Made available in DSpace on 2014-06-11T19:35:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-25Bitstream added on 2014-06-13T20:06:50Z : No. of bitstreams: 1 sleutjes_fcm_dr_botfm.pdf: 725660 bytes, checksum: 9a58cee8a9d2137fdcb115679023885d (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Investigar os óbitos neonatais pode ser uma importante estratégia para redução da mortalidade infantil e fetal, pois contribui para melhorar a qualidade da informação sobre esse evento adverso e possibilita a adoção, pelos serviços de saúde, de medidas para a prevenção de óbitos evitáveis. Objetivo Geral: avaliar os óbitos neonatais investigados no Departamento Regional de Saúde VI – Bauru, considerando-se os Colegiados de Gestão Regional, no ano de 2009. Metodologia: estudo descritivo e transversal, que analisou 162 óbitos investigados, a partir das informações digitadas no Sistema de Informações sobre Mortalidade Neonatal (SIM-Neo). Os resultados são apresentados de forma descritiva e a partir de escore síntese que considerou a qualidade da atenção ao pré-natal, ao parto e ao recém-nascido; fatores de risco pré-natal, no parto e com relação ao recém-nascido e situação sociodemográfica materna. Para análise dos escores foi ajustado um modelo para proporções do tipo logístico, considerando Colegiados e categorias como efeitos principais e a interação Colegiados versus categorias. Resultados: passaram por alguma investigação 88,5% dos óbitos ocorridos e 67,3% tiveram investigação completa. A análise dos escores relativos à qualidade da atenção pré-natal evidenciou diferença quando se consideraram os piores resultados (escore menores que cinco), sendo o Colegiado Vale do Jurumirim diferente e melhor que o de Bauru e o de Lins. Com relação à qualidade da assistência ao parto, houve diferença quando se compararam os Colegiados Vale do Jurumirim, Bauru e Cuesta Botucatu com Lins, sendo pior a situação de Lins. Para a qualidade da atenção ao neonato, os Colegiados de Bauru e Jaú diferiram e foram melhores que o Vale do Jurumirim. Quanto ao risco do neonato, o Colegiado Vale do Jurumirim... / Introduction: Investigating neonatal deaths can be an important strategy to reduce child and fetal mortality as it contributes to improve the quality of information on such adverse event and allows for the adoption of measures for prevention of evitable deaths by health care services. Objective: To evaluate neonatal deaths investigated at the Regional Health Department VI (DRS VI) – Bauru by taking into account the Regional Management Collegiates in 2009. Methodology: This is a descriptive crosssectional study that analyzed 162 deaths investigated from the information entered on the Neonatal Mortality Information System (SIM-Neo). Results are presented in a descriptive fashion and based on a synthesis score which considered the quality of prenatal care, the care to delivery and the care to newborns; prenatal risk factors, delivery risks and those related to newborns as well as maternal sociodemographic conditions. For score analysis, a logistic model was fitted for proportions by taking into account Collegiates and categories as main effects and the Collegiate-versuscategory interaction. Results: 88.5% of the occurring deaths underwent some investigation, and 67.3% were completely investigated. The analysis of the scores related to the quality of prenatal care showed difference when the worse scores (scores lower than five) were considered, and Vale do Jurumirim Collegiate was different and better than those in Bauru and Lins. As regards the quality of care to delivery, difference was found when comparing the Collegiates in Vale do Jurumirim, Bauru and Cuesta Botucatu with that in Lins, and Lins showed the worst situation. As for the quality of care to neonates, the Collegiates in Bauru and Jau differed and were better than that in Vale do Jurumirim. Concerning risk to neonates, the Collegiate... (Complete abstract click electronic access below)

