Magister Public Health - MPH / Teenage pregnancy is one of the major public health problems facing teenage girls in Zambia (Webb, 2000; Warenius, 2008). Teenage girls access to and utilization of adolescent reproductive health (ARH) services is important for the prevention of teenage pregnancies and sexually transmitted infections (STIs) amongst teenagers.High incidence of teenage pregnancies has been noted in the district despite availability of ARH services. Teenage pregnancy is a major contributing factor to the high school drop-out rate amongst the girls and is one of the challenges faced by non-governmental organizations (NGOs) that support girl child education, such as the campaign for female education (CAMFED) as well as for government agencies such as the Ministry of Education. The high incidence of teenage pregnancies could be an indication of poor access to and utilization of ARH services and therefore an assessment of the accessibility and utilization of the ARH services was done to explore the reasons for this.This research aimed to explore the factors affecting teenage girls access to and utilization of ARH services in the Mpika district, Zambia. The research was a qualitative, descriptive and exploratory study using individual interviews with ten in-school teenage girls, four key informants rendering ARH services and a focus group discussion (FGD) with ten pregnant teenage girls. By exploring these particpants perceptions and experiences, appropriate interventions to improve accessibility to and utilization of ARH services could be designed that would be appropriate for the local context in order for them to be effective. Thematic analysis with categorizing and coding methods was used to analyze the data. The study used the theory of planned behaviour (TPB) which stipulates that an individuals attitude,subjective norms and perceived behavioural control influence behaviour as a framework to explain the findings of the results of the study. The findings of the study indicated that physical, psychological and social barriers hindered adolescents from accessing and utilizing ARH services. The findings also suggested that high levels of knowledge about RH services do not necessarily translate into accessibility and utilization of ARH services. Accessibility to and utilization of ARH services by adolescents can also be determined by an individual attitude, subjective norms, and perceived behavioural control as illustrated by the TPB. Adolescents need to feel comfortable using ARH services. Therefore the three variables of TPB should be taken into consideration when designing comprehensive ARH programmes in order to accommodate the unique reproductive health needs of the adolescents. There is need to encourage participation in and involvement of adolescents in planning and implementation of ARH programmes. The participants also made recommendations which included strengthening information and education on ARH, strengthening adolescent-friendly services, improving staffing levels and promotion of school health services. / South Africa

Ma recherche tente d’étudier l’impact des implications des normes sociales et des impératifs législatifs sur la construction et les interrogations identitaires chez les femmes de culture arabo-musulmane en France et en Tunisie. En fait, je m’interroge dans cette recherche de thèse sur les implications psychologiques possibles du dédoublement socioculturel sur la structuration du Moi. Je me pose aussi la question de savoir si la construction identitaire chez les femmes de culture arabo-musulmane est marquée par une certaine confusion référentielle ou si elle est tributaire d’une élaboration