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M.P.H., Faculty of Health Sciences, University of the Witwatersrand 2011 / Background: The Employee Health and Wellness (EHW) Centre at the Kimberley Hospital Complex (KHC) started off as a staff clinic, rendering nursing services to staff members with occupational injuries and minor ailments such as influenza, colds and headaches. Since the EHW Programme was introduced in 2004 there has been no evaluation of the services provided. There is no information about referrals and current usage of the service, which compromises further planning. Study aim: The aim of the study was to describe the extent and patterns of utilization of the Employee Health and Wellness Services at the Kimberley Hospital Complex for the period 1 January 2008 to 31 December 2009. Methodology: This was a cross sectional descriptive study, involving a retrospective record review at the EHW Centre. Data extraction from various data sources was recorded on data collection tools using coding instead of names to protect the identity of the employees. The study setting was the EHW Centre at Kimberley Hospital Complex, which is the only hospital with a Centre for Employee Health and Wellness in the Northern Cape Province. Conclusion: The utilization rate of the EHW services at KHC is generally low (6.2% and 6.4%) in 2008 and 2009 respectively. There is a need for further research to determine the reasons for low utilisation through employee and employer interviews and focus group discussions. An interesting fact is the steep increase in the number of employees with multiple visits. It would be interesting to conduct a study that will determine the reasons for multiple visits in one month. There was no significant difference between the age and utilization of EHW services but there was a significant association between gender and components of services used, (chi-square test, p<0.001) for both PHC and OHS components. More males used the PHC component whilst more females used the OHS component of the services. While the reasons have not been established, it may possibly be related to a larger number of female employees in the professional category in the health sector. Thus there is a need for further research to explore the gender mismatch in utilising PHC and OHS components of the services. The Wellness programme was minimally used. There was no significant association between age and medical aid status and the usage of service components. The average length of employment for employees who visited the EHW centre was less than 10 years; there was no significant difference in usage of the service between more experienced and less experienced staff. There is a need for further studies to explore reasons for the low utilization rate of the EHW services as well as the perceptions of service providers and employees regarding the utilisation of these services at Kimberley Hospital Complex.

No description available.

INTRODUCTION: Maternity services are a priority for all health care services but in most cases there have been serious challenges experienced through service performance. The National District Hospital (NDH)‟s key performance indicator is bed occupancy rate which showed an underutilization of this facility. The maternity services statistics, especially did not give a clear picture of the performance of the unit. Various studies have been conducted to identify management challenges in maternity units of district hospitals, but no formal study has been done to systematically document this problem at the National District Hospital (NDH), although there has been anecdotal evidence of problems in the performance of the unit. It was therefore important to investigate the functioning of the maternity unit of the NDH and identify problems that hinder it from functioning effectively. AIM: To evaluate the performance of maternity services in the maternity unit at the National District Hospital. METHODOLOGY: A cross sectional study design was used comprising of a retrospective record review. The setting of this study was the maternity unit at National District Hospital. Data was collected on various variables that are relevant to the performance of maternity services. ANALYSIS: The data collected was analyzed and revealed that the factors contributing to the poor performance of the maternity services were:  Poor record keeping, such as incomplete recording of partograms.  Non adherence to guidelines and protocols, such as poor management related to HIV and AIDS care and poor management of patients in the advanced labor phase.  Failure to make informed decision due to information mismanagement.  Poor supervision in the unit. No adherence to objectives of peer review meetings. RECOMMENDATION: The recommendations based on the findings are: - Establish patient centered maternity services - Train and retraining of health care providers in the maternity unit - Review existing strategies to improve quality of care in the maternity unit - Improve information management and functioning of the Maternal Morbidity Review meetings CONCLUSION: The recommendations given can be used to improve maternity services within district hospitals as well as provincial and national maternity services.

The purpose of this pilot study was to investigate the effect of preferred recorded music versus preferred live music provided as procedural support by a music therapist on reducing problem behaviors and increasing positive behaviors exhibited by persons with dementia during bathing procedures. Carrying out bathing procedures with persons who have dementia has been identified as one of the most challenging tasks faced by caregivers. Persons with dementia often exhibit aggressive and hostile behaviors when engaged in bathing procedures with their caregivers. Because of the lack of previous research designed to address these problem behaviors, and the personal nature of bathing procedures, an experimental probe was carried out with five individuals in the later stages of dementia living in a nursing facility. The designated caregivers of these five individuals volunteered their loved ones to serve as participants in this pilot study. Participants were observed for a total of three showers: one with no music, one with recorded preferred music, and one with music therapy with live preferred music. During the three showers, the music therapist and the staff member administering the bath observed the durations of both problem and positive behaviors. Results were mixed among the five participants; though preferred live music was generally more effective than recorded preferred music or no music in reducing problem behaviors and increasing positive behaviors. / A Thesis submitted to the College of Music in partial fulfillment of the Master of Music. / Fall Semester 2015. / October 26, 2015. / Bathing, Music therapy, Procedural Support / Includes bibliographical references. / Alice-Ann Darrow, Professor Directing Thesis; Dianne Gregory, Committee Member; Jayne Standley, Committee Member.

