Dissertations / Theses on the topic 'Health problems'

Deinstitutionalization has had an impact increasing the number of offenders with mental health problems within the correctional system. Furthermore, preliminary research claims that offenders with mental health problems are disproportionately denied when applying for parole. The reasons for this are not well understood. This exploratory qualitative research draws on 48 decisions from the Parole Board of Canada decision registry, four interviews with former parole board members, and observation data from 17 parole hearings to explore how mental health problems are constructed within the conditional release decision-making process. Against a risk logic back drop, this institutional ethnography analyzes the way parole board members understand and operationalize mental health within the decision-making process. Self-regulation, medication compliance, and the role of the expert were strong themes that emerged through a content analysis. By integrating symbolic interactionism and a governmentality framework, the current study explores how mental health in parole decision-making is influenced by individual, organizational, and macro-level risk rationalities that draw on neoliberal responsibilization strategies and "psy" expertise. The findings are presented within Hawkin’s (2002) legal decision-making framework. Policy and human rights implications are discussed.

This thesis comprises three main sections: a literature review, research report and a critical appraisal of the research process. The literature reviewed is the current scientific literature relating to shame and guilt. The review attempts to clarify the conceptual confusion regarding shame and guilt and in particular attempts to delineate the distinctions between the two constructs whilst acknowleding the intricate and entwined relationship. The review also attempts to clarify the confusion regarding the role of guilt and its capacity to elicit both adaptive and maladaptive responses according to the way in which it is operationalised and conceptualised. The importance of the relationship between shame, guilt and mental health problems is presented with supporting empirical evidence. It is concluded that a new shame and guilt measure is required to show how shame and the maladaptive and adaptive aspects of guilt can be operationalised. It is hoped that this will enable future researchers to consider incorporating a profile approach to guilt in particular and that clinicians will consider the multiple and complex roles of shame and guilt in relation to psychological symptoms. The research report (Section 2) comprises two studies. Study 1 is the design, development and piloting of the new questionnaire assessing dispositional shame and guilt. The new measure is constructed and validity tested using an inductive approach. Study 2 is the use of the new measure with a forensic clinical sample and the relationship between guilt, shame and psychological symptoms is examined. It is hoped that this study will encourage researchers to locate future investigations within the clinical population. The final section is the researcher's critical appraisal of the research process based on her personal diary. This section is reflective and considers the impact of the research process on the researcher, the highs and lows of the research process and what changes the researcher might make.

Mental health problems in pregnancy and the postnatal period can have long-term negative effects on women and their children. A key barrier to helping women in this period is the low level of identification of mental health problems. Depression has commonly been screened for using the Whooley Questions or Edinburgh Postnatal Depression Scale (EPDS) but women may experience a broad range of symptoms of distress not captured by these measures. The research reported in this dissertation was designed to address several aims. The first strand aimed to explore women's experiences of postnatal mental health problems and how they conceptualise their symptoms. The focus of the first qualitative study was the lived experience of 17 women who had experienced psychological distress in the first postnatal year, and used interpretative phenomenological analysis. The second qualitative study used thematic analysis with the same sample to explore different symptoms of distress and women's experiences of being assessed for these. The second strand reviewed and evaluated currently existing measures of commonly reported affective symptoms with a view to informing future assessment. A systematic review found a lack of measures of anxiety designed for or validated sufficiently with perinatal women. Factor analyses of the EPDS then explored the structure of depression and anxiety symptoms in the perinatal period in the Avon Longitudinal Study of Parents and Children (N = 11,195 – 12,166). Results suggested symptom clusters of anhedonia, depression and anxiety. Finally, validity of the CORE-10, a short measure of psychological distress was evaluated in a sample of 366 pregnant women. The CORE-10 showed promising psychometric properties. Anxiety was the most reported symptom. Overall findings suggest that perinatal women need to be assessed for a variety of mental health problems and that further work is needed to identify the most effective assessment tool and process.

There is evidence of unmet need for mental health interventions for primary school children. Such children are generally unable to seek help for themselves and therefore, depend on the adults with whom they interact to seek help on their behalf. These adults include teachers, who have advantages over parents in terms of help-seeking, such as their knowledge of normative development. Government policies have outlined the teacher's role in terms of the mental well-being of their pupils, and fulfilling this role includes the ability to recognise that a problem exists and knowledge of how to seek appropriate help for the problem. It is unclear as to whether teachers possess the knowledge and skills to fulfil this role effectively. This study therefore used a cross-sectional design to explore teachers' perceptions of children's mental health problems. To obtain the necessary information, a questionnaire, composed of vignettes of children with clinical symptomatology, sub-clinical symptomatology or problem-free children, was created.

Despite a sound evidence base, the consideration of exercise as a therapeutic adjunct remains rare in mental health settings. This research project reports a series of studies examining the consideration of exercise as a strategy for promoting mental health in clinical settings. A broad, multi-level and multi-method analysis of exercise and mental health was adopted by focusing on trainers (key stakeholders responsible for treatment dissemination), providers (individuals at the forefront of treatment) and service users (individuals with clinical depression). First, the perceptions of exercise as an adjunctive therapy is qualitatively explored through interviews with Course Directors of UK training programmes in clinical psychology and mental health nurses working in acute, inpatient settings. A range of conceptual barriers are revealed such as the perceived `simplicity' of exercise interventions and the incompatibility of exercise with traditional models of understanding and treating clinical conditions. Second, the nature and extent of exercise promotion are identified within one NHS Mental Health Trust. A lack of training and protocols are the most significant barriers. The Theory of Planned Behaviour variables of attitude, subjective norms, perceived behavioral control, and intention predict stage of change of physical activity promotion in a health care setting. However, the past promotion of physical activity overrides much of these effects. Third, the role of exercise in the lives of individuals with depression is explored in a case study analysis of four participants of an exercise referral scheme. The context of each person's life is instrumental in understanding adherence and the experiences associated with participation in exercise and/or physical activity. These studies offer insight to some of the conceptual and structural barriers inhibiting the promotion of exercise as well as factors that may contribute to the success of such promotion within mental health settings. Recommendations are offered to enhance the development of comprehensive physical activity provision for people with mental health problems.

