Yrkesverksamma inom hälso- och sjukvården är skyldiga att göra en anmälan till socialtjänsten genast då de i sin verksamhet fattar misstanke om eller får kännedom om att ett barn far illa. Det är känt att trots att det finns misstanke om att ett barn far illa så är det vanligt att det inte anmäls till socialtjänsten. Syftet med studien var att beskriva erfarenheter hos sjuksköterskor inom barnhälsovården av att göra orosanmälan vid misstanke om att ett barn far illa. Deltagarna bestod av nio sjuksköterskor verksamma vid barnhälsovården i norra och mellersta Sverige. Studien genomfördes med en kvalitativ ansats och med semistrukturerade intervjuer som datainsamlingsmetod. Intervjuerna analyserades genom kvalitativ innehållsanalys och resulterade i fem kategorier. Resultatet visade att sjuksköterskor verksamma inom barnhälsovården upplevde svårigheter att identifiera att ett barn far illa och att de vanligtvis använde stödjande åtgärder i första hand. De uppgav att en god relation med familjen var mycket betydelsefull och viktig för samarbetet med familjen. Sjuksköterskor försökte arbeta familjecentrerat, men brist på tid gjorde att de inte alltid kände att de gjorde ett tillräckligt arbete. Samtliga sjuksköterskor önskade ett bättre samarbete med socialtjänsten. Studien visar på brister i sjuksköterskornas stöd för att kunna ta beslut om anmälan och brister i kommunikation mellan sjuksköterskor och socialtjänsten.

In the United States, political and social attention to child health care remains insufficient, as it has for decades, especially that which serves the needs of low-income families. In response to this widespread negligence, many communities around the country have developed innovative programs to meet the needs of disadvantaged infants and children. That need for coordinated health services exists among poor children in the Roanoke Valley. The local solution has developed since 1988 as the Children's Health Investment Project (CHIP). This thesis explores, from a geographic perspective, how the relationship between enrolled families and their providers affects attitudes and perceptions toward health care services made available through CHIP. Also, the implications of the current spatial distribution of CHIP participants are examined for geographic relevance. / M.S.

Fong, Hildy Felicia. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 221-234). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendix also in Chinese.

Submitted in fulfilment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, 2013. / South Africa is one of 12 countries where the under-five child mortality rate has increased. In response to this challenge, the WHO and UNICEF in the 1990s developed Integrated Management of Childhood Illness (IMCI), a strategy to reduce child mortality and morbidity. IMCI training was launched in South Africa in 1998. Health care workers trained in IMCI face many challenges when applying the new integrated case management approach. Training settings tend to differ from the actual work environment. Simulation is practiced in an enclosed environment and certain assessments are not possible for example chest in drawing, level of consciousness, oedema amongst others. In South Africa, there has been limited research on IMCI in-service and pre-service training and no research has been conducted regarding the training of student nurses on IMCI and follow up of these learners in the clinical field. Purpose of the study The purpose of this study was to evaluate the IMCI training of learners in the use of IMCI Guidelines in the KwaZulu-Natal College of Nursing (KZNCN). Methodology This study followed a descriptive quantitative approach and evaluates the training of the learners and the facilitation and training of lecturers with regards to IMCI in the KZNCN campuses. Data was collected using questionnaires for facilitators and learners on the three campuses. Results The findings of this study revealed that teaching and learning approaches used to facilitate IMCI were adequate except for clinical practice and theory which was reported to be insufficient.

