This diploma thesis deals with veterinary clinics in Prostejov. The building is secluded on almost flat land. The building has a simple rectangular shape, replicating the street, with a receding second floor. The building is brick, two-storey, basement, covered with a flat roof and green roof terrace. On the first floor are situated surgeries, surgeries, operating rooms, facilities for employees and utility room. On the second floor there is a pet shop, counseling, treatment plant dog, sanitary facilities for public office and facilities for temporary accommodation of employees, where it is possible to get to the green roof terrace. The building is insulated, partially with white plaster and partly with wooden facade panels. The building is in part intended for the general public designed wheelchair.

HIV/AIDS is severely affecting the armed forces in South Africa. Combating HIV/AIDS demands a high level of commitment from the Ministry of Defence and all the Divisions and Services at all levels in the Department of Defence. Prevention practice for HIV/ AIDS is a challenged because the nature and full extent of the impact on the forces, and in particular on serodiscordant couples, are not known. This research study explored the experiences of serodiscordant couples regarding the impact of serodiscordancy on their marriages. The Infectious Disease Clinic engages serodiscordant couples as active participants in dealing with their HIV status. The researcher explored the impact of HIV serodiscordancy on married couples attending the Infectious Disease Clinic at 1 Military Hospital with the intended outcome of informing intervention and prevention strategies and programmes for serodiscordant couples. The study utilised a qualitative research approach and the research design was an instrumental case study. The population for the study was all the married serodiscordant couples in the Infectious Disease Clinic at 1 Military Hospital. The sample consisted of 20 serodiscordant couples attending the Infectious Disease Clinic for at least the past two years. The data was collected through semi-structured interviews. The study concluded that empowerment programmes on HIV/AIDS should include knowledge of, as well as coping skills and guidance for couples dealing with serodiscordancy, including disclosure and discrimination; marital and parenting roles; health management, building of trust; facilitating open and positive communication; and financial management. Based on the conclusions of the study, the main recommendation is that prevention strategies and empowerment programmes for serodiscordant couples should be based on a holistic, well-integrated intervention plan which contextualises strategies and programmes for prevention, treatment, counselling, empowerment and continuous support of the employee, their spouse and their family, including home visits, as required by the serodiscordant couple. Furthermore, it should clearly conceptualise the role of each team member at both the Infectious Disease Clinic and the relevant units of the SANDF, in particular the role of the social worker. / Dissertation (MSW)--University of Pretoria, 2010. / Social Work and Criminology / unrestricted

Department of Psychology / PhD (Psychology)

The thesis focuses on the use of Evidence Based Medicine (EBM) methods and principles at the Psychiatric Clinic of the First Faculty of Medicine of Charles University and the General University Hospital in Prague. There is a theoretical introduction to EBM - its origin and development, EBM information resources as well as general basic principles of this approach to work with clinical evidence. Part of this work introduces the history and current activities of the Psychiatric Clinic and the related Psychiatric Association of the Czech Medical Association of J. E. Purkyně. The practical part of the thesis describes the preparation of research and its results. Based on semi-structured interviews with physicians of the Psychiatric Clinic, the results of this research represents their current attitude towards EBM and use of EBM methods in their daily work. The aim of the thesis is also a proposal to raise awareness of EBM information sources in the form of information materials and educational seminars.

The demand for circumcision in Swaziland has dramatically increased since it was reported that circumcision ensures 60% protection against HIV infection. The aim of this study was to explore the reasons for, and the motives behind, this increasing interest in undergoing circumcision. A generic qualitative research design was used, in which 17 circumcised men selected by convenience sampling at FLAS Clinic, Mbabane, participated. In-depth unstructured face-to-face interviews were used to collect data. The results showed that the main reasons for circumcision are perceived health, hygiene and sexual benefits, community influences, as well as medical reasons. It was concluded that the major motives underlying circumcision are personal and partner safety and satisfaction during sex. These motives were found to be both promotive and threatening to the interests of public health. After evaluating the risks and benefits, it was recommended that mass circumcision be promoted alongside reinforced and accurate health education on circumcision / Health Studies / M.A. (Public Health)

