In the South African public health care system, HIV Counselling and Testing (HCT) has become a function that is routinely entrusted to lay counsellors. These counsellors are expected to educate clients about HIV and AIDS, encourage them to be tested and convince them to change risky behavioural practices. They have to convey the clients’ test results and assist those who test HIV-positive and their families to cope with the psychological challenges associated with the diagnosis. The counsellors occupy the front line of HIV and AIDS service delivery, even though they are not formally employed in the health care system. They only have basic training and are not adequately remunerated. The counsellors are confronted with psychological and structural stressors in their work. Psychological stressors include the impact of emotionally challenging work, the lack of appropriate training, debriefing and supervision. Because they are not formally employed in the health care system, there is a lack of formal supervision or channels to discuss their frustrations. This research focuses on the stressors which HIV counsellors experience, how they cope, and the impact it has on their psychological well-being. As part of the mixed methods approach 50 HCT counsellors working at the City of Tshwane clinics completed the Bar-On Emotional Quotient Inventory, the Maslach Burnout Inventory for Human Services Survey (MBI- HSS), the Centre for Epidemiologic Studies Depression scale (CES-D), and the Brief COPE scale to assess their psychological well-being. In addition, they participated in focus group discussions. EQ-i scores indicated that counsellors reported below average emotional skills, with the overall group score of (88.76). Scores that indicated average emotional skills were Self-Regard (101), Interpersonal Relationships (100.12), and Impulse Control (102.66). Scores that indicated low emotional skills were Independence (86.66), Self-Actualization (88.28), and Reality Testing (83.94). Although they reported high levels of Emotional Exhaustion (27.66), they also have a sense of high Personal Accomplishment (38.64) (MBI-HSS). Counsellors reported an overall CES-D score which was indicative of mild depression (26.08). Counsellors used mostly positive coping skills that included religion, planning, and direct action in coping with stressors in their lives. In a regression analysis with depression as the dependent variable, there was a positive relationship between depression and depersonalization and a negative relationship with positive or active coping and assertiveness. It was concluded that counsellors experienced some depression, emotional exhaustion, and lower than average levels of emotional well-being. Despite that, they reported positive ways of coping and high levels of personal accomplishment. Counsellors were motivated by their sense of altruism, compassion towards their clients, the positive changes they see in client’s lives as well as the reciprocal relationships they have formed with their clients. Counsellors thus have strengths to cope with the high level of stressors and challenges related to their work. It can be concluded that their state of mental health is in line with Keyes’ proposal that mental health forms a continuum. They fluctuate between mental well-being and mental ill-being. However, it is necessary to assist HCT counsellors to develop their emotional capacities to enable them to enhance their ability to counsel their clients effectively. / Dissertation (MA)--University of Pretoria, 2013. / gm2014 / Psychology / unrestricted

The diploma paper analyses the health care system in Germany with a view to principles of organization and financial relations in the system. After short description of historical system development follows brief analysis of incomes. Then there is made the analysis of the health care system focused on the expenditures. In this chapter there are presented the segments of health care, way of their organization, forms of payment and analysis of expenditures between the years 1995 and 2007. An unavoidable part of this paper is also the selection of positive constructional elements of health care system and their recommendation for application in the system of Czech Republic.

Bakgrund: Kvinnlig könsstympning är en djupgående tradition som främst utövas inom länder i Afrika, Asien och mellanöstern. På grund av den ökande migrationen har detta blivit ett globalt problem. Kvinnor med könsstympning möter flertal komplikationer, fysiska, psykiska och inom nära relationer. Syfte: Syftet med studien är att beskriva hur kvinnor med könsstympning upplever vårdmötet.Metod: En kvalitativ litteraturstudie genomfördes där systematisk sökning av vetenskapliga artiklar gjordes. Data samlades in genom användandet av relevanta databaser i Cinahl, Medline och Pubmed, och utvalda vetenskapliga artiklar analyserades.Resultat: Utvalda vetenskapliga artiklar beskrev hur kvinnor rapporterade att vårdmötet upplevdes varierande, dock hade flertal kvinnor upplevt rädsla och stress i samband med undersökningar. Vidare beskriver kvinnorna upplevelsen av bristande kunskap hos vårdpersonal då vårdpersonalen oftast inte visste vad kvinnlig könsstympning var. Kvinnorna rapporterade att vårdpersonal inte ställer frågor om könsstympning. Och om frågan ställs, upplevs brister med vidare hantering, då vårdpersonalen upplevs osäkra på vad som skall ske efter. Slutsats: Kvinnorna rapporterade att vårdpersonalen behöver våga ställa frågor kring kvinnlig könsstympning, samt inleda samtalet kring det då kvinnorna upplever det svårt att inleda samtalen själva. Fynden i denna studie visar att utbildning för vårdpersonal om kvinnor med könsstympning bör implementeras för att öka kunskapen och kvaliteten på omvårdnaden för dessa kvinnor. Framtida forskning bör fortsätta undersöka hur kvinnor med könsstympning upplever vården.

