El objetivo general de este trabajo es medir el impacto económico de las enfermedades y pacientes atendidos en un Centro de Atención Primaria, así como describir el comportamiento y la adaptación de un sistema de clasificación de pacientes por iso-consumo de recursos (ACGs) en nuestro ámbito. Se efectúa un diseño observacional descriptivo de carácter exploratorio. El emplazamiento es en el Área básica de Salud Apenins-Montigalà de Badalona (centro urbano reformado y concertado), que atiende a una población adulta de referencia de unos 20.000 habitantes (10,8% mayores de 65 años). Inició su actividad en diciembre de 1997 y está constituido por un equipo de 7 médicos y 6 enfermeras. Participantes: todos los pacientes atendidos por el EAP durante el período de estudio (1999 para los episodios y 2000 para los pacientes). Se detalla la definición y la medida de cada variable: episodio (a partir de la clasificación CIAP), contacto de atención, visitas, órdenes médicas, campos relacionados con la casuística, la edad y el sexo. Se realizó una conversión de la clasificación CIAP a la ICD-9-MC. Los indicadores económicos fueron obtenidos a partir de la cuenta de pérdidas y ganancias; los costes se clasificaron, diferenciando aquellos propios del centro (personal, limpieza, mantenimiento, amortizaciones, etc.) y aquellos gastos variables en función de la actividad desarrollada (laboratorio, radiología, pruebas complementarias, derivaciones a especialistas, ambulancias y prescripción farmacéutica). El registro de la información se realizó con el sistema informatizado OMI-AP y el análisis de los datos a partir de Microsoft Access y el programa SPSSW.En general, la investigación muestra que el comportamiento de los grupos es aceptable, y no muy diferente a los obtenidos en otros estudios. Se remarca la importancia de que en futuras investigaciones se contemple la depuración de los datos en cada categoría para conseguir una mayor homogeneidad.

This research engages critically with major public sector accountability theories in relation to the development of law centres in Aotearoa/New Zealand (and comparative international examples) focusing on the two centres in Otago, the Ngai Tahu Maori Law Centre and the Dunedin Community Law Centre. Definitions of accountability are argued to be embedded within theoretical discourses which produce definable models of accountability corresponding to these theoretical statements. Case studies of the discourses of both law centres and their funding bodies are described and contrasted in terms of their views of the role of law centres, interaction with various interest groups and their accountability relationships. The data identifies a desire of both community law centres to engage with a communitarian, �bottom-up�, model of accountability, in contrast to the former social democratic-bureaucratic and current liberal �stakeholder� and �contract� models of the official funding agencies. The current dominance of the liberal �stakeholder� discourse is seen as based on professional power, hierarchical legal structure and control of funding. It is argued that any shift in the dominance of power relationships surrounding community law centres in Aotearoa/New Zealand would entail a strengthening of ties and links with the community, through seeking alternative power supports, a participatory structure and locally controlled funding. Keywords: accountability; power relationships; community law centres; dominance; community.

