No description available.

This thesis focused on the situation of family members of persons with psychotic illness, particular on their experience of the approach of the healthcare professionals and of their feelings of alienation regarding the professional care of their family member. A further aim was to explore how siblings who have participated in a support group for siblings experienced their situation. A questionnaire was developed that enabled the aims of this thesis to be investigated (I). Seventy family members from various parts of Sweden participated, and data were collected via the questionnaire developed in study I (II-III). Thirteen siblings who previously had participated in a support group participated in follow-up focus groups interviews (IV). The questionnaire developed was shown to be reliable and valid in these studies (I). In many cases, the participants had experienced an approach from professionals that indicated that they did not experience openness, confirmation and cooperation, and that they felt powerless and socially isolated in relation to the care. There was also found to be a certain degree of association between how the participants experienced the approach and whether they felt alienation (II). The majority of the participants considered openness, confirmation, and cooperation to be important aspects of professional’s approach. The result also identified a low level of agreement between the participants’ experience and what they considered to be significant in the professional’s approach (III). The findings revealed the complexity of being a sibling of an individual with psychotic illness. Participating in a support group for siblings can be of importance in gaining knowledge and minimizing feelings of being alone (IV). Although the psychiatric care services in Sweden have been aware of the importance of cooperating with family members, the results indicated that there is a need for further research in this area.

Submitted by Daniele Santos (danielesantos.htl@gmail.com) on 2017-02-21T20:29:41Z No. of bitstreams: 1 Gus Davidson.pdf: 970488 bytes, checksum: 476e7012037f6f72d871810a4fdaf8f5 (MD5) / Approved for entry into archive by Janete de Oliveira Feitosa (janete.feitosa@fgv.br) on 2017-02-23T16:38:01Z (GMT) No. of bitstreams: 1 Gus Davidson.pdf: 970488 bytes, checksum: 476e7012037f6f72d871810a4fdaf8f5 (MD5) / Made available in DSpace on 2017-02-24T12:39:36Z (GMT). No. of bitstreams: 1 Gus Davidson.pdf: 970488 bytes, checksum: 476e7012037f6f72d871810a4fdaf8f5 (MD5) Previous issue date: 2016-11-10 / Health care is a rapidly evolving industry with new technologies constantly entering the marketplace. Supply for quality care has to continuously catch up to demand. The United States’ primary care system is at a crossroads, as patients rightly demand the best in health care costs, access, and quality. How will the industry continue to deliver high quality of care with our nation’s increasing demands? What technologies can be best utilized when caring for our aging population? This thesis is built around key sections that address our country’s impending physician shortage and how our health care system can combat growing demand with better processes and technologies. First, this thesis will examine physician shortages in America and what opportunities are available to address the problem. Existing health care research has found that advanced practice providers improve the costs, access, and quality of care as a solution to the impending shortage. This review will also assess the effectiveness of advanced care providers and health systems using telehealth, and how technology can alleviate the primary care physician shortage. An analysis was also conducted to document the United States’ current ratio of physician to patients in each state, which shows that adding advanced primary care providers and telehealth services can narrow the gap between supply and demand in most states. Second, this thesis will analyze the impact of telehealth in the U.S. health care system. A literature review of telehealth’s definition and history will give a foundation of how the technology has already changed how Americans access care, especially in rural areas. This thesis is proposing that advance practice providers can deliver primary care services using telehealth. Through the review of studies and literature, in addition to interviews with industry experts, it is suggested that there is a lack of concrete evidence with which to fully assess the economic impact of telehealth. Two of the most common economic evaluation methods are cost-utility analysis (CUA) and cost-effectiveness analysis (CEA). The main x objective of CUA, which is used especially in health technology assessment, is to estimate the ratio between the cost of a health-related intervention and the benefit it produces in terms of the number of years lived in full health by the users. In health technology assessments, the benefits are usually expressed in quality adjusted life years.1

