Att befinna sig i ett terminalt skede i livet kan innebära en känsla av oro och ångest inför sjukdomen och döden. Möjligheten att då få tillbringa sin sista tid i hemmiljö med nära och kära kring sig genererar för många en trygghet. Syftet med denna uppsats är att belysa vuxna människors erfarenheter av att i livets slutskede vårdas av anhöriga i hemmiljö. Metoden som använts är systematisk litteraturstudie där aktuell forskning inom området sammanställts. Databaser som använts för sökningen var PsycINFO, Medline, Cinahl, Elin@kalmar och SweMed+. Artiklar som syftade till problemformuleringen kvalitetsgranskades och resultatet bygger på tio vetenskapliga artiklar. Resultatet visade att sociala relationer och stöd från familjen genererar livskvalitet och trygghet hos människan som vårdas i livets slutskede. Delaktighet i sin vård och känsla av att inte förlora kontrollen över sina symtom gjorde att människan kände hopp och att de klarade av situationen. Slutsatserna var att möjligheten att få bo kvar hemma ansågs mycket betydelsefullt. Sociala relationer bidrog till att människor hemma kände en lägre grad av symtom. Den sjuke uppskattade stödet från familjen men ville inte bli en börda för anhöriga. Information om stöd och en realistisk planering samt insikt i situationens allvar bidrog till att hon kände delaktighet och bättre kunde hantera situationen.

Among the age competition, more and more companies know how to provide fine, humane benefit cares, in order to obtain satisfactory outcome and secure good employees. Therefore, companies should know employees¡¦ diverse needs in being cared. The purposes of the employees¡¦ benefit committee devoting to promote benefit cares are to lift working spirits, to raise working efficiency, and to increase the enterprise overall profits. The best method to evaluate employees¡¦ feelings toward the benefit of cares is to measure their satisfaction. At the customer-oriented new economy age, most companies realize that having satisfied employees can eventually bring in customer satisfaction. The main purposes of this study are to explore the degrees of satisfaction and importance, respectively, of the employees toward the care items proposed by the Taiwan Sugar Corporation Employee¡¦s Benefit Committee and to provide suggestions and ways of improving. We randomly draw 5¢H employees from the Taiwan Sugar Corporation and they are the subjects of this study. Totally 210 copies of questionnaires are given away and 188 copies deemed effective are retrieved. There are 34 survey questions in the questionnaire. The Likert scale is adopted and SPSS for Windows is used as the tool for statistical analysis. This paper tries to figure out the top five satisfactory/unsatisfactory, important/unimportant benefit care items. The benefit care items are categorized into four groups. They are the group with balanced demand and supply, the group with excess demand, the group with excess supply, and the group with wasted resources. The result can be a reference for Taiwan Sugar Corporation Employee¡¦s Benefit Committee to improve their benefit care items. This study finds that there is a difference between the degrees of satisfaction and the degrees of the importance and employees with different personal backgrounds are different toward the perception of satisfaction and importance.

Literature has consistently documented that religious involvement and identity have a positive, protective impact on health. Gay and lesbian persons, as members of a stigmatized group, are at particular risk for numerous physical and psychological difficulties and may benefit from competent care by clergy. The purpose of this dissertation is to report the results of a survey of 1,000 Protestant clergy in the United States designed to describe clergy’s training, knowledge, and experience regarding homosexuality and to examine the predictors of clergy’s attitudes toward issues of homosexuality. Evidence indicates that training and contact with homosexual persons can transmit knowledge to clergy, and that such knowledge is associated with more positive attitudes toward gays and lesbians. However, in this sample, males and respondents reporting more conservative religious beliefs scored lower on the knowledge scale than their more liberal counterparts. Additionally, respondents’ formal training about homosexuality overall appears to have been insufficient to meet their professional needs as more information was received through informal training and continuing education. Conservative respondents reported less personal and professional experience with homosexuals and issues of homosexuality. Similarly, conservative respondents, males, persons from the Midwest and South, persons who did not receive clinical pastoral education (CPE) training, and those with less personal experience with homosexual persons reported significantly more conservative attitudes. The one exception to these findings was with conservatives reporting significantly more professional experience providing pastoral care to a homosexual who wanted to become heterosexual. This finding is congruous with conservatives scoring incorrectly more often on knowledge items regarding the changeability/choice of homosexuality. While knowledge was a consistent and significant predictor of attitudes (less knowledge predicted more conservative attitudes/beliefs), religious beliefs provided a stronger contribution to regression models with conservative beliefs significantly predicting more negative attitudes.

The U.S. pharmaceutical industry has been remarkably successful in developing new treatments for many of the leading causes of morbidity and mortality. These new treatments and their high prices lead government and private parties to increase spending and raise the issue of access. Price and cost increases have stimulated insurance costs, raising questions about the value of new technologies. A key way to address the increase in pharmaceutical prices is to investigate the impact of newer therapies on overall health expenditure. There is a conflict among researchers about the benefits and costs of newer and better drugs. Some researchers argue that newer and better drugs keep people out of hospitals and provide significant cost savings. Another group of researchers argue in their work that newer drugs do not really provide significant cost savings. This dissertation investigates the impacts of break-through drug classes on overall health care expenditures. Empirical evidence presented in this dissertation shows that drugs belonging to new drug classes provide significant advances in treatment of conditions compared to other drugs. The results indicate that all new drug classes except Fluoroquinolones provide substantial cost savings on overall health care expenditures. This dissertation also explores the relations between FDA Therapeutic Drug Classification and total health care expenditures. It offers a better methodology by incorporating both the quality and the age of the drugs to capture their effects on total health care expenditures. It studies the impacts of the quality and the age of the drugs on the diseases of following therapeutic classes: musculoskeletal system and connective tissue, skin and subcutaneous tissue, neoplasm, mental disorders, nervous system and sense organs, circulatory system, respiratory system, digestive system, genitourinary system. The nature of therapeutic conditions coupled with their duration lead us to conclude that for some therapeutic categories newer priority drugs are preferable, for others newer standard drugs are better. The results suggest that there is no general rule to state that newer priority drugs decrease health care expenditures.