Introduction: People with mental health problems sometimes have the choice whether or not to disclose this to others. The decision to disclose or conceal is likely to have a number of consequences, both positive and negative, and is likely to depend on a variety of factors, which may differ between individuals. We aimed to review the literature relating to these factors. Method: A systematic review of three databases (PsycINFO, Scopus and Web of Science) was carried out to identify articles looking at factors affecting disclosure of a mental health problem outside the workplace, published between January 2005 and August 2015. Results: 19 articles, including qualitative and quantitative methodologies, were identified. Common factors affecting the decision to disclose or conceal included stigma, characteristics of the target, relationship with the target, mental health of the discloser, rules and beliefs about mental health problems, and fears about control and sense of identity. Discussion: Limitations of the current literature, and implications for future research and policy are discussed.

The growth of e-health system has influenced the way health organizations conducttheir business. Communication between these systems is one of the most significantfactors since a more efficient communication system can improve an organizationperformance. Nowadays the health organizations make a lot of investments to deploya suitable information and communication technology to meet their goals.This study investigates the health information exchange within different healthinformation systems. We first carried out a theoretical study to find out the relevantconcepts by reviewing the related literature and analyzing them. As a result of ourtheoretical study we investigate and redesign the basic model of the “Super Clinic” asa new model for health information exchange system. Then we conducted anempirical study to validate the result from the theoretical study which helped us tonarrow down our research area. We revised our proposed theoretical model by thelesson learnt from our empirical study results. Three interviews were conducted withexperts and the outcomes were analyzed using comparative analysis. These interviewsallowed us to outline the most important factors of successful health informationexchange systems (i.e. “Super Clinic”).They also helped us to design a central hub (i.e. “health Hub”) for communicationand information exchange between different information systems. This revised modelof Super Clinic (with the central hub) could be going under more investigation infuture works.
Program: Masterutbildning i Informatik

A range of electronic databases and two journals were subjected to a detailed literature search, focusing on studies evaluating psychological interventions with children aged 0-5 years of age. Outcome studies, utilising experimental design, were included for critical review. The search strategy revealed predominantly attachment-informed intervention studies, prompting a review of this aspect of the literature. A total of twelve studies were identified for closer scrutiny: five with a preventative focus; four describing interventions with clinical populations and three detailing large-scale intervention programmes. This review found evidence that early interventions are effective in altering maternal sensitivity and insecure patterns of attachment. Moreover, interventions were effective in reducing the effects of postnatal depression on attachment security, reducing the incidence of placement breakdown in fostered and adopted children and preventing behaviour difficulties in school-age children. These findings indicate a burgeoning evidence base for attachment-based intervention models for the prevention or treatment of infant or child psychopathology.

Thesis: Ph. D., Massachusetts Institute of Technology, Sloan School of Management, Operations Research Center, 2017.
This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 99-102).
Health care expenditures in the United States have been increasing at unsustainable rates for more than thirty years with no signs of abating. Decisions to accept or reject deceased-donor kidneys offered to patients on the kidney transplantation wait-list currently rely on physician experience and intuition. Scoring rules to determine which end-stage liver disease patients are in most dire need of immediate transplantation have been haphazardly designed and reactively modified in an attempt to decrease waitlist mortality and increase fairness for cancer patients. For each of the above problem settings, we propose a framework that takes real-world data as input and draws upon modern data analytics methods ranging from mixed integer linear optimization to predictive machine learning to yield actionable insights that can add a significant edge over current practice. We describe an approach that, given insurance claims data, leads conservatively to a 10% reduction in health care costs in a study involving a large private US employer. Using historical data for patients on the kidney waitlist and organ match runs, we build a model that achieves an out-of-sample AUC of 0.87 when predicting whether or not a patient will receive a kidney of a particular quality within three, six, or twelve months. Given historical data for patients on the liver waitlist, we create a unified model that is capable of averting an additional 25% of adverse events in simulation compared to current practice without disadvantaging cancer patients.
by Jerry Lai Kung.
Ph. D.

Introduction There is a paucity of knowledge regarding adolescent's preferences for care. The health related problems they face have implications for individuals and nations. Objectives To determine the health problems and needs of adolescents, their knowledge, use of, and preferences for health related services and service providers. Study design A descriptive study involving a two-stage probability sample. An interview schedule was designed for data collection. Setting Eight randomly selected main-stream high schools in Stoke-on-Trent, England. Subjects One hundred and eleven males and 142 females aged 14 and 15 years between 1 st April and 30th June 1994. Results The adolescents had unmet problems and needs relating to lifestyle and risk-taking behaviour, sexual and reproductive health, and emotional problems, influenced by socio-economic and legislative factors. Services were used primarily for physical problems. Knowledge of the location and opening times of two local contraceptive services for adolescents was poor (10/253,4%). Factors they associated with confidentiality were identified. Preferences for service providers varied with the nature of the problem. The girls were more likely to give advice to peers regarding substance abuse, and issues relating to sexual and reproductive health, and expressed a greater preference for advice from peers on these issues. The services the adolescents wanted to see provided were appropriate to their needs and reflected a holistic concept of health. Conclusions • The Health of the Nation targets will not be met unless these problems and needs are addressed. • Potential intervention points for health promotion are being missed. • Local services must be widely advertised. • Adolescents need specific reassurance from service providers that their care will be confidential. • Positive actions adolescents are prepared to take need reinforcing. • Peer counselling programmes might be expected to have a greater positive impact on girls. • Adolescents' opinions regarding service provision must be taken into account.