Orientador: Cristina Maria Garcia de Lima Parada / Banca: Maria Antonieta de Barros Leite Carvalhaes / Banca: Luana Carandina / Banca: Marilisa Barros / Banca: Maria José Clapis / Resumo: Investigar os óbitos neonatais pode ser uma importante estratégia para redução da mortalidade infantil e fetal, pois contribui para melhorar a qualidade da informação sobre esse evento adverso e possibilita a adoção, pelos serviços de saúde, de medidas para a prevenção de óbitos evitáveis. Objetivo Geral: avaliar os óbitos neonatais investigados no Departamento Regional de Saúde VI - Bauru, considerando-se os Colegiados de Gestão Regional, no ano de 2009. Metodologia: estudo descritivo e transversal, que analisou 162 óbitos investigados, a partir das informações digitadas no Sistema de Informações sobre Mortalidade Neonatal (SIM-Neo). Os resultados são apresentados de forma descritiva e a partir de escore síntese que considerou a qualidade da atenção ao pré-natal, ao parto e ao recém-nascido; fatores de risco pré-natal, no parto e com relação ao recém-nascido e situação sociodemográfica materna. Para análise dos escores foi ajustado um modelo para proporções do tipo logístico, considerando Colegiados e categorias como efeitos principais e a interação Colegiados versus categorias. Resultados: passaram por alguma investigação 88,5% dos óbitos ocorridos e 67,3% tiveram investigação completa. A análise dos escores relativos à qualidade da atenção pré-natal evidenciou diferença quando se consideraram os piores resultados (escore menores que cinco), sendo o Colegiado Vale do Jurumirim diferente e melhor que o de Bauru e o de Lins. Com relação à qualidade da assistência ao parto, houve diferença quando se compararam os Colegiados Vale do Jurumirim, Bauru e Cuesta Botucatu com Lins, sendo pior a situação de Lins. Para a qualidade da atenção ao neonato, os Colegiados de Bauru e Jaú diferiram e foram melhores que o Vale do Jurumirim. Quanto ao risco do neonato, o Colegiado Vale do Jurumirim... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Investigating neonatal deaths can be an important strategy to reduce child and fetal mortality as it contributes to improve the quality of information on such adverse event and allows for the adoption of measures for prevention of evitable deaths by health care services. Objective: To evaluate neonatal deaths investigated at the Regional Health Department VI (DRS VI) - Bauru by taking into account the Regional Management Collegiates in 2009. Methodology: This is a descriptive crosssectional study that analyzed 162 deaths investigated from the information entered on the Neonatal Mortality Information System (SIM-Neo). Results are presented in a descriptive fashion and based on a synthesis score which considered the quality of prenatal care, the care to delivery and the care to newborns; prenatal risk factors, delivery risks and those related to newborns as well as maternal sociodemographic conditions. For score analysis, a logistic model was fitted for proportions by taking into account Collegiates and categories as main effects and the Collegiate-versuscategory interaction. Results: 88.5% of the occurring deaths underwent some investigation, and 67.3% were completely investigated. The analysis of the scores related to the quality of prenatal care showed difference when the worse scores (scores lower than five) were considered, and Vale do Jurumirim Collegiate was different and better than those in Bauru and Lins. As regards the quality of care to delivery, difference was found when comparing the Collegiates in Vale do Jurumirim, Bauru and Cuesta Botucatu with that in Lins, and Lins showed the worst situation. As for the quality of care to neonates, the Collegiates in Bauru and Jau differed and were better than that in Vale do Jurumirim. Concerning risk to neonates, the Collegiate... (Complete abstract click electronic access below) / Doutor

Magister Artium (Social Work) - MA(SW) / The purpose of this study was to explore the challenges parents of children with mental health disabilities and disorders in Namibia face when attempting to access mental healthcare resources. The study used a qualitative exploratory approach. Purposive sampling was used to include parents, caregivers and relatives of children with metal health disabilities and disorders. The sample also included key informants. Data was collected through focus group discussions with the participants and individual interviews with the key informants. Overall, a total of 41 people provided information for this study. Thematic data analysis was used to assess the data. The results suggest that parents/caregivers and relatives of children with mental health disabilities and disorders do experience barriers accessing mental health care. The challenges go beyond commonly-reported problems in the literature such as stigma and discrimination and include basic challenges such as a lack of transportation to healthcare services and a lack of acceptance of the mental health disorders by the parents. The study offers recommendations for how service provision can be improved and how parents of children with mental health challenges can have better access to services. / South Africa

Masters in Public Administration - MPA / The public health sector over the years had been under constant criticism for the lack of or substandard service delivery. The post1994 democratic era was accompanied by slogans such as ‘a better life for all ’. These slogans in part stem from the Constitution of the Republic of South Africa, 1996. The Constitution, chapter two, in its discussion on the Bill of Rights states that everyone has the right to quality health care services. The critics argue that the fundamental r right enshrined with in the Constitution in as far as it pertains to healthcare has been violated. The state introduced various interventions, such as human resource capacity development t programs, to turn the dismal state of public health care around. This research focused on the impact and the relevance of the human resource development within the public health sector. The following research question had been formulated to guide the research; is skills development within the state undertaken for compliance sake or is it a focused interventionist approach aimed at improving the skills set of staff to perform effectively and efficiently? The research was qualitative in nature and the case methodology was used. In this regard Tygerberg hospital was used as the case study. A number of findings emanated from the data collection process, amongst other, that the skills development is not workplace specific but rather undertaken for compliance sake. Furthermore, that no individual staff development plans exist. The end result is that the skills development intervention aimed at improving the staff capacity and the state of health service generally is not making any meaningful impact. The major recommendation is that a health audit must be done, which must inform the development of the hospital staff skills development plan. This in turn must be used to develop individual staff f development plans. This alignment of development plans from provincial level to hospitals and then to the individual will result in a more focussed skills intervention and ultimately an improved public health sector.

