Data gathered from Tyler, Texas, the University of North Texas, and the National Survey of Families and Households (NSFH) were used to compare children from commercial, home, church, and university based day care with children not attending day care. The research group, comprised of children attending day care (N=142), were located using non-probability sampling; those not in day care (the control group) came from the NSFH (N=1775). Data from the research group were weighted to match the control group. The independent and control variables included the child's age, length of time in day care, intellectual functioning; the parent's marital status and social class; the day care's staff to child ratio and the staff's training. All data, except that pertaining to the facility itself, were gathered from the children's parents using a self-report questionnaire. The remaining data were gathered through personal interview by the researcher. The dependent variable was an index of emotional and behavioral problems reported for the child. Overall, children who attended day care had only slightly more problems reported than those who did had not attended day care. When each center was examined separately, the children in home centers had the greatest number of problems, followed by the commercial centers and university center, with children from the church centers scoring the lowest. In contrast to earlier research, intellectual functioning was not enhanced by the day care experience. While the staff's training had a statistically significant relationship to the children's well-being, no relationship was found for the staff to child ratio. Further research on the impact of other characteristics of each type of day care is recommended.

Hospital-based specialist palliative care services are designed to address the needs of critically ill patients by psychosocial and spiritual support, improving symptoms management, and offering discussions on goals of care. Integrating palliative care upstream in the care continuum for patients who eventually die in the hospital will help to address the many individualistic needs of the critically ill patient. The diffusion of specialist hospital-based palliative care services requires an understanding of patterns of utilization by patients. The purpose of this study was to examine the population characteristics of decedents who may or may not have utilized specialist palliative care services in a hospital setting in order to develop a model of predictors of access to specialist palliative care services. The basic constructs of this study are grounded in the Behavioral Model of Health Services Use. Potential access is measured in terms of population characteristics, which include predisposing characteristics, enabling resources, and evaluated need. Building on this theoretical model, the study sought to better understand equitable and inequitable access to specialized palliative care services and to define which predictors of realized access were dominant. The research question asked was: What are predictors of access to specialized palliative care within a large urban public teaching hospital? A model of access to a palliative consult and a predictor of access to a palliative care unit were explored. Findings from this study revealed that factors encouraging access to a palliative care consult include older age, White non-Hispanic ethnic membership, a diagnosis with solid cancer and insurance. Factors encouraging access to a palliative care unit include older age, gender (female), insurance, and either a solid cancer or hematologic malignancy diagnosis.

The criminal defences are of a very high importance especially in the context of health care services. They set the conditions under which health care services may be provided without any criminal sanction. Legislation regarding the criminal defences has been under constant development and the topic remains very actual nowadays. The thesis is divided into five chapters. First chapter introduces the reader the issue and explains the importance of dealing with criminal defences. Second chapter concerns general aspects of criminal defences and is divided into three parts. First of them deals with the term of unlawfulness, since the circumstances which are subject to this research, exclude the unlawfulness. Next part is dedicated to the legal regulation of defences and relations between them. Last part of first chapter explains philosophical and moral principles of acting within the scope of defences. Such principles are introduced both on a theoretical level and practical cases. Third chapter deals with particular criminal defences, including the defences which are not explicitly stated in the criminal code, and thoroughly explains issues related to them in its five parts. First part offers detailed overview of conditions of necessity and its impact on providing of health care services. Attention is paid also...

M.Ed. (Didactics Mathematics) / Mathematical literacy is essential for functioning effectively in a technological society. Many occupations which may appeal to young people require mathematical ability as a prerequisite. By establishing factors which contribute to a pupil's difficulties within a subject, teachers are better able to assist these pupils ...

M.Ed. (Educational Management) / Please refer to full text to view abstract

Student Number 9705165A Master of Arts in Forced Migration Studies Faculty of Humanities / Objective: To identify and investigate barriers faced by Somali forced migrants when accessing health care in Johannesburg. In particular, the study seeks to compare perceptions of health personnel and migrants as to the nature of such access constraints. Design and Methods: The study made use of semi-structured and in-depth interviews with a snowball sample of health personnel and migrants. Ten health personnel were interviewed and twenty migrants (ten male and ten female). Results: Constraints of language and xenophobia were identified by both health personnel and forced migrant interviewed. Constraints related to the shortage of resources and the poor functioning of the referral system are experienced by all users of the public health system, irrespective of their nationality. No mention was made of traditional or allopathic medicine. Conclusions: There exists a gap between the access to health care guaranteed in the Refugees Act and practices at facility level. There are many similarities across interviews in the constraints identified by migrants and some agreement in the constraints identified by migrants and health personnel. These results confirm that migrants experience a fairly severe level of constraint when attempting to utilize formal health care services in Johannesburg.