Many college students have reported struggling with mental health problems while dealing with challenging demands of college. The initial theoretical framework for this research was Pearlin's stress process model (SPM). Building on the SPM, the three additional mediating variables of perceived control, meaninglessness, and financial worries were added to create a composite model for the research. Mental health outcomes in the model were measured by a comprehensive range of factors, which included: psychological distress, suicide, substance abuse, and anger. Data were collected from a non-probability convenience sample of 463 undergraduate students attending a large state supported university in the southwestern region of the United States. Among the social status variables measured, being married, female, and white were significant predictors of poor mental health in the sampled college students. Poor self-image, feeling of meaninglessness, and worrying about current and future finances were significant mediating variables. Poor mental health could make individuals overwhelmed and discouraged. This is a formula for failure in college. The results of this study contribute to a better understanding of the correlates of mental health problems among college students. A greater understanding means that families and college administrations will have better ideas about how to intervene to reduce the stress of students and to focus the available and often limited resources to help young adults in their college experience.

Thesis (M.A.)--West Virginia University, 2004.
Title from document title page. Document formatted into pages; contains v, 121 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 56-61).

Ce manuscrit porte sur certaines extensions à des séries temporelles prenant des valeurs entières du modèle paramétrique périodique autorégressif établi pour des séries prenant des valeurs réelles. Les modèles que nous considérons sont basés sur l'utilisation de l'opérateur de Steutel et Van Harn (1979) et généralisent le processus autorégressif stationnaire à valeurs entières (INAR) introduit par Al-Osh & Alzaid (1987) à des séries de comptage périodiquement corrélées. Ces généralisations incluent l'introduction d'un opérateur périodique, la prise en compte d'une structure d’autocorrélation plus complexe dont l’ordre est supérieur à un, l'apparition d'innovations de variances périodiques mais aussi à inflation de zéro par rapport à une loi discrète donnée dans la famille des distributions exponentielles, ainsi que l’utilisation de covariables explicatives. Ces extensions enrichissent considérablement le domaine d'applicabilité des modèles de type INAR. Sur le plan théorique, nous établissons des propriétés mathématiques de nos modèles telles que l'existence, l'unicité, la stationnarité périodique de solutions aux équations définissant les modèles. Nous proposons trois méthodes d'estimation des paramètres des modèles dont une méthode des moments basée sur des équations du type Yule-Walker, une méthode des moindres carrés conditionnels, et une méthode du quasi maximum de vraisemblance (QML) basée sur la maximisation d'une vraisemblance gaussienne. Nous établissons la consistance et la normalité asymptotique de ces procédures d'estimation. Des simulations de type Monte Carlo illustrent leur comportement pour différentes tailles finies d'échantillon. Les modèles sont ensuite ajustés à des données réelles et utilisés à des fins de prédiction. La première extension du modèle INAR que nous proposons consiste à introduire deux opérateurs de Steutel et Van Harn périodiques, l'un modélisant les autocorrélations partielles d'ordre un sur chaque période et l'autre captant la saisonnalité périodique des données. Grâce à une représentation vectorielle du processus, nous établissons les conditions l'existence et d'unicité d'une solution périodiquement corrélées aux équations définissant le modèle. Dans le cas où les innovations suivent des lois de Poisson, nous étudions la loi marginale du processus. Á titre d'exemple d'application sur des données réelles, nous ajustons ce modèle à des données de comptage journalières du nombre de personnes ayant reçu des antibiotiques pour le traitement de maladies respiratoires dans la région de Vitória au Brésil. Comme les affections respiratoires sont fortement corrélées au niveau de pollution atmosphérique et aux conditions climatiques, la structure de corrélation des nombres quotidiens de personnes recevant des antibiotiques montre, entre autres caractéristiques, une périodicité et un caractère saisonnier hebdomadaire. Nous étendons ensuite ce modèle à des données présentant des autocorrélations partielles périodiques d'ordre supérieur à un. Nous étudions les propriétés statistiques du modèle, telles que la moyenne, la variance, les distributions marginales et jointes. Nous ajustons ce modèle au nombre quotidien de personnes recevant du service d'urgence de l'hôpital public de Vitória un traitement pour l'asthme. Enfin, notre dernière extension porte sur l'introduction d'innovations suivant une loi de Poisson à inflation de zéro dont les paramètres varient périodiquement, et sur l’ajout de covariables expliquant le logarithme de l'intensité de la loi de Poisson. Nous établissons certaines propriétés statistiques du modèle et nous mettons en oeuvre la méthode du QML pour estimer ses paramètres. Enfin, nous appliquons cette modélisation à des données journalières du nombre de personnes qui se sont rendues dans le service d'urgence d'un hôpital pour des problèmes respiratoires, et nous utilisons comme covariable la concentration de polluant dans la même zone géographique
