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The purpose of the present research is to investigate whether or not chronically ill children are victims of child abuse more frequently than healthy children. The gender of the child and of the parent will also be examined for differences in the treatment children receive.

The purpose of this study was: (1) to evaluate the level of grief experienced by healthcare providers in a pediatric subacute facility, (2) to compare the levels of grief between different groups of healthcare providers (Certified Nurses' Aides, Licensed Nurses, and Respiratory Care Practitioners), and (3) to describe the personality/demographic factors that influence a healthcare provider's ability to cope effectively with compound grief.

El presente trabajo es una oportunidad de negocio que brinda asistencia y coaching nutricional a la población del distrito de San Juan de Lurigancho que es el más poblado de Lima con un sector industrial y comercial desarrollado, lo que hace de SJL un excelente lugar para el presente emprendimiento. Este servicio está dirigido a personas preocupadas por su apariencia física y/o que presentan sobrepeso y obesidad la cual puede desencadenar más adelante en enfermedades no transmisibles como diabetes, hipertensión arterial, enfermedades cardiovasculares, etc. Para el desarrollo de este proyecto se realizó un estudio de mercado que permiten realizar una eficiente segmentación de mercado. Obteniendo como resultado que los encuestados requerían y necesitaban este tipo de servicio. La empresa tendrá el nombre de NUTRIMIND S.A.C., brindará a nuestros clientes: consulta nutricional presencial y coaching nutricional vía online completando el servicio con talleres nutricionales y de mindfulness organizacionales. Todo ello para que nuestro cliente se sienta comprometido en lograr su objetivo de salud y tome conciencia de la importancia de esta. La implementación de este negocio requiere una inversión inicial de S/.25915.2 soles que será cubierta por el aporte de capital propio. Consecuentemente el estudio se presenta como un plan de negocios viable y rentable. Obteniéndose una TIR de 83% y un VAN de 69 738.36. Este negocio permitirá el emprendimiento y a la misma vez generar empleo a más profesionales de la salud debido a que sus resultados son favorables. / The present work is a business opportunity that provides nutritional assistance and coaching to the population of the district of San Juan de Lurigancho that is the most populated of Lima with an industrial and commercial sector developed which makes SJL an excellent place for the present venture. This service is aimed at people concerned about their physical appearance and/or who are overweight and obese which can later trigger in noncommunicable diseases such as diabetes, high blood pressure, cardiovascular disease, etc. For the development of this project a market study was carried out that allow efficient segmentation of the market. Getting as a result that respondents required and needed this type of service. The company will be named NUTRIMIND S.A.C., will provide our clients: face-to-face nutritional consultation and nutritional coaching via online completing the service with nutritional workshops and organizational mindfulness. All this so that our client feels committed to achieving their health goal and become aware of the importance of it. The implementation of this business requires an initial investment of S/.25915.2 soles that will be covered by the contribution of own capital. Consequently, the study is presented as a viable and profitable business plan. Obtaining an 83% TIR and a VAN of 69 738.36. This business will allow entrepreneurship and at the same time generate employment for more health professionals because their results are favorable. / Tesis

