This thesis presents the results of a qualitative study of self-care in pregnancy, birth and lactation within a non-random sample of 27 women in British Columbia, Canada. The women were interviewed in the third trimester of pregnancy, and 23 of the participants were re-interviewed post-partum. Interviews were tape recorded, transcribed, and subjected to thematic analysis. Results were discussed in the context of the social science literature on the medicalization of pregnancy and childbirth. All but one woman used herbal medicine while pregnant. In the post-partum interviews, nearly half reported using galactagogue herbs. The safety and efficacy of each herbal remedy are discussed here. Most of the herbs are considered safe and effective according to the herbal literature, but clinical reports are largely lacking. While many of the women were cautious about using herbs during pregnancy, as a general rule, they considered them to be safer than pharmaceutical drugs. In choosing to self-medicate with herbs, the women said they were guided by prior knowledge (32%), trusted sources of advice (56%), and intuition (12%). Trusted sources of advice included books, friends, family members, maternity care providers, herbalists, herbal shops, and internet. The majority of herbal advice (69%) was received by word-of-mouth. Prolonged pregnancy also proved to be an interesting situation. Many women said they were opposed to labour induction at the time of the first interview, yet all but one woman who went beyond 40 weeks gestation used self-help measures to stimulate labour. This appeared to be a response to pressure from maternity care providers, friends, and family members. Though the medical definition of prolonged pregnancy is 42+ weeks gestation, in the social context, 40+ weeks was cause for concern. Health care professionals, partners, family members, friends, and co-workers all affected self-care behaviour, and their influence could be positive or negative. After an overwhelmingly negative experience with a maternity care provider, over half of the women went to another care provider, or forewent formal maternity care entirely. These findings did not support the hypothesis that childbearing is almost completely medicalized, at least for the sample population. Rather, women negotiated their maternity care within several frameworks, including the medical, midwifery, and self-care models. Medical language was used to describe birth stories, but only by women in physician care. There was an almost universal effort among the women to normalize the childbearing experience. The findings of this study point to a need for: (1) clinical investigation of herbal medicines used in pregnancy, birth and lactation; (2) public and care-provider education regarding social and psychological aspects of prolonged pregnancy; (3) broad-scale inquiry into the phenomena of medicalization/normalization of the childbearing experience, and (4) further investigation into women’s preferences for empowering styles of maternity care. / Graduate

abstract: One of the critical issues in the U.S. healthcare sector is attributed to medications management. Mismanagement of medications can not only bring more unfavorable medical outcomes for patients, but also imposes avoidable medical expenditures, which can be partially accounted for the enormous $750 billion that the American healthcare system wastes annually. The lack of efficiency in medical outcomes can be due to several reasons. One of them is the problem of drug intensification: a problem associated with more aggressive management of medications and its negative consequences for patients. To address this and many other challenges in regard to medications mismanagement, I take advantage of data-driven methodologies where a decision-making framework for identifying optimal medications management strategies will be established based on real-world data. This data-driven approach has the advantage of supporting decision-making processes by data analytics, and hence, the decision made can be validated by verifiable data. Thus, compared to merely theoretical methods, my methodology will be more applicable to patients as the ultimate beneficiaries of the healthcare system. Based on this premise, in this dissertation I attempt to analyze and advance three streams of research that are influenced by issues involving the management of medications/treatments for different medical contexts. In particular, I will discuss (1) management of medications/treatment modalities for new-onset of diabetes after solid organ transplantations and (2) epidemic of opioid prescription and abuse. / Dissertation/Thesis / Doctoral Dissertation Industrial Engineering 2019

A study of social exchange between working mothers and their sitters was based on a sample of terminated family day care arrangements in Portland, Oregon (1966-67). The sample, provided by the Multnomah County Public Welfare Commission and the Day Care Exchange Project of northwest Portland consisted of the arrangements of 27 mothers and 23 sitters. Review of the literature on family day care revealed a paucity of research on the relationship between mothers and sitters in such arrangements. The purpose of the study was to test the hypothesis that continuity of a family day care arrangement is a function of the independent variables of satisfaction with and dependence on the arrangement. Respondents were interviewed in relation to three phases of their family day care arrangement: formation, mainte'nance, and termination. Likert-type attitudes, scales and semi-structured interview schedules were developed. Findings partially confirmed the hypothesis. Using Guttman scale analysis, a scalar relationship was found associating low dependence with high satisfaction. The mothers who showed low dependence and high satisfaction tended to have arrangements of longer duration.

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.