This manuscript deals with some extensions to time series taking integer values of the autoregressive periodic parametric model established for series taking real values. The models we consider are based on the use of the operator of Steutel and Van Harn (1979) and generalize the stationary integer autoregressive process (INAR) introduced by Al-Osh & Alzaid (1987) to periodically correlated counting series. These generalizations include the introduction of a periodic operator, the taking into account of a more complex autocorrelation structure whose order is higher than one, the appearance of innovations of periodic variances but also at zero inflation by relation to a discrete law given in the family of exponential distributions, as well as the use of explanatory covariates. These extensions greatly enrich the applicability domain of INAR type models. On the theoretical level, we establish mathematical properties of our models such as the existence, the uniqueness, the periodic stationarity of solutions to the equations defining the models. We propose different methods for estimating model parameters, including a method of moments based on Yule-Walker equations, a conditional least squares method, and a quasi-maximum likelihood method based on the maximization of a Gaussian likelihood. We establish the consistency and asymptotic normality of these estimation procedures. Monte Carlo simulations illustrate their behavior for different finite sample sizes. The models are then adjusted to real data and used for prediction purposes.The first extension of the INAR model that we propose consists of introducing two periodic operators of Steutel and Van Harn, one modeling the partial autocorrelations of order one on each period and the other capturing the periodic seasonality of the data. Through a vector representation of the process, we establish the conditions of existence and uniqueness of a solution periodically correlated to the equations defining the model. In the case where the innovations follow Poisson's laws, we study the marginal law of the process. As an example of real-world application, we are adjusting this model to daily count data on the number of people who received antibiotics for the treatment of respiratory diseases in the Vitória region in Brazil. Because respiratory conditions are strongly correlated with air pollution and weather, the correlation pattern of the daily numbers of people receiving antibiotics shows, among other characteristics, weekly periodicity and seasonality. We then extend this model to data with periodic partial autocorrelations of order higher than one. We study the statistical properties of the model, such as mean, variance, marginal and joined distributions. We are adjusting this model to the daily number of people receiving emergency service from the public hospital of the municipality of Vitória for treatment of asthma. Finally, our last extension deals with the introduction of innovations according to a Poisson law with zero inflation whose parameters vary periodically, and on the addition of covariates explaining the logarithm of the intensity of the Poisson's law. We establish some statistical properties of the model, and we use the conditional maximum likelihood method to estimate its parameters. Finally, we apply this modeling to daily data of the number of people who have visited a hospital's emergency department for respiratory problems, and we use the concentration of a pollutant in the same geographical area as a covariate
Este manuscrito trata de algumas extensões para séries temporais de valores inteiros domodelo paramétrico periódico autorregressivo estabelecido séries temporais de valores reais. Osmodelos considerados baseiam-se no uso do operadorde Steutel e Van Harn (1979) e generalizamo processo autorregressivo depara números inteiros estacionários (INAR) introduzidos por Al-Osh & Alzaid(1987) para séries de contagem periodicamente correlacionadas. Essas generalizações incluem aintrodução de um operador periódico, a consideração de uma estrutura de autocorrelação mais complexa,cuja ordem é maior do que um, o aparecimentode inovações de variâncias periódicas, e também ainflação zero em relação a uma lei discreta dadana família de distribuições exponenciais, bem comoo uso de covariáveis explicativas. Essas extensões enriquecem muito o domínio de aplicabilidade dosmodelos do tipo INAR. No nível teórico, estabelecemospropriedades matemáticas de nossos modeloscomo a existência, a unicidade, e a estacionariedadeperiódica de soluções para as equações que definemos modelos. Propomos três métodos para estimarparâmetros de modelos, incluindo um métodode momentos baseado nas equações de Yule-Walker,um método de mínimos quadrados condicionais e ummétodo de quasi-máxima verossimilhança (QML) baseadona maximização de uma probabilidade Gaussiana. Estabelecemos a consistência e a normalidadeassintótica desses procedimentos de estimativa. Assimulações de Monte Carlo ilustram seus comportamentospara diferentes tamanhos de amostras finitas.Os modelos são então ajustados para dados reais eusados para fins de previsão. A primeira extensão domodelo INAR que propomos consiste na introdução de dois operadores periódicos de Steutel e VanHarn, o primeiro atua modelando as autocorrelações parciais de ordem um em cada período e o outro capturando a sazonalidade periódica dos dados.Através de uma representação vetorial do processo,estabelecemos as condições existência e unicidadede uma solução periodicamente correlacionada às equações que definem o modelo. No casoem que as inovações seguem as leis de Poisson,estudamos a lei marginal do processo. Como umexemplo de aplicação no mundo real, estamos ajustandoeste modelo aos dados diários de contagemdo número de pessoas que receberam antibióticos para o tratamento de doenças respiratórias na região de Vitória, Brasil. Como as condições respiratórias estão fortemente correlacionadas com a poluição doar e o clima, o padrão de correlação dos números diários de pessoas que recebem antibióticos mostra,entre outras características, a periodicidade semanale a sazonalidade. Em seguida, estendemosesse modelo para dados com autocorrelações parciaisperiódicas de ordem maior que um. Estudamosas propriedades estatísticas do modelo, como média,variância, distribuições marginais e conjuntas. Ajustamosesse modelo ao número diário de pessoascom problema respiratório que receberam atendimentode emergência no pronto-atendimento da redepública do município de Vitória. Finalmente, nossa última extensão trata da introdução de inovações de acordo com uma lei de Poisson com inflação zero cujos parâmetros variam periodicamente, e daadição de covariáveis explicando o logaritmo da intensidadeda lei de Poisson. Estabelecemos algumaspropriedades estatísticas do modelo e usamoso método QML para estimar seus parâmetros. Porfim, aplicamos essa modelagem aos dados diários sobre o número de pessoas que visitaram o departamentode emergência de um hospital por problemasrespiratórios e usamos como covariável a sérieconcentrações diárias e um poluente medido namesma área geográfica