L’amélioration du pronostic des pathologies chroniques à début pédiatrique s’est accompagnée d’un nombre grandissant de patients atteignant l’âge adulte. Cependant, l’adolescence et l’entrée dans la vie adulte est une période de multiples changements et de crises, pouvant être à l’origine de rupture avec le système de soins et de complications médicales. Dans cette thèse, j’ai tout d’abord décrit les hospitalisations et la mortalité des jeunes ayant été déclarés en affection de longue durée (ALD) avant 14 ans (N=1752), en comparaison à des jeunes sans pathologie chronique (N=52346). Pour cela, une cohorte rétrospective (2005-2014) a été reconstruite à partir de l’échantillon généraliste des bénéficiaires de l’Assurance maladie. Environ 3% des jeunes de 14 ans avaient déjà été déclarés en ALD. Les profils de mortalité par sexe et les tendances par âge de l’incidence des hospitalisations étaient différents de ceux de la population générale du même âge, en particulier après 18 ans, où l’on observait une chute de l’incidence des hospitalisations. Ensuite, à partir de ces mêmes données, j’ai montré que le pronostic de ces jeunes malades, y compris la mortalité, était associé à la précarité sociale, mesurée par la couverture maladie universelle complémentaire, montrant ainsi que la gratuité des soins à laquelle ces jeunes ont droit dans le système de santé français ne permettait pas de compenser les inégalités sociales dans cette population. Enfin, à un moment ou un autre, ces jeunes sont transférés vers un service d’adultes. Ce passage est un moment crucial dans leur suivi, qui peut être à l’origine d’une discontinuité du suivi médical. Des programmes de transition sont mis en place progressivement pour préparer et accompagner ce transfert. J’ai réalisé une revue systématique de la littérature (23 études) qui a montré qu’il existait deux aspects de la continuité des soins au moment de ce transfert : l’engagement (premier contact) et le maintien dans le suivi en service d’adultes. Cette analyse a également mis en exergue la pauvreté des études existant actuellement pour évaluer les programmes de transition en termes de continuité des soins. Finalement, ces résultats soulèvent de nombreuses questions, notamment les stratégies d’adaptation de ces jeunes vis-à-vis des situations à haut risque et le rôle du transfert en service d’adultes sur le comportement des patients, le pronostic et les pratiques cliniques. Des études incluant largement l’ensemble des jeunes atteints d’une pathologie chronique, intégrant notamment des facteurs liés à l’organisation des soins, liés à la pathologie, individuels et familiaux, devraient être encouragées. / The prognosis of childhood-onset chronic conditions has improved, such that more patients now reach adulthood. However, adolescence and entry into adulthood is a critical period that may be associated with poor outcomes, including gaps in care continuity and medical complications. Here, I first described hospitalization and mortality rates in youths registered for a long-term disease (LTD) before the age of 14 (N=1,752), relative to those with no LTD (N=52,346). A retrospective cohort (2005-2014) was built from a sample of the French national health insurance database, called Echantillon généraliste des Bénéficiaires. Approximately 3% of 14-year-old youths had been registered for a LTD. The mortality patterns by gender and the trend in hospitalization rates by age were different from those in the general population of the same age, especially after reaching the age of 18, which was followed by a fall in hospitalization rates. Then, using the same data, I showed that the prognosis of these youths living with a chronic disease, including mortality, was associated with low socio-economic level, as measured by being covered by Couverture Maladie Universelle Complementaire, a public complementary health insurance offering free access to care, delivered on the basis of very low househould incomes. Hence, overcoming financial barriers did not offset social health inequalities in this population. At last, one day, these youths have to be transferred to adult care. Moving to adult care is a critical time in patients’ follow-up that may lead to discontinuity in medical care. Transition programs are being gradually implemented, to prepare and smooth the transfer and support youths during this period. I performed a systematic review of literature (23 studies) that highlighted two aspects of continuity of care during transfer: engagement (first contacts) and retention in adult care once the first contact has been established. This review also emphasized the paucity of knowledge to evaluate transition programs in terms of care continuity. Finally, the results of this PhD raises many issues that need to be addressed, including coping strategies of young patients with high risk situations, and the role of transfer to adult care on patient behavior, prognosis and clinical practices. Studies involving patients with a large spectrum of severe chronic diseases, including factors related to healthcare organization, related to the disease, individual and familial, should be encouraged.

Thesis (Ph. D. (Social Work)) -- University of Limpopo, 2016 / Refer to document / University of Limpopo

Millions of people in the United States alone suffer from undiagnosed or late-diagnosed chronic diseases such as Chronic Kidney Disease and Type II Diabetes. Catching these diseases earlier facilitates preventive healthcare interventions, which in turn can lead to tremendous cost savings and improved health outcomes. We develop algorithms for predicting disease occurrence by drawing from ideas and techniques in the field of machine learning. We explore standard classification methods such as logistic regression and random forest, as well as more sophisticated sequence models, including recurrent neural networks. We focus especially on the use of medical code data for disease prediction, and explore different ways for representing such data in our prediction algorithms.