Os recém-nascidos de muito baixo peso ao nascer alcançam taxas de sobrevivência cada vez maiores. No entanto, eles ainda apresentam problemas como déficit de crescimento, atrasos do desenvolvimento, baixa prevalência de aleitamento materno exclusivo e dificuldades de vinculação afetiva com a família. Essa problemática resulta da condição de nascimento dessas crianças, das conseqüências do tratamento intensivo necessário à sua sobrevivência, e das peculiaridades da assistência neonatal tradicional cujos procedimentos impõem a separação entre a mãe e o bebê. A observação de aspectos relativos aos problemas citados sinaliza que algumas dessas dificuldades poderiam ser atenuadas, quando não resolvidas, por um modelo de assistência neonatal que privilegiasse a interação entre a mãe e o bebê. Visando a elucidar tal questão, compararam-se os resultados obtidos com setenta bebês, divididos em dois grupos, um assistido pelo método Mãe-canguru e outro pelo método Tradicional de assistência neonatal. Foi realizado um estudo de coorte prospectivo que contemplou duas abordagens: uma análise epidemiológica dos dados objetivos referentes às características comparáveis entre os dois grupos, ou seja, atributos maternos, dados sobre a gestação, o parto e o nascimento, eventos da evolução clínica, parâmetros do crescimento e do desenvolvimento e marcos do processo de aleitamento materno; além da outra abordagem que se constituiu como uma análise compreensiva dos dados subjetivos através do método fenomenológico. Constatou-se que o crescimento das crianças estudadas manteve-se aquém da referência ideal preconizada, a saber, o crescimento intra-uterino, sendo que as medidas antropométricas mostraram-se menores entre as crianças do método Canguru. As diferenças encontradas entre os dois métodos quanto ao desenvolvimento neurossocial não foram estatisticamente significativas. O método Canguru favoreceu a prática de aleitamento materno exclusivo, mesmo após a alta hospitalar. A compreensão e a interpretação dos depoimentos das mães, através do método fenomenológico, permitiram que se vislumbrassem as repercussões dessa situação sobre a função materna, e as suas conseqüências sobre o desenvolvimento e a prevalência do aleitamento materno. Deslindou-se, assim, a influência direta da qualidade da interação entre a mãe e o bebê sobre a experiência de se tornar mãe nessas circunstâncias. Nessa perspectiva, concluiu-se que o cuidado dispensado a recém-nascidos de muito baixo peso ao nascer exige, além do emprego da alta tecnologia, a priorização da permanência da mãe junto ao filho e a aptidão da equipe de assistência neonatal para abordar o bebê e a mãe em conjunto, como componentes de um sistema que se distinguem entre si, mas não se separam. / Very low birthweight infants have achieved increasing survival rates over time. However, they still suffer from problems such as growth deficit, developmental delays, low exclusive breastfeeding prevalence and difficulties with the bond formation process. These problems result from birth circumstances, consequences of survival-necessary intensive care and peculiarities of traditional neonatal care, whose procedures impose a prolonged separation between mother and baby. Observation of aspects relative to these problems indicates that some of those difficulties might be lessened, if not altogether solved, by a neonatal care model that favors the mother-child interaction. Aiming to clarify this matter, a comparison of results obtained for seventy babies was carried out. Infants were divided in two groups, one treated by means of the Kangaroo Mother Method and the other by means of the Traditional Neonatal Care Method. A prospective cohort study was carried out which included two approaches. The first approach was an epidemiological analysis of objective data concerning comparable characteristics of the two groups, such as maternal characteristics, data about pregnancy, labor and birth, clinical evolution events, developmental and growth parameters and landmarks of the breastfeeding process. The second approach was a comprehensive study of subjective data by means of the Phenomenological Method. It was found that growth of studied children was consistently below intrauterine growth, the established ideal. Antropometrical measures were smaller for children in the Kangaroo Mother Method group than for those treated by means of the Traditional Method. No statistically meaningful differences were found concerning neurosocial development. The Kangaroo Mother Method was found to favor the practice of exclusive breastfeeding even after child discharge. Phenomenological comprehension and interpretation of oral accounts given by the mothers of studied infants about their experiences with their preterm children revealed the repercussions of this situation on maternal function and the resulting consequences to development and breastfeeding prevalence. The direct influence that the quality of interaction between mother and baby has on the experience of becoming a mother under such circumstances was thereby unveiled. Under this perspective, it was concluded that care given to very low birthweight infants requires, in addition to the employment of high technology, that the staying of mothers beside their infants be prioritized and that the neonatal care team be made able to handle mother and infant as a compound unit, as two components of a system that are distinct, yet not separate.