Le décès d’une personne sur cinq à travers le monde est associé à l’hypertension artérielle (HTA). Or, près de la moitié des individus avec HTA ignorent leur condition : ils n’ont pas été dépistés. Cette thèse a pour objectif, principalement à travers la présentation de deux articles originaux, de contribuer à l’amélioration du dépistage de l’HTA. Avant la présentation des deux articles de cette thèse, les résultats d’un examen de la littérature sur les effets des démarches de dépistage de l’HTA en milieux hors hospitaliers sont exposés. On y constate notamment qu’une telle démarche permet d’identifier près d’un adulte sur trois comme ayant une pression artérielle (PA) élevée. La pratique infirmière dans la prise en charge de l’HTA est également explorée. Il en ressort que leurs interventions non pharmacologiques et leurs interventions directes sur le traitement pharmacologique permettent à la fois une amélioration des habitudes de vie ainsi qu’un abaissement de la PA au moins équivalente aux soins médicaux usuels. Le premier article de cette thèse consiste en une revue systématique effectuée en utilisant le protocole Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Diagnostic Test Accuracy (PRISMA-DTA). Les objectifs de cette revue systématique étaient de décrire la performance (valeur prédictive positive, taux de suivi) de la stratégie de dépistage de l’HTA qui consiste à tirer profit de la mesure de la PA effectuée d’emblée auprès des millions de personnes qui se présentent annuellement dans les départements d’urgence. Les méthodes de mesure de la PA utilisées lors de la consultation initiale à l'urgence, les moyens utilisés pour assurer un suivi, ainsi que les méthodes utilisées pour confirmer un diagnostic de l’HTA sont également décrits. À la suite d’une recension initiale de 1030 articles, 10 de ceux-ci répondaient aux critères d’inclusion. L’outil Quality Assessment of Diagnostic Accuracy Studies-2 (Quadas-2) a été utilisé pour l’évaluation de la qualité des études. L’âge moyen des participants est de 51,6 ± 6,4 ans. Pour effectuer la mesure de la PA au département d’urgence, un appareil au mercure a été utilisé dans la moitié des études, quatre ont utilisé un appareil électronique et pour deux études, cette information n’était pas disponible. Parmi ceux ayant eu un dépistage positif, le taux de suivi moyen est de 61,9 %. Parmi eux, 50,2 % ont reçu la confirmation d’un diagnostic d’HTA à la suite d’une démarche de suivi. L’on retrouve dans seulement deux études une méthode de confirmation diagnostique correspondant aux standards des sociétés savantes en HTA. Une autre solution pour l’amélioration du dépistage de l’HTA est d’augmenter la validité de la méthode de mesure de la PA. Le second article de cette thèse avait pour objectif d’évaluer la performance (valeurs prédictives, sensibilité, spécificité, coefficient de kappa et taux de suivi) d’une nouvelle stratégie de dépistage de l’HTA au moment d’une consultation pour urgence mineure. La stratégie consiste, à la suite d’une mesure initiale de la PA dont le résultat est élevé, en l’ajout d’une seconde méthode de mesure de la PA : la mesure oscillométrique en série. Un monitorage ambulatoire de la pression artérielle (MAPA) d’une durée de 24 heures a été fait pour chaque participant afin d’évaluer la performance de la combinaison des deux méthodes de mesures cliniques. Le MAPA constitue la mesure étalon en HTA. Effectuée dans une clinique GMF de Laval, 50 des 80 participants (62,5 %) inclus ont complété l’étude en se présentant au rendez-vous de suivi pour un MAPA. L’âge moyen des participants est de 51,9 ans. À la suite d’une mesure initiale de la PA dont le résultat est élevé, l’ajout de la mesure oscillométrique en série a été associé à une valeur prédictive positive de 62,5 % et une valeur prédictive négative de 83,3 % (sensibilité, 87 %; spécificité 56 %; coefficient de kappa 0,41). Cette thèse permet d’offrir des pistes de réponses qui pourront contribuer à l’amélioration du dépistage de l’HTA. Tout d’abord, le premier article met en lumière le fait que les consultations au département d’urgence représentent une excellente opportunité pour le dépistage de l’HTA. En effet, cela permet de rejoindre un nombre très important d’individus. Une mesure de la PA est effectuée à chacun d’eux, ils sont plutôt jeunes et lorsque le résultat de la mesure est élevé, cela correspond réellement à une HTA pour la moitié des cas. Le taux de suivi se situe à environ 60 %. La démarche de dépistage à l’urgence consiste essentiellement à reconnaitre une PA élevée, puis d’effectuer une référence afin d’obtenir une prise en charge. Cela implique qu’à chaque 100 adultes avec une PA élevée à l’urgence et pour qui une démarche de dépistage serait effectuée, 30 individus pourraient avoir un diagnostic d’HTA confirmé ainsi qu’une prise en charge subséquente. Malgré cela, le défi de la validité de la mesure et du suivi demeure. La contribution originale du deuxième article s’attarde à cette question. À la suite d’une mesure initiale de la PA dont le résultat est élevé, l’ajout de la mesure oscillométrique en série