This study focused on the psychosocial effects of parental loss on children orphaned by HIV/AIDS. The primary aim of the research was to explore the psychosocial effects of parental loss on children orphaned by HIV/AIDS through the eyes of the caregivers. Five participants were selected for this study using convenience sampling. The data was collected using face-to-face semi-structured interviews. The interviews were analysed using thematic content analysis and themes were extracted and presented. The results of this study indicate that children orphaned by HIV/AIDS living in the children’s home experience many psychosocial problems. Further research on the psychosocial issues specific to orphaned children raised in children’s homes in rural areas is recommended / Psychology / M. A. (Clinical Psychology)

Made available in DSpace on 2014-06-11T19:35:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-25Bitstream added on 2014-06-13T20:06:50Z : No. of bitstreams: 1 sleutjes_fcm_dr_botfm.pdf: 725660 bytes, checksum: 9a58cee8a9d2137fdcb115679023885d (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Investigar os óbitos neonatais pode ser uma importante estratégia para redução da mortalidade infantil e fetal, pois contribui para melhorar a qualidade da informação sobre esse evento adverso e possibilita a adoção, pelos serviços de saúde, de medidas para a prevenção de óbitos evitáveis. Objetivo Geral: avaliar os óbitos neonatais investigados no Departamento Regional de Saúde VI – Bauru, considerando-se os Colegiados de Gestão Regional, no ano de 2009. Metodologia: estudo descritivo e transversal, que analisou 162 óbitos investigados, a partir das informações digitadas no Sistema de Informações sobre Mortalidade Neonatal (SIM-Neo). Os resultados são apresentados de forma descritiva e a partir de escore síntese que considerou a qualidade da atenção ao pré-natal, ao parto e ao recém-nascido; fatores de risco pré-natal, no parto e com relação ao recém-nascido e situação sociodemográfica materna. Para análise dos escores foi ajustado um modelo para proporções do tipo logístico, considerando Colegiados e categorias como efeitos principais e a interação Colegiados versus categorias. Resultados: passaram por alguma investigação 88,5% dos óbitos ocorridos e 67,3% tiveram investigação completa. A análise dos escores relativos à qualidade da atenção pré-natal evidenciou diferença quando se consideraram os piores resultados (escore menores que cinco), sendo o Colegiado Vale do Jurumirim diferente e melhor que o de Bauru e o de Lins. Com relação à qualidade da assistência ao parto, houve diferença quando se compararam os Colegiados Vale do Jurumirim, Bauru e Cuesta Botucatu com Lins, sendo pior a situação de Lins. Para a qualidade da atenção ao neonato, os Colegiados de Bauru e Jaú diferiram e foram melhores que o Vale do Jurumirim. Quanto ao risco do neonato, o Colegiado Vale do Jurumirim... / Introduction: Investigating neonatal deaths can be an important strategy to reduce child and fetal mortality as it contributes to improve the quality of information on such adverse event and allows for the adoption of measures for prevention of evitable deaths by health care services. Objective: To evaluate neonatal deaths investigated at the Regional Health Department VI (DRS VI) – Bauru by taking into account the Regional Management Collegiates in 2009. Methodology: This is a descriptive crosssectional study that analyzed 162 deaths investigated from the information entered on the Neonatal Mortality Information System (SIM-Neo). Results are presented in a descriptive fashion and based on a synthesis score which considered the quality of prenatal care, the care to delivery and the care to newborns; prenatal risk factors, delivery risks and those related to newborns as well as maternal sociodemographic conditions. For score analysis, a logistic model was fitted for proportions by taking into account Collegiates and categories as main effects and the Collegiate-versuscategory interaction. Results: 88.5% of the occurring deaths underwent some investigation, and 67.3% were completely investigated. The analysis of the scores related to the quality of prenatal care showed difference when the worse scores (scores lower than five) were considered, and Vale do Jurumirim Collegiate was different and better than those in Bauru and Lins. As regards the quality of care to delivery, difference was found when comparing the Collegiates in Vale do Jurumirim, Bauru and Cuesta Botucatu with that in Lins, and Lins showed the worst situation. As for the quality of care to neonates, the Collegiates in Bauru and Jau differed and were better than that in Vale do Jurumirim. Concerning risk to neonates, the Collegiate... (Complete abstract click electronic access below)