This thesis interrogates immigration detention as a space of intricate ambivalence - one which seeks to exclude, but which is also entreated to protect. The focus is so-called ‘unauthorised’ asylum seekers detained both within Australia and offshore on the Pacific island of Nauru between 1999 and 2003 - when the numbers of detained asylum seekers reached its maximum and the government introduced offshore processing centres. Australia’s immigration detention regime sits awkwardly with the discourse of universal human rights and brings into sharp conflict two robust political values: the right of endangered people to seek refuge and the right of the nation to determine who will enter. Focusing on the experiences of detainees reveals immigration detention as a complex regime through which the state’s dominating power targets the stateless, non-white, male body. This targeting is intentional, serving to secure sovereign borders and to rearticulate the naturalised ties between the national population and the modern state. Immigration detention holds the seeker in a limbo that sets parameters for the seeker’s experience of ongoing and intensifying insecurity. It specifically and intentionally fractures the identity of detainees: masochistic actions and collective protests, from hunger strikes to breakouts, reflect the common currency of anxiety and violence. The creation of offshore camps was, in part, a response to ongoing protests within onshore detention and the failure of onshore detention to stop boat arrivals. My chief focus here is the largest Pacific camp, ‘Topside’, on the island of Nauru. Unlike the onshore detention centres where publicised protests and breakouts screamed of continuing detention of asylum seekers, those on Nauru were effectively silenced. The thesis explores purpose as inscribed within the body of the exile. To give up hope for asylum is to face the possibility of endless wandering and death. Mechanisms of resistance, whether explicit protest or more passive waiting, are parts of the continuing struggle by the detained against mechanisms of exclusion and exception. The detained carve out small openings to contest their exclusion and to reassert an identity as survivors. There is a complex and fluid interplay between such resistance and government policies aiming to silence protest and limit identity – and ultimately to deter all unauthorised boat arrivals.

This thesis seeks to assess the exposure of children in outdoor play areas of early childhood centres in Auckland City to traffic-related PM10 pollution. An estimated 400 premature deaths occur each year in New Zealand due to motor vehicle emissions. In addition to premature deaths, acute and chronic health effects including asthma, chronic obstructive pulmonary disease (COPD), heart disease and bronchitis, as well as increased hospitalisations and restricted activity days (sick days) are also associated with vehicle emissions. Epidemiological studies have shown that respiratory diseases such as asthma can be exacerbated by increases in the concentration of particulates of less than 10 microns in diameter (PM10) from motor vehicle emissions. Significant positive associations have been found between proximity to heavily travelled roads and increased childhood respiratory disease symptoms including hospitalisations for childhood asthma. In spite of this evidence, many early childhood centres in Auckland are located adjacent to busy roads. Children at these early childhood centres spend much of their time playing in the outdoor areas of these centres with the potential for particulates from motor vehicle emissions to exacerbate symptoms in those children already suffering from respiratory disease and asthma. Very little research has been carried out either in New Zealand or internationally on the air quality of outdoor play areas of early childhood centres in relation to motor vehicle emissions and childhood respiratory disease and asthma. The extent of monitoring is also limited and the amount of exposure data available in New Zealand relatively sparse, particularly in comparison with Europe. Levels of traffic-related PM10 in the outdoor play areas of early childhood centres were measured in centres located adjacent to busy roads and in centres away from a quiet road or adjacent to a very quiet road for comparison. Two of five early childhood centres located alongside busy roads had PM10 levels that exceeded the World Health Organization (WHO) guideline value. While PM10 levels monitored at the other three centres located alongside busy roads did not exceed the WHO guideline value, results were often only marginally within this guideline value. In contrast, PM10 levels monitored at two centres located away from a quiet road and one centre located adjacent to a very quiet road were well within the WHO guideline value. This pilot study provides preliminary evidence that children attending early childhood centres located alongside busy roads have greater exposure to traffic-related PM10 pollution than those attending early childhood centres located away from a quiet road or adjacent to a very quiet road. If the link between PM10 exposure and health effects is causal, as suggested by epidemiological studies, then children attending early childhood centres proximal to busy roads are at a greater risk of respiratory illness than children attending early childhood centres adjacent to quiet roads. Further work is required to confirm the findings in this small sample of air quality around early childhood centres in a larger sample, and possibly to undertake an epidemiological study to confirm the link to health effects. Drawing on the precautionary principle, prudent territorial local authorities should be encouraged to introduce regulations ensuring that any new early childhood centres are located at a specified distance from major roads, and that information for parents, ongoing PM10 monitoring and processes for issuing PM10 advisories when limits are exceeded are available in existing early childhood centres that are adjacent to busy roads.