With the increasing demands of rising medical costs in combination with a boom in elderly patients in need of quality patient care medical practices are being stressed. Patient to nurse ratios are increasing and government spending in the medical domain is at an all-time high threatening the futures of government medical programs such as Medicare and Medicaid. In this thesis we propose a framework for the monitoring of a patient's vital statistics in a home-based setting using a mobile smart device. We believe that in taking advantage of the wireless sensor technology which is readily available today we can provide a solution that is both economically and socially viable offering a solid quality of healthcare in a comfortable and familiar environment. Our framework exposes both 802.11 and Bluetooth wireless protocol transmitting medical sensor devices using an Android platform device as a monitoring hub. / by Mark Conaster. / Thesis (M.S.C.S.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

Introdução: A legislação brasileira prioriza a atenção às crianças, aos portadores de deficiência, às gestantes, lactantes, pessoas acompanhadas por crianças de colo e pessoas idosas em serviços públicos e privados. No entanto, não é claro o que diferencia a priorização entre esses grupos ou dentro do mesmo grupo. Com o progressivo aumento da população idosa, faz-se necessária a adequação das políticas públicas de forma a atender as novas e crescentes demandas econômicas, sociais e de saúde. Em situações nas quais os recursos assistenciais existentes podem não ser suficientes para o atendimento global, torna-se necessária a hierarquização dos mesmos a partir de critérios objetivos e claros que reorganizem o fluxo assistencial dos serviços de acordo com as suas reais necessidades e demandas. Objetivo: Identificar os critérios relacionados à priorização de atendimento em saúde de pessoas idosas, considerando aspectos biomédicos/clínicos, epidemiológicos, etários e bioéticos. Método: Trata-se de um estudo de revisão bibliográfica realizada nas bases de dados CINAHL, EMBASE, LILACS e PubMed. Foram encontrados 1.973 artigos e, após análises, mantiveram-se 11 artigos. Resultados: Os trabalhos encontrados apresentaram-se de forma bem diversa em relação aos objetivos e metodologias utilizadas diante de diferentes formas de classificação, hierarquização e seleção de idosos de acordo com os riscos de gravidade, declínio ou morte. De acordo com os estudos, foram selecionados pacientes com maior necessidade ou risco de acordo com instrumentos ou por avaliação dos profissionais. Os principais motivos foram: idosos acima de 85 anos, homens, uso de polifarmácia, isolamento social, necessidade de ajuda para realizar as atividades cotidianas, comprometimento cognitivo e problema respiratório. Conclusão: A priorização dos cuidados de saúde dos idosos deve ser embasada em fatores que mais impactam essa população e em critérios que destaquem casos mais susceptíveis a riscos, mediante escolhas hierarquizadas entre alternativas de cuidados e recursos disponíveis. É necessário garantir o acesso aos idosos nos diferentes níveis de atenção à saúde de forma eficiente, permitindo o efetivo monitoramento e gerenciamento de sua condição clínica. / Introduction: Brazilian law prioritizes care for children, people with disabilities, pregnant women, nursing women, people carrying infants and elderly people in several public and private services. However, it is not clear what differentiates the prioritization between these groups or within each group. With the progressive increasing of the elderly population, it is necessary to adapt public policy in a way that suits the new and growing economic, social and health demands. In situations which the available care resources may not be sufficient to provide medical attention globally, it is necessary to hierarchize care through objective and clear criteria that allows a reorganization of the care flux according to the actual needs and demands of each case. Objective: To identify criteria related to the prioritization of health care for elderly people, considering biomedic/clinic, epidemiologic, age-related and bioethical aspects. Method: The following is a bibliography review study. The bibliographical search was done on the CINAHL, EMBASE, LILACS and PubMed databases. 1973 articles were identified and, after multiple analysis, 11 articles were kept. Results: The papers identified presented diverse objectives and methodologies, which were utilized to identify diferente forms of classification, hierarchization and elderly selection, accordingly to risks related to severity, decline or death. According to these studies, patients with more needs or in more risk were selected either through instruments or through professional evaluation. The main causes were: elderly over the age of 85, male, polypharmacy, social isolation, needing help to perform daily activities, cognitive impairment and respiratory issues. Conclusion: The prioritization of health care for the elderly must be based in the factors that cause the most impact on this population and in criteria that highlights cases more susceptible to risks, through hierarchized choices between care alternatives and the available resources. It is necessary to ensure access to elderly people on every different level of health care in an efficient way, allowing the effective monitoring and management of their clinical condition.

