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In Canada, the literature regarding First Nations people’s experiences with dementia is sparse, as is the literature relating to the health and wellness of Indigenous dementia caregivers. Colonization has imposed physical, psychological and structural disadvantages on Indigenous communities that impact the family’s ability to provide informal dementia care. The First Nations senior population is growing rapidly and there is a pressing need to gather knowledge about the unique needs of First Nations informal dementia caregivers. This doctoral research seeks to contribute to the growing body of literature on this vitally important topic. This thesis reports the findings from my PhD research study, which was conducted in collaboration with the Nuu-Chah-Nulth Tribal Council, and with generous support from the Nuu-Chah-Nulth community. Using an Indigenous storytelling research method, the study explored the following questions: What are the experiences of Nuu-Chah-Nulth First Nations dementia caregivers? What support services do caregivers access and what services do they perceive are lacking? Nine Nuu-Chah-Nulth caregivers shared their experiences providing support and care to a family member with memory loss, and their perspectives on memory care resources. Interviews were conducted in various locations within the Nuu-Chah-Nulth territories to gather the caregiver’s knowledge. The author’s story as an informal dementia caregiver is also interwoven throughout the dissertation. The Nuu-Chah-Nulth caregivers narratives revealed diverse and complex experiences with the following central themes and sub-themes: trauma over the life-cycle (residential school, family violence, grief and loss); pressures of care-giving (managing the symptoms of dementia, health and family dynamics); and finally, participants’ perceptions of community resources. The findings from this research reveal that Nuu-Chah-Nulth dementia caregivers and the family members they supported were still healing from the various traumas that were inflicted on their mind, body and spirit through residential school experiences. Most of the caregivers reported that they prefer to care for their family member at home but community supports are limited. / Graduate

In his classic book, Experiencing Architecture, Rasmussen (1959) noted that architects inspired by addressing problems in built environments created buildings with a special spirit: a distinctive stamp. Recent problems in healthcare facilities, specifically those related to reducing stress and anxiety, have inspired designers to create positive, uplifting distractions to redirect a patient's attention from a sterile environment and/or noxious event. In doing so, healthcare facilities have become special environments with a caring spirit. This study examined a specific aspect of creating a caring environment: determining whether or not a positive distraction, a child's art-light mosaic movie developed by the researcher, would lower pain and distress in children 4, 5, and 6 years old during an immunization procedure. The researcher conducted a randomized controlled study in two locations using a child's self-report pain scale, heart rate, parent/guardian report, and nurse report measures. After collecting and analyzing data from 76 well-participants receiving one to five immunizations, the researcher found no statistically significant difference between the conditions for any of the measures. Thus, the null hypothesis, the art-light mosaic image would not assist in lowering pain and distress in pediatric patients, 4 to 6 years old, during an immunization procedure, was not rejected. From these results, the researcher recommended future studies incorporate training the parent and child on how to use the distraction, combine the distraction with a topical analgesic, provide a clear understanding of pain and distress from the child's point of view, and develop more sensitive self-report measures of pain for children. / Ph. D. / In his classic book, Experiencing Architecture, Rasmussen (1959) noted that architects inspired by addressing problems in built environments created buildings with a special spirit. Recent problems in places that provide healthcare, specifically those related to reducing stress and anxiety, have inspired designers to create positive, uplifting distractions to redirect a patient’s attention from an unfriendly environment and/or unpleasant event. In doing so, healthcare facilities have become special places with a caring spirit. This study investigated one area in creating a caring environment: determining whether or not a positive distraction, a child’s art-light mosaic movie developed by the researcher, would lower pain and distress in children 4, 5, and 6 years old receiving a vaccination. The researcher conducted a study in two locations using proven measures to determine the child’s anxiey. After collecting and analyzing information from 76 well-children receiving one to five vaccinations, the researcher found no difference between the children’s anxiety watching or not watching the positive distraction during a vaccination. Therefore the researcher stated the positive distraction, an art-light mosaic image, would not help lower pain and distress in children, 4 to 6 years old, during a vaccination. From these results, the researcher recommended future studies include training the parent and child on how to use the distraction, combine the distraction with a cream designed to rub on the skin to relieve pain, provide a clear understanding of pain and distress from the child’s point of view, and develop better measures to determine pain in children.