This work is the continuation of previous research by A. Raza and other contributors to the field of fibre optic plethysmography. Plethysmography is defined as the volume estimation of an object according to its external dimensions. fu particular, this technique can be used to produce an estimation of the respiratory volume of a human subject according to the dimension of his chest, measured at the thoracic and abdominal levels. A respiratory plethysmograph simply attempts to deliver a signal being the closest possible estimation of the true respiratory volume, as measured by a spirometer or a pneumotachometer. There are essentially two instrumental approaches to respiratory plethysmography: 1) The Respiratory Inductive Plethysmograph (RIP) estimates the cross section area of the chest by monitoring the variation of inductance in an electrical wire encircling the chest. 2) The Fibre Optic Respiratory Plethysmograph (FORP) sees the contribution of fibre optic sensors to measure the chest's circumference variations. The purposes of the present investigation were to improve the performance of previous FORP prototypes, and to extend its capabilities to cardiac monitoring. Both these targets have been reached, and the new prototype is now demonstrating the potential of plethysmography as a sound investigation technique for both cardiac and respiratory monitoring. Overall, the improved sensor and acquisition system permitted the resolution of details of the plethysmographic waveforms that were beyond the reach of the previous prototype. The new FORP prototype is generally more reliable and more precise, if not less compact. From a medical point of view, research carried out with the new FORP prototype has had two major outcomes: 1) The increased temporal resolution-of the new acquisition system has given us the possibility to precisely measure the phase shifts between the plethysmographic signals, and the spirometric signal. Such measurements have contributed. to producing a better estimation of the spirometric signal, therefore increasing the credibility of the FORP as a non-invasive, respiratory volume monitoring device. 2) The increased amplitude resolution of the new acquisition system, coupled with the better linearity, better precision and smaller hysteresis of the new sensor, has enabled the FORP to detect body circumference variations due to cardiac activity around head, neck, thorax and abdomen of a patient. Observations of heart movements at thoracic level had already been reported with the RIP, the direct analogue of the FORP. The signal processing required by the RIP for such monitoring only permitted offline, Electro-Cardio-Gram (ECG) assisted interrogation of cardiac displacements. However, thanks to better signal processing, the FORP has been made capable of real time cardiac position monitoring, without referencing to a simultaneous ECG signal. The combined impact of this research and previous research by A. Raza and A. Augousti on respiratory gating with the FORP, is potentially important in the field of cardiac imaging with Magnetic Resonance and Computed Tomography scanners. The FORP should permit better synchronisation with cardiac movements, while helping the patient to maintain stable chest position, subsequently increasing the image resolution by limiting motion blur.

ABSTRACT Introduction In Southern Botswana, an expected advantage of the decentralisation and integration of mental health services into general health services was the potential to allow for the district hospitals to manage a larger number of mentally ill patients thus decreasing the patient load of Lobatse Mental Hospital. However, the number of admissions to the referral hospital for the south of Botswana is increasing. The objective of the study was to describe the capacity of district hospitals to care for mentally ill patients in terms of the provision of relevant inpatient, outpatient and outreach mental health services as well as the availability of trained workers who agree with the principles of decentralisation of mental health services. Materials and methods This was a descriptive cross sectional study involving a self-administered questionnaire survey of key informants and health care providers conducted in five district hospitals in the south of Botswana. There were a total of 5 Chief Medical Officers, and 75 ward staff (12 doctors and 63 nurses) in the study. The quantitative data was entered using the Statistical Package for Social Scientists (SPSS version 13) and analyzed by this software. The qualitative data was coded and thematically analysed and reported. Results In all five hospitals, all the doctors and nurses had undergraduate training in psychiatry and were expected to manage mentally ill patients. There were eighteen health workers (1 doctor and 17 nurses) with postgraduate training in psychiatry/mental health.