As características e conceitos dos sistemas complexos adaptativos (SCA) e a dinâmica de sistemas podem ser utilizados como ferramentas altamente efetivas para analisar a organização de um sistema de saúde. Várias das propriedades dos SCA são relevantes para este propósito especialmente a emergência de padrões auto-organizativos. Os objetivos são descrever os fluxos intermunicipais de gestantes para a resolução da gravidez visando compreender os fatores que influenciam estes deslocamentos considerando os recursos hierárquicos disponíveis e propor modelos explicativos da regionalização ao cuidado ligado à gravidez e ao parto e à regulação do sistema. Esta pesquisa aplicou conceitos de sistemas complexos adaptativos para estudo dos fluxos de gestantes entre municípios no sistema de atenção ao parto e puerpério na região de Ribeirão Preto- São Paulo determinando as áreas de captação de pacientes e fatores que influenciam deslocamentos. Para isto foram construídas matrizes de origem-destino das gestantes que tiveram a resolução da gravidez na área do Departamento Regional de Saúde XIII (DRS XIII) sediado em Ribeirão Preto no ano de 2012. Foram utilizadas ferramentas ligadas ao fluxo de altas disponíveis no Observatório Regional de Atenção Hospitalar, aplicando modelos de interação espacial e análise de redes para determinar a suficiência das regiões e sub-regiões para a realização dos procedimentos selecionados e explorar os fatores determinantes dos deslocamentos de pacientes. Em 2012, os hospitais de Ribeirão Preto (sede da DRS XIII) receberam 3807 internações por parto de fora do município, das quais 597 foram provenientes de 114 municípios fora da jurisdição do DRS XIII. Observou-se que 25 % das pacientes se deslocaram a outro município para a resolução da gravidez, percorrendo uma distancia média ponderada de 27 km. Os fluxos de pacientes mostram uma alta concentração em Ribeirão Preto e Sertãozinho, embora grande parte dos casos derivados não requeriam serviços de alta complexidade. O DRS XIIII é suficiente como região para a resolução destes casos e se comporta como um importador de pacientes de uma região mais ampla que compreende ao menos 60 municípios. Vários municípios do DRS XIII também têm serviços suficientes para as necessidades de sua população. O sistema de regulação do estado e do DRS XIII e as preferências dos pacientes, famílias e médicos são determinantes mais importantes dos fluxos que as distancias geográficas. A evolução da demografia e epidemiologia, da geografia política e organizacional do SUS, da oferta de serviços e os comportamentos e preferências dos agentes (usuários, médicos e outros) devem ser analisadas em conjunto como sistemas dinâmicos para compreensão dos fluxos de pacientes e assim reformular as redes de serviços para responder melhor às necessidades da assistência materna e puerperal na região coberta pelo DRS III. / The characteristics and concepts of complex adaptive systems (CAS) and system dynamics can be used as highly effective tools to analyze the organization of a health system. Several of the properties of an CAS are relevant to this purpose, especially the emergence of self-organizing patterns. Objectives: To describe the intermunicipal flows of pregnant women at the end of the pregnancy, in order to understand the factors that influence these displacements considering the available hierarchical resources and propose explanatory models of the regionalization of care related to pregnancy, delivery and regulation of the system. This research applied concepts of complex adaptive systems to study the flows of pregnant women among municipalities in the maternal care system in the Ribeirão Preto - São Paulo region, determining the catchment areas of patients and analyzing the factors that influence their displacement. For this purpose, the research gathered origin-destination matrices of the pregnant women who had the pregnancy resolution in the area of the Regional Health Department XIII (DRS XIII), based in Ribeirão Preto, for the year 2012. The tools used for these matrices were built in the discharge-flow utility available at the Hospital Regional Observatory webpage. Using spatial interaction models and network analysis it was possible to determine the sufficiency of regions and sub-regions to perform the selected procedures and to explore the determinants of patient travel. In 2012, maternity hospitals in Ribeirão Preto (headquarters of DRS XIII) received 3807 hospitalizations related to deliveries coming from outside the municipality, of which 597 came from 114 municipalities outside the jurisdiction of DRS XIII. It was observed that 25% of the patients moved to another municipality for the events related to the end of the pregnancy, traveling a weighted average distance of 27 km. Patient flows show a high concentration in Ribeirão Preto and Sertãozinho, although a majority of the derived cases did not require services of high complexity. DRS XIIII is sufficient as a region to resolve these cases and behaves as an net importer of patients from a wider region comprising at least 60 municipalities. Several municipalities of DRS XIII also have sufficient services for the needs of their population. The system of regulation of the state and DRS XIII and the preferences of patients, families and doctors are more important determinants of flows than geographical distances. The evolution of demography and epidemiology, the political and organizational geography of the SUS, the service offerings and the behaviors and preferences of the agents (users, doctors and others) should be analyzed together as dynamic systems for understanding patient flows allowing to redesign the service networks to better respond to the needs of maternal and child care in the region covered by DRS XIII.