A atenção domiciliar (AD) é uma modalidade de atenção à saúde que visa reorganizar o processo de trabalho das equipes de diferentes serviços, reduzir a demanda por atendimento hospitalar, ampliar a autonomia dos usuários e de seus familiares, além de proporcionar a integralidade da atenção. No âmbito do sistema único de saúde, a AD é operacionalizada, na atenção primária, por meio da Estratégia de Saúde da Família (ESF) e do programa Agentes Comunitários de Saúde (PACS) e pelo programa Melhor em Casa que organiza os Serviços de Atenção Domiciliar (SAD). O estudo teve como objetivo caracterizar os indivíduos assistidos pela equipe multiprofissional de atenção domiciliar (EMAD) do município de Ribeirão Preto, SP. Trata-se de um estudo epidemiológico descritivo que utilizou um formulário e o domínio motor da Medida de Independência Funcional (MIF) para obter o perfil e a incapacidade funcional, respectivamente. Participaram do estudo 58 indivíduos maiores de 18 anos, residentes na área de abrangência e cadastrados na EMAD entre o período 1 de janeiro à 12 de agosto de 2013. Para a realização da análise dos dados, utilizou-se o aplicativo Stata 9.0. Além da análise descritiva, realizou-se o teste de comparação de médias entre os grupos por meio do teste t de Student e ANOVA one way. Os indivíduos caracterizam-se pelo discreto predomínio do sexo masculino (51%), idosos (79,4%), sendo que 91,4% estão inseridos na modalidade de atenção domiciliar AD2 e 87,9% receberam a visita domiciliar do enfermeiro. Houve o predomínio do acesso à atenção domiciliar por demanda espontânea (48,2%) e 41,4% dos participantes realizavam fisioterapia, no momento da entrevista, no SUS (79,2%). Além disso, 37,6% necessitavam usar fraldas e equipamentos (91,4%), sendo este a cadeira de rodas (39,6%) e a maioria foi adquirido por meio do SUS (51%). Quanto aos diagnósticos, os mais frequentes são o acidente vascular encefálico (11%) e a doença pulmonar obstrutiva crônica (11%). Em relação aos cuidadores, 80,4% são do sexo feminino, idosos (41%), com o grau de parentesco esposa (37,6%). Entre aqueles que cuidam de indivíduos que fazem ou fizeram fisioterapia, 90% receberam orientações. No que tange à MIF, a média do domínio motor foi de 50,5 pontos. A maior categoria foi alimentação, sendo que 43,1% apresentaram independência completa, e a menor foi escadas, com 58,6% de indivíduos que necessitaram de ajuda total. O perfil dos indivíduos assistidos pela EMAD e a utilização de uma ferramenta que avalia a incapacidade funcional dos mesmos evidenciaram aspectos propositivos para potencializar o planejamento e a operacionalização da assistência e do processo de trabalho da EMAD. / Home care (AD) is a type of health care that aims to reorganize the work process of the different services teams, reduce the demand for hospital attendance, increase the autonomy of the users and of their family members, in addition to providing comprehensive care. Within the framework of the public health system, AD is operationalized, in the primary care, by means of the Family Health Strategy (ESF), of the Community Health Agents (PACS) program and by the Better Home program which organizes the Homecare Services (SAD). The study aimed at characterizing the individuals assisted by the multidisciplinary team of home care in the city of Ribeirão Preto, Brazil. This is a descriptive epidemiological study which made use of a form and of the motor domain included in the Functional Independence Measure (MIF) to get the profile and the functional disability, respectively. The study included 58 patients over 18 years old living in the area covered and enrolled in the EMAD in the period between January 1 to August 12, 2013. For carrying out the data analysis, Stata 9.0 application was used. In addition to the descriptive analysis two variables or more were compared using the t Student and ANOVA one way test. Individuals are characterized by a slight predominance of males (51%), elderly (79.4%), and 91.4% are inserted into the modality of home care AD2 and 87.9% received home visits of the nurse. There was a predominance of access to home care by spontaneous demand (48.2%) and 41.4% of the participants performed physical therapy at the time of interview, in the SUS (79.2%). Furthermore, 37.6% needed to wear diapers and equipment (91.4%), these being the wheelchair (39.6%) and most had been obtained through the SUS (51%). With regard to diagnosis, the most frequent are the stroke (11%) and the chronic obstructive pulmonary disease (11%). Regarding caregivers, 80.4% are female, elderly (41%), with the degree of relationship wife (37.6%). Among those who took care of individuals who are undergoing or underwent physical therapy, 90% received guidance. Concerning the MIF, the average of motor domain was of 50.5 points. The largest category was feeding, and 43.1% had complete independence, and the lowest was stairs, with 58.6% of individuals requiring total assistance. The profile of the individuals assisted by the EMAD and the use of a tool that evaluates their functional disability highlighted propositive aspects so as to enhance the planning and the operationalization of the assistance and of the EMAD working process.