Orientador: Cristina Maria Garcia de Lima Parada / Banca: Maria Antonieta de Barros Leite Carvalhaes / Banca: Luana Carandina / Banca: Marilisa Barros / Banca: Maria José Clapis / Resumo: Investigar os óbitos neonatais pode ser uma importante estratégia para redução da mortalidade infantil e fetal, pois contribui para melhorar a qualidade da informação sobre esse evento adverso e possibilita a adoção, pelos serviços de saúde, de medidas para a prevenção de óbitos evitáveis. Objetivo Geral: avaliar os óbitos neonatais investigados no Departamento Regional de Saúde VI - Bauru, considerando-se os Colegiados de Gestão Regional, no ano de 2009. Metodologia: estudo descritivo e transversal, que analisou 162 óbitos investigados, a partir das informações digitadas no Sistema de Informações sobre Mortalidade Neonatal (SIM-Neo). Os resultados são apresentados de forma descritiva e a partir de escore síntese que considerou a qualidade da atenção ao pré-natal, ao parto e ao recém-nascido; fatores de risco pré-natal, no parto e com relação ao recém-nascido e situação sociodemográfica materna. Para análise dos escores foi ajustado um modelo para proporções do tipo logístico, considerando Colegiados e categorias como efeitos principais e a interação Colegiados versus categorias. Resultados: passaram por alguma investigação 88,5% dos óbitos ocorridos e 67,3% tiveram investigação completa. A análise dos escores relativos à qualidade da atenção pré-natal evidenciou diferença quando se consideraram os piores resultados (escore menores que cinco), sendo o Colegiado Vale do Jurumirim diferente e melhor que o de Bauru e o de Lins. Com relação à qualidade da assistência ao parto, houve diferença quando se compararam os Colegiados Vale do Jurumirim, Bauru e Cuesta Botucatu com Lins, sendo pior a situação de Lins. Para a qualidade da atenção ao neonato, os Colegiados de Bauru e Jaú diferiram e foram melhores que o Vale do Jurumirim. Quanto ao risco do neonato, o Colegiado Vale do Jurumirim... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Investigating neonatal deaths can be an important strategy to reduce child and fetal mortality as it contributes to improve the quality of information on such adverse event and allows for the adoption of measures for prevention of evitable deaths by health care services. Objective: To evaluate neonatal deaths investigated at the Regional Health Department VI (DRS VI) - Bauru by taking into account the Regional Management Collegiates in 2009. Methodology: This is a descriptive crosssectional study that analyzed 162 deaths investigated from the information entered on the Neonatal Mortality Information System (SIM-Neo). Results are presented in a descriptive fashion and based on a synthesis score which considered the quality of prenatal care, the care to delivery and the care to newborns; prenatal risk factors, delivery risks and those related to newborns as well as maternal sociodemographic conditions. For score analysis, a logistic model was fitted for proportions by taking into account Collegiates and categories as main effects and the Collegiate-versuscategory interaction. Results: 88.5% of the occurring deaths underwent some investigation, and 67.3% were completely investigated. The analysis of the scores related to the quality of prenatal care showed difference when the worse scores (scores lower than five) were considered, and Vale do Jurumirim Collegiate was different and better than those in Bauru and Lins. As regards the quality of care to delivery, difference was found when comparing the Collegiates in Vale do Jurumirim, Bauru and Cuesta Botucatu with that in Lins, and Lins showed the worst situation. As for the quality of care to neonates, the Collegiates in Bauru and Jau differed and were better than that in Vale do Jurumirim. Concerning risk to neonates, the Collegiate... (Complete abstract click electronic access below) / Doutor