Delirium is an acute change in cognition accompanied by inattention, which affects up to 88% of adult critical care patients. Delirium causes increased hospital complications, longer lengths of hospital stay, functional disability, cognitive impairment, and increased mortality. The purpose of this evidence-based quality-improvement project was to implement and evaluate a delirium screening process in adult intensive care units at a large medical center. This included education of nurses, implementation of a structured, validated tool, and review of tool use documentation. The implementation of this project was guided by an evidence-based practice model, Disciplined Clinical Inquiry-© and Lewin's change theory. Evaluation of this quality-improvement project used audits of the electronic medical record. The audits included the presence and accuracy of delirium screening documentation in the patients' medical records. Results of 3 sequential documentation audits revealed a gradual adoption of this practice change by nurse clinicians. The percentage of charts with missing, incomplete, or inaccurate data decreased from 50% on the first week to 27.9% and 25.0% on the 2nd and 3rd weeks, respectively. These findings were an indication of practice change by validating the requirement for delirium screening on the units. In the first 3 weeks alone, 17 patient audits were positive for delirium, indicating the potential for poor short-term and long-term patient outcomes if not addressed promptly. Implementation of delirium screening ensures the dignity and worth of adult critical care patients by decreasing the poor outcomes associated with the diagnosis, which is an important contribution to positive social change.

Thesis (MPH)--University of Limpopo, 2009. / Background: An understanding of the effectiveness of the hospital-based palliative care programme and the extent to which it changes the way patients are managed in the general medical wards is required, in order to develop evidence-based palliative care guidelines for Public Hospitals on the management of HIV/AIDS patients. Purpose: The study aimed to identify and describe the effectiveness of the Palliative Care programme on the management of HIV/AIDS patients at Chris Hani Baragwanath Hospital. The objectives of the study included to: • Determine the proportion of HIV positive patients admitted into Chris Hani Baragwanath general medical wards accessing services of a hospital-based palliative care team • Identify the care and support needs experienced by HIV positive patients • Compare the frequency of the met and unmet needs of HIV positive patients in those referred as opposed to those not referred to the hospital-based palliative care team Methods: Non-random quota sampling of 50 HIV positive patients confirmed by an ELISA test, and admitted with HIV related illnesses were selected from admission records of medical wards in Chris Hani Baragwanath Hospital. 8 (16%) of the patients were too ill to communicate, 12 (24%) declined the interview and 30 (60%) gave consent to be interviewed. The data was collected using researcher administered questionnaires, and captured on Microsoft Excel 2003. Descriptive statistics were analyzed using STATA 10. Participants were assessed for enrolment into the hospital-based palliative care programme, common palliative care needs experienced and the frequency of identification and provision of palliative care needs provided for patients in the medical wards with focus on physical symptoms, pain, psychosocial problems, integration of care and counselling needs. The group was further divided into those under a palliative care program and those not under palliative care, for further data analysis. Results: Findings revealed that very few patients (27%) with HIV&AIDS were accessing services of the hospital-based palliative care. Significant proportion (67%-77%) of HIV infected patients were experiencing physical symptoms, pain and psychosocial problems requiring palliative care interventions. Further findings revealed that for those participants who were not referred for the palliative care programme, symptoms and pain complaints were not effectively identified and treated by health personnel. Provision of psychosocial and spiritual support was inadequate and that the quality of life for HIV/AIDS patients was compromised due to lack of comprehensive and integrated holistic care. These components were found to be effectively addressed amongst the referred group. iv Conclusion and recommendations: Hospital-based palliative-care has limited effectiveness due to the small size of the team which is working against demands from increasing numbers of HIV positive patients. All health providers working in medical wards need to be trained in palliative care, to develop a capacity to integrate palliative care principles into the routine medical care of HIV/AIDS patients.

Thesis (MPH) -- University of Limpopo, 2011. / Introduction STIs, including easily treatable bacterial infections such as syphilis and gonorrhoea, continue to cause a huge burden of ill health in both developing and developed countries. Syndromic management is currently the best approach for the management of sexually transmitted infections in developing countries, but its successful implementation is often questionable Objectives The overall aim of this study was to assess and compare the quality of STI services in the primary health care clinics in Leribe district, Lesotho. The specific objective of the study was to assess the availability of STI drugs, clinicians’ knowledge of STI management, and the availability of STI examination equipment Methods A descriptive cross-sectional quantitative study was conducted with 23 nurse clinicians in PHC clinics in Leribe district of Lesotho. This study explored the gaps and issues around the provision of syndromic management of STIs using the DISCA tool. Results Most of the facilities have inadequate and non reliable equipment and supplies as well poor and inadequate infrastructure. There is lack of continuous training on STI management, low complete treatment to STI clients with only a few of the health centres giving complete treatment and there was also poor contact tracing of partners. Almost all clinicians cited the correct treatment for managing male urethral syndrome. Conclusion The lack of continuous training compromised STI management because nurse clinicians lacked skills to provide quality services. In general, although the principles of syndromic management are well understood by most clinicians, there are no systems in place to support the use of these guidelines