Os recém-nascidos de muito baixo peso ao nascer alcançam taxas de sobrevivência cada vez maiores. No entanto, eles ainda apresentam problemas como déficit de crescimento, atrasos do desenvolvimento, baixa prevalência de aleitamento materno exclusivo e dificuldades de vinculação afetiva com a família. Essa problemática resulta da condição de nascimento dessas crianças, das conseqüências do tratamento intensivo necessário à sua sobrevivência, e das peculiaridades da assistência neonatal tradicional cujos procedimentos impõem a separação entre a mãe e o bebê. A observação de aspectos relativos aos problemas citados sinaliza que algumas dessas dificuldades poderiam ser atenuadas, quando não resolvidas, por um modelo de assistência neonatal que privilegiasse a interação entre a mãe e o bebê. Visando a elucidar tal questão, compararam-se os resultados obtidos com setenta bebês, divididos em dois grupos, um assistido pelo método Mãe-canguru e outro pelo método Tradicional de assistência neonatal. Foi realizado um estudo de coorte prospectivo que contemplou duas abordagens: uma análise epidemiológica dos dados objetivos referentes às características comparáveis entre os dois grupos, ou seja, atributos maternos, dados sobre a gestação, o parto e o nascimento, eventos da evolução clínica, parâmetros do crescimento e do desenvolvimento e marcos do processo de aleitamento materno; além da outra abordagem que se constituiu como uma análise compreensiva dos dados subjetivos através do método fenomenológico. Constatou-se que o crescimento das crianças estudadas manteve-se aquém da referência ideal preconizada, a saber, o crescimento intra-uterino, sendo que as medidas antropométricas mostraram-se menores entre as crianças do método Canguru. As diferenças encontradas entre os dois métodos quanto ao desenvolvimento neurossocial não foram estatisticamente significativas. O método Canguru favoreceu a prática de aleitamento materno exclusivo, mesmo após a alta hospitalar. A compreensão e a interpretação dos depoimentos das mães, através do método fenomenológico, permitiram que se vislumbrassem as repercussões dessa situação sobre a função materna, e as suas conseqüências sobre o desenvolvimento e a prevalência do aleitamento materno. Deslindou-se, assim, a influência direta da qualidade da interação entre a mãe e o bebê sobre a experiência de se tornar mãe nessas circunstâncias. Nessa perspectiva, concluiu-se que o cuidado dispensado a recém-nascidos de muito baixo peso ao nascer exige, além do emprego da alta tecnologia, a priorização da permanência da mãe junto ao filho e a aptidão da equipe de assistência neonatal para abordar o bebê e a mãe em conjunto, como componentes de um sistema que se distinguem entre si, mas não se separam. / Very low birthweight infants have achieved increasing survival rates over time. However, they still suffer from problems such as growth deficit, developmental delays, low exclusive breastfeeding prevalence and difficulties with the bond formation process. These problems result from birth circumstances, consequences of survival-necessary intensive care and peculiarities of traditional neonatal care, whose procedures impose a prolonged separation between mother and baby. Observation of aspects relative to these problems indicates that some of those difficulties might be lessened, if not altogether solved, by a neonatal care model that favors the mother-child interaction. Aiming to clarify this matter, a comparison of results obtained for seventy babies was carried out. Infants were divided in two groups, one treated by means of the Kangaroo Mother Method and the other by means of the Traditional Neonatal Care Method. A prospective cohort study was carried out which included two approaches. The first approach was an epidemiological analysis of objective data concerning comparable characteristics of the two groups, such as maternal characteristics, data about pregnancy, labor and birth, clinical evolution events, developmental and growth parameters and landmarks of the breastfeeding process. The second approach was a comprehensive study of subjective data by means of the Phenomenological Method. It was found that growth of studied children was consistently below intrauterine growth, the established ideal. Antropometrical measures were smaller for children in the Kangaroo Mother Method group than for those treated by means of the Traditional Method. No statistically meaningful differences were found concerning neurosocial development. The Kangaroo Mother Method was found to favor the practice of exclusive breastfeeding even after child discharge. Phenomenological comprehension and interpretation of oral accounts given by the mothers of studied infants about their experiences with their preterm children revealed the repercussions of this situation on maternal function and the resulting consequences to development and breastfeeding prevalence. The direct influence that the quality of interaction between mother and baby has on the experience of becoming a mother under such circumstances was thereby unveiled. Under this perspective, it was concluded that care given to very low birthweight infants requires, in addition to the employment of high technology, that the staying of mothers beside their infants be prioritized and that the neonatal care team be made able to handle mother and infant as a compound unit, as two components of a system that are distinct, yet not separate.