In the complex landscape of healthcare, patients navigate through various institutions from hospitals to long-term care facilities, and each step of their journey plays a crucial role in their disease progression and treatment plan. Traditional analyses often focus on individual transitions, offering limited insight into the broader picture of patient care and disease progression. This thesis aims to explore the entire sequence of patient transitions within the Canadian healthcare system to uncover meaningful patterns and commonalities. This research employs an innovative approach to leveraging the Canadian Institute for Health Information (CIHI) dataset, consisting of around 250,000 patient records after data cleaning and including approximately 10-11 variables. Extracting a diverse category of features, such as temporal, semantic, and clinical information, constructs a detailed profile for each patient journey. These profiles then undergo an parallel mini-batch average agglomerative hierarchical clustering process, grouping together patients with similar healthcare trajectories to identify prevailing pathways and transitions within the system. By understanding these patterns, healthcare providers and policymakers can gain insights into the patient experience, potentially revealing areas for improvement, optimization, and personalization of care. Key findings include uncovering transitions in the healthcare environment, identifying the most common pathways, and studying the alternate level of care length of stay for each scenario. Looking ahead, the research anticipates incorporating additional layers of data, such as specific interventions and medications, to enrich the analysis. This expansion aims to offer a more comprehensive view of patient journeys, further enhancing the ability to tailor healthcare services to meet individual needs effectively. / Thesis / Master of Computer Science (MCS)

No / Poor standards of care are unacceptable, but solutions are far from being straightforward. This is a complex issue that is influenced by individual attitudes, perceptions and cultural norms

No

Purpose – To examine the relationship between outpatient service quality expectation, perception and their effect on satisfaction at Gauteng public hospitals. Problem - Gauteng Public healthcare facilities are perceived to be offering deficient and poor quality service to their outpatient clients. Methodology – The SERVQUAL questionnaire tool is used, it encompasses the six dimensional structures of quality. 406 outpatients at public hospitals are the respondents. Limitations – Data collection environment could have led to the collection of inaccurate data. Data collection errors could exist due to the fact that the field workers had to translate questions for the candidates. These limitations limit the conclusions that can be drawn on the study. Findings/implications – The majority of outpatient expectations are not met. Patients are dissatisfied with the overall service quality provided by their outpatient departments. This has the effect of making patients reluctant to attend such facilities and could lead to treatment non compliance.

