyst, in the desire's ethics. So it’s possible recovering the symbolic-creative-desiring aspect of activities, intended as clinical devices capable of equating impasses in specifics processes of subjectivity. In this mode of relationship of the man with his doing, with the signifier and with others men, there’re possibilities’s transference more symbolic and less imaginary, less alienating. Above all, the production of singularized subjectivities, by definition, subversive to the dominant social set. Only then will it be possible to move toward supplanting the old alienating occupational therapies pertaining to the Psychiatric Hospitalocentric Medicalizing Paradigm, not by chance in syntony with the Capitalist Mode of Production.

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48

Neuwirth, Richard. "Poptávka na trhu wellness služeb v ČR a v zahraničí." Doctoral thesis, Vysoká škola ekonomická v Praze, 2007. http://www.nusl.cz/ntk/nusl-114053.

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PhD dissertation: "Demand in the wellness market for services in the Czech Republic and abroad" deals with an emerging sphere in the market for services. The service sector contributes not only to the GDP but participates in improving living standards in developed countries. Wellness market for services could influence the way how to spend free time, increase the whole quality individual lives and contribute to reduce spending on health care in the future. In the introductory part there is analyzed the current situation on the wellness market in the Czech Republic. The view of some Czech businessmen on the wellness market for services is often considered (for the purpose) as a way of earnings regardless the broader content of the sphere connected with the healthy lifestyle. The term "wellness" often includes activities which do not concern this sphere, only use this term for marketing purpose. The dissertation is based on the own definition as a term. This term is defined as a permanent feeling of higher quality of life achieved through performing physical and mental activities and internal acceptance of the healthy lifestyle. The goal of this dissertation is a demand survey for these services, it specifically concerns the research of public awareness in this sphere, finding the attitude to activities, which are connected with wellness and acquiring next information which is principal for development in successful business activities, particularly for the strategic decision in pricing policy, the equipment in wellness premises and the quality provided services. In the dissertation were assumed three basic hypotheses: 1. On the basis of research there will be possible to put a qualified customer group and to determine chosen activities. They are suitable as a content of offered programmes for clients who are informed of this sphere or seek to achieve outlined goals. 2. Customers with interest and knowledge of the sphere will be interested in the healthy nutrition, the consumption of dietary supplements and in next activities concerning wellness. 3. Next assumption is a fact that the level of knowledge and understanding the whole conception will be at a lower level in the public. The theoretical part of the dissertation is based on the classical microeconomic theory. The attention is mainly paid to the theory of consumer optimum. Subsequently the dissertation focuses on the issue of marketing research, particularly on the analysis of appropriate quantitative methods which could and should be used in the application part. Great emphasis is placed on the communication policy which is a very important tool for the marketing mix. The application part of the dissertation focuses on its own demand research within that over nineteen thousand data from more than three hundred respondents were obtained. The results were presented after analyzing the obtained data. They showed that all age groups of respondents included in the population survey have within their categories very different features. Thanks to that fact popular sports have been identified, it was possible to determine a client's price concept about services suitable for this sphere and to describe an opinion on the quality and the equipment of wellness premises. Next, for purposes of comparison, two researches from abroad were used and these have become a valuable source of information and serve as a basis for comparative research i.e. comparison of foreign experience with the situation on the Czech market. Both differences and facts generally applicable in the Czech Republic and abroad were found. The result of the investigation was not only the recommendation for following research directions, particularly the need to do research in specialized wellness premises among informed customers with regard to data which were not possible to find out during the overall market research. Another task resulted from the finding that the respondents have very little awareness of the sphere and it will be necessary to establish the wellness programme conception and to introduce this concept to the public particularly by focusing on high schools oriented on physical education and sport and other public institutions. There is a fact that the Czech institutions in the health sector do not consider the prevention in the field of diseases of civilization important enough. It will be necessary to carry out next education of the public in order to achieve savings in the treatment of diseases of civilization in the Czech health care in the future. At the end of the dissertation it is stated that the goals and tasks were fulfilled despite difficulties in obtaining foreign materials and information suitable for comparison with the market in the Czech Republic. In the introduction the presented hypotheses were mostly confirmed, excluding the customer's price concept. It could not be determine intended consumer optimum because of significant heterogeneity of statistical results. In any case the dissertation showed the low level of public awareness of the concept wellness (as expected), the necessity of more distinctive defining of mental activities suitable for this field and the need to unite different opinions on the whole sphere of these services.

