Two projects are documented within this MEM Report: I. The first project examined what was learnt involving the critical infrastructure in the aftermath of natural disasters in the Canterbury region of New Zealand – the most prominent being the series of earthquakes between 2010 and 2011. The project identified several learning gaps, leading to recommendations for further investigations that could add significant value for the lifeline infrastructure community. II. Following the Lifeline Lesson Learnt Project, the Disaster Mitigation Guideline series was initiated with two booklets, one on Emergency Potable Water and a second on Emergency Sanitation. The key message from both projects is that we can and must learn from disasters. The projects described are part of the emergency management, and critical infrastructure learning cycles – presenting knowledge captured by others in a digestible format, enabling the lessons to be reapplied. Without these kinds of projects, there will be fewer opportunities to learn from other’s successes and failures when it comes to preparing for natural disasters.

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Sammanfattning: 20 – 50 % af patienter indlagt på sygehuse er underernæret eller i risiko for underernæring. 40 % af alle indlagte patienter får ikke dækket det daglige behov for energi og protein og der er evidens for, at sundhedsprofessionelles viden om ernæring til småtspisende patienter er begrænset. 2oo2 blev der udviklet et ernæringsscreeningsredskab, der kan vurderer ernæringstilstanden hos alle patienter indlagt på Sygehus Sønderjylland. Det er således muligt at vurdere patientens ernæringstilstanden og iværksætte en forebyggende ernæringsindsats. Dette vil forårsage en bedring i patientens levevilkår og konsekvenser af underernæring mindskes. Studiets teoretiske kontekst indeholder elementer fra et sundhedsfremmende perspektiv, kvalitets- og implementeringsprocesser og postmodernisme. Formål: Udvikling og afprøvning af et redskab, der kan vurdere kvaliteten af den sundhedsprofessionelle ernæringsindsats til de småtspisende patienter. Metode: Der er gennemført en kvantitativ spørgeskemaundersøgelse, survey. Resultat: Det ses ikke, at sundhedsprofessionelle under implementeringsprocessen har fået øget faglig viden på ernæringsområdet til de småtspisende patienter. Der er sket en mindre vidensudvikling i forhold til ernæringsscreeningsredskabet. Fortsat er der usikkerhed i de sundhedsfaglige arbejdsrutiner på ernæringsområdet og det tværfaglige og tværsektorielle samarbejde er nærmest usynligt. Der ses ikke effekt af ernæringsindsatsen til patienten i denne undersøgelse. Konklusion: En implementeringsproces af et ernæringsscreeningsredskab tager mere end et år og det er nødvendigt at fortsætte kvalitets- og forbedringsarbejde på ernæringsområdet.Kvalitetsudviklingsarbejde synliggør et sundhedsfagligt indsatsområde. Ønskes derimod at skabe en forankring af den sundhedsfaglige indsats er udfordringen at anvende redskaber fra systemtænkning og forbedringsarbejde. Når sundhedsprofessionelle får mulighed for at udvikle ejerskab og ansvar for implementeringsprocessen, får kvalitetsarbejdet større effekt og bliver attraktivt. Nøglebegreber i fremtidige implementeringsprocesser er kvalitetsudvikling og forandrings arbejde, såvel som fokus på værdibaseret faglig ledelse og igangsættelse af læreprocesser / Abstract: 20 – 50 % of patients are in nutritional risk on admission to hospital. 40 % of the patients do not receive an adequate amount of energy and protein to cover the daily need for nutrition and health professionals knowledge about nutritional needs to underweight patients are limited. In 2002 a nutritional screening tool, which can be used to estimate the nutritional status in all patients admitted to Sygehus Sønderjylland was developed. It is now possible to estimate nutritional status at an early stage and start nutritional treatment with the purpose to avoid under nutrition. This leads to improved life skills for the patient and consequences of under nutrition are limited. The theoretical context of this study contains elements from a health promotion perspective, system thinking, quality- and implementation processes and postmodernism. Purpose: Developing and testing of a tool that can determine the quality of nutritional treatment and care given by health professionals to undernourished patients. Method: A quantitative questionnaire, survey, has been carried out.Result: The result of the survey does not provethat health professionals under the implementation process have increased their knowledge about the undernourished patients. In relation to the nutritional screening tool only minimum of improvement in knowledge has been detected