This thesis is an epidemiological study that investigates the impact of the social, psychological and physical factors on bus `drivers' health, in the Islamic Republic of Iran, specifically around the regions of Hamadan and Yazd. The availability of proper health care to this group is also discussed. The epidemiological study of intercity `bus drivers' health problems is an important aspect of this thesis. Therefore, 219 `bus drivers were chosen from the two mentioned areas and the comparison between `bus drivers and 236 office workers was made. The results of the survey have indicated that the most prevalent health problems among `bus drivers are musculoskeletal diseases, ulcer & hyperacidity, obesity, hypertension and diabetes. The results have also indicated that there is a significant association between the `bus drivers who have been involved in `bus accidents and those who have been most affected by Low Back Pain; Back Pain; Leg Pain; Neck Pain; Hypertension; Migraine. A model of `bus drivers' diseases due to risk factors and `bus accidents was presented. From the results it can be concluded that working conditions are the main cause of health problems among `bus drivers and are directly related to their health. In the light of the data collected, and the results therefrom, recommendations are put forward to address some of the fundamental problems and their solutions.

No description available.

No description available.

The experiences of the relatives of patients in Intensive Care Units (ICUs) are of international concern. In Greece however, the difficult nature of their experience has not yet been recognised and a considerable number of people have not received adequate attention from the medically-orientated Greek healthcare system. Here, the experience of relatives of ICU patients in Greece is examined from a qualitative perspective using in-depth interviews with 25 relatives of leU patients, together with observations to cross-validate the data obtained. The research is underpinned by the social constructionist version of grounded theory described by Charmaz (1990, 2000). Analysis of the data consisted of line-by-line coding, selective coding, memo writing and constant comparisons to define and refine the identified categories. Codes and categories identified were cross-validated by two other independent bilingual researchers. Seven major categories were identified. The experiences of the families revolve around the two core categories 'Intense Emotions' and 'Vigilant Attendance'. The Intense Emotions category and its main component, 'anticipatory grief', affect vigilant attendance positively, as these aspects cause family members to remain close to the patient to observe proceedings. Conversely, a 'loss of intimacy' causes an additional grief to relatives; some avoided a reminder ofthis loss by not going to visit the patient. The conceptualisation of three new categories in this field, 'Vigilant Attendance', 'Religiosity' and 'Loss of Intimacy', form an original contribution to knowledge. Three further categories were identified, namely 'Caring', 'Dignity' and 'Information' and the various interrelationships between all seven categories were also examined. The findings ofthis study suggest that major changes need to be made to the management ofthe families of critically ill patients in Greece, particularly in relation to information and visiting policies. Further implications for policy, research and practice are discussed.

Bangladesh is one of the poorest developing countries in the world where infant and young children (IYC) suffer from extremely high levels of malnutrition resulting in high morbidity and mortality rates. IYC are defined here as birth to 3 years old. Due to the double burden of climate variability and urbanisation, longer and more severe floods affect people living in urban slums, with IYC being highly vulnerable. Insufficient research exists into understanding the mechanisms leading to poor nutritional child health related to flooding in urban slums. Maternal nutritional status associated with infant and child health has been established previously, but rarely in the aftermath of a flood. This study explores, 1) whether maternal nutritional status measured soon after a flood can predict the current nutritional status and the risk for future deterioration of nutritional status of their children, 2) the impact of flooding on IYC feeding practices during flooding compared to non-flooding and the coping strategies developed by caretakers in urban slums, 3) the perceptions of root causes of malnutrition including flooding for IYC living in urban slums and 4) develops a pilot study for an intervention to tackle malnutrition in IYC living in urban slums. The research uses 1) quantitative data (n=143, secondary analysis of data collected after the 1998 flood in Bangladesh) to answer the first research question, and 2) a mixed method approach of qualitative data (participant observation n=24, semi-structured interviews n=23 (18 mothers, 5 community health workers), and focus group discussions n=10) and quantitative data (household questionnaire n=23 and anthropometric measurements n=55 for IYC and n=23 for mothers and community health workers) collected in slums in Dhaka to answer the second and third research questions. A new technique is used to answer question three. This technique is based on existing methods for the building of a causal model combined with a pile sorting of photographs to understand the root causes and processes leading to malnutrition. The participants of the mixed method were mothers, pregnant women and Bangladesh Rural Advancement Committee (BRAC) community health workers living and working in the slums. The key findings are: 1) maternal nutritional status measured soon after a flood can predict the current nutritional status and the risk for future deterioration of nutritional status of their children, 2) feeding practices for IYC deteriorate during flooding in Dhaka slums, 3) the coping strategies of IYC caretakers are limited and their resilience capacity to floods is low, 4) there is a good perception of the root causes of malnutrition by participants living in Dhaka slums but feeding practices are not meeting the WHO guidelines due to barriers, limitations and poor knowledge, and 5) there is a need for a pilot project to test the feasibility of an intervention aiming at improving IYC nutritional health and feeding practices. This research deepens the understanding of coping strategies for feeding practices and perceived roots of malnutrition for IYC living in urban slums exposed to flooding. It brings evidence of the interactions between coping strategies and nutritional health in relation to flooding. It also casts new anthropological light onto the series of existing studies and previous research essentially focused on the flood event itself. As a result, the research leads to recommendations for risk reduction strategies and nutrition promotion for flood exposed populations with infants and young children.