Master of Public Health - MPH / Urban health policy has remained a neglected area in India. The homeless remain the most deprived, neglected and stigmatized group amongst the urban poor. While they suffer from a large burden of disease, there are a variety of reasons that prevent them from accessing the available health care services – particularly in the public health sector. Some interventions by concerned non-governmental organisations have attempted to circumvent the barriers to health care access faced by the homeless but these have not been well documented or assessed. This study seeks to establish both the barriers and facilitating factors for access to health care and health care seeking amongst adult street dwellers in an area of New Delhi which is known for a high concentration of homeless persons. Using a qualitative approach 18 adult street dwellers (both male and female) were individually interviewed – along with 6 key informants working in the public and non-governmental health sector. This was accompanied by a process of participant-observation. The results were analyzed by identifying recurrent themes associated with barriers and facilitating factors for access to health care by the homeless, following which a set of recommendations related to the homeless, have been developed so as to inform those working in the public health sector. In terms of ethics, informed consent was taken from each interviewee and they were explicitly given the option not to participate without adverse consequences to themselves. If any participant was found with acute health problems immediate assistance was facilitated. The study reveals a number of barriers faced by the homeless in attempting to access health care services. While minor ailments are taken care of by local private practitioners, they need to access public health care services for major problems. There they encounter many barriers due to the lack of money, delays and being shunted from place to place. Moreover, they are not able to get admission for reasons such as lack of address and the lack of an attendant. Facilitating factors include assistance for transportation, facilitation of admissions, arranging money for out of pocket expenditures on drugs and consumables, arranging blood and providing after-care. The role of social contacts in enabling access is also demonstrated through this study. The recommendations that emerge from the study are intended to assist in policy advocacy towards a comprehensive health care system for them, as well as assist health care providers to provide a better service for homeless people.

This thesis deals with the usage possibilities of franchising within the scope of health care services provided in the Czech Republic. First part of the thesis concerns franchising in general, describes its principals, development, law regulation etc. Second part analyzes franchising market in the Czech Republic and subsequently identifies respective concepts that are active within the scope of health care services. In my opinion, based on the analysis performed and with respect to theoretical findings, due to specifics of health care services, franchising might represent a suitable form of cooperation only among selected types of these services. Recommended among the concepts available on our market within the scope of health care services are those, which according to my opinion have potential to become a successful business opportunity.

The diploma thesis focuses on the relation of gender and health. Attitudes and behavioral manifestations associated with the male or female roles of individual personalities in society are one of the factors that affect human health and the length of life. The thesis maps the situation in the Czech Republic - whether there is a policy aimed at reducing gender inequalities in the use of health services, and whether differences between women and men in needs and in attitudes to their health are reflected. The thesis is based on the theory of implementation focusing on the identification of barriers to successful implementation, the concept of health determinants and gender mainstreaming. Qualitative and quantitative research methods were applied. The primary data was collected through both expert interviews and written comments of experts. Among the secondary data, strategic public policy documents and published statistics were key. It has been found that the Czech Republic adopted strategic goals in relation to gender inequalities, but there is no adequate action to achieve them. Several barriers have also been identified that can make it difficult or impossible to meet those strategic goals. These barriers were divided into two main groups: subjective and objective barriers.

Decentralization versus centralization is a discussed subject within the field of management, and it is about where control is allocated in the organization. This thesis aimed to contributewith understanding of these two contrasting structures by a multiple-case study consisting of Swedens’ decentralized, and Norway’s centralized national health care service in the context of the coronavirus pandemic. Opportunities and challenges are studied within each organizational model by studying the handling of the shortage of personal protective equipment (PPE). The empirical findings showed that the allocation of control at regional level in the organization of Sweden’s national health care resulted in opportunities to create new forms of regional collaborations, and challenges of having to change the current organizational model due to the complexity of the problem. In Norway, where control is allocated at the national level, an opportunity was the establishing of a national purchase and distribution system and to handle the problem proactively. For some parts of the local level, implementation of directives given by central authorities turned out to be a challenge.