synthétique face à deux statuts sociaux antagonistes qui leur sont assignés.Sous l’emprise interculturelle, les identités culturelles contemporaines sont marquées par des remaniements permanents. Toute culture est encore une organisation interculturelle. Pour cela, j’ai émis l’hypothèse principale selon laquelle, face à l’emprise interculturelle qui marque notre époque historique, toute identité culturelle est façonnée par l’influence du contact des cultures et des interférences normatives pour devenir encore multiple et se transformer en « Identité interculturelle ». Dans le cas des femmes, il semble que cette catégorie sociale soit doublement atteinte du fait de l’ampleur du dédoublement socioculturel et de l’emprise interculturelle sur l’identité et l’image de leur corps.Sur le plan méthodologique, l’adoption d’une démarche multidisciplinaire centrée sur une approche clinique m’a conduit, d’une part à m’appuyer sur de multiples moyens d’investigation, et d’autre part à m’orienter vers des outils proprement liés à la pratique clinique. La confrontation des analyses cliniques aux résultats statistiques vise à révéler des données psychologiques approfondis susceptibles de proposer une réponse à la problématique. Une analyse de l’organisation psychodynamique individuelle peut offrir des enseignements cliniques pointus sur les caractéristiques psychologiques des membres du groupe. En effet, l’adoption d’une approche clinique vise à identifier les propriétés psychodynamiques des membres appartenant au groupe d’étude. Enfin, ce travail de recherche ambitionne d’inscrire ce projet dans le développement d’une psychologie clinique interculturelle. / My research tends to study the impact of the implications of social norms and the legislative imperatives on the construction of the identity questions among women of Arab-Muslim culture in France and Tunisia. In fact, I wonder in this thesis research about the possible psychological implications of socio-cultural splitting in the construction of the identity. I also want to know whether the building of identity among women of arab-muslim culture is marked by certain referential confusion or it’s attributed to a synthetically elaboration of two clashing social statuses.Under the intercultural hold, the contemporary cultural identities are marked by permanent remnants. Every culture is again an intercultural organization. Thus, I’ve put forward the hypothesis stating that against the intercultural hold, every cultural identity is fashioned by the influence of the contact of cultures and the normative interferences to be multiple and be transformed into “an intercultural identity. In the case of women, it seems that social category is doubly attained by the effect of the ampleness of socio-cultural splitting and the intercultural hold on both the identity and the image of their bodies.Methodologically speaking, the adoption of a multidisciplinary procedure centered on a clinical approach led me on the one hand to focus on the multiple means of investigation, and on the other hand to seek other tools properly related to clinical practice. The confrontation of clinical analyses and the numerical results target revealing deep psychological lying itself to a response to the problematic. An analysis of the individual psychodynamic organization could offer clinical teachings focusing on psychological features of group members. In fact, the adoption of a clinical approach targets the identification of psychodynamic properties of members belonging to a study group. Finally, this work of research has the ambition to subscribe this project in the development of an intercultural clinical psychology.

