Este trabalho teórico busca uma nova forma de entender a saúde mais ampla e interdependente em relação ao meio no intuito de superar a forma atual cartesiana e antropocêntrica de ver a saúde e as dificuldades por ela enfrentadas. Faz isto se utilizando da Teoria da Complexidade, inspirada em Morin, e ao estudar suas características e compará-las com as da saúde, propõe a construção de uma Noção Complexa de Saúde, demonstra aspectos de sua importância e dá exemplos de sua abrangência, sugerindo que seja aplicada na educação, numa aprendizagem conjunta da Noção Complexa de Saúde com a Teoria da Complexidade, num processo de auxílio mútuo que estamos chamando de pedagogia recursiva. / This theoretical work seeks a new way of understanding the wider and interdependent health in relation to the environment in order to overcome the Cartesian and anthropocentric current way of seeing the health and the difficulties it faces. He does this by using the Complexity Theory, inspired by Morin, and by studying its characteristics and comparing them with those of health, proposes the construction of a Complex Notion of Health, demonstrates aspects of its importance and gives examples of its scope, suggesting That is applied in education, in a joint learning of the Complex Notion of Health with the Complexity Theory, in a process of mutual assistance that we are calling recursive pedagogy.

Este trabalho teórico busca uma nova forma de entender a saúde mais ampla e interdependente em relação ao meio no intuito de superar a forma atual cartesiana e antropocêntrica de ver a saúde e as dificuldades por ela enfrentadas. Faz isto se utilizando da Teoria da Complexidade, inspirada em Morin, e ao estudar suas características e compará-las com as da saúde, propõe a construção de uma Noção Complexa de Saúde, demonstra aspectos de sua importância e dá exemplos de sua abrangência, sugerindo que seja aplicada na educação, numa aprendizagem conjunta da Noção Complexa de Saúde com a Teoria da Complexidade, num processo de auxílio mútuo que estamos chamando de pedagogia recursiva. / This theoretical work seeks a new way of understanding the wider and interdependent health in relation to the environment in order to overcome the Cartesian and anthropocentric current way of seeing the health and the difficulties it faces. He does this by using the Complexity Theory, inspired by Morin, and by studying its characteristics and comparing them with those of health, proposes the construction of a Complex Notion of Health, demonstrates aspects of its importance and gives examples of its scope, suggesting That is applied in education, in a joint learning of the Complex Notion of Health with the Complexity Theory, in a process of mutual assistance that we are calling recursive pedagogy.

Este trabalho teórico busca uma nova forma de entender a saúde mais ampla e interdependente em relação ao meio no intuito de superar a forma atual cartesiana e antropocêntrica de ver a saúde e as dificuldades por ela enfrentadas. Faz isto se utilizando da Teoria da Complexidade, inspirada em Morin, e ao estudar suas características e compará-las com as da saúde, propõe a construção de uma Noção Complexa de Saúde, demonstra aspectos de sua importância e dá exemplos de sua abrangência, sugerindo que seja aplicada na educação, numa aprendizagem conjunta da Noção Complexa de Saúde com a Teoria da Complexidade, num processo de auxílio mútuo que estamos chamando de pedagogia recursiva. / This theoretical work seeks a new way of understanding the wider and interdependent health in relation to the environment in order to overcome the Cartesian and anthropocentric current way of seeing the health and the difficulties it faces. He does this by using the Complexity Theory, inspired by Morin, and by studying its characteristics and comparing them with those of health, proposes the construction of a Complex Notion of Health, demonstrates aspects of its importance and gives examples of its scope, suggesting That is applied in education, in a joint learning of the Complex Notion of Health with the Complexity Theory, in a process of mutual assistance that we are calling recursive pedagogy.

India, the world’s largest democracy and second most populous country, is in the midst of an economic boom with gross domestic product growth averaging nearly 8% over the past several years despite a worldwide recession. The World Health Organization (WHO) has predicted that trauma case related deaths in India will move from ninth position up to the third position by 2020. The organization structure for an improved national trauma system in India will depend on a national inclusive strategy supported by resources and funding within a service quality framework to win public trust. This must include an integrated nationally coordinated approach to the organization of pre-hospital care facilities, hospital networking and communication systems, and the organization of in-hospital care.