Aim: Hairdressing is a common worldwide occupation which, in Australia, comprises largely of a female workforce. Hairdressers are exposed to a range of potential health hazards in their work environment. There is a lack of current research into common health problems experienced by Australian hairdressers. This study aims to investigate health issues experienced by this occupational group, to identify potential health problems that may be associated with their work and to identify concerns for future research. Methods: A review of current literature examining the health of hairdressers was conducted to ascertain areas of health concern for hairdressers. This information was used to inform a survey to investigate the prevalence of common health problems for female, Western Australian hairdressers. The survey included a range of workplace related questions, as well as questions on common health problems sourced directly from the Australian Longitudinal Study on Women’s Health (ALSWH). The survey was distributed to all hairdressing salons in Western Australia. The data obtained from the hairdresser group was compared to data obtained from the Australian Longitudinal Study on Women’s Health data books. Additionally, some comparisons were also made to other published Australian data on women’s health. Results: Overall, working as a hairdresser impacts negatively on an individual’s health. In particular, this study found that younger hairdressers were most at risk of increased respiratory illness, musculoskeletal problems, skin conditions, bowel issues, and general poor health. Other specific areas of health concern for hairdressers include an increased use of fertility hormones and a possible increase in pelvic organ prolapse. While younger hairdressers reported a higher prevalence of common health problems than the general population cohort, mid age and older hairdressers were overall as healthy as the general population. This result may be attributable to the ‘healthy worker effect’, in which poorer health individuals, prompted by health concerns, retire from the occupation. Conclusions: Education concerning the existing risks in the workplace environment is recommended for all hairdressers. Encouragement and support for better personal health management would promote general health and well being across the industry. Younger workers are particularly identified as requiring support to manage their own health. Further health research is indicated for a range of concerns, but this research needs to be occupation specific.

This study aimed to explore how the experience of previous mental-health problems affects clinical and counselling psychologists’ approach to practice. Semi-structured interviews were conducted with six clinical and four counselling psychologists who had experienced mental-health difficulties. Data was analysed using Interpretative Phenomenological Analysis. Analysis of the interviews highlighted five master themes: Use of the personal-self of psychologist; Ambivalence; Identity as a psychologist; Psychologists as agent of change; and Finding meaning in suffering. The results of this research showed that psychologists with a history of mental-health problems actively draw upon their experience. In managing their dual identity of service-user and professional, they reported a degree of ambivalence which influenced the way that they viewed themselves and their practice. Their personal experiences seemed to be closely tied up with their professional-identity, which either conflicted with their sense of self or complemented it through highlighting how fortunate they were compared to others. The interviews frequently highlighted how psychologists’ experiences can provide an impetus to speak out for patients’ rights to ensure that they are treated with respect and dignity. A number of psychologists with an experience of mental-health difficulties felt that they might not have pursued their career had they not had previous mental-health difficulties. There appeared to be mixed findings concerning whether the participants felt that their mental-health difficulties had helped or hindered their practice.

This study is one of few to examine reproductive health problems affecting men in the Pacific region. Four hundred men in Honiara suburbs were interviewed about their reproductive and sexual problems and their general health. Disorders of sexual function were reported by many men in the Solomon islands, and were associated with common chronic diseases and poor mental health. However, levels of help-seeking, medical screening and treatment were low. The study recommends development of culturally sensitive reproductive health care for men in Pacific Island nations and territories.

The purpose of the studies reported in this thesis was to describe and investigate the health problems in captive West Australian dhufish, Glaucosoma hebraicum. The dhufish is a potential aquaculture species due to its popularity as an edible species and fishing pressure on wild fisheries. The two most significant health problems were exophthalmos in otherwise apparently normal fish and infestation of gills with a monogenean parasite, Haliotrema abaddon. Other health problems were described and investigated as they occurred throughout the tenure of the project. Exophthalmic lesions were described following gross and histological examination, followed by investigations into the aetiology and pathogenesis of the condition. Epidemiological data were gathered to identify risk factors that may increase the pre-disposition of dhufish to the development of exophthalmos. The anatomical arrangement of vasculature supplying the eye was described, followed by an investigation of the haemoglobin-oxygen transport properties of dhufish blood that were considered to be relevant to pathogenesis of the condition. Oxygen concentration and tension in the normal retina and in exophthalmic eyes was recorded. Risk factors for the development of exophthalmos were investigated in an experimental design using unaffected fish and variable water temperature, fright-induction and exercise regimes. Gas and haemorrhage were present in the choroid of exophthalmic eyes, with haemorrhage in retrobulbar tissues resulting from perforation of the sclera in some eyes. Oxygen content of gas in eyes with recently developed exophthalmos was high (up to 73%). In some eyes with retrobulbar haemorrhage, oxygen tension approached zero, indicating severe disruption of blood supply to the eye. Oxygen tension at the retinal-vitreal junction of normal dhufish eyes was 344 ± 26 mm Hg, with oxygenated blood supplied to the choroid body from the gills via the pseudobranch. The finding of a single haemoglobin with pronounced Root and Bohr effects in dhufish was significant and may contribute to the susceptibility of the species to exophthalmos. Investigations suggest that exophthalmos is physiological in origin and is related to the environmental differences between the natural habitat of the fish and the conditions that are experienced in aquaculture. Dhufish appear to be highly adapted to a relatively inactive life-style with relatively constant environmental conditions at high hydrostatic pressure. Rapid changes of temperature or blood acid-base characteristics may precipitate the development of exophthalmos. Haliotrema abaddon was described and stages of its life-cycle identified. As the parasite was troublesome in captive fish, potential treatments were investigated using in vitro and in vivo studies. Praziquantel was identified as the most effective ‘in water’ treatment of fish infested with H. abaddon. Other useful but less effective and safe treatments were low salinity baths (<1.5 ppt for ninety minutes) and 0.5 mg L-1 trichlorphon for 36 hours. Life in tanks appears stressful for many dhufish, resulting in health problems such as exophthalmos and disease outbreaks, including severe H. abaddon infestation. Multiple risk factors appear to pre-dispose the fish to these conditions. They include environmental factors such as water temperature, depth and physico-chemical composition, diet and stocking density; host factors such as physiological and social adaptation to a relatively solitary, sedentary lifestyle in a deep-water habitat and pathogen factors such as increased fecundity and decreased generation time in wanner water temperatures. Decreasing fish stress and maintaining environmental conditions close to those in the natural habitat, including increasing tank depth and decreasing light intensity are expected to improve the overall health of captive dhufish.