This research reports on an observation study conducted in Adelaide, South Australia of how 12 educators working in six long day care centres spent their day when working in their care. Specifically the study sought to answer the following research questions: 1. How do educators spend their day in a long day care setting?-- 2. What is the quality of the interactions that occur between educators and children?-- 3. In what ways, if any, does an educator's qualifications and experience impact on the quality and frequency of interactions?

This thesis addresses the issue of environmental influences on the manifestation of unwanted child behaviours (UCBs) in early childhood services. Specifically it examines the evidence for UCBs that result from the interface of physical, social, structural, and cultural components of the environment of a child care centre with the psychological habitats of individual children over the full day of their attendances. The identified unwanted behaviours are used as starting points to analyse children’s behaviour streams for indication of environmental influences in the production of UCBs and to establish common patterns of influence across different children. To facilitate a systematic investigation of the complex child:environment relationships in a child care centre, a conceptual framework was developed to describe time-space locations of settings and situations, the basic components of environmental influence, the child’s psychological habitat, UCBs, and the contextualisation of child behaviours in situ. The framework was utilised to review literature associated with components of both the child’s psychological habitat and the environment of a child care centre, implement an appropriate data collection strategy, as well as guiding data analysis and interpretation of findings. The qualitative approach to data collection involved full-day observations of individual children and recording on audio-tape a continuous concurrent narrative of their actions within a variety of settings and situations. Observations of 30 different children over 54 days yielded almost 400 hours of recordings, which were transcribed onto more than 1000 typed pages. Examination of the transcripts provided evidence of 1384 manifestations of UCBs embedded in 1028 distinct sequences of unwanted behaviours within behaviour streams. Analysis of the behaviour streams and interpretation of antecedent events implicated a variety of interrelated physical, social, structural, and cultural factors in the production of UCBs, which are considered in light of findings from previous studies. Overall, no single factor was found to influence the behaviours of all children, or the same child across different settings and situations. The findings serve to reinforce the known complexity of person:environment relationships, which is further intensified in children between the ages of 3-5 years by their developing socio-emotional and cognitive systems, innate and learned within-child characteristics, and different experiences of centre-based child care. The findings also reinforce the need for practitioners and researchers to consider more fully the individuality of each child when planning programs and investigations into the impact of child care on children. Implications of the findings for practitioners are stated and recommendations are made for future research. / PhD Doctorate

Mémoire (M.P.M.O.)-- Université du Québec à Chicoutimi, 1988. / Document électronique également accessible en format PDF. CaQCU

Thèses (M.Sc.)--Université de Sherbrooke (Canada), 2005. / In ProQuest dissertations and theses. Titre de l'écran-titre (visionné le 1 février 2007). Publié aussi en version papier.