Thesis (MPH) -- University of Limpopo, 2012. / Background: Youth friendly services were introduced in all the ten districts t of Lesotho to meet the adolescents health needs including reproductive health of adolescents. Despite this initiative there is still a high prevalence of teenage pregnancy and human immunodeficiency virus (HIV) infection among young people. Aim: The aim of the study was to investigate the utilization, and factors influencing the utilization of reproductive health services (RHS) among high school adolescents in Thaba-Tseka district of Lesotho. Methodology: This was a quantitative descriptive cross-sectional study. The study population was adolescents aged between 13 -19 years in the two high schools in the district. A total of 800 adolescents were asked to complete a structured, self-administered questionnaire. Descriptive statistics were used to summarise demographics, sexual activity, experience of sexually transmitted infections (STIs), and awareness and use of RHS. The chi-square test was used to identify associations between categorical variables, and binary logistical regression modelling was used to identify significant predictors of utilisation of RHS. Results: The response rate was 97.5% (780/800), but only 723 questionnaires had sufficient data to be analysed. The mean age of respondents was 16.4 years with a standard deviation of 1.7years. Of the respondents, 49.5% (358/723) had been sexually active with the youngest age at sexual debut of 8 years. Of these, 71.5% (256/358) were presently sexually active; 82.4% (295/358) had low overall levels of awareness of RHS; 37.9% (136/358) had ever visited the adolescent health corner (AHC); 34.9% (125/358) reported that there was a place that provided RHS in their local clinic; 57.3% (205/358) had ever used condoms; and 56.7% (203/358) had experienced a STI; Of those presently sexually active, 89.5% (229/256) used some form of contraceptive, with 95.2% (218/229) buying condoms from a retail shop although only 94.0% (205/218) reported using them, while 38.9% (89/229) also obtained them from the AHC. Only 13.3% (27/203) of those who had experienced signs of STI ever visited the AHC for treatment. Of those who knew about RHS, 54.4% (68/125) utilized the services. Statistically significant predictors of RHS utilization were having a friend using RHS (odds ratio [OR] =8.87; P value< 0.001) and access to RHS (OR=7.97; P < 0.001). Participants in higher grades were significantly less likely to use RHS compared to participants in lower grades (OR=0.21; P<0.001). Conclusion: Almost half of the adolescents engage in sexual activity at an early age and RHS are under-utilised, mostly because of lack of access. There is a need to embark on increasing accessibility of RHS among adolescents to promote utilization of RHS.

State and federal aid payments to local governments have grown explosively over the last fifteen years. One reason for this growth is that the donor governments can alter a local government's budget choices through grants. Grants have not remedied social problems, however, because the local governments' responses to grants were not anticipated. Economists have broadened our understanding, but debates remain about the proper modeling of local buur grant impact knowledge. Accordingly, this study examined the effects of thdgeting and, because researchers used aggregated data, gaps exist in oree types of mental health grants on the budget allocations for Oregon counties. The theoretical literature on the expenditure effects of grants was first reviewed. The constrained maximization, median voter, and budget maximization models of local fiscal decision-making were described and then compared as to their predictions about the effects of different grants. It was concluded that too little was known about budgetary processes to use or compare the models' predictions. Empirical studies were then reviewed. Researchers, largely using demand frameworks, found that grants significantly affected local spending and that different grants induced different spending responses. Their estimates of the stimulus differed, though. Moreover, little or no research was undertaken on the employment, wage, and output effects of grants. The theoretical and statistical problems with these studies were examined. These problems were: (1) the misspecification of aid variables; (2) the aggregation of government units and public services; (3) the lack of institutional and political realism. A theoretical model of Oregon counties' expenditure and production decision-making for mental health services was developed based on the insights and criticisms of existing models. The model consists of eleven equations; some describing the "expenditure stage" of the budget process, others describing the "output stage". It was argued that county commissioners make the expenditure decisions, and that mental health administrators make the production decisions. The framework allowed us to examine the effects of mental health grants on expenditures, wages, staff numbers, patient numbers, and output and to study the determinants of grant participation. Using regression analysis, the equations were estimated from the observations for 31 Oregon counties in fiscal year 1975-1976. Ordinary least squares was used in the expenditure and grant participation equations. Two-stage and three-stage least squares were used in the rest. Regressions were run for western and eastern Oregon counties when possible. For all observations, the major findings suggested that a dollar of state matching mental health aid per capita stimulated per capita mental health expenditures by $1.37, increased the professional staff by .556 to .762 persons per 10,000 county residents and increased average professional salaries by $2,173. A dollar of federal matching aid per capita appeared to have an expenditure effect of $1.03, an employment effect of .722, and no salary effect. A dollar of non-matching aid per capita had an estimated expenditure effect of $1.00, an estimated employment effect of .35, and no salary effect. In eastern Oregon, the major findings indicated that the marginal expenditure effect of federal aid was $1.41, the marginal expenditure effect of non-matching aid was $.96, and that state matching aid had no expenditure effect. In western Oregon, a dollar of state matching aid per capita had an estimated expenditure effect of $2.23, a professional employment effect of 1.25, and no significant salary effect. A dollar of non-matching aid per capita had an estimated expenditure effect of $1.67, and no significant employment or salary effects. In all regressions, the mental health grant estimates were not statistically different from one another. Finally, a production function for mental health services was unsuccessfully estimated and discussed. / Graduation date: 1979

Thesis (Ph. D.)--Open University. BLDSC no. DX219994.