<p>This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sources are used: (1) The Tierp study of community-dwelling persons (n=421, ages 75+), (2) the SWEOLD nationally representative samples (n=537 in 1992 and n=561 in 2002, ages 77+), and 3) SNAC-K comprised of home-help recipients in a district of Stockholm (n=1108, ages 65+).</p><p>Study I suggests that the length of the follow-up period may explain some of the differences found in predictor strength when comparing mortality studies. Predictors that can change rapidly (e.g., health) were found to be strongest for the short term, with a lower average mortality risk for longer follow-ups. Stable variables (e.g., gender) were less affected by length of follow-up.</p><p>Studies II and III present a measure of complex health problems based on serious problems in at least two of three health domains. These were diseases/symptoms, mobility, and cognition/communication. Prevalence of complex health problems increased significantly between 1992 and 2002. Older age, female gender, and lower education increased the odds of having complex problems. Complex problems strongly predicted 4-year mortality. Controlled for age, gender, health, and education, mortality decreased by 20% between 1992 and 2002. Men with complex problems accounted for this decrease. Thus, in 2002 the gender difference in mortality risk was almost eliminated among the most vulnerable adults.</p><p>Study IV revealed that physical and cognitive limitations, higher age, and living alone were significantly related to home-help allocation, with physical and cognitive limitations dominating. Psychiatric symptoms did not affect the assessment.</p><p>The increased prevalence of complex health problems and increased survival among people with complex needs have important implications concerning the need for collaboration among service providers.</p>

This thesis investigates health trends among very old people and the allocation of public home-help services. A further aim is to examine methodological issues in mortality analysis. Three data sources are used: (1) The Tierp study of community-dwelling persons (n=421, ages 75+), (2) the SWEOLD nationally representative samples (n=537 in 1992 and n=561 in 2002, ages 77+), and 3) SNAC-K comprised of home-help recipients in a district of Stockholm (n=1108, ages 65+). Study I suggests that the length of the follow-up period may explain some of the differences found in predictor strength when comparing mortality studies. Predictors that can change rapidly (e.g., health) were found to be strongest for the short term, with a lower average mortality risk for longer follow-ups. Stable variables (e.g., gender) were less affected by length of follow-up. Studies II and III present a measure of complex health problems based on serious problems in at least two of three health domains. These were diseases/symptoms, mobility, and cognition/communication. Prevalence of complex health problems increased significantly between 1992 and 2002. Older age, female gender, and lower education increased the odds of having complex problems. Complex problems strongly predicted 4-year mortality. Controlled for age, gender, health, and education, mortality decreased by 20% between 1992 and 2002. Men with complex problems accounted for this decrease. Thus, in 2002 the gender difference in mortality risk was almost eliminated among the most vulnerable adults. Study IV revealed that physical and cognitive limitations, higher age, and living alone were significantly related to home-help allocation, with physical and cognitive limitations dominating. Psychiatric symptoms did not affect the assessment. The increased prevalence of complex health problems and increased survival among people with complex needs have important implications concerning the need for collaboration among service providers.

Children with complex health problems who are dependent upon medical technology require frequent hospitalizations, during which parents must make difficult decisions regarding their child’s care. Although principles of “family-centred care” have been widely adopted by paediatric hospitals, studies indicate that many parents are dissatisfied with their roles in decisions about their child’s care. Pierre Bourdieu’s Logic of Practice, specifically his concepts of field, capital, and habitus, as they relate to cultural and symbolic capital within the field of pediatric medicine, were used to guide the design of a parent briefing intervention aimed at improving parents’ satisfaction with decision making. Briefings were conducted during daily hospital rounds. Physicians and nurses were asked to sit while using a checklist as a communication guide. A two-part study was conducted to determine feasibility of a randomized controlled trial of a parent briefing. One component was a psychometric evaluation of an instrument to measure parents’ satisfaction with decision making. The other was a phase I single group, post-test study of the parent briefing. Eighty-two parents of children admitted to an in-patient unit in a large metropolitan pediatric health centre, with an expected length of stay ≥ 3 days, completed the Family Satisfaction with Decision Making (FS/DM) subscale and the Decisional Conflict Scale (DCS) prior to discharge. A subgroup of parents participated in the parent briefing study. The Cronbach’s alpha reliability coefficient of the FS/DM was 0.87, and it was inversely correlated with the DCS (r2= -0.635, p<0.0001). Eighteen physicians, 25 nurses, and 31 parents participated in the phase I trial of the briefing intervention. Sixty-eight out of an expected 93 briefings were carried out as per study protocol. Nineteen parents did not receive the required “dose” of the study intervention. Mean time to complete the intervention was 11.9 minutes (SD = 6.9). Parents and nurses rated the acceptability and usefulness of the intervention favourably, whereas physicians’ ratings were mixed. The FS/DM instrument is a suitable primary outcome measure for an RCT. However, more work needs to be done, to ensure the feasibility of the intervention, including more intensive clinician training.