Magister Public Health - MPH / In South Africa, governance structures in the form of clinic committees, hospital boards and district health councils are intended to provide expression to the principle of community participation at a local and district level. They are meant to act as a link between communities and health services and to provide a conduit for the health needs and aspirations of the community to be represented at various local, districts, provincial and national levels. This study aimed to assess the functioning of health governance structures in the form of clinic committees. Specifically, the study sought to ascertain the number of clinic committees associated with public health facilities in three provinces in South Africa namely the Eastern Cape, Free State and KwaZulu Natal and to identify the factors that are perceived by clinic committee members to either facilitate or impede the effective functioning of clinic committees. / South Africa

A construção desta tese está alicerçada na inter-relação entre profissionais e usuários do Sistema Único de Saúde (SUS), no que diz respeito às questões relativas a saúde mental relacionada ao trabalho. Existem atualmente propostas relativas a políticas e ações voltadas à saúde dos trabalhadores, porém o campo de práticas, neste contexto, não tem produzido respostas significativas para atender as demandas de sofrimento psíquico do trabalho. Assim, esta pesquisa se propôs a compreender de que modo os profissionais da saúde percebem a saúde mental relacionada ao trabalho vivenciada pelos usuários do SUS. O embasamento teórico e metodológico está fundamentado na Psicodinâmica do Trabalho e nas teorias voltadas para a Saúde Mental e Trabalho. O método de pesquisa foi baseado na Psicodinâmica do Trabalho, em que foi realizada uma adaptação da proposta strictu sensu, sendo composta pela pré-pesquisa, pesquisa propriamente dita e pela perlaboração como validação. Participaram da pesquisa mulheres e homens que atuam como profissionais da saúde no SUS. O material de análise e interpretação resultou de 15 entrevistas individuais e 4 coletivas, totalizando 69 participantes. Além disso, registros realizados no diário de campo também integraram o material analisado, fundamentando assim a observação clínica. Os resultados se propuseram a atender aos objetivos da investigação e originaram cinco eixos-temáticos, sendo estes: Trabalho e Subjetividade: Entre Saberes e Fazeres; Saúde Mental e Trabalho no SUS: Articulações em Rede; Organização do Trabalho nos Serviços do SUS; Produção de Saúde e Adoecimento no Trabalho; Pesquisa-Intervenção como Possibilidade de Reflexão-Transformação. Ao falar do trabalho, é necessário dizer sobre o trabalhador, desse modo, esta pesquisa abordou tanto as especificidades do fazer desses profissionais, quanto a dinâmica de prazer e sofrimento vivenciada por eles. Observou-se que a percepção sobre a saúde mental relacionada ao trabalho dos usuários é atravessada pelo reconhecimento da centralidade do trabalho e do potencial criativo/destrutivo dos modos de trabalhar. Identificou-se a elaboração de estratégias defensivas e estratégias de resistência para lidar com as adversidades do trabalho. Para que seja possível colocar em circulação a Clínica do Trabalho para os usuários-trabalhadores, é primordial a constituição de uma Clínica do Trabalho Institucional voltada para os profissionais da saúde. Enfatiza-se assim, a importância dos espaços de fala e escuta, em que os profissionais do SUS possam compartilhar aquilo que faz sofrer no meio laboral, dando a esta carga psíquica um lugar de potência e transformação. A partir desse acolhimento poderão então estar disponíveis para um cuidado integral e humanizado, relativo a saúde dos trabalhadores-usuários, colocando em movimento um olhar permeado pela Clínica do Trabalho. / This thesis construction is based in the interrelationships between professionals and users of the Unified Health System (SUS), in relation to the mental health related issues related to work. Currently, there are proposals for policies and actions aimed at the workers' health, but the field of practices, in this context, has not produced meaningful answers to meet the demands of mental suffering from work. Thus, this research intends to understand how the health professionals perceive the work related mental health experienced by the SUS users. The theoretical and methodological basement is based on the Psychodynamics of Work and the theories focused on Health Mental and Work. The research method was based on Work Psychodynamics, in which the strictu sensu proposal was adapted, being composed by pre-research, research per se, and working through as validation. Women and men who work as health professionals in the SUS participated in the research. The analysis and interpretation material resulted from 15 individual and 4 collective interviews, totaling 69 participants. In addition, records made in the field diary also integrated the analyzed material, thus grounding the clinic observation. The results set out to meet the objectives of the research and originated five thematic axes, these being: Work and Subjectivity: Between knowledge and making; Mental Health and Work in SUS: Network Joints; Work Organization in the SUS Services; Health Productions and Illness at work; Research- Intervention as a Reflection-Transformation Possibility. When talking about work, it is necessary to tell about the worker, in this way, this research addressed both the specificities of the work of these professionals, and the dynamics of pleasure and suffering experienced by them. It was noted that the user’s perception about work related mental health is crossed by the recognition of the centrality of work and the creative/destructive potential of the ways of working. It was identified the elaboration of defensive and resistance strategies for dealing with adversity at work. In order to be able to put into circulation the work clinic for the user-workers, it is essential to establish an Institutional Work Clinic focused on the health professionals. This emphasizes the importance of spaces for speaking and listening, in which the SUS professionals can share what causes suffering in the workplace, giving this psychic burden a place of power and transformation. From this reception can then they be available for an integral and humanized care, concerning the health of the workers-users, putting in motion a look permeated by the work clinic.