In the study reported in this thesis sociological theories were used to underpin an investigation into the organisation and delivery of community mental health care. Set against a background of accelerating change in the wider, macro-level, system of mental health work ethnographic data were first generated relating to the meso-level organisation of interagency services in two contrasting study sites. In each site interviews, observations and documentary analysis were also used to generate data relating to the micro-level care delivered to three exemplar service user case study subjects over a four to five month period. Macro-level public services modernisation was triggering sustained upheaval at the meso-level at which local services were planned, commissioned and provided. Complex structural, historical and people-related factors combined together to both help and hinder efforts to reconstitute local systems of work. Case study data were drawn on to examine the micro-level roles and responsibilities of paid and unpaid workers and the unfolding of complex service user trajectories, as these were played out in the two contrasting meso-level contexts. Findings exemplify the degree to which roles are realised in specific, interactive, workplaces. The work of psychiatrists, social workers, nurses, clinical psychologists, general practitioners, pharmacists, health and social care assistants and unpaid lay carers and service users was found to be highly sensitive to local particularities and to the 'lines of impact' running between macro, meso and micro-levels. Features with consequences for the work of particular groups included: team composition and history relative resource availabilities and arrangements for the funding of particular types of work progress on the agreement of formal policies and procedures spatial and temporal organisational factors the localised exercise of occupational jurisdictional authority differentiations and non-differentiations of roles and responsibilities made by recipients of services and personal factors, including individual practitioners' levels of knowledge and skill.

This thesis investigated the risk of psychiatric disorders and symptoms and adverse educational outcomes in offspring of parents with mental health problems. The data for this thesis came from both primary (longitudinal birth cohort data) and secondary (published studies). Findings suggested that, after adjusting for potential confounders, parental mental health problems were associated with increased risk of a wide range of mental health problems in the offspring during childhood, adolescence, and young adulthood.

Every person can do something to help contribute to healthy living, it just takes a little effort but the rewards are great. The interest to the health and the healthy way of life is natural. The origins of health care lie in the people’s culture. Like the folk song didn’t lose its meaning for the modern musical culture, the original folk active games, entertainments, dancing and bathing also took a certain place in the physical education system.

There is an increasing trend of mental health problems both globally and in Sweden. Moreover, in recent decades there has been an increase in screen time among adolescents. The present study aimed to examine the associations between screen time (i.e., smartphone, computer, and TV) and mental health problems among adolescents in Västmanland and to investigate if the association was different due to gender. A quantitative method with a cross-sectional design was applied. The study used secondary data from the Survey of Adolescent Life in Västmanland 2020. The sample consisted of 3880 adolescents from 9th grade in compulsory school and 2nd grade in upper secondary school. The results showed that high screen time on smartphone was associated with an increased probability for mental health problems in the total sample. In contrast, screen time on TV and computer showed no significant association with mental health problems. Thus, smartphone use was a significant contributor to mental health problems. Furthermore, for girls, high screen time on the smartphone, computer, and TV was associated with increased probability of mental health problems, whereas no significant associations were found among boys. In brief, this study’s findings suggest developing Swedish guidelines to regulate harmful effects from screen time.

The study was in two parts. In Part 1 the thematic content analysis of the nurses’ individual accounts of their trial experience revealed how the CMHNs’ aimed to be an agent of change in the nurse-patient encounters and how the trial setting contrasted with everyday practice. Following this, detailed micro-analysis of the narratives of nurse-patient encounters found that the nurses’ goal to be an agent of change was not always borne out when the construction of their accounts was examined. In Part 2 the thematic content analysis of group discussions about CMHN role illuminated the tensions in CMHNs’ everyday practice and their perceived role with people with CMHPs outside of the experimental setting. Overall, the treatment of people with CMHPs was exceptional in that the nurses interpreted their trial experience in the way it contrasted with their everyday practice. Further, in line with the results of the randomised controlled trial, CMHNs did not think that people with CMHPs should be treated by specialist nurses within community mental health services. The nurses suggested a range of methods in which individual, community and primary care resources could be augmented to support people with the aim of preventing referral to specialist services. The integration of the key findings from both parts of the study demonstrated how the nurses used and valued a range of types and sources of knowledge, both in their practice and when forming their views about CMHPs and service organisation. These knowledge sources were not those valued in contemporary healthcare. The dominant evidence-based practice movement champions research evidence of effectiveness above other forms of knowledge. Broadening the understanding of evidence and narrowing the claims of evidence-based practice is suggested to permit all forms of knowledge to be valued in healthcare decision-making

Thesis (Ph. D.) -- University of Maryland, College Park, 2006.
Thesis research directed by: Counseling and Personnel Services. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.

