Biomedical ethics gave birth to different kinds of ethics committees which pursue essentially a better understanding of the multidisciplinary problems it raises. The present thesis will first elucidate the legal implications related to the emergence of those committees. These preliminary considerations will show the topicality of those legal aspects as to hospital ethics committees. The author will then focus on the potential civil liability of all actors evolving within the hospital setting for the participation of those committees in the medical decision making process. In theory, this participation could arguably entail rather easily the liability of the health care providers and of the hospitals. The ethics committees, on the contrary, seem to be more protected. This thesis suggests nonetheless that the obligations related to the participation of the ethics committees to the medical decision making process are significant. Hence, it stands to reason that the creation of ethics committees should be evaluated with care. The conviction that the ethics committees will protect the health care providers from malpractice suits appears to be incorrect in any event.

Computerization has had a large impact on hospital intensive care units, allowing continuous monitoring and display of physiological patient data. Treatment of the critically ill patient, however, now requires assimilating large amounts of patient data. / Computers can help by processing the data and displaying the information in easy to understand formats. Also, knowledge-based systems can provide advice in diagnosis and treatment of patients. If these systems are to be effective, they must be integrated into the total hospital information system and the separate computer data must be jointly integrated into a new database which will become the primary medical record. / This thesis presents the design and implementation of a computerized database for an intensive care unit patient data management system being developed for the Montreal Children's Hospital. The database integrates data from the various PDMS components into one logical information store. The patient data currently managed includes physiological parameter data, patient administrative data and fluid balance data. / A simulator design is also described, which allows for thorough validation and verification of the Patient Data Management System. This simulator can easily be extended for use as a teaching and training tool for PDMS users. / The database and simulator were developed in C and implemented under the OS/2 operating system environment. The database is based on the OS/2 Extended Edition relational Database Manager.

<p> This study analyzes different demographic groups and the ability to understand a physician and how this contributes to feeling carefully listened to. There are four hypotheses being tested, each predicting a different group within each variable will feel the most carefully listened to. The Statistical Package for Social Services (SPSS) was used to analyze data from the California Health Interview Survey (CHIS). The portion of the survey that focused on adults was utilized in this study. Data was analyzed using t-tests and ANOVA tests. The results of the study determined that the elderly, males, and participants that could understand their physician felt the most carefully listened to for each variable. As for race, Whites, African American, and participants that identified as more than one race felt more carefully listened to when compared to Asians and participants that identified as a race not specified. These finding only supported one hypothesis, participants that understood their physician would feel that most carefully listened to. Theses result are a valuable tool that can be used to being quality improvement efforts focused on patient centered communication.</p>

<p> Infant mortality rate has long been an important factor when measuring a country's overall health status. The lower the infant mortality rate the better the country's health status. This study examines the variation of infant mortality in Hispanic/Latinos, Black/African Americans, and Medicaid beneficiaries in the United States. Secondary data was drawn from the National Hospital Ambulatory Medical Care Survey for the year 2011-2012. Results of the study did not reveal or support the demographic or socioeconomic factors that influence the outcome of infant mortality. Future research should include data from the neo-natal intensive care unit, and not just the emergency department, where infant mortality is better recorded.</p>

<p> The objective of this study was to examine the associations of socioeconomic factors on young children's health insurance status based on their parent's health care coverage. Variables considered were educational attainment, annual household's income, citizenship status, and race.</p><p> Secondary data analysis was performed using a subset of data (excluding 65 years olds) from the 2011-2012 CHIS survey. Chi Square and One-way ANOVA tests were conducted through the use of SPSS. Results demonstrated a highly significant relationship between income and employer- based insurance, in addition to educational attainment and employer-based insurance. Income is interpreted in terms of federal poverty level due to the important use of this measure during the determination of eligibility for public health care program, such as Medi-Cal. Health care is transforming and additional initiatives need to take place to reduce the number of uninsured children and to improve the overall health status of children.</p>

<p> This dissertation examines the factors that will affect nursing home quality of care using several national data sources on market regulation, county demographic characteristics, market structural and the characteristics of different types of long-term care providers in 2010. </p><p> The first study examines how nine different measures of nursing home care quality respond to the greater levels of local market competition from these alternative providers of long-term care, as well as other nursing homes. Findings reveal that faced with greater competition from assisted living facilities, nursing homes are left to care for more disabled, less healthy patients. Although the nursing home's staff-to-bed ratios rise in response, other measures of care quality decline, such as more process- and outcome-based measures. Competition from home health agencies likewise has mixed effects on nursing home care quality, and competition from other nursing homes in a market tends to decrease care quality. These finding suggest that care quality in nursing homes may continue to erode as the market for alternative, community-based long-term care services expands. </p><p> The second study examines the Medicare regulation effects on nursing home quality controlling for the whole long-term care market competition structure. In many local markets nursing homes now compete with assisted living facilities for residents, yet most previous studies of the effects of Medicaid nursing home reimbursement policies on care quality have analyzed nursing homes in isolation, ignoring the presence of nearby competitor firms, and how state regulation of assisted living facilities might also affect care quality in nursing homes. This study uses a richer model specification that accounts for a much broader range of state long-term care regulations as well as the structure of a nursing home's local market. Findings reveal that a higher Medicaid reimbursement rate leads to significant improvements in nine different aspects of nursing home quality, while state certificate-of-need programs for nursing homes lead to a decline in several (but not all) dimensions of it. A large presence of assisted living beds in a local market also tends to reduce nursing home quality, and state regulations regarding assisted living facilities indirectly affect nursing home care quality by altering the nature of local market competition. Overall, these results suggest that state laws related to all long-term care providers, not just nursing homes, are important determinants of nursing home care quality.</p>