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Pulga, Vanderléia Laodete. "Mulheres camponesas plantando saúde, semeando sonhos, tecendo redes de cuidado e de educação em defesa da vida." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2014. http://hdl.handle.net/10183/115967.

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Esta tese consiste na identificação de contribuições político-pedagógicas dos movimentos sociais populares nas experiências e práticas culturais, integrativas, tradicionais de cuidado e de educação popular em saúde, especialmente do Movimento de Mulheres Camponesas, que poderão compor a caixa de ferramentas pedagógicas dos processos de formação de profissionais/trabalhadores (as) da saúde para sua atuação no Sistema Único de Saúde (SUS) em comunidades do campo, da floresta e das águas. A pesquisa foi realizada junto ao Movimento de Mulheres Camponesas através de análise de observações, registros, documentos, histórias de vida, oficinas e círculos de cultura feitos com mulheres que participam dessa organização, como também as redes de interação com a educação popular e permanente em saúde. A pesquisa articula essas experiências e seus saberes no contexto de produção de vida, saúde e adoecimento das populações que vivem nesses territórios e os desafios para o cuidado integral e a educação em saúde. Territórios marcados pelos interesses do capital transnacional e seus impactos sobre os camponeses (as), onde os determinantes sociais e as desigualdades compõe a complexidade da situação de saúde dessas populações. Traz a ação das mulheres camponesas na produção de cuidado da vida e da saúde na sua trajetória histórica, os eixos estruturantes articulados às relações sociais de gênero, raça/etnia, classe e orientação sexual, ao feminismo e ao projeto popular de agricultura camponesa. Pelo caminho percorrido, foi possível perceber que as políticas públicas de saúde no Brasil, especialmente nos territórios de atuação dessas mulheres camponesas, são recentes e frágeis na garantia do acesso e na atenção integral à saúde. O MMC surge como espaço de luta e valorização das mulheres camponesas na conquista de direitos e a saúde emergem como uma das lutas importantes do movimento. Nele as mulheres se ressignificam, tem o cuidado com vida e a saúde como base central do seu agir e fazem experiências de libertação e emancipação, enquanto sentido profundo de sua práxis portadora de uma dinâmica educativo-terapêutica e uma mística libertadora. Dessa forma, constroem novos significados à integralidade da saúde, fortalecem o sentimento de pertença das mulheres para com o movimento, ao mesmo tempo em que fazem o enfrentamento ao agronegócio, ao neoliberalismo, à cultura machista e às formas de opressão, de exploração, de discriminação e de violência. Das experiências de organização, de cuidado, de luta e de formação que o movimento desenvolve, bem como a interação com os movimentos e práticas de educação popular em saúde e de educação permanente em saúde emergem as contribuições politico-pedagógicas que ajudam a repensar o modo de cuidar a vida e a saúde, bem como as políticas públicas de educação da saúde, tanto para o meio acadêmico, como para os processos de trabalho e educação na saúde junto ao Sistema Único de Saúde e seus atores, principalmente para a atuação no campo, nas florestas e nas águas.
This thesis consists in the identification of the social movements political-pedagogical contributions in the cultural, integrative, traditional experiences and practices of care and the popular education in health, especially in the Rural Women Movement, that would compose the pedagogical toolbox of the workers and health professional formation process to their actuation in the Single Health System in the field, forest and water communities. The search was realized along with the Rural Women Movement, through analysis of observations, records, documents, life stories, workshops and cultural circles made with women that make part of this organization, as well the interaction network with the popular and permanent health education. The search articulate these experiences and its knowledge in the life, health and illness production contest of the population that live in these territories, and the challenges for the comprehensive care and the health education. Territories marked by transnational capital interests and its impacts on farmers, were the social determinants and the inequalities make the complexity of these people health situation. It brings the rural women action in the life and health care in this historical trajectory, the structural axis articulated to social relation of gender, race/ethnicity, class and sexual orientation to the feminism and to the popular design of peasant agriculture. By the path taken, it was possible realize that the public health politics in Brazil, especially on the action territory of these rural women, are recent and frail in the ensuring access and in the comprehensive health care. The Rural Women Movement arises as a fight and valorization space of the rural women in the rights conquers and the health emerges as one of the most important movement fights. In it, women reframe there selves, have care with life, and have the health as a central bases of their action, and make liberation and emancipation experiences, as a deep sense of their praxis carried of a educative-therapeutic dynamics and a liberating mystic. Thereby, they construct new meanings to the health integrality, strengthen the women sense of belonging to the movement, at the same time that make the confronting agribusiness, neoliberalism, machist culture, and the forms of oppression, exploitation, discrimination and violence. From the organization, care, fight and formation experiences that the movement develops, as well as the interaction with the movements and health popular education practices and permanent health education emerges the political-pedagogical contributions that helps to rethink the way of care life and health, as well the health education public policy, both for academic as for the work processes and health education in the Single Health System and its actors, mainly to the field, forests and water action.
Esta tesis es la identificación de las contribuciones políticas y pedagógicas de los movimientos sociales populares en las experiencias y las prácticas culturales, de integración, de cuidado tradicional y un programa de educación para la salud, especialmente el Movimiento de Mujeres Campesinas, que podrán componer la caja de herramientas pedagógicas de procesos de formación de los trabajadores (as) y profesionales de la salud para actuación en el Sistema Único de Salud (SUS ) en comunidades del campo, de los bosques y de las aguas. La encuesta fue realizada junto al Movimiento de Mujeres Rurales a través del análisis de las observaciones, registros, documentos, historias de vida, talleres y círculos culturales realizados con mujeres que participan de esta organización, así como las redes de interacción con la educación popular y permanente en salud. La investigación articula estas experiencias y su sabiduría en el contexto de la producción de vida, salud y enfermedad de las poblaciones que viven en estos territorios y los desafíos para el cuidado integral y la educación en salud. Territorios marcados por los intereses del capital transnacional y su impacto sobre los campesinos (as), donde los determinantes sociales y las desigualdades constituyen la complejidad de la situación de salud de estas poblaciones. Trae la acción de la mujer rural en la producción del cuidado de la vida y la salud en su trayectoria histórica, los ejes estructurales articulados a las relaciones sociales de género, raza/etnia, clase y orientación sexual, al feminismo y proyecto popular de la agricultura campesina En el camino recorrido, se reveló que las políticas de salud pública en Brasil, sobre todo en los territorios de acción de estas mujeres agricultoras, son recientes y frágiles para garantizar el acceso y la atención integral de la salud. El MMC aparece como un espacio de lucha y valoración de las mujeres rurales en la conquista de los derechos y la salud surge como una de las importantes luchas del movimiento. En ella las mujeres se resignifican, tienen el cuidado con la vida y la salud como base central de su actuar y hacen experiencias de liberación y emancipación, mientras sentido profundo de su praxis portadora de una dinámica educativa-terapéutica y una mística liberadora. Por lo tanto, construyen nuevos significados a la integralidad de la salud, fortalecen el sentimiento de pertenencia de las mujeres al movimiento, mientras hacen el enfrentamiento a la agroindustria, al neoliberalismo, la cultura machista e las formas de opresión, de explotación, de discriminación y de violencia. De las experiencias de organización, de cuidado, de lucha y de formación que el movimiento desarrolla, así como la interacción con los movimientos y prácticas de la educación popular e continua en salud emergen las contribuciones políticas y pedagógicas que ayudan a repensar la forma de cuidar la vida y la salud, así como las políticas públicas de educación para la salud, tanto para la comunidad académica como de los procesos de trabajo y educación en la salud por el Sistema Nacional de Salud y sus actores, principalmente para actuar en el campo, bosques y aguas.