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-01-06T16:18:59Z No. of bitstreams: 1 julianabernardonazareth.pdf: 579524 bytes, checksum: 434bd270de91c7daad809e503673f672 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-02-02T11:48:41Z (GMT) No. of bitstreams: 1 julianabernardonazareth.pdf: 579524 bytes, checksum: 434bd270de91c7daad809e503673f672 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-02-02T11:48:58Z (GMT) No. of bitstreams: 1 julianabernardonazareth.pdf: 579524 bytes, checksum: 434bd270de91c7daad809e503673f672 (MD5) / Made available in DSpace on 2017-02-02T11:48:58Z (GMT). No. of bitstreams: 1 julianabernardonazareth.pdf: 579524 bytes, checksum: 434bd270de91c7daad809e503673f672 (MD5) Previous issue date: 2016-08-31 / Objetivou-se desvelar sentidos do cuidador familiar na vivência da internação domiciliar. Método de investigação qualitativa, fundado na fenomenologia de Martin Heidegger. Constituíram-se cenário as residências das famílias cadastradas no Departamento de Internação Domiciliar localizado na zona da mata, no interior de Minas Gerais e que atende exclusivamente pela rede pública de saúde do Sistema Único de Saúde,sendo participantes 13 cuidadores familiares. A entrevista fenomenológica teve como questões orientadoras: como é para você cuidar de seu familiar em casa? Você recebeu alguma orientação para vivenciar este momento? Como é sua relação com os profissionais que prestam a Assistência Domiciliar? Dos depoimentos, emergiram então as estruturas essenciais de modo a construírem as Unidades de Significados. A compreensão vaga e mediana desses significados permitiu a elaboração do fio condutor que conduziu ao segundo momento metódico, a compreensão interpretativa ou hermenêutica. O modo de ser-aí-cuidador-efamiliar-de-paciente-em-internação-domiciliar é desvelado pelo cuidador familiar lançado na facticidadequando se mostram como ser-no-mundo-de-cuidados ao familiar. O ser-aí-cuidador-familiar permanece no modo da ocupação ao desempenhar suas atividades. Mostrou que namanualidadeesta junto-a e é ser-paracuidar. A relação do cuidador-familiar com oDepartamento de Internação Domiciliar deixa-se dominar pela cotidianidade mostrando-se como ser da impropriedade ao desconsiderar-se como ser de possibilidades. Revela o falatório na reprodução da linguagem técnica que não é do cuidador. Desvela o ser-no-mundo presente nas relações interpessoais harmoniosas com os profissionais de saúdeao exercer um cuidado inautêntico. Conhecer os sentidos que os cuidadores familiares atribui ao seu fazer possibilitará que gestores de saúde e membros da equipe multiprofissional de saúde de internação domiciliar possam repensar as intervenções mais direcionadas de acordo com necessidades singulares de cada paciente e cuidador familiar. / This study aimed to reveal the meanings of family caregivers in the experience of home care.Method of qualitative research, based on the phenomenology of Martin Heidegger. Was established as setting the residences of families enrolled in the Department of Home Care located in Minas Gerais and caters exclusively by the public health by the Unified Health System, with participants 13 family caregivers. The phenomenological interview was to guiding questions: how to you take care of your family at home? You received some guidance to experience this moment? How is your relationship with the professionals who provide Homecare? Then emerged the essential structures in order to build Units Meanings.The vague understanding ofthe meanings and median led to the elaboration of a wire leading to the second moment methodical,interpretive or hermeneutics understanding. The mode of being-therecaregiver-family-of-patient in-hospital-home is unveiled by the family caregiver launched in factuality when they are being in the world-of-care to family. The beingcaregiver-family remains in occupation mode to perform their activities. The beingthere-family and being-there-caregiver showed that in manualidade this together and it is being-for-care. The relationship of the caregiver-familiar with the Department of Home Care allowed to dominate the everydayness showing up as being of impropriety to be disregarded as being possibilities. Reveals the talk in the reproduction of technical language that is not the caregiver. Unveils the being in the world in this harmonious interpersonal relationships with healthcare professionals to exercise care inauthentic. We believe that knowing the way that family caregivers attribute to their doing enables health managers and members of the multidisciplinary team of home care health can rethink the most targeted interventions according to individual needs of each patient and family caregiver.