<p> It has been shown on both local and national scales in the US that there is a small number of people whose healthcare costs make up a significantly disproportionate amount of total healthcare costs. Much of the costs that these "high-utilizers of care" incur come from emergency department visits and inpatient hospital admissions for health problems that would be treated more economically by primary and specialist care. Numerous "hot-spotting" intervention programs have been created over the last decade in attempts to both lower costs and improve the quality of care and health outcomes of "high-utilizers" by actively connecting patients with the existing primary and specialist care system and the social services system. Initial quantitative analyses have shown that this approach appears to largely accomplish these aims. However, there is a need for complementary research that seeks to understand the processes behind such important outcomes. </p><p> This study takes a closer look at one program's process of connecting patients to services, using "structural vulnerability" theory to frame its findings. Qualitative data from open-ended, semi-structured interviews with 17 participants (including patients, patient family members, program staff, and healthcare providers) were coded using qualitative analysis software. Resulting themes are used to first describe the problems faced by both patients and providers, emphasizing how these problems are exacerbated or caused by structural factors. Second, the program's process of connecting patients and providers is illustrated, paying particular attention to themes that showed discrepancies in participant responses and that point to the existence of incidental services provided by outreach workers. Ultimately, results show how the connection process is more than simply training patients and providers to work together, but in fact requires bandaging and sometimes healing "structural wounds" and other systemic problems before productive connections can be made and sustained.</p>

<p> The overall purpose of this study was to determine the association between patients who talked to their doctor about their risk for falling or a balance problem and fall occurrence. This study analyzed a secondary data set based on the Medicare Health Outcomes Survey (HOS) for the Medicare Advantage patients 65 years and older. There were a total of 196,913 beneficiary records included and identified as Cohort 10, whose demographics, chronic medical conditions, physical health symptoms, management, including Fall Risk Management have been surveyed.</p><p> Chi-square test yielded findings showing significant relationship between patients talking to their doctor about a fall and balance problem and a previous fall occurrence. Test results on patient personal disposition such as educational level, gender, and race indicated an influence in patient communication behavior. Further, patients who talked to their doctor about a fall or balance problem facilitated the doctor to educate patient on how to prevent future falls. However, future investigation is recommended to ascertain true pre-dispositional factors that affect patient communication, in order to address any barriers that could impede patient-provider collaboration in prevention of falls.</p>

<p> Inadequate health care infrastructures and lack of qualified and trained health care professionals are barriers against timely and prompt access to health care services in the rural communities of Akwa Ibom State. The absence of immediate health care services, coupled with the lack of basic infrastructure and qualified health care professionals, has led to high mortality from preventable causes. Compounding the problem are poor governance, endemic corruption, and lack of involvement of trained professionals for management of human and material resources to support health care delivery, particularly in building the capacity and removing barriers and obstacles to effective delivery of primary health care services at the local community level. A quantitative quasi-experimental research study was used to evaluate access to health care services in the rural community in Etim Ekpo Local Government Area of Akwa Ibom State, Nigeria by introducing mobile phones and community health care educators. Four sets of hypotheses were tested to provide answers to two research questions using statistical analysis. The results indicated the importance of health care facilities and access to qualified health care professionals and the direct link to improved clinical outcome. The myriad of evidence presented in the literature that telemedicine infrastructure has been effectively used to create access to rural communities in most third world and developing countries was supported through this study. The results indicated mobile communication technology can make the difference in the Nigerian health care service delivery, particularly in remote villages.</p>

<p> Body image disturbances are associated with a variety of health compromising behaviors; however, less is known about their impact on health maintenance behaviors. The present study investigated the relationship between body image disturbances and the frequency of a specific body-focused health maintenance behavior: breast self-examination (BSE). It was hypothesized that two manifestations of body image disturbance, body shame and body avoidance, would be negatively associated with frequency of BSE in the past year and intended frequency of BSE in the coming year. Furthermore, it was hypothesized that health anxiety and risk perception for breast cancer would moderate the relationship between body image disturbance and frequency of BSE in the past year. As a secondary research question, the impact of body image disturbance on the self-reported level of negative affect experienced during BSE was investigated. </p><p> Participants were 120 women between the ages of 21 and 40 (M age = 24.14, SD = 4.78; M BMI = 24.73, SD = 5.75) recruited from a large public university. Following informed consent, participants completed a battery of self-report questionnaires assessing demographic variables, body image disturbances, BSE behaviors and intentions, health anxiety, and risk perception. Participants were also encouraged to complete follow-up questionnaires for three months assessing frequency of BSE and associated negative affect. </p><p> Results showed that when the entire sample was considered, neither body shame nor body avoidance were significantly associated with past year BSE or BSE intentions and neither health anxiety nor risk perception emerged as moderators. However, when only women ages 22 to 40 years old were considered in post hoc analyses, body shame significantly predicted past year BSE and both body shame and body avoidance significantly predicted BSE intentions. Additionally, risk perception emerged as a predictor of past year BSE. An additional post hoc analysis revealed that age moderated the relationship between risk perception and past year BSE when the entire sample was considered. Follow-up data revealed that neither body avoidance nor body shame significantly predicted affect during BSE after controlling for physical discomfort. These findings have important implications for health promotion among women of all ages.</p>