The movement of nursing professionals from the public sector to the private sector, and from the private sector to foreign countries severely impact on the ability of developing countries to meet their domestic health care needs. In South Africa, the public health care system is facing serious human resource constraints, due to this migration. There simply aren’t enough experienced nurses to manage the escalating health care service consumption caused by factors such as population growth, increased burden of disease, the HIV/AIDS pandemic and decreased training of nursing personnel. A staggering 37 801 doctor and nurse posts are vacant in public hospitals and clinics (Kahn, 2008). Unless improved human resource management strategies are implemented urgently, the migration of health care workers from especially public service health institutions in South Africa will seriously hamper implementation of the stated health care reform strategy. This study investigates the reasons why South African nurses are leaving the public and private health sector, or their profession, or even the country as a whole. Based on the results of a survey of 67 nurses in the private and public health sectors in the northern Kwazulu Natal area, the study found that unfavorable working conditions together with low levels of job satisfaction caused by perceived reasons such as insufficient salaries, limited career advancement, ineffective management, excessive workload and safety concerns led to this state of job satisfaction. Most of the drivers responsible for this exodus can be attributed to the real or perceived deterioration in socio-political factors. The recommendations for the health care sector in South Africa are; • Review nurses salaries annually – not only during restructuring or crisis situations. • Ensure that nurse’s remuneration packages are competitive with those of similar professions. • Pay nurses incentives for working unsocial hours. • Pay nurses bonuses for acquiring additional qualifications. • Pay nurses who work late shifts additional allowances. • Train nursing managers. • Provide training and education opportunities for nursing staff. • Respect should be shown by managers, physicians and colleagues. • Improve the workplace environment and working conditions of nursing staff. • Improve overall morale by rewarding excellence and treating nurses with respect and dignity.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Objective: Mental health plays a central role in the well‐being of individuals. Understanding the factors that influence mental wellness is critical in order to develop effective policy that addresses the burden of mental illness in society. The objective of this study is to identify a possible relationship between healthcare access and the presence of mental distress in individuals. Methods: Logistic regression was performed using cross sectional data from a CDC developed nationwide behavioral health surveillance program (BRFSS, 2013‐4). Odds ratios were estimated using frequent mental distress as the outcome of interest while adjusting for confounding variables such as smoking, binge drinking, obesity, etc. Six models were estimated utilizing our hypothesized variables of interest. Results: The calculated adjusted odds ratios (AOR) and confidence intervals (CI) demonstrated a positive correlation between certain variables measuring access to healthcare and the reporting of frequent mental distress, agreeing with the hypothesis. Those variables were financial cost preventing access to medical care (AOR [2], CI [1.9‐2.1]) as well as a span of more than 2 years having elapsed since a routine medical checkup by a healthcare provider (AOR [1.1], CI [1.1‐ 1.2]). The opposite effect was demonstrated in individuals who had no insurance coverage (AOR [.8], CI [.7‐.9]), which was contrary to the hypothesis. Conclusion: After adjusting for confounding variables, a strong relationship exists between individuals who are not able to see a physician due to cost, and the presence of frequent mental distress. Frequent mental distress is also increased in individuals who have not had a routine medical checkup with a physician in the last 2 years.

In this dissertation, we investigate three topics: predictive models for disease diagnosis and patient behavior, optimization for cancer treatment planning, and public health decision making for infectious disease prevention. In the first topic, we propose a multi-stage classification framework that incorporates Particle Swarm Optimization (PSO) for feature selection and discriminant analysis via mixed integer programming (DAMIP) for classification. By utilizing the reserved judgment region, it allows the classifier to delay making decisions on ‘difficult-to-classify’ observations and develop new classification rules in later stage. We apply the framework to four real-life medical problems: 1) Patient readmissions: identifies the patients in emergency department who return within 72 hours using patient’s demographic information, complaints, diagnosis, tests, and hospital real-time utility. 2) Flu vaccine responder: predicts high/low responders of flu vaccine on subjects in 5 years using gene signatures. 3) Knee reinjection: predicts whether a patient needs to take a second surgery within 3 years of his/her first knee injection and tackles with missing data. 4) Alzheimer’s disease: distinguishes subjects in normal, mild cognitive impairment (MCI), and Alzheimer’s disease (AD) groups using neuropsychological tests. In the second topic, we first investigate multi-objective optimization approaches to determine the optimal dose configuration and radiation seed locations in brachytherapy treatment planning. Tumor dose escalation and dose-volume constraints on critical organs are incorporated to kill the tumor while preserving the functionality of organs. Based on the optimization framework, we propose a non-linear optimization model that optimizes the tumor control probability (TCP). The model is solved by a solution strategy that incorporates piecewise linear approximation and local search. In the third topic, we study optimal strategies for public health emergencies under limited resources. First we investigate the vaccination strategies against a pandemic flu to find the optimal strategy when limited vaccines are available by constructing a mathematical model for the course of the 2009 H1N1 pandemic flu and the process of the vaccination. Second, we analyze the cost-effectiveness of emergency response strategies again a large-scale anthrax attack to protect the entire regional population.