Abstract The purpose of this study was to produce a hypothetical model for the organization of services in accordance with a shared-responsibility mode of living. The model was constructed step by step. At the first stage, the current possibilities of home care clients aged over 75 to live at home and the modes of organizing home help services were analyzed. The key factors affecting the elderly clients' ability to manage at home were the mode of living (alone or with a family member), their ability to move, the adequacy of home care services, the family caregiver's resources and the elderly person's own preferences. At the next stage, the research data were searched for alternative ways of organizing the support services supplied by family members, municipalities (home help services and home nursing), the third sector and private service providers, i.e. different service structure models were outlined. Finally, the costs and functional contents of the service structure models were evaluated. The empirical date were collected by arranging questionnaire survey among the home care clients aged over 75 (N=150) and the caregivers who knew them best (N=145) in Hämeenkyrö, Lohja, Oulu and Tampere. In addition to this, the functions during the working hours of one week were recorded (N=146) with the aim of finding out, by functions, the time spent to help each client and the number of actors needed. The data were analyzed using the SPSS for Windows 10.0 statistical software by calculating absolute and percentage distributions and cross-tabulating the results. The statistical differences between the localities, for example, were compared using box plots and correlation diagrams. The results were illustrated with tables and graphs. The responses to the open-ended questions were analyzed with methods of content analysis. The possibilities of home care clients to choose between different modes of living were still small. No adequate intermediate modes of living have been developed. For a person unable to manage the daily activities at home, the main alternative is a group home or an assisted-living unit, both of which can be considered institutional care in view of their contents and organization. Home care clients are mostly helped by municipal home helpers. Hardly any private services are used, and additional help, when necessary, is provided by the municipal staff. The services provided by the third sector mainly consist of discussion and listening. In the participating municipalities, social services available in the private sector were scant or not utilized. Compared to the other service structure models, the shared-responsibility model of living is cost-effective and competitive, and it will be needed as an alternative to the other models. Further development of the shared-responsibility model will provide more alternatives to the family members or caregivers who want to assume responsibility for the care of their elderly relative. / Tiivistelmä Tämän tutkimuksen tarkoituksena on tuottaa hypoteettinen palvelujen organisointimalli vastuunjaolla toimivassa asumismuodossa. Mallin rakentaminen etenee vaiheittain. Ensimmäisessä vaiheessa analysoidaan yli 75-vuotiaiden kotihoidon asiakkaiden nykyisiä kotona asumisen mahdollisuuksia ja kotipalvelujen järjestämistapoja. Kotona suoriutumisen kannalta avaintekijöitä ovat vanhuksen asumismuoto (yksin tai läheisen kanssa), liikuntakyky, kotihoidon palvelujen riittävyys, läheishoitajan jaksaminen ja iäkkään oma tahto. Seuraavassa vaiheessa määritellään ja muotoillaan tutkimusaineistosta nousseita erityyppisiä tukipalvelujen toimintavaihtoehtoja eli palvelurakennemalleja, joiden tuottajina ovat omaiset, kunnat (kotipalvelut ja kotisairaanhoito), kolmas sektori sekä yksityiset palvelujen tuottajat. Lopuksi arvioidaan palvelurakennemallien kustannuksia ja toiminnallista sisältöä. Empiirinen aineisto kerättiin Hämeenkyrössä, Lohjalla, Oulussa ja Tampereella survey-kyselyllä yli 75-vuotiailta kotihoidon asiakkailta (N=150) ja heidät parhaiten