Introdução: A legislação brasileira prioriza a atenção às crianças, aos portadores de deficiência, às gestantes, lactantes, pessoas acompanhadas por crianças de colo e pessoas idosas em serviços públicos e privados. No entanto, não é claro o que diferencia a priorização entre esses grupos ou dentro do mesmo grupo. Com o progressivo aumento da população idosa, faz-se necessária a adequação das políticas públicas de forma a atender as novas e crescentes demandas econômicas, sociais e de saúde. Em situações nas quais os recursos assistenciais existentes podem não ser suficientes para o atendimento global, torna-se necessária a hierarquização dos mesmos a partir de critérios objetivos e claros que reorganizem o fluxo assistencial dos serviços de acordo com as suas reais necessidades e demandas. Objetivo: Identificar os critérios relacionados à priorização de atendimento em saúde de pessoas idosas, considerando aspectos biomédicos/clínicos, epidemiológicos, etários e bioéticos. Método: Trata-se de um estudo de revisão bibliográfica realizada nas bases de dados CINAHL, EMBASE, LILACS e PubMed. Foram encontrados 1.973 artigos e, após análises, mantiveram-se 11 artigos. Resultados: Os trabalhos encontrados apresentaram-se de forma bem diversa em relação aos objetivos e metodologias utilizadas diante de diferentes formas de classificação, hierarquização e seleção de idosos de acordo com os riscos de gravidade, declínio ou morte. De acordo com os estudos, foram selecionados pacientes com maior necessidade ou risco de acordo com instrumentos ou por avaliação dos profissionais. Os principais motivos foram: idosos acima de 85 anos, homens, uso de polifarmácia, isolamento social, necessidade de ajuda para realizar as atividades cotidianas, comprometimento cognitivo e problema respiratório. Conclusão: A priorização dos cuidados de saúde dos idosos deve ser embasada em fatores que mais impactam essa população e em critérios que destaquem casos mais susceptíveis a riscos, mediante escolhas hierarquizadas entre alternativas de cuidados e recursos disponíveis. É necessário garantir o acesso aos idosos nos diferentes níveis de atenção à saúde de forma eficiente, permitindo o efetivo monitoramento e gerenciamento de sua condição clínica. / Introduction: Brazilian law prioritizes care for children, people with disabilities, pregnant women, nursing women, people carrying infants and elderly people in several public and private services. However, it is not clear what differentiates the prioritization between these groups or within each group. With the progressive increasing of the elderly population, it is necessary to adapt public policy in a way that suits the new and growing economic, social and health demands. In situations which the available care resources may not be sufficient to provide medical attention globally, it is necessary to hierarchize care through objective and clear criteria that allows a reorganization of the care flux according to the actual needs and demands of each case. Objective: To identify criteria related to the prioritization of health care for elderly people, considering biomedic/clinic, epidemiologic, age-related and bioethical aspects. Method: The following is a bibliography review study. The bibliographical search was done on the CINAHL, EMBASE, LILACS and PubMed databases. 1973 articles were identified and, after multiple analysis, 11 articles were kept. Results: The papers identified presented diverse objectives and methodologies, which were utilized to identify diferente forms of classification, hierarchization and elderly selection, accordingly to risks related to severity, decline or death. According to these studies, patients with more needs or in more risk were selected either through instruments or through professional evaluation. The main causes were: elderly over the age of 85, male, polypharmacy, social isolation, needing help to perform daily activities, cognitive impairment and respiratory issues. Conclusion: The prioritization of health care for the elderly must be based in the factors that cause the most impact on this population and in criteria that highlights cases more susceptible to risks, through hierarchized choices between care alternatives and the available resources. It is necessary to ensure access to elderly people on every different level of health care in an efficient way, allowing the effective monitoring and management of their clinical condition.