The purpose of this study has been to examine the construction of identities that are taking place when Swedish children and teenagers are, according to their local social services, in need of a family home. We have collected and analyzed data in the form of advertisement that is publicly available from the Swedish website Familjehemsbanken.se. It is a kind of marketplace that specializes as a go-between for the local social services in different Swedish municipalities and the presumptive local family homes. The descriptions of the children were looked at through a social constructionism lens where we identified patterns and different themes to which we assigned our own meanings or interpretations, based on the analyzed data and previous research and theories. What we found were broadly categorized into three themes; descriptions that were aiming to sell the kids to prospective buyers (family homes), descriptions that highlighted certain issues or problems that the child needed support with or descriptions that we considered neutral or ambivalent. As we conclude in the study, the descriptions in the last category could also be interpreted as either good or bad, depending on the reader and their own values and life experience. Our results show that even though child auctions (in essence: a form of economic slavery) were abolished in Sweden in 1918, today’s Swedish society are still dealing with socially vulnerable children as they – in practice – are still commodities on a marketplace. The methods and language may have changed, but the end result is still strikingly similar to what happened over a hundred years ago. One of the biggest challenges the authors faced was that it doesn’t exist any previous Swedish research on the subject at hand. We would argue, however, that the marketization of socially vulnerable children is an important issue that should be more deeply and thoroughly researched by further studies on the subject.

The Child and Adolescent Level of Care System/Child and Adolescent Service Intensity Instrument (CALOCUS/ CASH) is designed to help determine the intensity of services needed for a child served in a mental health system of care. The instrument contains eight dimensions that are rated following a comprehensive clinical evaluation. The dimensions are risk of harm, functionality, co-morbidity (psychiatric, substance abuse, development disability and medical), environmental stressors, environmental supports, the child's resiliency, and the child and family's willingness to engage in treatment. An algorithm connects the ratings to a level of care recommendation. The instrument specifies six levels of care defined flexibly enough to consider whatever services are available. The results of psychometric testing using raters with a broad range of clinical experience and training from four different systems of care around the country are presented. The testing demon-strates excellent reliability when rating vignettes. Using children and adolescents in live system of care clinical settings, the CALOCUS/CASH demonstrates reasonable validity when compared with the Child Global Assessment Scale, and the Child and Adolescent Functional Assessment Scale.