as a result of increased documentation. Still the working routines in the nutritional area among health professionals are unclear and the cross-sectional and interdisciplinary co-operation is invisible. The result of this survey does not show any improvement related to the nutritional effect of the undernourished patient. Conclusion: An implementation process of a nutritional screening tool takes more than one year and it is necessary to continue the quality and improvements in the nutritional area. Quality and managing change will high light a health promoting area. If change in working routines and values among health professionals is wanted, the challenge is to use tools from system thinking and improvement strategies. When health professionals get the opportunity to create ownership and responsibility for an implementation process in a health promoting area, the effect of quality management will become larger and more attractive. Keywords in future implementation processes are quality and managing change as well as focus on value-based management and to start learning processes / <p>ISBN 978-91-85721-03-0</p>

The high prevalence of sexual abuse suffered by women as children is well documented, both internationally and in South Africa. The life outcomes of women who had experienced childhood sexual abuse are generally reported as adverse, yet some of these survivors manage to overcome the abusive relationship and experience positive changes in themselves and their lives. Emerging trauma literature thus supports a philosophical shift from a pathogenic to a autogenic paradigm in which the focus is on positive and adaptive post trauma outcomes. Previous trauma models, which were based on a pathogenic model, are now shifting to a positive psychology trend by incorporating a salutary component, which includes a spiritual and existential dimension as well as an area of potential emerging growth. Information on the constructive coping behaviours, posttraumatic growth and psychological well-being of women who had experienced childhood sexual abuse can lead to the formulation of guidelines with strategies for an intervention programme that can facilitate and enhance coping, posttraumatic growth and psychological well-being in survivors of childhood sexual abuse. This research investigated the coping behaviours, posttraumatic growth and psychological well-being of women who had experienced childhood sexual abuse. The research was carried out in South Africa in the greater Gauteng Province and surrounding areas, with women who had experienced sexual abuse in childhood. A mixed method research design was used in which: the first phase was quantitative research conducted with validated psychometric instruments measuring coping behaviour, posttraumatic growth and psychological well-being. These instruments were the COPE (Coping Self-efficacy Scale), the Posttraumatic Growth Inventory, the Mental Health Continuum, Rosenberg’s Self-esteem Scale and the General Health Questionnaire. The second phase was of a qualitative nature, and explored the stories and experiences of women identified as coping constructively, manifesting posttraumatic growth and psychological well-being, by using semi-structured interviews. Lastly, the data obtained was used to formulate guidelines with specific strategies, which can be used by helping professionals in a group context to facilitate and enhance constructive coping, posttraumatic growth and psychological well-being in survivors of childhood sexual abuse. The results of this research were as follows: prevalence of constructive coping, posttraumatic growth and psychological well-being was determined, and indicated that 58% of participants manifested constructive coping, 60% manifested posttraumatic growth and 42% manifested psychological well-being. Semi-structured interviews conducted with the women scoring in the upper range of coping constructively, growing after the trauma and emerging psychologically well were transcribed and analysed by means of interpretative phenomenological analysis, and the following broad themes emerged: psycho-socio spiritual resources, the healing process and positive strengths. These themes and sub-themes produced data which could be used in the formulation of guidelines with strategies for an intervention programme aimed at enhancing and facilitating constructive coping, posttraumatic growth and psychological well-being thereby improving the therapeutic services available to childhood sexual abuse survivors. Finally the study was evaluated and conclusions and recommendations were made. / PhD, Psychology, North-West University, Vaal Triangle Campus, 2012