No description available.

Cette thèse présente un ensemble de travaux qui s'inscrivent dans le domaine du génie biomédical pour des applications cliniques. L'objectif principal de ce travail est de fournir aux cliniciens un mode d'imagerie ultrasonore pour extraire simultanément la vitesse du flux et le mouvement de la paroi à des cadences d'imagerie élevées dans les artères. Les pathologies cardiovasculaires sont une cause majeure de décès et d'invalidité dans le monde. Bien que l'origine de ces maladies ne soit pas encore entièrement comprise, il semble que certains marqueurs pathologiques de la paroi et du flux pourraient permettre une détection plus précoce. Parce que les tissus artériels sont sujets à des phénomènes rapides et complexes, une modalité d'imagerie à haute cadence semble très pertinente pour étudier les pathologies du système cardiovasculaire. Malheureusement, aucune technique n'est actuellement utilisée cliniquement ni même approuvée pour l'extraction de marqueurs pathologiques du sang et de la paroi à des cadences d'imagerie élevées. C'est pourquoi, dans cette thèse, je propose de concevoir une séquence et un algorithme ultrasonore permettant d'extraire ces deux aspects, à des cadences d'imagerie élevées sur les artères, pour une application clinique potentielle. Trois contributions scientifiques principales sont présentées cette thèse : i) la conception de la séquence ultrasonore avec un estimateur de mouvement 2D, ii) une nouvelle approche adaptative de filtrage de paroi, et iii) un essai clinique. La séquence d'imagerie ultrasonore est basée sur la transmission d'ondes planes permettant d'obtenir des cadences d'imagerie allant jusqu'à 10 000 Hz sur la carotide. La méthode d'estimation de mouvement est basée sur une approche introduisant une oscillation latérale virtuelle dans les images qui, couplée à un estimateur de phase 2D basé sur des travaux antérieurs de la littérature, permet d'extraire des champs vectoriels de vitesses. Les validations pour l'estimation des vitesses du flux et du mouvement des parois ont été effectuées à l'aide d'un fantôme d'écoulement Doppler commercial et d'un fantôme de carotide réaliste conçu pour les expériences. Une technique de filtrage adaptatif de paroi a été développée et validée sur des volontaires à l'aide des estimations de vitesses tissulaires, ce qui permet d'éliminer précisément le signal du tissu des signaux du sang. Enfin, l'essai clinique a été réalisé à l'hôpital avec un groupe de volontaires et un groupe de patients. La séquence ultrasonore, l'algorithme d'estimation de mouvement et les approches adaptatives de filtrage de paroi ont été validés dans la thèse. La méthode permet d'extraire les vitesses du flux et de la paroi à haute cadence d'imagerie, avec de faibles erreurs et écarts-types. L'approche adaptative du filtrage de paroi permet de mieux extraire le flux par rapport à d'autres approches standard. Cette amélioration est particulièrement perceptible à proximité de la paroi, ce qui permettrait des mesures précises de l'écoulement et des contraintes le long des parois artérielles où les plaques peuvent se former et se développer. Pour conclure, l'essai clinique a démontré la faisabilité de notre approche dans un environnement clinique avec l'extraction des mouvements tissulaires, du flux et de paramètres artériels qui ont montré des différences entre et au sein des groupes. Cette thèse est donc un pas en avant vers l'utilisation clinique de l'imagerie ultrasonore à haute cadence pour la quantification du mouvement tissulaire et du flux pour la détection et le diagnostic des maladies cardiovasculaires / This thesis is focused on biomedical engineering for clinical applications. The main goal of this work is to provide to clinicians an ultrasound mode to simultaneously extract wall motion and flow at high frame rates in arteries. Cardiovascular pathologies are a major cause of death and disability worldwide. Although the formation of such diseases is still not fully understood, it appears that some pathological markers from both wall and flow could allow an earlier detection. Because tissues are subject to fast and complex phenomena in the arteries, a high frame rate imaging modality seems highly relevant to extract as much information as possible on the condition of the cardiovascular system. Unfortunately, no technique is currently clinically used or even approved for the extraction of both flow and wall pathological markers at high frame rates. Therefore, in this thesis, I propose to design an ultrasound sequence and algorithm permitting to extract both aspects, at high frame rates on arteries, for a potential clinical application. There are three main scientific contributions in this thesis: i) the design of the ultrasound sequence with a 2D motion estimator, ii) a new adaptive clutter filtering approach, and iii) a clinical trial. The ultrasound sequence is based on plane wave acquisition permitting to yield frame rates up to 10 000 Hz in the carotid. The pipeline used an approach introducing a virtual lateral oscillation in ultrasound images which, coupled with a 2D phase-based estimator based on previous works from the literature, allows to extract vectorial velocity fields. Validations for both flow and wall motion estimation were performed on a commercial Doppler flow phantom and an in-house realistic carotid phantom was designed for the experiments. An adaptive clutter filtering technique was also developed and validated on volunteers based on tissue estimates, which permit to precisely remove tissue clutter from flow signals. Finally, the clinical trial was performed at the hospital with a group of volunteers and a group of patients. The ultrasound sequence, motion estimation algorithm, and adaptive clutter filtering approaches were well validated in the thesis. The method can provide both wall motion and flow estimates at high frame rates, with low errors and standard deviations. The adaptive clutter filtering approach permits to better extract the flow compared to other standard approaches. This improvement is especially noticeable close to the wall, which would allow accurate flow and stress measurements along arterial walls where plaques can form and develop. To conclude, the clinical trial has demonstrated the feasibility in a clinical environment with the extraction of wall motion, flow, and arterial parameters that showed differences between and within groups. This thesis is then a step toward clinical use of high frame rate ultrasound imaging for quantification of both wall motion and flow for pathological detection of cardiovascular diseases