Thesis (MPH) -- University of Limpopo, 2011. / Background: Health care workers (HCWs) are prone to occupational exposures to blood-borne viruses (BBVs), which include hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Post exposure prophylaxis (PEP) is available for both HBV and HIV, and if administered correctly can reduce the risk of HBV and HIV transmission by 80%. This study investigated the knowledge and practices of HCWs regarding PEP for BBVs at Medunsa Oral Health Care Centre (MOHC). Methods: This was a cross sectional study conducted among 166 HCWs at the MOHC using a self-administered, anonymous questionnaire on knowledge and practices of HCWs regarding PEP for BBVs. Binary logistic regression method was used to determine factors associated with reporting an occupational exposure and uptake of PEP. Results: The response rate was 67%. The mean age was 27yrs (SO =7.67yrs), and 68.7% of . respondents were female. The overall knowledge regarding PEP among the HCWs was inadequate as 46.9% had poor knowledge. The majority (77.7% [128/166]) of HCWs experienced occupational exposures and amongst them 39.0% (50/128) experienced it twice or more. Almost two-thirds (60.9%) of HCWs experienced an occupational exposure while performing scaling and polishing. Only 28.9% (37/128) of those who were potentially exposed to a BBV reported the incident to the authorities. Out of those who reported, 37% (14/37) took PEP for HIV, and 32.4% (12/37) took PEP for HBV. Among those taking HIV PEP, 21.4% (3/14) indicated that they completed the course. HCWs who haq five or more years of experience j were less likely (OR=0.138, p=0.043) to report compared to those who had less than five years of experience. Conclusion: Overall, participants' knowledge regarding PEP as well as reporting of an exposure was inadequate. The majority of HCWs experienced an occupational exposure while performing scaling and polishing.

Thesis (MPH) -- University of Limpopo, 2010. / Background Namibia is one of the country most affected by HIV/AIDS epidemic in the world and in Sub¬Sahara Africa with an adult prevalence of 19,7 %, and 210.000 people estimated to be living with HIV/AIDS at the end of 2003. The Caprivi region adult prevalence in adult pregnant wom~n is estimated at 43%. The health care services are overstrained with patients and home-based care (HBC) is seen a possible solution. The scale up of HBC and expansion of coverage to patients has lessened the burden of public hospitals to deal with all these chronically ill patients. The challenges that volunteers are facing impact in the quality of care people living with HIV I AIDS receive. Objectives This study assessed the utilization of home-based care service, knowledge and perception of People living with HIV and AIDS (PL WHA) toward home-based care services. The views of volunteers towards home-based care service are also reported. Methods This is a qualitative study that utilized Focus Group Discussions (FGDs) for the home-based care-givers and in-depth interview with the clients accessing antiretroviral treatment at Katima State Hospital. A total of four focus group discussions were organized with care-givers comprising 31 adult participants (15 males and 16 females) and 18 in-depth interviews were conducted with the people living with HIV and AIDS accessing antiretroviral treatment (ART) at Katima State Hospital. All FGDs were tape recorded and one-to-one interview was hand written. Result The study demonstrates that most of the participants have positive attitudes toward utilization of HBC service. However, few people are still afraid to disclose their health status. In general, the community participation has tremendously reduced stigmatization. The self-reported health status by the HBC givers in order to have access to nutrition support may have played a role in reducing the stigma associated with HIV and thus increased the number of people utilizing the HBC service. The HIV -positive participants valued the assistance received from the volunteers and volunteers appreciate the training received to enable them to undertake their duties with more confidence. The dress code of volunteers when visiting patients was perceived to disclose HIV status but did not influence patient attitude to access the service. Conclusion The improvement in community knowledge about HIV and HBC service has enhanced the positive attitude toward utilization of home-based care service which has consequently reduced the stigma associated with HIV. Advocacy is required to improve the working condition of volunteer care-givers home-based care by policy markers. The collaboration between different stakeholders will advance and sustain the HBC service in focusing on prevention of HIV infection.

Thesis (M Med (Family Medicine)) -- University of Limpopo, 2010. / Background: Many patients move from one healthcare provider to another, disturbing the continuity of holistic patient care. Objectives: The aim of this study is; to investigate the reasons why patients leave their nearest clinic, and to determine if these patients are able to use the provided care when they need to. Methods: A cross-sectional, quantitative study was conducted during the winter of 2010. Questionnaires were given to 350 patients attending Karen Park Clinic. Patients completed the questionnaires in the presence of the researcher, who was able to assist where needed. Variables addressed in the questionnaire included: place where they stay; if they visited their nearest clinic; what services there are at their nearest clinic; would they go back to their nearest clinic and if not, what would be the reasons. Results: The majority of respondents stayed in Soshanguve, 153 (43.7%), Mabopane 92(26.3%)Garankuwa, 29(8.3%)and Hebron 20(5.7%), Most ofthe respondents were females 271(77.4%), with 177 (50.6%)aged between 26 and45years. Eighty percent of patients indicated that they visited their nearest clinic and 191(54.6%) said that they will not return to that clinic. The reasons for not returning to the nearest clinic were: - no medication, 39(11.1%); long queues, 59(16.9%); rude staff, 59(16.9%); long waiting time to be helped, 88(25.1%) and other, 63(18.0%). Conclusion: The researcher found that many patients, who first attended their nearest clinic, opted not to return. Reducing long waiting times and long queues at a primary health care centre can be achieved. Satisfied health care providers would provide quality service to patients. Training courses for management committee members could lead to improving the health center's management and patients could be redirected to their nearest clinic by giving them referrals or transfer letters. Purchasing enough medicine will reduce the problem of no medication and increase the capability of the health center. Staff should receive training about health care practices, to reduce the rude behaviors that drive patients away.