Background: In Vietnam, problems of high out-of-pocket payments for health, leading to catastrophic health expenditure and resulting impoverishment for vulnerable groups, has been at focus in the past decades. Since the beginning of the 1990’s, the Vietnamese government has launched a series of social health insurance reforms to increase prepayment in the health sector and thereby better protect the population from the financial consequences of health problems. Objective: The objective of this thesis is to contribute to the discussion in Vietnam on how large the problems of catastrophic health expenditure are in the population as a whole and in a special subgroup; the elderly households, and to assess important aspects on health insurance as a means to reduce the problems. Methods: Catastrophic health expenditure has been estimated, using an established and common method, from two different data sources; the Epidemiological Field Laboratory for Health Systems Research (FilaBavi) in the Bavi district, and Vietnam Household Living Standards Survey (VHLSS) 2010. Results from two cross-sectional analyses and a panel study have been compared, to gain information on whether the estimates of catastrophic health spending may be overestimated when using cross-sectional data. Then, the size of the problem for one group, the elderly households; hypothesized to be particularly vulnerable in this context, has been estimated. The question of to what extent a health insurance reform; the Health Care Funds for the Poor (HCFP), has offered protection for the insured against health spending is being assessed in another study over the period 2001 – 2007, using propensity score matching. The value that households attach to health insurance has also been explored through a willingness to pay (WTP) study. Results: Comparing results from two cross-sectional studies with a panel study over a full year in which the respondents were interviewed once every month, the estimates of catastrophic spending vary largely. The monthly estimates in the panels study are half as large as the cross-sectional estimates; the latter also having a recall period of one month. Among the elderly households, catastrophic health spending and impoverishment are found to be problems three times as large as for the whole population. However, household health care expenditure as a percentage of total household expenditure was affected by the HCFP, and significantly reduced for the insured. In the study of household WTP for health insurance, it was iiifound that households attach a low value to this insurance form; WTP being only half of household health expenditure. Conclusions: Cross-sectional studies of catastrophic spending with a monthly recall period are likely to be affected by recall bias leading to overestimations through respondents including expenditure in the period preceding the recall period. However, such problems should not deter researchers form studying this phenomenon. If using the same method, estimates of catastrophic spending and impoverishment can be compared between different groups – as for the elderly households – and over time; e.g. studying the protective capacity of health insurance. It should be used more, not less. The VHLSS rounds offer the Vietnamese a possibility to regularly study this. The HCFP were found to be partly protective but important problems remain to be solved, e.g. the fact that people are reluctant to use their health insurance because of e.g. quality problems and possible discrimination of the insured. The findings of a low WTP for health insurance may be another reflection of this.

Stepped care is designed to provide mental health treatment in the most effective and efficient way. It aims to provide patients with low intensity interventions in the first instance and only move onto high intensity treatments if outcome is not 'successful'. However, there is a paucity of research about how health professionals make decisions about treatment and the experiences of patients within this decision-making process. Using a multi-method approach, this study aimed to explore health professional and patient decision-making in stepped care for anxiety and depression. 24 health professional interviews from three stepped care sites were conducted, which included the completion of an active information search (AIS) think-aloud task. In addition, 14 patients were interviewed about their experiences of decision-making whilst being managed within stepped care model. Qualitative interview data was analysed using the principles of Framework analysis, while some of the data collected in the AIS think-aloud task lent itself to quantitative analysis.This study revealed that three core tensions exist when making decisions within the stepped care model. These are 1. The notion of standardisation of outcomes versus the individual needs of patients; 2. The public health orientation of stepped care versus the therapeutic orientation of health professionals and; 3. The rhetoric about patient choices versus the realities of shared decision-making in a resource-limited system.The complexity of decision-making within the stepped care model was highlighted. The success of stepped care relies on ensuring that there is an adequate workforce to deliver the intended interventions, where this is not present health professionals are faced with difficult decisions and it is clear that those most affected are the less-experienced frontline workers. Scarcity of resources impacts heavily upon the decisions that are made. This can have a substantial impact upon variability in treatment decisions and on the ability to allow for patient choice to be incorporated. Decisions that are made for a patient are influenced by the need to provide them with the treatment that they want (which may not be regarded as what they need within the stepped care model nor necessarily by the health professional) and the capacity of the service. The problem that exists with primary care mental health is that the current demands exceed capacity. Optimal patient care is, in part, traded off by the need to meet the demands of the service. Improving the flexibility of the service may be one solution to the problem and adopting a stratified/stepped care approach might help to resolve some of the tensions and help to relieve some of the capacity issues.

This study has examined various problems experienced by migrants from a non-English speaking background, in particular with relation to accidents in the workplace. Special attention has been paid to back injuries and the workers’ compensation migrant workers receive compared to that awarded to non migrant workers. Discrimination in the workplace, and various other related problems, not necessarily peculiar to migrant workers, such as the relationship between the incidence of accidents and the length of employment have also been examined. In addition to data obtained from the Water Authority of Western Australia, the Royal Perth Hospital and the Australian Electrical, Electronics, Foundry and Engineering Union, specially designed questionnaires were used to solicit information from workers, employers and trade unions. A total of 322 workers participated in the survey of which 216 were born overseas representing twenty five countries in Europe, Asia and the Middle East. The data obtained from all questionnaires were analysed using the 'Complete Statistical System' (CSS), a Statistical software package for the Social Sciences, produced by the StatSoft Company in the United States of America. Information obtained during interviews with employers, employing approximately 12,500 migrant and non-migrant workers, and with trade union officials, representing non-migrant and migrant workers, was also used to determine the validity of the hypotheses. The main conclusions of this study are that migrant workers have more industrial accidents than nonmigrant workers; are over-represented in the high risk low paid jobs; are discriminated against m the workplace; they do not sustain more back injuries than the average for the workforce as a whole; in workers' compensation settlements they receive smaller pay-outs than non-migrant workers; lack of proficiency in English does not necessarily increase the risks of industrial accidents and the majority of industrial accidents do occur in the first two years of employment.

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B.S.
Bachelors
Health and Public Affairs
Criminal Justice

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics
Every year many workers fail to turn up to work due to health problems or disability. The loss of working days affects negatively individuals’ wellbeing, employers, and society in general. If on the one hand employers feel that they support most of the costs while workers are absent due to illness, on the other hand disabled employees face discrimination in labor market as employers believe that they are more likely to be absent from work. Using data from the 2005/2006 Portuguese National Health Survey, the goal of this work project is to investigate the role of health conditions on absence days reported by workers. The results, obtained from a probit model, confirm what has been found in economic literature for other countries. Disability has a positive impact on probability of absenteeism. However, in Portugal this effect is small; it amounts to a marginal increase of at most 1 day in a year.