The South African government intends to overhaul the entire public health system by introducing the National Health Insurance (NHI) system. The implementation of the NHI has created concerns amongst the majority of South African citizens who have a poor image of the quality of services provided by the public sector. One of the major questions that this study attempted to address was whether one of the largest clinics in Soweto could deliver quality healthcare in terms of the proposed NHI system. The study conducted is quantitative in nature and two-pronged. The first part of the study involved a survey conducted amongst staff members at the Soweto clinic to determine their awareness of the National HeaIth Insurance (NHI) and their knowledge of the National Core Standards (NCS). The second part of the study used an assessment questionnaire to determine compliance of the Soweto clinic to the six ministerial priority areas. The results of the survey conducted among the Soweto clinic’s staff members in all staff categories, showed that there is general awareness amongst staff members of National HeaIth Insurance and they have some knowledge of the NCS; however, more education on NHI and NCS is needed for staff working in specialised or isolated departments who are unaware of NHI and have no knowledge of the NCS. The Soweto clinic showed some advancement with regard to the vital measures compliance scores compared to those of the rest of the Gauteng province in the three priority areas. The Soweto clinic has, however, failed to comply under the other four ministerial priority areas, with ratings of less than 80%. This study has shown a disconnect between knowledge of the NCS and the NCS’s implementation by staff members, as staff members have failed to implement or comply with four of the ministerial priority areas, with sub-standard ratings of less than 80%. The Non-NHI clinic is still very far from ensuring the provision of basic quality health service for its clients and it is, thus, not ready to implement NHI. Recommendations from the study: - Managers must drive the quality improvement agenda for their facilities. - Awareness campaigns and more knowledge on NHI and quality improvement (NCS) must be communicated to all staff categories in the health establishments to ensure a deeper understanding of these concepts. - Workshops must be conducted for all staff members in the Soweto clinic, to support the creation of a culture of excellence, with emphasis in providing quality care to clients. Similar future studies need to be conducted on a large scale such as in the whole of Gauteng to determine staff at health establishments’ knowledge of the quality NCS. / MBA, North-West University, Potchefstroom Campus, 2015

The South African government intends to overhaul the entire public health system by introducing the National Health Insurance (NHI) system. The implementation of the NHI has created concerns amongst the majority of South African citizens who have a poor image of the quality of services provided by the public sector. One of the major questions that this study attempted to address was whether one of the largest clinics in Soweto could deliver quality healthcare in terms of the proposed NHI system. The study conducted is quantitative in nature and two-pronged. The first part of the study involved a survey conducted amongst staff members at the Soweto clinic to determine their awareness of the National HeaIth Insurance (NHI) and their knowledge of the National Core Standards (NCS). The second part of the study used an assessment questionnaire to determine compliance of the Soweto clinic to the six ministerial priority areas. The results of the survey conducted among the Soweto clinic’s staff members in all staff categories, showed that there is general awareness amongst staff members of National HeaIth Insurance and they have some knowledge of the NCS; however, more education on NHI and NCS is needed for staff working in specialised or isolated departments who are unaware of NHI and have no knowledge of the NCS. The Soweto clinic showed some advancement with regard to the vital measures compliance scores compared to those of the rest of the Gauteng province in the three priority areas. The Soweto clinic has, however, failed to comply under the other four ministerial priority areas, with ratings of less than 80%. This study has shown a disconnect between knowledge of the NCS and the NCS’s implementation by staff members, as staff members have failed to implement or comply with four of the ministerial priority areas, with sub-standard ratings of less than 80%. The Non-NHI clinic is still very far from ensuring the provision of basic quality health service for its clients and it is, thus, not ready to implement NHI. Recommendations from the study: - Managers must drive the quality improvement agenda for their facilities. - Awareness campaigns and more knowledge on NHI and quality improvement (NCS) must be communicated to all staff categories in the health establishments to ensure a deeper understanding of these concepts. - Workshops must be conducted for all staff members in the Soweto clinic, to support the creation of a culture of excellence, with emphasis in providing quality care to clients. Similar future studies need to be conducted on a large scale such as in the whole of Gauteng to determine staff at health establishments’ knowledge of the quality NCS. / MBA, North-West University, Potchefstroom Campus, 2015

The risk adjustment model currently used does not adequately compensate insurers for predictable differences in individuals' health care expenditures in the Czech Republic. It then leads to financial inequality in the redistribution of funds to the insurance companies and causes their financial problems. This study introduces a PCG model as another method for risk adjustment and determines to what extent the predictive performance of the model can be improved when applied to Czech data. We analyze 10% of population sample in the Czech Republic in years 2011 and 2012. Our results confirm the appropriateness of the PCG model for the Czech environment. When the PCG variables are added to the demographic model, R2 value of the prediction model increases from 2.03% to 13.87%.