Masters of Science / There is evidence of the rising incidence and prevalence of chronic diseases of lifestyle in developing countries. It is estimated that by 2020 chronic diseases of lifestyle in Sub-Saharan Africa will be almost 50% of the burden of disease. Rapid urbanization with changes in lifestyle, such as physical activity patterns could explain at least partially the ongoing epidemiological transition. The purpose of this study was to assess levels of participation in physical activity among working Rwandan women in Kigali, in relation to socio-economic demographic characteristics. A cross-sectional study design using both quantitative and qualitative methods was used. Participants' level of participation in physical activity and influence of socio-economic demographic factors on questionnaire adapted from Sub-Saharan African Questionnaire. A focus group discussion assessed the need for a health promotion program related to physical activity participation among working women. Data analysis, using Statistical analysis version 8e, was used to obtain frequency tables and histograms. Chisquare tests and Fisher's exact tests were utilized to test for association between variables. Focus group discussion data were transcribed and translated into English. Data were then coded and put into themes and categories. There were 352 participants, with a mean age of 33.4 years. 71.9% of the participants were classified as sedentary and only 28.1 % of the participants were classified as physically active. Participation in physical activity decreased with age, and there were more participants classified as sedentary people in the married group (77%) than in non-married group (63.2%). A lower level of education and income of participants, the higher the level of participation in physical activity. Among the reported prevalence of chronic diseases, high blood pressure and diabetes were only reported by participants classified as sedentary. During the focus group discussion, participants reported facilitators and benefits of physical activity including, routine, relaxation, socialization and fitness, managing obesity and health purposes. Barriers limiting the participants' ability to engage in physical activity included lack of time, lack of knowledge, laziness, domestic helper, lack of motivation and culture. The main themes, which were identified as important in the development of a health promotion program were: The education and encouragement of girl children; education of women in the community, finding facilities and appropriate venues, a suitable environment and the contribution of physical activity program towards unity and reconciliation was emphasised. The findings of this study demonstrate a problem concerning sedentary lifestyle among the working women in Kigali/Rwanda. It is alarming that the participants who are already classified as sedentary and who will probably experience the consequences of sedentary lifestyle in the future are already reporting chronic diseases like high blood pressure and diabetes. There is therefore an urgent need to design, implement and evaluate a health promotion intervention aimed at promoting a physically active lifestyle in Rwanda.

Les maladies chroniques non transmissibles sont la première cause de mortalité évitable dans le monde. L’origine de ces maladies est multifactorielle. L’inactivité physique (IP) et la sédentarité sont progressivement devenues des facteurs de risque majeurs de ces maladies. L’activité physique (AP) régulière permet d’améliorer la santé et de prévenir les risques de comorbidités et de mortalité. L’arrivée massive des Technologies de l’Information et de la Communication (TIC) offre de nouveaux outils de promotion de l’AP. L’objectif de ces travaux est d’évaluer le potentiel des TIC en tant que support d’accompagnement en AP auprès de patients atteints d’une maladie chronique. Ainsi, le premier travail avait pour objectif de déterminer les connaissances, usages et intérêts des patients vis-à-vis de l’utilisation des TIC dans le parcours de soins et pour l’AP. Dans une deuxième étude, nous avons étudié l’effet d’un réentrainement supervisé de trois mois et d’un podomètre sur les intentions et les motivations vis-à-vis de l’AP, la perception de l’état de santé et le niveau d’AP et de sédentarité de sujets porteurs de pathologies chroniques. Enfin, la troisième étude portait sur l’impact d’un atelier d’information en AP Adaptée (APA) couplé à l’utilisation d’un dispositif numérique d’accompagnement personnalisé pendant un an, comparé à celui d’une brochure d’information et d’exemples d’exercices en APA, sur l’atteinte des recommandations en AP chez des patients. Ces travaux montrent que les patients atteints de maladie chronique utilisent les TIC, mais qu’ils ont des connaissances technologiques partielles. Ils sont moyennement favorables à l’utilisation de ces outils dans le domaine de la santé et de l’AP. Les patients ont besoin d’être rassurés et formés à l’utilisation de ces nouveaux outils. La prise en charge thérapeutique par l’AP est efficace pour instaurer le changement comportemental chez les patients mais ne permet pas de le maintenir sur le long terme. La remise d’un podomètre ne suffit pas à les remotiver pour pratiquer l’AP. Les résultats préliminaires de la troisième étude obtenus sur un sous–échantillon des patients indiquent qu’un atelier en APA suivi d’un accompagnement personnalisé par un dispositif numérique ou que la remise d’une brochure de conseils et d’exemples d’exercices pourrait augmenter la quantité d’AP déclarée à 12 mois. L’analyse en intention de traiter reste à faire pour confirmer ces résultats. La prise en charge thérapeutique par l’AP est efficace pour instaurer le changement comportemental, à condition que le patient soit prêt et motivé. Souvent elle ne suffit pas pour maintenir ce changement sur le long terme, révélant la nécessité d’un accompagnement personnalisé en AP, qui peut prendre plusieurs formes suivant les besoins des patients (sessions d’AP individuelles ou en groupe, dispositif numérique, brochure). / Non communicable chronic diseases are the first cause of avoidable death in the world. The origin of these diseases is multifactorial. Physical inactivity and sedentary behavior are gradually becoming major risk factors. Regular Physical Activity (PA) allows improving health and preventing the risks of comorbidity and mortality. Massive development of Information and Communication Technologies (ICT) offers new tools of PA promotion. The aim of these works is to assess the ICT as a mean to support patients with chronic diseases in their PA practice. Thus, the first study aimed to determine patients’ knowledge, use and interest towards ICT applied to health and PA fields. In a second study, we studied the impact of a 3-months supervised PA program associated with a pedometer on the intentions and motivations towards PA, perceived health and active and sedentary behaviors. Finally, the third study was a one-year intervention comparing the effect of an Adapted Physical Activity (APA) workshop associated with a personalized digital system with that a guideline and examples in APA on the achievements of the PA recommendations. These works showed that patients with chronic diseases used the ICT, but they had partial technological knowledge. They were moderately in favour of the ICT use in health and the PA fields. The patients needed to be reassured and trained in the use of these new tools. Patients care by PA resulted in a significant change in behavior but did not allow maintaining it in the long term. The pedometer was not sufficient to increase PA practice. Preliminary results of the third study indicated that an APA workshop followed by a personalized digital system use or a guidelines and exercises book could increase reported PA level 12 months after the study beginning. The intent-to-treat analysis will be performed later to confirm these results.Patients care by PA is effective to provoke behavioral changes if the patient is ready and motivated by health benefits. Often this initial care is not sufficient to keep 150 min-by week PA in the long term, revealing the need to continue the patients’ accompanying. Several forms could be considered depending on patients’ needs (individual or group sessions, digital device, guideline).