After analysing the major theoretical contributions to health and development, the author develops a dialectical materialist approach. Health, both physical and mental, is defined as a movement of energy that is simultaneously conserved and expanded. It is reality in movement. It is the vital ingredient of labour power and the capacity to create. Fundamental to humanity's health, both on a personal and public level, is productive activity. The relations and forces of production are the main determinants of public health. The relative power of the oppressed and the contemporary means of production affect both the type and spread of disease. In the specific historic Investigation of health and development in the Maltese Islands, the prevalence of contemporary diseases is appraised with reference to the balance of forces between nations, classes and the sexes. The particular significance of imperialism, merchant capital and religion is discussed. Examination of three major diseases, cholera, undulant fever and cancer, between 1837 and 1987, is the empirical basis of the thesis. The transition from high mortality rates to high morbidity rates in the past forty years reflects Malta's late and uneven development. Health policy to overcome disease is limited because health and disease are manifestations of the mode of production. Health in developing countries is placed in the dialectic of imperialism and development, chauvinism and development and, essentially, the dialectic of capitalism and development.

Caregivers of children with health problems have been demonstrated to show poorer physical and psychological health than caregivers of healthy children. It has been suggested that child behavioural problems are key and account for a large proportion of the variance in caregiver health. Currently, the relation between behaviour problems and caregiver health remains unclear. We conducted a meta-analysis and a secondary data analysis using national data to describe and compare the associations between internalizing and externalizing behaviour problems and caregiver health. Meta-analytical results suggest an association between child behaviour problems and parental stress, depression, and presence of psychiatric symptoms. National data analyses suggested an important association between child behaviour problems, particularly externalizing behaviour problems, and caregiver physical and psychological health when accounting for socioeconomic variables. Results suggest mothers may be more impacted than fathers, and that externalizing behaviour problems may contribute to bigger caregiver health effects than internalizing behaviour problems.

This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sources are used: (1) The Tierp study of community-dwelling persons (n=421, ages 75+), (2) the SWEOLD nationally representative samples (n=537 in 1992 and n=561 in 2002, ages 77+), and 3) SNAC-K comprised of home-help recipients in a district of Stockholm (n=1108, ages 65+).

Study I suggests that the length of the follow-up period may explain some of the differences found in predictor strength when comparing mortality studies. Predictors that can change rapidly (e.g., health) were found to be strongest for the short term, with a lower average mortality risk for longer follow-ups. Stable variables (e.g., gender) were less affected by length of follow-up.

Studies II and III present a measure of complex health problems based on serious problems in at least two of three health domains. These were diseases/symptoms, mobility, and cognition/communication. Prevalence of complex health problems increased significantly between 1992 and 2002. Older age, female gender, and lower education increased the odds of having complex problems. Complex problems strongly predicted 4-year mortality. Controlled for age, gender, health, and education, mortality decreased by 20% between 1992 and 2002. Men with complex problems accounted for this decrease. Thus, in 2002 the gender difference in mortality risk was almost eliminated among the most vulnerable adults.

Study IV revealed that physical and cognitive limitations, higher age, and living alone were significantly related to home-help allocation, with physical and cognitive limitations dominating. Psychiatric symptoms did not affect the assessment.

The increased prevalence of complex health problems and increased survival among people with complex needs have important implications concerning the need for collaboration among service providers.

Research Aim: The primary purpose of this Saudi-based study is to identify the stigma surrounding mental health problems, as well as to identify the existing and latent views of mental health professionals holding a stigma towards people living with mental health problems in Riyadh, Saudi Arabia. It will focus on mental health experts involved in health care in Riyadh, Saudi Arabia. Methods: A methodological strategy was devised, via the use of a mixed-method approach, which uses quantitative (phase 1) and qualitative (phase 2) data collection approaches and analytical techniques. In Phase 1 (50 participants), two tools were used to assess stigma; the Emotional Reaction on People with mental health problems Scale, and the Attitude Scale. In Phase 2 (5 participants), a one-hour focus group discussion was the method of data collection. The reliability of the two scales for Phase 1 evaluated by measuring internal consistency using SPSS. In Phase 2, Nvivo, version 10 was used for an analysis of the data. The group discussion was thematically analyzed. Principal Findings: The findings confirm that many mental health care providers hold a professional stigma against those with mental health problems of varying degrees. And how the existence and extent of these views might impact on the services provided by mental health professionals and the recovery of people with mental health problems. Phase 1 findings indicate factors that lead to professional stigma, wherein ‘exclusion’, ‘rejection and caution’ and ‘risk and fear’ lead to high levels of professional stigma against people with mental health problems. Phase 2 findings, fit into four main themes influence the issue of professional stigma in mental health services: ‘experiences of professional stigma’; ‘causes of professional stigma’; ‘impact of professional stigma on mental health services’ and ‘recommended minimizing stigma’. The findings of the present study point to the significant convergent between emotional reactions with negative attitudes exhibited regarding people with mental health problems. It was also found that interactions with individuals with mental health concerns contributed to an increase in incidences of stigma by professional mental health staff. Also, it has been shown that insufficient knowledge and undesirable perceptions of people with mental health problems remain apparent, both in Saudi Arabian society and in the mental health profession. Conclusion: It is necessary to focus on reducing professional stigma against people with mental health problems. This can be accomplished through appropriate practices, mental health training, education, and research, as well as professional and social awareness through the media in S.A.; publicize ethical guidelines for mental health care professionals; enhance the provision of mental health practitioners in mental health care services; enact legislation by the Ministry of Health in S.A. Keywords: Stigma, mental health problems, and mental health professional perspective, Saudi Arabia.