permet d’augmenter la validité de la démarche de dépistage. En effet, ceux pour qui le résultat de cette mesure est normal peuvent être considérés, d’une façon sécuritaire, comme étant non hypertendus. Ainsi, les individus dirigés afin d’effectuer un examen de confirmation diagnostique seront mieux ciblés, les ressources existantes mieux utilisées. Enfin, des recommandations sont présentées relativement au dépistage de l’HTA, à sa prise en charge, mais également sur la pratique infirmière. / One out of five people worldwide dies from causes linked to hypertension (HTN). Yet, nearly half of individuals with HTN are unaware of their condition as they have not been screened. The goal of this thesis, mainly through the presentation of two original articles, is to help improve HTN screening. Before presenting the two articles, the results of a literature review on the effects of the HTN screening process in an out-of-hospital setting are outlined. In particular, it is noted that such a process helps to identify nearly one out of three adults as having elevated blood pressure (BP). The nursing practice in HTN management is also explored. It is concluded that their non-pharmacological interventions and direct interventions on the pharmacological treatment help to improve lifestyles and lower BP by at least the same amount as customary medical care. The first article of this thesis consists in a systematic review conducted with the use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Diagnostic Test Accuracy (PRISMA-DTA) protocol. The purposes of this systematic review are to describe the performance (positive predictive value, follow-up rate) of the HTN screening strategy, which consists in drawing on the BP measurement taken on millions of people who show up in the emergency department (ED) annually. The BP measurement methods used during the initial ED consultation, the methods used to ensure follow-up, and the methods used to confirm an HTN diagnosis are also described. Following an initial review of 1030 articles, 10 of these met the inclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies-2 (Quadas-2) tool was used to evaluate the quality of the studies. The average age of participants is 51.6 ± 6.4 years. To take a BP measurement in the ED, a mercury device was used in half of the studies, four used an electronic device and for two studies, this information was unavailable. Among those with a positive screen, the average monitoring rate is 61.9%. Among them, 50.2% received confirmation of an HTN diagnosis following the follow-up process. Only two studies mention a diagnosis confirmation method that meets the standards of learned HTN societies. Another solution to improve HTN screening is to increase the validity of the BP measurement method. The goal of the second article of this thesis was to evaluate the performance (predictive values, sensitivity, specificity, kappa coefficient and monitoring rate) of a new HTN screening strategy when consulting for a minor emergency. Following the initial high BP measurement, the strategy consists in adding a second BP measurement method: the automated office blood pressure measurement (AOBP). Each participant underwent 24-hour ambulatory blood pressure monitoring (ABPM) to evaluate the performance of the combination of both clinical measurement methods. ABPM is the gold standard for BP measurement. Conducted in a GMF clinic in Laval, Quebec, 50 of the 80 participants (62.5%) included completed the study by showing up to the follow-up ABPM appointment. The average age of participants is 51.9 years old. Following an initial high BP measurement, adding the AOBP is linked to a positive predictive value of 62.5% and a negative predictive value of 83.3% (sensitivity 87%, specificity 56%, kappa coefficient 0.41). This thesis offers possibilities that can help improve HTN screening. The first article highlights the fact that ED consultations are an excellent opportunity to screen for HTN. Indeed, this helps to reach many individuals: BP measurement is taken on each one, they are rather young, and when the measurement is high, this actually corresponds to an HTN for half of the cases. The follow-up rate is about 60%. The ED screening process mainly consists in recognizing high BP, and then making a referral to obtain treatment. This implies that for every 100 adults with high BP in the ED and on whom a screening process would be conducted, 30 people could have a confirmed HTN diagnosis and subsequent treatment. And yet, the validity of the measurement and follow-up remains a challenge. The original contribution of the second article examines this question. Following an initial high BP measurement, adding the AOBP helps to increase the validity of the screening process. Indeed, those for whom the result of this measurement is normal can safely be considered as non-hypertensive. As such, those referred to complete a diagnosis confirmation exam will be better targeted and the existing resources better used. Lastly, recommendations are made regarding HTN screening, its management, and the related nursing practice.