There is strong evidence from developing countries to support the hypothesis that physical accessibility of health services, particularly absolute distance from clinics, is a major determinant of health service utilization and health status. In South Africa, such evidence is very limited and as a result the relationship between absolute distance and health service utilization and health status is not fully understood. As an attempt to understand this relationship, a household survey of mothers with children aged 12-23 months was conducted in a rural district of KwaZulu-Natal province, South Africa. Maternal and child health (MCH) service utilisation and MCH status patterns were then compared at different absolute distances from PHC clinics. The find ings reveal that the study population is characterised by impoverished living conditions (86%), high functional illiteracy (67%), high fertility and unemployment rates . In comparison with other studies conducted previously in the same population, MCH service utilization rates are high. Based on mean distances of homesteads from PHC clinics in the entire study area before the Clinic Upgrading and Building Programme it has been concluded that the physical accessibility of fixed PHC clinics, when compared with the WHO recommendations, was suboptimal. When this assessment is based on clinic usage patterns, it is found that clinic usage decreased from 86.4% at 0-5 km to 79% at 6-10 km with a dramatic decrease to 37.8% at distances beyond 10 km. This decrease in usage at distances above 5 km translates into a considerable reduction in effective coverage of the target population by PHC clin ic services if it is considered that above 50% of the population live greater than 5 km from these clinics. An assessment of the effect of distance of homesteads from PHC clinics on specific MCH service utilization and MCH status has found very few or no significant differences between mothers and children living at 0-5 km, 6-10 km or > 10 km from these clinics. This observation is consistent even after adjustment for the effects of potential confounding. The fact that distance from clin ics has little or no effect on the indicators of MCH service utilization and MCH status is counter-intuitive. A few explanations can be provided. These include the fact that only 50% of the population, even in one of the most rural parts of South Africa access clinics on foot. Since the traditional assumption has been that this distance effect is a function of straight-line walking distances between homesteads and clinics, Euclidian distances alone may be a poor explanatory variable for health service utilization. Furthermore, if the hypothesis is valid that health status is a function of service utilization, it may also be a poor explanatory variable for health status of community members who are reliant on these services. Secondly, based on data from other sources, there is evidence that there have been steady declines in both mortality and fertility rates in the study population over the past 10-20 years suggesting that client communities are already benefiting quite substantially from health services in general and from MCH services in particular in spite of residual distance barriers. In other words, this distance effect on service utilization and health status may be more evident in populations with much higher background infant, child and maternal mortality rates. Thirdly, it is also possible that distance effect still exists, but that methodological limitations prevented this study from showing this effect. For instance, the fact that people use mobile clinics for some MCH services may have confounded the effect of distance from fixed clinics. It is also possible that people use different facilities for different services even though they are further away, and the assumption that all facilities have equal attraction for clients and that the only determinant of use is distance may be flawed. For example, it is evident from this and from other studies in South Africa that whereas most clients use fixed clinics for vaccinations, deliveries are now increasingly conducted at hospitals. Other methodological issues include the fact that certain health outcomes such as stunting are not an exclusive reflection of health service inputs, but are a function of social and economic determinants. Based on these findings, a number of recommendations are made. / Thesis (Ph.D.)-University of Natal, Durban, 2004.

Dissertation (Ph.D.)--University of South Florida, 2009. / Title from PDF of title page. Document formatted into pages; contains 123 pages. Includes vita. Includes bibliographical references.

Human papillomavirus (HPV) is the most common cause of sexually transmitted diseases. It is the causative agent of cervical cancer, anal, and penile cancers. The purpose of the study was to determine the knowledge, attitude and behaviour of parents towards HPV and HPV vaccine in preventing cervical cancer in girls aged 9 to 13 years and HPV vaccine uptake. The study was conducted in Sefhare village, in the Central District of Botswana. The researcher selected a quantitative, descriptive cross-sectional research design and data was collected using a questionnaire in face-to-face interviews. The study population consisted of parents of adolescent girls of ages 9-13 years living in four wards of Sefhare village. Data was analysed using SPSS version 19. The study found a high level (71.8%) of knowledge about HPV infection, cervical cancer and HPV vaccine and a positive attitude (81.5%) and behaviour (62%) towards the HPV vaccine. / Health Studies / M.P.H.