Bakgrund: Att arbeta i en miljö där hälsofarlig rök och risk för smitta förekommer innebär en risk för operationssjuksköterskans hälsa. På universitetssjukhuset finns riktlinjer om när mun- och andningsskydd ska användas. Syfte: Att undersöka om operationssjuksköterskorna på universitetssjukhuset har fullgoda kunskaper om sjukhusets riktlinjer angående mun- och andningsskydd. Att undersöka förutsättningarna för operationssjuksköterskorna att kunna följa riktlinjerna, deras upplevelse av riktlinjernas tillgänglighet samt vilka faktorer som avgör operationssjuksköterskornas val av mun- och andningsskydd. Metod: Studien är en deskriptiv enkätstudie med tvärsnittsdesign och kvantitativ ansats. Enkäter delades ut till operationssjuksköterskor på universitetssjukhuset vilka är verksamma på operationssal. För att bli godkänd i sin kunskap krävdes att respondenten hade 100 % rätta svar på kunskapsfrågorna. Data från enkäterna hanterades deskriptivt och analyserades med Mann Whitney u-test och Chi-två-test. Resultat: Hos 62 % fanns inte fullständiga kunskaper om universitetssjukhuset riktlinjer angående mun- och andningsskydd. Vidare upplevde 60 % att riktlinjerna inte är lättillgängliga. Resultatet visade att 24 % ansåg sig alltid kunna följa riktlinjerna. Slutsats: Resultatet visar att kunskapen gällande riktlinjerna är ofullständig vilket innebär att en stor del av operationssjuksköterskorna i studien riskerar sin hälsa i sitt arbete. För att operationssjuksköterskorna ska kunna uppdatera sina kunskaper bör universitetssjukhuset utforma tydligare riktlinjer angående mun- och andningsskydd i ett samlat dokument. / Background: OR nurses work in a place where there is hazardous smoke and contagion. This represents a risk to their health. The teaching hospital has guidelines for when to use facial protective devices. Aim: To see if the OR nurses at the teaching hospital have complete knowledge about the hospital guidelines regarding facial protective devices, and to study the OR nurses’ ability to follow the guidelines. The study will also determine the nurses’ perception of the availability of the guidelines and which factors determine the OR nurses’ choice of facial protective devices. Method: This is a descriptive questionnaire study with a cross-sectional design and a quantitative approach. The questionnaires were distributed to OR nurses who work in the operating room. In order to pass the test about the guidelines the respondent had to get 100 % correct answers. Data from the questionnaire were described and analyzed using Mann Whitney U test and Chi-square test. Result: Of the OR nurses, 62 % were lacking complete knowledge about the guidelines regarding facial protective devices. Furthermore, 60 % perceived the guidelines as not easily accessible. The result showed that 24 % always considered themselves to be able to follow the guidelines. Conclusion: The result shows a lack of knowledge regarding the guidelines. This means that a big part of the OR nurses in this study risk their health at work. To enable the OR nurses to update their knowledge, the teaching hospital should develop clearer guidelines on facial protective devices in one single document.

The objective of the thesis was to evaluate the quality of diabetes care in the Canadian Forces by determining the extent to which physicians adhere to recommendations outlined in the 2008 Canadian Diabetes Association (CDA) clinical practice guidelines. In addition, the effect of patient age, sex, rank and size of base on quality of care was assessed and the accuracy of a diagnosis of diabetes in an extract of the electronic medical record (EMR) was evaluated. Fourteen bases within the Canadian Forces were selected for investigation, representing roughly half of the Canadian Forces population. Cases of diabetes were ascertained based on laboratory criteria following a chart review. Twenty-one CDA guideline recommendations were considered. The Canadian Forces demonstrated greater than 75% adherence with each of 9 recommendations, 50-75% adherence with each of 7 recommendations and less than 50% adherence with each of 5 recommendations. The overall adherence with all applicable recommendations per patient was 60.3% (SE 0.66). Age, sex, rank and size of base were not important factors influencing guideline adherence. The sensitivity of a diabetes diagnosis in an extract of the EMR was 84.5%, the specificity was 99.8%, the positive predictive value was 85.1% and the negative predictive value was 99.8%. This is similar to the performance of provincial and national diabetes registries. The quality of diabetes care in the Canadian Forces compared favourably with that of the civilian population within Canada and internationally. The creation of a diabetes registry is expected to lead to further improvements in diabetes care.