Migrant women are often omitted within the migrant discourse/research, with that in mind, the research study brings to the fore migrant women's experiences when accessing public health care services within underdeveloped communities. The study explored Zimbabwean migrant women's experiences in accessing public health care services in Makhado, a small town based in Limpopo, South Africa which has only two public health care services namely, Louis Trichardt Memorial Hospital and Louis Trichardt clinic. To conduct this study, ethical clearance was obtained in November 2018 from the Department of Sociology at the University of Cape Town. The qualitative research method was adopted in collecting the data. The study conducted in-depth interviews with five Zimbabwean migrant women who had made use of the two public health care services in Makhado. Field notes, diary entry, an impromptu focus group were used to collect the study data. The sample for the study was purposively selected. The study worked with a total of twelve participants, in-depth interviews with five Zimbabwean women, and a focus group with seven health care workers. The collected data was manually transcribed and was analyzed using the framework analysis. Main themes and sub-themes were extracted from the transcribed interview scripts. The study revealed that migrants accessing the two hospitals in Makhado faced challenges such as language barriers, discrimination, and adverse health personnel attitudes based on the patient's citizenship status. Furthermore, the challenges that nurses are faced within their workplace, which include lack of resources, absenteeism, long working hours and overcrowded public health care services within their workplace contributed towards their negative attitude in assisting patients. As a result, migrants bore the challenges faced by the nurses within the public health care services. Therefore, the migrants reverted to having other alternatives such as traditional healers, churches, connections with nurses working in the hospitals, private hospitals and over the counter medication. However, participants underscored that in order for betterment within the public health care services, the following measures ought to be implemented, these include the introduction of independent centres, an increase of mobile clinics, increased number of interpreters, better working environment for the health personnel within the public health care facilities and intensive education training of the health personnel around the awareness migrant issues when accessing public health care services. Foucault's (1980) theory on power and knowledge, played a significant role in understanding the operational systems of public health care services. It also assisted in understanding how public health care services function, to exclude and control migrant patients, through the introduction of fees and required documentation to access public health care services.

Bakgrund: Migration är vanligt förekommande i världen och i Sverige är invandring en stor anledning till folkökningen. När människor behöver söka sig till hälso- och sjukvården i ett nytt land så kan språkbarriärer uppstå, vilket påverkar kommunikationen. För att uppnå en god relation samt ett personcentrerat förhållningssätt i vården, så är kommunikation en betydelsefull aspekt. Ett sätt att kommunicera på vid språkbarriär är via tolk, vilket sjuksköterskor beskriver som värdefullt men ibland problematiskt. För att förbättra kommunikationen med patienter vid språkbarriärer så behöver patienters perspektiv undersökas, inte endast vårdpersonalens.  Syfte: Att undersöka patienters upplevelser av kommunikation vid språkbarriärer mellan patient och vårdpersonal inom hälso- och sjukvård.  Metod: En litteraturstudie baserad på tio kvalitativa originalartiklar. Datainsamling utfördes i databaserna PubMed och CINAHL. De artiklar som har valts ut till studien har uppfyllt inklusions- och exklusionskriterier, samt har bedömts vara av hög kvalitet i kvalitetsgranskning.  Resultat: Tre huvudkategorier lyftes fram under resultatanalysen; Hur språkbarriärer påverkar den personcentrerade vården, Missförstånd och konsekvenser samt Användning av tolk. Den första huvudkategorin delades in i tre underkategorier; Upplevd diskriminering, Känslor till följd av språkbarriärer och Preferenser gällande hälso- och sjukvårdspersonal. Även den sista huvudkategorin delades in i tre; Professionell tolk, Informell tolk och Andra sätt att kommunicera.  Slutsats: Språkbarriärer har stor påverkan på kommunikationen mellan patienter och vårdpersonal. Detta kan av flera anledningar få negativa följder i vården. För att säkerställa en personcentrerad vård, så är vårdpersonalens bemötande och utveckling av de kommunikationssätt som finns avgörande. / Background: Migration is common in a global perspective and immigration is an important reason for the population increase in Sweden. When individuals are in need of healthcare in a new country, language barriers can arise and affect the communication. To achieve patient-centered care and a good relationship in healthcare, communication is a crucial aspect. Use of interpreters is one way to overcome language barriers, which nurses describe as valuable but sometimes problematic. To improve the communication with patients when there are language barriers, patients’ perspectives needs to be explored in addition to healthcare professionals.  Aim: To investigate patients’ experiences of communication, when there are language barriers between patients and health care professionals in health care.  Method: A literature study based on ten qualitative original articles. The databases Pubmed and CINAHL were used for data collection. The articles chosen for the study met the criteria of inclusion and exclusion. Their quality was also assessed as high in the quality analysis.  Results: Three main categories were highlighted under the analysis of the results; How language barriers affect person-centered care, Misunderstandings and consequences and The use of interpreters. The first main category was divided into three sub-categories; Experienced discrimination, Feelings due to language barriers and Preferences regarding healthcare professionals. The last main category was also divided into three; Professional interpreter, Informal interpreter and Other ways to communicate.  Conclusion: Language barriers have a big impact on the communication between patients and healthcare professionals. This can affect healthcare negatively for many reasons. The behavior of healthcare professionals and development of existing means of communication, is crucial to ensure a patient-centered care.