tuntevilta hoitajilta (N=145). Lisäksi tehtiin viikon ajalta työajan seuranta (N=146), jonka tarkoituksena oli saada selville toiminnoittain asiakkaan auttamiseen käytetty aika ja toimijoiden määrä. Tutkimusaineistot analysoitiin SPSS for Windows 10.0 -tilasto-ohjelmalla laskemalla suorat ja prosenttijakaumat sekä ristiintaulukoimalla tuloksia. Tilastollisia eroja mm. paikkakunnittain vertailtiin boxplot-kuvioilla ja korrelaatiodiagrammeilla. Tulokset on havainnollistettu taulukoilla ja graafisilla kuvioilla. Avoimet kysymykset analysoitiin sisällön analyysillä. Kotihoidon asiakkaiden valinnan mahdollisuudet erilaisten asumismuotojen välillä ovat edelleen vähäiset. Välimuotoisia asumismuotoja ei ole riittävästi kehitetty. Mikäli kotona ei enää suoriuduta päivittäisissä toiminnoissa, vaihtoehtona on lähinnä ryhmä-/ pienkoti ja palveluasunto, jotka toiminnalliselta sisällöltään ja järjestelyiltään voidaan rinnastaa laitoshoitoon. Kotihoidon asiakkaiden pääasiallisina auttajina toimivat kodinhoitajat. Yksityisiä palveluja ei juuri käytetä, ja lisäapua tarvittaessa palveluja halutaan kunnan työntekijöiltä. Kolmannen sektorin tarjoamat palvelut ovat lähinnä keskustelua ja kuunteluapua. Yksityissektorin sosiaalista palvelutarjontaa on tutkituissa kunnissa joko vähän tai niitä ei käytetä. Palvelurakennemallien kustannuksia arvioitaessa vastuunjaolla toimiva asumismuoto on kilpailukykyinen ja sitä tarvitaan yhtenä vaihtoehtona nykyisten rinnalla. Vastuunjaon mallin kehittäminen lisää valinnan mahdollisuuksia niille omaisille tai omaishoitajille, jotka haluavat ottaa hoitovastuuta läheisistään.

D.Phil. / The formulation of the Draft White Paper for Social Welfare in 199S/1996 and the publication of the White Paper for Social Welfare on 8 August 1997 heralded a new era for social welfare services in South Africa. The focus of service rendering not only shifted service fields and directions of specialisation to developmental welfare. but also recognised the contributions of the various other categories of welfare personnel to social welfare.

M.A. / A child that is mentally healthy develops psychologically, emotionally, creatively, intellectually and spiritually (Dwivedi & Harper, 2004). Therefore the researcher is of the opinion that the mental health of children is integral in successful development. It was however observed that there are challenges associated with providing for the needs of children with mental health problems. Often attributed to a lack of knowledge, child care workers, social workers and other staff appear to not have the necessary skills, knowledge and resources to deal appropriately with children with mental health problems in child and youth care centres. This study therefore investigates the identified gap in service delivery, and what could be done to minimise it. It attempts to explore the characteristics of a child with a mental health problem, what their emanating needs are, and what guidelines exist that may help to provide for the identified needs. In exploring these guidelines, the roles of different role-players involved on different ecosystemic levels, are also explored. This exploration is conducted by utilising qualitative research methods only. A literature study firstly explores relevant social work, mental health, psychiatric and legislative literature. Secondly, focus groups are conducted with key role-players that work with children with mental health problems. These two sources provide the researcher with information pertaining to the objectives and goal of this research study. The ultimate goal of this study is to provide a management programme to mainstream and specialised child and youth care centres, on how to care optimally for children with mental health problems. When this goal is achieved, the field of social work amid children will benefit tremendously. Not only can such a programme assist in the enhancement of the mental health of children in child and youth care centres, but it may provide the foundation for future development in this.