In my diploma thesis I would like to introduce the readers to the issue of mental health care in the Czech Republic. I will focus on mental health definition, classification of mental illnesses, and also introduce services provided to people with mental illness. Furthermore, I will deal with the systém of mental health care in the Czech Republic, where I will try to point out the greatest positives and also some negatives of this system. The reader will also learn about Czech legislation related to this issue. Finally, I will inform about the psychiatric care reform, which started in 2013 in the Czech Republic - I will mention the main milestones, plan and strategy of this reform, and the benefits of this reform will be demonstrated on particular steps and realized projects. In the research section, I will focus on personal experience of care users, where thanks to the interviews, I can mediate the biggest mental health care problems from users point of view. KEYWORDS mental health, mental illness, psychiatric care system, psychopathology, psychiatric care reform

O presente estudo buscou compreender a dimensão política no trabalho do enfermeiro da atenção básica em um município paulista. Consideramos como dimensão política a relação que os trabalhadores estabelecem com a gestão pública em saúde e seus desdobramentos no trabalho na Atenção Básica nas distintas modalidades de organização da Atenção Básica (AB). Relação esta que não se limita aos espaços formais, como reuniões e normativas, mas que também se refletem nos modelos de atenção e organização do trabalho presentes nos serviços de saúde. Dessa forma, ao resgatar o caráter político da Reforma Sanitária Brasileira e o papel estratégico do SUS como política de Estado, este estudo pretende colaborar com o atual debate em torno da politização da saúde. O método utilizado para o desenvolvimento deste estudo foi o Estudo de Caso, alicerçado pela abordagem qualitativa, do tipo instrumental, a partir das seguintes fontes de dados: observação participante em cinco unidades de saúde de distintas modalidades de organização da AB, entrevista semiestruturada com oito enfermeiros, considerados informantes chaves e documentos oficiais de planejamento em saúde de instancia municipal de cinco quadriênios de gestão municipal. A coleta de dados foi realizada nos meses de outubro de 2013 a março de 2014. Foi realizada análise discursiva na perspectiva de Pêcheux com o material produzido nas entrevistas. Na análise documental, o que encontramos foi que, não obstante as dificuldades vividas pelos grandes municípios, mencionadas na literatura, é uma transição incompleta do modelo de AB, mais como mistura do que de transição, com uma implantação incipiente e incompleta da estratégia Saúde da Família, apesar dos documentos de planejamento, reiteradamente, colocarem essa estratégia como a opção municipal para a AB. Fica claro que a relação entre trabalhadores e gestão, por parte dos enfermeiros, não é de confiança, nem de corresponsabilidade. Não há a perspectiva de participação nos processos de decisão. Surgem críticas, responsabilizando a gestão, pela forma como são conduzidas determinadas políticas de saúde. É interessante observar que a crítica mais veemente surja justamente numa temática que envolve o interesse direto, poderíamos dizer até corporativo, dos trabalhadores. Por fim, parece ficar reforçada a ideia de Maria Cecília Puntel de Almeida, de que há entre as enfermeiras uma aceitação das limitações de poder, de forma relativamente passiva / This study sought to understand the political dimension of the work of the primary care nurse in a city in São Paulo. We consider the political dimension as the relationship that workers have with the public health management at work and its developments in Primary Care services in different modalities of Primary Care organization. A relationship that is not confined to formal settings, such as meetings and norms, but is also reflected in models of care and work organization present in health services. Thus, by returning to the political nature of the Brasilian Heath Reform and the strategic role of the SUS as a state policy, this research intends to collaborate with the current debate on the politicization of health. An instrumental case study was the method of choice for the development of this study, with a qualitative approach, using the following data sources: participant observation involving five health units of different modalities of organization, semi-structured interviews with eight nurses we considered to be key informants and official documents in health planning from the municipal management in five four-year periods. Data collection was conducted from October 2013 to March 2014. Pêcheux\'s discourse analysis was used for the interview data. In document analysis, what we found was, despite the difficulties experienced by large municipalities mentioned in the literature, an incomplete transition of the Primary Care model, more like a mixed system than a transition, with an incipient and incomplete implementation of the Family Heath strategy despite planning documents repeatedly putting this strategy as the municipal option for Primary Care. It is clear that the relationship between workers and management is not of trust. There is no prospect of participation in decision-making. Criticism does appear, blaming the management by the way they conducted certain health policies. It is interesting to note that the most vehement criticism arises precisely in a theme that involves direct interest of the workers. Finally, it seems the idea of Maria Cecilia Puntel de Almeida is reinforced, that between nurses there is an acceptance of the limitations of power, in a relatively passive way