Thesis (MPH.) -- University of Limpopo, 2019 / Background: HIV and AIDS is the leading cause of death among adults in subSaharan Africa, and the burden of non- communicable diseases such as diabetes mellitus is high and growing as well. This has resulted in the increase of dual diagnosis of HIV and Diabetes Mellitus in recent years increasing disease burden and self-care challenges being experienced by these patients. This study explored patient challenges arising from this dual diagnosis, and investigated how well the Limpopo healthcare system is servicing these lived experiences, and disease burden challenges these patients have to bear. Methods: A qualitative study approach was used and a phenomenology study design employed in this study. Patients‟ lived experiences and their capability to cope with the co-morbidity of HIV and Diabetes Mellitus was investigated. Sixty four (64) HIV patients with Diabetes Mellitus were identified representing 48% of HIV patients in the HIV/AIDS program at the sites of the study (Mankweng hospital POP clinic, Nobody and Dikgale Clinics) in the Polokwane municipality area of the Limpopo province in South Africa. Fifteen (15) of these patients made the sample and were interviewed. In addition, the five (5) of the seventeen (17) health care providers participated in the interviews. Criterion purposive sampling was used whereby the subjects had to have HIV and AIDS and diabetes in order to be part of the study. The semi-structured interview was conducted. An interview schedule was created to ensure that the key research questions related to workload and capacity are adequately covered during the interviews. Results: The evidence collected suggested that HIV and Diabetes comorbidity patients had increased workload and capacity challenges for self-care. Among the challenges was despondency. Patients found it difficult to adjust to symptoms and demands of the dual diagnosis. Counseling and education was noted as easing anxiety and lowered despondency. Poor services at the clinics worsened their experience and disease burden. Shortage of staff, poor housing of clinics, poor facilities and equipment, lack of training and occasional shortage of drugs were the reasons put forward by the health 2 care professional for the poor services. Separate clinics for HIV and Diabetes Mellitus increased the patients time away from a productive life, increased expenses, and somewhat complicated their lives. Good compliance to treatment was observed. Most patients coped well with medication and had no side effects, the few that had side effects continued to take their medication incorporating additional instructions from the health workers who managed the side effects. Family and buddy support improved the capability to cope with the disease burden and their general attitude to life. Conclusion and recommendations: Primary health care must be strengthened to meet the challenges disease convergence is bringing through continued education of staff and improvement of facilities and equipment, and streamlining service delivery processes. Note of significance is that despite the health care professionals being poorly prepared and under staffed, the clinic facility being poorly housed and poorly equipped, the healthcare professionals are managing to meet their service mandate through commitment and hard work.