In the past, medical industry is a highly exclusive field, people would overcome a great amount of restriction and obstacle while seeking for medical advice. However, the financial obstacle was much reduced after the National Health Insurance program began in March of 1995. It is now easier and more convenient for people to seeking for medical assistance. By learning more about the key point of what people think before seeking for medical assistance, hospital can make more effective marketing programs. The purpose of this research is to understand the situation of medical care seeking behavior of the public. The structrued survey study sampled 334 patients by quota sampling. Information collected in the questionnaire includes situation of the medical care seeking behavior and medical services utilization. A multiple regression was also performed to examine the factors that influenced the medical care seeking behavior. Some managerial implications were also proposed according to the results.

In the provision of public goods such as health care for the uninsured, nonprofit organizations serve important functions in society. Because they often rely on volunteer labor, and funding is frequently unstable, their survival depends on factors not present in either private enterprise or state agencies. This comparison case study examines three clinics, one surviving clinic and two that did not survive, to find patterns that characterize organizational success and survival. Theories about public goods, volunteering, and organizational coordination and communication provide insight into different aspects of the case study. Data was gathered from 19 in-depth interviews with individuals connected to the three clinics. The analysis employs Ostrom’s characterization of eight principles of longstanding common-pool resource organizations, with slight adjustments for the public goods setting. As expected, the successful clinic reflects more of the characteristics, or possesses them to a greater degree, than the unsuccessful ones. Specifically, the successful clinic reflects a greater degree of congruence between organizational rules and local conditions (as evidenced by community support), and collective-choice arrangements (as indicated by the presence of an actively engaged board of directors). In addition, the successful clinic is loosely nested with other organizations, whereas the nonsurviving clinics were more tightly nested within local organizations; the looser nesting allows for greater autonomy in decision-making. Finally, an unexpected finding drawn from the interviews concerns the manner in which the clinics framed their message and mission. The successful clinic framed its mission in terms of serving the “working poor,” whereas the nonsurviving clinics stated their mission as charity for the poor and needy. This variance may have contributed to greater community support for the successful clinic.

Transportation is frequently cited as a barrier to health care, but rarely have researchers analyzed the problems in depth. The purpose of this study was to assess the role transportation plays in the utilization of preventive health care services among Medicaid recipients ages 0 - 20 in Texas. This preventive care is known as Early Periodic Screening and Diagnostic Testing (EPSDT), a comprehensive prevention and treatment program for Medicaid eligible children. Our computer assisted telephone interviewing based survey was administered to Medicaid recipients selected from a representative sample through a stratified sampling scheme. Binary logistic regression models were used to assess and predict factors associated with utilization of the Texas Medicaid Transportation Program (MTP) and utilization of EPSDT. We also used k-means cluster analysis to identify subgroups of Medicaid clients with particularly acute transportation barriers. Of the 1,214 Medicaid recipients interviewed, the overall odds of a Medicaid recipient being a MTP non-user was 0.94. For clients with automobile access, the probability increases to 0.98. Clients who experienced difficulties paying for gasoline decreased the overall odds to 0.86. When examining utilization of EPSDT, the overall probability of being a low utilizer was 0.59. Two factors, Spanish-speaking patients (0.21) and clients with more than one child at home (0.54) decreased the overall odds of being a low utilizer, while those with difficulty paying for gasoline increased the odds of being a low utilizer to 0.63. Increasing EPSDT utilization among the millions of Texas Medicaid recipients is an important policy objective. Because the Texas Medicaid population is large and diverse, no single approach to increasing utilization is likely to address all needs. The group concept provides a means to understand which Medicaid recipients do not access MTP services and those with low utilization rates. These groupings can be useful in targeting Medicaid clients with specific transportation difficulties. Instead of broad informational campaigns, policy makers should devise targeted strategies to promote the most appropriate types of assistance. In addition to expanding transportation options, policy makers should also examine the locations in which care is delivered, considering telemedicine, mobile health and school-based health clinics as options.

N/A (long introduction)

Univ., Diss.--Nijmegen, 2006.

Thesis (Ed. D)--College of Saint Mary -- Omaha 2009. / A dissertation submitted by Barbara J. Braband to College of Saint Mary in partial fulfillment of the requirement for the degree of Doctor in Education with an emphasis on Health Professions Education. This dissertation has been accepted for the faculty of College of Saint Mary by: Peggy L. Hawkins, PhD, RN, B.C., CNE, chair ; Connie L. Clark, PhD, RN, committee member ; Pat Morin, PhD, RN, committee member. Includes bibliographical references.