Children with complex health problems who are dependent upon medical technology require frequent hospitalizations, during which parents must make difficult decisions regarding their child’s care. Although principles of “family-centred care” have been widely adopted by paediatric hospitals, studies indicate that many parents are dissatisfied with their roles in decisions about their child’s care. Pierre Bourdieu’s Logic of Practice, specifically his concepts of field, capital, and habitus, as they relate to cultural and symbolic capital within the field of pediatric medicine, were used to guide the design of a parent briefing intervention aimed at improving parents’ satisfaction with decision making. Briefings were conducted during daily hospital rounds. Physicians and nurses were asked to sit while using a checklist as a communication guide. A two-part study was conducted to determine feasibility of a randomized controlled trial of a parent briefing. One component was a psychometric evaluation of an instrument to measure parents’ satisfaction with decision making. The other was a phase I single group, post-test study of the parent briefing. Eighty-two parents of children admitted to an in-patient unit in a large metropolitan pediatric health centre, with an expected length of stay ≥ 3 days, completed the Family Satisfaction with Decision Making (FS/DM) subscale and the Decisional Conflict Scale (DCS) prior to discharge. A subgroup of parents participated in the parent briefing study. The Cronbach’s alpha reliability coefficient of the FS/DM was 0.87, and it was inversely correlated with the DCS (r2= -0.635, p<0.0001). Eighteen physicians, 25 nurses, and 31 parents participated in the phase I trial of the briefing intervention. Sixty-eight out of an expected 93 briefings were carried out as per study protocol. Nineteen parents did not receive the required “dose” of the study intervention. Mean time to complete the intervention was 11.9 minutes (SD = 6.9). Parents and nurses rated the acceptability and usefulness of the intervention favourably, whereas physicians’ ratings were mixed. The FS/DM instrument is a suitable primary outcome measure for an RCT. However, more work needs to be done, to ensure the feasibility of the intervention, including more intensive clinician training.

The survival rate and life expectancy of infants with complex health needs have increased overthe last decades, and this increases the number of families who have to care for such infants at home. These families seek support in the community setting, and supporting them has a positive impact on the well-being of both the parents and the infant. In South Africa the needs of these parents are not known, and this fact makes it difficult to adequately support them in the community. The aim of this study was to explore and describe the needs of parents of infants with complex health needs in the community setting. Two objectives were set to reach the aim mentioned above: 1) to critically appraise and synthesise the best available evidence on the support needs of parents of infants with complex health needs and 2) to explore and describe parents’ emic perspective on their support needs as parents of infants with complex health needs in a South African context. A sequential mixed method approach was utilised in two phases, here discussed in five chapters. In an attempt to meet objective one, the support needs of parents of infants with complex health needs were determined by means of an integrative literature review from studies obtained through computerised searches of several electronic databases, supplemented by checking reference lists and consultation with experts. This was followed by individual face-to-face interviews with the stated parents in three different settings. The latter addressed the second objective of the study, namely to provide an emic perspective on the support needs of parents of infants with complex health needs in a South African context. The integrative literature review described five main themes on the support needs of parents of infants with complex health needs: need for information, need for parent-to-parent support, need for professional support, need for self-confidence in the care of the infant and need for social support. All of these themes were confirmed in the South African context through the interviews with parents. However, South African parents added an additional theme: the need for normality. The final chapter offers an evaluation of the study and discusses study limitations and recommendations for nursing practice, education and research. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

The survival rate and life expectancy of infants with complex health needs have increased overthe last decades, and this increases the number of families who have to care for such infants at home. These families seek support in the community setting, and supporting them has a positive impact on the well-being of both the parents and the infant. In South Africa the needs of these parents are not known, and this fact makes it difficult to adequately support them in the community. The aim of this study was to explore and describe the needs of parents of infants with complex health needs in the community setting. Two objectives were set to reach the aim mentioned above: 1) to critically appraise and synthesise the best available evidence on the support needs of parents of infants with complex health needs and 2) to explore and describe parents’ emic perspective on their support needs as parents of infants with complex health needs in a South African context. A sequential mixed method approach was utilised in two phases, here discussed in five chapters. In an attempt to meet objective one, the support needs of parents of infants with complex health needs were determined by means of an integrative literature review from studies obtained through computerised searches of several electronic databases, supplemented by checking reference lists and consultation with experts. This was followed by individual face-to-face interviews with the stated parents in three different settings. The latter addressed the second objective of the study, namely to provide an emic perspective on the support needs of parents of infants with complex health needs in a South African context. The integrative literature review described five main themes on the support needs of parents of infants with complex health needs: need for information, need for parent-to-parent support, need for professional support, need for self-confidence in the care of the infant and need for social support. All of these themes were confirmed in the South African context through the interviews with parents. However, South African parents added an additional theme: the need for normality. The final chapter offers an evaluation of the study and discusses study limitations and recommendations for nursing practice, education and research. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.