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Hoffer, Laurent. "Développement et validation du logiciel S4MPLE : application au docking moléculaire et à l'optimisation de fragments assistée par ordinateur dans le cadre du fragment-based drug design." Phd thesis, Université de Strasbourg, 2013. http://tel.archives-ouvertes.fr/tel-00874644.

Full text

Abstract:

Cette thèse a pour but de développer le pendant in silico des étapes clés du Fragment-Based Drug Design (FBDD), et ce dans le cadre plus général du développement de l'outil S4MPLE. Le FBDD génère des ligands drug-like à partir de petites molécules (fragments). Après une étape de validation de S4MPLE et de sa fonction d'énergie, un recentrage autour du FBDD est réalisé, à travers le docking puis l'optimisation virtuelle de fragments par growing ou linking (G/L). Cette stratégie reposesur 1) la création d'une chimiothèque focalisée en connectant un ou deux fragment(s) avec des linkers pré-générés, et 2) l'échantillonnage avec S4MPLE des composés chimères dans le site avec des contraintes. Des simulations de G/L plus ou moins ambitieuses (site flexible, ajout de H2O libres) permettent de valider cette approche avec des études rétrospectives basées sur des données expérimentales. La dernière phase de la thèse a consisté à appliquer ce protocole in silico à un projet de l'entreprise.

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Dissertations / Theses on the topic 'Health care fields'

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