Magister Public Health - MPH / The introduction of National Health Insurance (NHI) and the Ideal Clinic Monitoring System have highlighted gaps and challenges with regard to medicine supply management (MSM) at primary health care (PHC) facilities. PHC facilities are the first point of contact communities have for their health needs, however, frequent stock-outs of medicines at PHC facilities in uMkhanyakude district, a rural district in KwaZulu-Natal, and have raised questions as to how medicine stock is managed at these facilities.

Les modèles classiques d'enseignement de la langue ne permettent pas aux lycéens d'appréhender leurs écrits pour, selon les termes de Jacqueline Lafont-Terranova (2008) « produire, dans une situation donnée, le meilleur écrit possible ». À ce constat s’ajoute celui de la difficile évaluation de ces écrits par les enseignants, plus souvent correcteurs que lecteurs. La relecture de Saussure, Benveniste et Bakhtine permet d’aborder deux questions, en miroir l’une avec l’autre. Comment écrire un texte et y revenir pour l’améliorer ? Comment lire ce texte et accompagner le sujet-scripteur vers une amélioration compte tenu des conditions d’enseignement allouées ? À partir de l’analyse de manuscrits (brouillons, écrits intermédiaires et écrits-copies) d’élèves de seconde, le rapport à l’écrit des sujets-scripteurs est interrogé conjointement aux dits dispositifs réflexifs mis en place par l’enseignante. Au réalisé scriptural de l’élève répond un réalisé professionnel. L’activité de l’un ne se conçoit pas sans l’activité de l’autre. / The traditional models of language do not allow high school students to comprehend their writings to, in the words of Jacqueline Lafont-Terranova (2008) ‘‘produce, in a given situation, the best possible writing’’. To this conclusion is added the difficult evaluation of these writings by teachers, more often proofreaders than readers. Reading once again the works by Saussure, Benveniste and Bakhtine makes it possible to address two questions that arise in mirror of each other. How to write a text and return to it improve it ? How to read this text and accompany the writer-subject towards an improvment given the allocated teaching conditions ? Based on the analysis of manuscripts (drafts, intermediate writings and copy writings) of tenth graders, the relation that writer-subjects have with writings is questioned collectively with the said reflexive measures set up by teacher. The scriptural accomplishement of the student is met by a professional accomplishment. The task led by one cannot be understood without the other’s task.

The American Indians population in Minneapolis, Minnesota has experienced limited health care access and threefold diabetes health disparity. The purpose of this study was to measure the extent to which collaborating marketplace clinics and community-based support groups expanded diabetes care and provided self-management education for this largely urban Indian neighborhood. The marketplace clinics located in nearby CVS, Walmart, Target, and Supervalu stores committed financial support, certified educators, and pharmacy staff for the community-based support group. The study was conducted within the patient activation measure (PAM) analytical framework to assess the participants' acquired knowledge, skills, and confidence for diabetes self-management. A case-control study and 3 years retrospective analysis of secondary data were used to test whether the Minneapolis marketplace clinics and the Phillips community diabetes support group participants (n = 48) had improved diabetes health outcomes relative to the control group (n = 87). The intervention group employed motivational interviewing and PAM in coaching diabetes self-care and behavioral modification. The control group received only basic self-management education. T test and Cohen's d effect size measurements were used to quantify the size of the health outcome variables' difference between the study intervention and comparison groups. The positive effects of marketplace clinics and community-based complementation were shown through improved blood sugar control (A1C), weight loss (BMI), and healthful lifestyle changes. Social change progress could be realized by incorporating PAM with diabetes prevention programs for 33 Urban Indian Health Organizations that are located in large cities throughout the United States.

The aim of the master´s project is to provide designs for building permission for a nearly zero-energy veterinary clinic. It is a detached building with two aboveground floors. There are three clinics, one operating rooms, laboratory and staff facilities in the building. First part presents the design of building structure, The superstructure is based on strip foundations made of reinforced concrete in combination with pre-cast permanent formwork made of concrete blocks. The structural system is designed as a masonry system from clay masonry with columns from reinforced concrete. The external walls are load-bearing and covered with thermal insulation and ventilated facade. The floor and roof bearing structure is made of prefabricated concrete slabs. The building is covered with a warm flat green roof. Second part includes the design of building services as lighting, heating, heat recovery ventilation unit. These processes are together shown in a global scheme. Third part is focused on Life cycle assessment of three different flat roof assemblies to compare how they affect the environment. It uses a functional unit 1m2 of a flat roof to define parameters and show how big impact they have on the environment. The project was elaborated using Revit, AutoCad, Deksoft, Building design, GaBi a Lumion software.