Bakgrund: Genomsnittsåldern för exponering av pornografi bedöms vara så låg som 10-års ålder. Ungdomar vänder sig till pornografi i brist på adekvat sex- och samlevnadsundervisning och konsumtion av pornografi kan leda till sexuellt riskbeteende. Barnmorskan har en vital roll i att främja sexuell hälsa såväl i enskilda samtal på ungdomsmottagningen som i skolan. Syfte: Att undersöka barnmorskors erfarenheter av att samtala om pornografi med ungdomar. Metod: I studien genomfördes intervjuer med sex barnmorskor verksamma på olika ungdomsmottagningar i sydvästra Sverige. Datamaterialet analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Analysen gav upphov till fyra kategorier; Barnmorskan anpassar sitt förhållningssätt, Effekter av ungdomars konsumtion, Pornografi finns överallt och Barnmorskan berikar sex- och samlevnadsundervisningen. Konklusion: Barnmorskor erfar att samtal om pornografi är utmanande. Pornografiskt material bidrar till komplex kring fysiologiska och kroppsliga attribut hos ungdomar och medför att normer förskjuts och aktioner normaliseras, vilket resulterar i att ungdomar utför saker mot sin vilja. Pornografins förmåga att influera och de potentiella risker som konsumtion medför i samband med att ingen barnmorska per automatik diskuterar pornografi med ungdomar bör ses som ett observandum. Samtalet om pornografi kan därmed vara avgörande för att främja och stärka den sexuella hälsan bland ungdomar. / Background: The average age of exposure of pornography is estimated to be as low as 10 years. Adolescents turn to pornography due to a lack of adequate sex and cohabitation education, and consumption of pornography can lead to a sexual risk behaviour. The midwife has a vital role in promoting sexual health in individual conversations at the youth clinic as well as in school. Aim: To explore midwives’ experiences of talking to adolescents about pornography Method: The study were conducted by interviews with midwives working at various youth centers in southwestern Sweden. The data material was analyzed using qualitative content analysis. Result: The analysis gave rise to four categories; The midwife adapts her approach, The effects of adolescents consumption, Pornography is everywhere and The midwife enriches sex and cohabitation education. Conclusion: Midwives find that talking about pornography is challenging. Pornographic material contributes to the complexity of physiological and physical attributes of adolescents and causes norms to be shifted and actions normalized, resulting in adolescents doing things against their will. Pornography’s ability to influence and the potential risks that consumption entails in connection with the fact that no midwife automatically discusses pornography with adolescents should be seen as an admonition. The conversation can therefore be crucial in promoting and strengthening the sexual health of adolescents.

Dentident está especializada en servicios de odontopediatría y ortodoncia, después de varios años de funcionamiento, ha decidido expandirse hacia otros distritos de Lima Metropolitana. Identificada una ventana de oportunidad en el distrito de San Borja, se elaboró el proyecto: “Nueva sede Dentident en el distrito de San Borja” En el proyecto se ha considerado el entorno internacional y nacional, golpeado por una grave crisis económica mundial, agudizada por la pandemia del coronavirus, que ha incidido en una caída de la producción, el empleo y el ingreso de la población en el país. La propuesta de valor consiste en la gestión por procesos en nuestros servicios de odontopediatría y ortodoncia con más de 10 años de experiencia, brindando un servicio de calidad y con tecnología de alto nivel, en un ambiente agradable y cálido. Para la segmentación del mercado se consideró criterios económicos, relacionados con los ingresos de la población, el distrito corresponde a sectores de ingresos medios altos y altos. Se aplicará la estrategia de enfoque, brindando servicios especializados en odontología infantil. El proyecto es viable y atractivo, los indicadores económicos y financieros indican que es rentable, el VANF de S/. S/552.746, el TIRF es de 76%. Aún, considerando una reducción de la demanda en un 11%, los indicadores son favorables. A lo que hay que agregar la experiencia, la calidad de los servicios y el posicionamiento logrado. / Dentident is specialized in pediatric dentistry and orthodontic services, after several years of operation, has decided to expand to other districts of Metropolitan Lima. Having identified a window of opportunity in the district of San Borja, the project was developed: "New Dentident headquarters in the district of San Borja" The project has considered the international and national environment, hit by a serious global economic crisis, exacerbated by the coronavirus pandemic, which has affected a drop in production, employment and the income of the population in the country. The value proposition consists of process management in our pediatric dentistry and orthodontic services with more than 10 years of experience, providing quality service and technology in a pleasant and warm environment. For the market segmentation, economic criteria were considered, related to the income of the population, the district corresponding to upper middle and upper income sectors. The focus strategy will be applied, providing specialized services in children's dentistry. The project is viable and attractive, the economic and financial indicators indicate that it is profitable, the VANF of S /. 552.746, the TIRF is 76%. Still, considering a reduction in demand by 11%, the indicators are favorable. To which must be added the experience, the quality of the services and the positioning achieved. / Trabajo de investigación

Diplomová práce se zabývá návrhem podnikatelského plánu pro založení soukromé kliniky řečové terapie v Brně, jako společnosti s ručením omezeným. Návrh je reakci na existenci tržní mezery v poskytování komplexích a kvalitních služeb v oblasti řečové terapie, psychoterapie a fyzioterapie. V následující práci jsou vyhodnoceny potřebné předpoklady úspěchu podnikání, zahrnující také finanční plán, včetně návrhu kroků pro samotmou realizaci firmy.

The topic of this Master‘s thesis is an elaboration of project documentation of construction part for a project of new building private clinic in Slavkov u Brna. Object is composed of three floors. In the first floor there are chemist and X-ray. In the second and third floor there are doctor's surgery. Construction system is transverse wall. The ceilings are made of prestressed panels. The roof of object is single-layer flat roof.