The focus of this study is to suggest guidelines for the implementation of a character education program in high schools. It has become clearly evident, from the literature that character education is of cardinal importance for instruction and education. The breakdown of values in South Africa is leading to an increase in crime in the country, which will have far-reaching consequences if learner crime is not addressed. Character education could offer a possible solution and make learners realise the difference between "right" and "wrong" as well as to say "no" to drugs, alcohol, sex, gangs and other social problems. A literature study was done to highlight the nature and scope of behaviour problems in overseas schools as well as South African schools. There was also looked at the impact of violence on the culture of instruction and learning as well as the external and internal factors that can play a role in violence within schools. Furthermore, the concept of character education was investigated as well as character education as possible solution to behavioural problems in high schools. There was also looked at whether character education does indeed produce positive results. Different character education programs that have already been implemented successfully abroad were investigated. Smart & Good High Schools seem suitable for the South African situation and could easily be adapted to the circumstances of individual schools. This program ascribes to the view that the best high schools have two main objectives in common, namely: to help learners to become smart - in the multi-dimensional sense of intelligence - and to help them become good - in the multi-dimensional sense of moral maturity. It is, therefore, about excellence and ethics. Lickona and Davidson (2005) mention schools that are committed to both these objectives, Smart & Good High Schools. Guidelines for the implementation of a character education program arose from discussing the program. In order to determine in what areas character education are needed with learners; how parents evaluate the character education of the learners of the school; what teachers are presently doing to promote character education; and how the learners' values changed within the scope of six months, questionnaire surveys were used. Questionnaires were given to learners wherein they had to judge their own values and that of their fellow learners. Questionnaires were given to parents asking their opinions on the values currently displayed by learners of the relevant school; what parents would like see with the learners; the character traits of the learners; and which traits the school should promote. Questionnaires were also distributed to the teachers of the school to determine to what extent particular promising practices are being pursued to promote character education with learners. A test sample of Grade 8 to 12 learners also filled out a revised questionnaire to determine to what extent these practices were indeed being applied in the classroom. The primary objective of the survey was to determine the character education practices of a particular high school in the North-West Province and to suggest guidelines for the implementation of a character education program. The empirical survey aided in achieving this objective. Findings of some concern, within the scope of six months, related to the general deterioration in the behaviour/habits of the learners at the school, inter alia the number of learners who smoke, drink, are aware of those who use drugs as well an increase in learners who tested positive for HIV/AIDS. In addition, almost half the learners indicated that they find it difficult to say "no" to negative peer pressure. It has been concluded that character education in schools offer a definite solution and that such a program can be integrated effectively into the existing curriculum. / Thesis (Ph.D. (Education))--North-West University, Potchefstroom Campus, 2008.

The rising population of older people in the UK (Office for National Statistics 2010) and pressure on healthcare services to reduce costs indicate the necessity of developing strategies that enable coping and independence. Loss through death of close family members, partners and friends is a key factor that inhibits physical, emotional and social well being of older people. The research carried out for this thesis explored bereavement in healthcare settings where contacts with bereaved older people commonly occur, and used data collected to develop guidelines for practice. The guidelines provide research informed enhancement to bereavement care and develop opportunities for meaningful interactions. They complement current policy development work on bereavement in healthcare settings (The Scottish Government 2011). A qualitative design drawing on phenomenological methodology was used to explore healthcare staffs’ experiences of caring for bereaved older people, and older people’s experiences of being bereaved and bereavement care. Theoretical sampling took place to recruit staff from a range of roles in general practice and community nursing, hospital wards and care homes, as well as a small sample of bereaved older people. Thirty nine participants took part in in-depth interviews that yielded four key themes: bereavement care depends on a relationship between healthcare staff and relatives; preparation for a relative’s death may not equate to preparedness for bereavement; the ‘Open Door’ to bereavement care is only slightly ajar, and bereavement care supports progression of the ‘Rolling Ball’ of life. The themes informed development of the guidelines in terms of structure and content. Recommendation statements consider bereavement care before the death; at the time of the death; and follow up in the weeks and months afterwards. Criteria in the recommendations provide suggestions for enhancements to practice that facilitate appropriate response to bereavement in older people. Consultation on the guidelines provided positive feedback that identified the potential to promote consistent interactions with bereaved older people, respond to needs and support coping.

Multiple-choice questions are acknowledged to be difficult for both English mother-tongue and second-language university students to interpret and answer. In a context in which university tuition policies are demanding explicitly that assessments need to be designed and administered in such a way that no students are disadvantaged by the assessment process, the thesis explores the fairness of multiple-choice questions as a way of testing second-language students in South Africa. It explores the extent to which two multiple-choice Linguistics examinations at Unisa are in fact ‘generally accessible’ to second-language students, focusing on what kinds of multiple-choice questions present particular problems for second-language speakers and what contribution linguistic factors make to these difficulties. Statistical analysis of the examination results of two classes of students writing multiple-choice exams in first-year Linguistics is coupled with a linguistic analysis of the examination papers to establish the readability level of each question and whether the questions adhered to eight item-writing guidelines relating to maximising readability and avoiding negatives, long items, incomplete sentence stems, similar answer choices, grammatically non-parallel answer choices, ‘All-of-the-above’ and ‘None-of-the-above’ items. Correlations are sought between question difficulty and aspects of the language of these questions and an attempt is made to investigate the respective contributions of cognitive difficulty and linguistic difficulty on student performance. To complement the quantitative portion of the study, a think-aloud protocol was conducted with 13 students in an attempt to gain insight into the problems experienced by individual students in reading, understanding and answering multiple-choice questions. The consolidated quantitative and qualitative findings indicate that among the linguistic aspects of questions that contributed to question difficulty for second language speakers was a high density of academic words, long items and negative stems. These sources of difficulty should be addressed as far as possible during item-writing and editorial review of questions.