Research report (MMed) -- Interdisciplinary Health Sciences, Stellenbosch, 2010. / ENGLISH ABSTRACT: Background The referral system is an important component of the health care system. In public health facilities, a high number of patients’ attendance has lead to a huge burden on the secondary and tertiary level of the care system in terms of manpower, equipments and resources. Public health in South Africa consumes around 11% of the government's total budget. The state contributes about 40% of all expenditure on health; the public health sector is under pressure to deliver services to about 80% of the population. Despite the huge spending on health care in most developing countries, health outcomes and services remain poor. Few studies are available to give insights into reasons for this disparity. Therefore the findings of this may help to explain some of the reasons for this overburden of public health facilities and further to make recommendations on how health service delivery may be improve on. The results of this study can be useful in future planning; this may lead to a reduction in huge health expenditure incurred by most developing countries. Methods A cross sectional survey of three different groups of people which comprises of 273 patients, 28 referral centre participants and 19 referring centre participants was carried out. All patients referred from Motherwell community health centre to Dora Nginza hospital were eligible for the study. Questionnaires were interview administered to patients after they had finished consultations in Dora Nginza Hospital. Health professionals from both facilities were also interviewed with the use of self administered questionnaires. Results Three out of every four patients interviewed were of the opinion that their referral to hospital was appropriate which is consistent with the results from referring health professionals, eighteen of nineteen respondents. However, only one-quarter (7) of the referral centre health professionals felt the referrals from referring centre to hospital were appropriate p<0.01.The majority of the patients were satisfied with the level of service received at the referral centre. 77% (210) reported that the staff at the referral centre was friendly and 84% (230) were happy with the explanation given for their illness. However, a source of concern is that, in most of the referred patients 58% (215), there was no formal response back to their primary care. In the referring centre, participants identified transportation of patients to referral centre as the major problem encountered when referring patients 68 % (13), whereas 32 % (6) felt it is communication. In addition, 73 % (14) were of the opinion that transportation was inadequate and 89 % (17) reported the response rate of transport was unsatisfactory. In the referral centre, results showed participants were more concerned about the adequacy of information provided in the referral letters with 78% (22) reporting they were often not adequate information on the referral letters. However, half of the respondents agreed that they do not have clear referral guidelines. Conclusion Primary care health professionals and patients in this study view the referrals to higher levels of care as appropriate. However, the referral centres health professionals were of the opinion that most referrals were inappropriate. The opinion of the referral centre can be attributed to their negative attitudes towards referrals. The referral centres needs to provide more support to primary care for a more efficient referral system .They also need to improve on the continuity of care by providing feedback to referrals. On the other hand, the primary health care needs to be strengthened in terms of resource allocation in order to gain more confidence from both patients and referral centres. / AFRIKAANSE OPSOMMING: geen opsomming

Introduction Trauma and emergencies contribute to the quadruple burden of disease in South Africa and being prepared for an emergency requires rapid access to emergency equipment, drugs and emergency trolleys to optimally manage an emergency. This is the first descriptive study looking specifically at essential emergency equipment, drugs and the emergency trolley required for the provision of optimal emergency care at Community Health Centres (CHCs) in the Western Cape Metropole. Aims and Objectives The aim of the study was to evaluate whether eight 24 hour emergency units at CHCs in the Western Cape Metropole had the appropriate and essential emergency equipment, drugs and emergency trolleys necessary for the delivery of optimal emergency care, using the Emergency Medicine Society of South Africa (EMSSA) guidelines as the audit tool. Objectives included: 1. To assess availability of essential emergency equipment 2. To assess availability of essential emergency drugs 3. To assess the functionality of existing emergency trolleys Methodology EMSSA guidelines were used as the evaluation audit tool to perform a survey of emergency equipment, drugs and emergency trolleys at eight 24 hour CHCs in the Western Cape Metro pole. Data collection for the study was conducted at the eight 24 hour CHCs over a 3 month period during the months of June 2012 to August 2012. The data was analyzed using the Statistical Package for Health Sciences (Statistica, version 10 of 2012) and Microsoft Excel. Results A total of 81 emergency equipment items, 43 emergency drug items (37 emergency drugs, 6 intravenous fluids) and 78 emergency trolley items were required to be in each emergency unit. An average of 62% of all recommended emergency equipment items, 80% of all emergency drugs and 52.4% of all emergency trolley items were found to be present in this survey. Essential emergency paediatric equipment including bag ventilation devices, Magill’s forceps, masks, intraosseous needles and appropriate blood pressure cuffs were found to be absent at 2 CHCs. All CHCs had access to a defibrillator and ECG machine but these were found to be dysfunctional at 2 CHCs due to expired batteries and no tracing paper being available. Expired first line emergency drugs (adrenaline and atropine) were found at certain CHCs. The recording of emergency trolley checklists and stocking of essential emergency items were found to be incongruent, inconsistent and not up to the recommended standard. Conclusion Essential emergency equipment and drugs and the functionality of emergency trolleys were found to be generally inadequate. Considerable deficiencies of essential emergency items were found, particularly paediatric equipment and drugs and this may negatively impact on resuscitative efforts and outcome in both paediatric and adult emergency care at CHCs in the Western Cape Metropole.