Background: Whilst many isolated educational interventions have been evaluated, less is known about the practical steps patients take to learn about their condition and how to live with it, the factors that influence their learning, or even the ability and inclination of health professionals to provide relevant education. Understanding the experience of education for people with ankylosing spondylitis (AS) will help to develop resources in the future and tailor existing resources for individual patients. Methods: Focus groups and a survey of UK Rheumatology health professionals were used to describe current practice and professionals’ perspectives of education for people with AS. Patients’ perspectives of learning were reported through focus groups, serial semi-structured interviews with 10 ‘new’ patients with AS, and further interviews with 12 ‘review’ patients. Finally, consensus methods were employed to review the findings. Results: A detailed description of education and learning for people with ankylosing spondylitis has been constructed, based on the current provision of education and the perspectives of both patients and relevant health professionals. Analysis of the interviews with patients led to the development of the Established Patient Model, which describes a search for information in four stages. The model indicates that patients do not strive to be experts on their condition, but instead reach a self-defined level of adequate knowledge based on their background and the disruption to their lives caused by AS. Conclusions: This thesis details how, when and why people with AS learn about their condition, and the content and delivery methods they value and choose. Equally, I have identified variations in the delivery of education by Rheumatology Departments. Understanding these issues allows changes to the provision and organisation of educational resources to be suggested. These potentially complement and facilitate patients’ learning, allowing clinicians to recommend educational resources which are likely to be acceptable and useful.

BACKGROUND Clinical audit is an intervention designed to improve the quality of clinical care. Although well established in high income countries, there is little research evidence for its effectiveness in resource poor settings. AIMS AND OBJECTIVES I aimed to evaluate the effectiveness of clinical audit in influencing clinical practice in providing diagnostic care for patients with suspected TB. METHODS A total of 26 health centres were recruited in total in Cuba, Peru and Bolivia. Clinical audit was introduced to improve the diagnostic care for patients attending with suspected TB. Standards were based on the WHO and TB programme guidelines relating to the appropriate use of microscopy, culture and radiological investigations. At least two audit cycles were completed over two years. Improvement was determined by comparing performance between two six-month periods pre-and-post intervention. Qualitative methods were used to ascertain facilitating and limiting contextual factors influencing change among health care professionals' clinical behaviour, following the introduction of clinical audit. RESULTS I found a significant improvement in 11 out of 13 standards in Cuba, two out of six in Bolivia and two out of five standards in Peru. Barriers to quality improvement included conflicting objectives for clinicians and TB programmes, poor coordination within the health system, and patients' expectations of illness and health services. CONCLUSIONS Clinical audit may drive improvements in the quality of clinical care in resource poor settings. It is likely to be more effective if integrated within local TB programmes. I recommend developing and evaluating an integrated model of quality improvement including clinical audit.

The escalating trend of childhood obesity within genetically stable populations indicates that environmental, and therefore modifiable, factors must be contributing. Infancy (when parents largely determine child-feeding), has been highlighted as a critical time for the development of maladaptive eating behaviours. Despite interest in early interventions, there is no research on child-feeding styles from UK non-white communities. Born in Bradford (BiB) aims to identify factors that contribute to differences in health outcomes between people in South Asian (S. Asian) and European origin. This birth cohort provides a valuable opportunity to explore feeding interactions that may contribute to risk of obesity in a bi-ethnic sample. The current study recruited thirty eight mother-child dyads, according to maternal weight status and ethnicity and observed them during a typical mealtime. A range of positive and negative interactions were coded using the Mealtime Observation Schedule (MOS, Sanders & LeGrice, 1993). Data was also collected regarding mealtime organisation. Observed interactions were compared to mother‟s self-reports on questionnaire assessments of feeding, parenting styles and infant characteristics. The differences found between the mealtimes of obese and healthy weight mothers were limited compared to the differences observed between S. Asian and non-Asian mothers. Obese mothers were observed to use a greater amount of positive eating comments. They were most likely to report Indulgent parenting, whereas healthy weight mothers were most likely to report Authoritarianism. This difference was not observed in the mealtime interactions. There were several differences between S. Asian and non-Asian mothers in both the meal structures and mother-child interactions. S. Asian mothers used negative parenting behaviours more frequently, and less positive behaviour. In the healthy weight S. Asian group, this was paralleled by greater levels of negative child behaviour. Both maternal and child age also influenced these outcomes. Differences in mealtime interactions may contribute to differences in obesity rates across different ethnicities. However, research regarding parenting styles is mostly based on white European samples. It is argued that current measures are not culturally appropriate for S. Asian families living in the UK. More research is needed in order to develop culturally appropriate interventions regarding child feeding.

No description available.

No description available.