Background: Many studies have reported that adherence to health promotion guidelines for diet, physical activity, and maintenance of healthy body weight may decrease cancer incidence and mortality, including site-specific cancers such as colorectal cancer. To date, there have been no studies investigating adherence to the American Cancer Society's (ACS) Nutrition and Physical Activity Cancer Prevention Guidelines and the development and characteristics of premalignant lesions. Several individual lifestyle factors targeted by the ACS guidelines have also been associated with circulating concentrations of vitamin D metabolites. These associations suggest that adherence to the ACS guidelines may be related to improved vitamin D status. This dissertation sought to 1) synthesize the evidence from published prospective cohort studies regarding adherence to the ACS and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) nutrition and physical activity cancer prevention guidelines and the risk of overall cancer incidence and/or cancer mortality and 2) to further explore the role of adhering to a healthy lifestyle pattern as outlined by the ACS guidelines on a) colorectal adenoma occurrence and b) circulating concentrations of vitamin D metabolites using secondary data analyses from completed large prevention trials. Methods: A systematic review was performed to examine associations between adherence to established cancer prevention guidelines for diet and physical activity and overall cancer incidence and mortality. PubMed, Google Scholar, and Cochrane Reviews databases were searched following the current recommendations of Preferred Reporting Items for Systematic Reviews and Meta-analysis Approach (PRISMA). Cross-sectional and prospective analyses of pooled participants were also conducted from the Wheat Bran Fiber (n=503) and Ursodeoxycholic Acid (n=854) trials. A cumulative adherence score was constructed using baseline data regarding body size, diet, physical activity, and alcohol consumption. Continuous vitamin D metabolite concentrations and clinically significant vitamin D categories were evaluated with adherence score category using multiple linear and logistic regression models, respectively. Baseline adenoma characteristics and new colorectal adenomas were evaluated by adherence score category using multivariate logistic regression models. Results: Twelve studies met inclusion criteria for the systematic review. High versus low adherence to established nutrition and physical activity cancer prevention guidelines was consistently and significantly associated with decreases of 10-61% in overall cancer incidence and mortality. Consistent significant reductions were also shown for breast cancer incidence (19-60%), endometrial cancer incidence (23-60%), and colorectal cancer incidence in both men and women (27-52%). Findings for lung cancer incidence were equivocal and no significant relationships were found between adherence and ovarian or prostate cancer. In the pooled analyses, concentrations of circulating 25-hydroxycholecalciferol [25(OH)D] were statistically significantly higher among participants with high versus low adherence to guidelines (31.4 ± 0.8 and 26.3 ± 0.8 ng/ml, respectively; p<0.001). For 1,25(OH)₂D concentrations, high adherence was again significantly related to greater metabolite levels, with mean concentrations of 36.4 ± 1.1 and 31.2 ± 1.2 pg/mL for high- and low-adherers, respectively (p<0.001). Furthermore, the odds of attaining sufficient 25(OH)D status were 4.30 times higher for those most adherent versus those least adherent (95% CI: 2.43-7.60). Significantly reduced odds of having three or more adenomas at baseline were shown for moderate (odds ratio [OR]=0.67, 95% confidence intervals [CI]: 0.46-0.99) and highly adherent (OR=0.50, 95% CI: 0.31-0.81) participants compared to those with low adherence (p-trend=0.005). Conversely, guideline adherence was not associated with the development of a new colorectal adenoma (moderate adherence OR=1.16, 95% CI: 0.85-1.59, high adherence OR=1.23, 95% CI: 0.85-1.79). Conclusion: From the systematic review, greater adherence to cancer prevention guidelines for diet and physical activity was consistently associated with lower risks of overall cancer incidence and mortality, including for some site-specific cancers. In addition, adherence to the ACS guidelines was associated with higher concentrations of both of 25(OH)D and 1,25(OH)₂D. Following the ACS guidelines could potentially increase 25(OH)D levels as much as that observed by a supplement of 1000 IU/d in a population similar to ours, and therefore may be a viable strategy for increasing both 25(OH)D and 1,25(OH)₂D concentrations. Further, our findings suggest that following the ACS Nutrition and Physical Activity guidelines may lead to a lower odds of multiple adenomas when at least one adenoma is detected. Finally, these guidelines and recommendations are consistent with strategies for the prevention of major diseases, and if followed, will ultimately lead to healthier lives overall.