Emergency departments (EDs) are the only source of medical care for many adults and have been found to be feasible venues for vaccinating high-risk patients against seasonal influenza. Since the CDC guidelines expanded in 2008 to include any adults wishing to protect themselves and those around them from the flu, the vaccination of low-risk patients in the ED has not been evaluated. This study sought to assess the acceptability among adult patients of all ages for vaccinating against seasonal influenza in the Urgent Care area of an urban ED, which treats primarily healthy adults. A convenience sample of adult patients in the Urgent Care area was surveyed in November 2009. Subjects were asked about their vaccination history, as well as their perceived need and potential acceptance of a vaccine in the ED. Demographic data obtained included age, race, education, insurance status, medical history, access to primary care and contact with high-risk individuals. 381 patients were approached, of whom 352 completed the survey (92.4%; 56% male, 44% female; mean age 36 years, Standard Deviation 12.4), and 349 were vaccine-eligible. 250 (72%) denied any significant medical history. While 169 patients (48.4%) had an influenza vaccination history, only 69 (20%) were vaccinated in 2009. Of the 280 not vaccinated this year, 179 (64%) would have accepted the vaccine in the ED. Factors associated with increased odds of vaccine acceptance in the ED included: age younger than 50 years (Odds Ratio [OR] 3.28, 95% Confidence Interval [CI] = 1.74 to 6.21, p<0.01), Latino/Hispanic ethnicity (OR 2.89, 95% CI = 1.52 to 5.51, p<0.01), and close contact with high-risk individuals (OR 2.28, 95% CI = 1.33 to 3.92, p<0.01). These results suggest that the majority of relatively healthy adult patients would accept the seasonal influenza vaccine in the ED. Although a shortage of vaccines and increased vigilance during a concurrent H1N1 outbreak may have influenced overall acceptability, we conclude that influenza vaccinations during the ED patient encounter would generally be acceptable to patients as a means to improve their overall health, and indirectly the health of their high-risk close contacts.

Involving patients in medical decisions by acknowledging patients personal values and individual preferences has become an important goal of providing ethical medical care. Despite a general movement towards a model of shared decision-making, many patients do not fully meet their preferred role in practice. The decision whether or not to accept a kidney once it is offered to a patient awaiting transplant has historically been made predominantly by the transplant surgeon with little involvement from the patient. Because dialysis can provide long-term renal replacement, declining a kidney is a viable option. Patient changes over time and inherent heterogeneity of donor kidneys make this an authentic decision requiring careful analysis of costs and benefits from the patient perspective. The purpose of this study is to improve our understanding of how patients and transplant surgeons prioritize different factors when deciding whether or not to accept a kidney that has become available, in order to empower patients to become more involved in the decision-making process. Phase I: We developed a comprehensive list of factors that patients might consider important through qualitative interviews with patients, and deliberation with a transplant surgeon (SK) and a transplant nephrologists (RF). Phase II: We quantified the relative importance of each factor for patients on the transplant list and for transplant surgeons with a computerized survey using Maximum Differences Scaling. We developed relative importance scores using Heirarchical Bayes analysis, and tested for associations between patient characteristics and relative importance scores using Spearmans correlation coefficient and the Mann Whitney U test for continuous and categorical variables respectively. Of the factors evaluated, patients placed the greatest value on Kidney quality, How closely matched you are to the kidney, and How strongly your surgeon feels you should accept the kidney. Relative importance of different factors did not change based on patient demographic characteristics. Patients who are on the waiting list longer give less importance to kidney quality (standard beta estimate -0.23, p value 0.03) and more importance to How difficult it is for you to be matched to a donor (ie whether or not you are sensitized) (standard beta estimate 0.28, p value 0.01). Surgeons placed the greatest value on Kidney quality, How difficult it is for the patient to be matched to a kidney (ie whether or not the patient is sensitized), and The age of the donor. This pilot study suggests a role for standardized education tools to help empower patients to be involved in this difficult decision. Development of decision aids can be guided by the results of this project.

Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1626. Advisers: George L. Delclos; Beatrice J. Selwyn. Includes bibliographical references.

Thesis--University of Oklahoma. / Bibliography: leaves 137-141.

Thesis--University of Oklahoma. / Includes bibliographical references (leaves 52-53).

Since 1994, a turning point in the history of South Africa (SA), significant changes were made in the delivery of health services by the public sector, provincially and nationally. The process of change involved making important decisions about health services provision, often based on past experience but ideally requiring detailed information on health status and health services. For an example, Primary Health Care (PHC) was made freely accessible to all citizens of this country. Many studies on the impact of free PHC in the country have shown increased utilization of these services.40 In the context of HIV/AIDS and its complications and other emerging health conditions, reasons for this increased utilization may not be that simple. I17, II8. Parallel with increased utilisatIon has been uncontrollable escalation of costs in the Department of Health (DoH), often resulting in ad-hoc and ineffective measures of cost-containment.40. For these and many other reasons of critical importance to public health services management, the issue of health information generally, and epidemiological inforn1ation in particular, should be brought higher on the agenda of health management. Public health services management is about planning, organization, leading, monitoring and control of the same services.2 Any public health plan must have a scientific basis. In order to achieve rational planning of public health services in the province, adequate, up to date, accurate information must be available, as a planning tool. Health information is one of key resources and an essential element in health services management. It is a powerful tool by which to assess health needs, to measure health status of the population and most importantly, to decide how resources should be deployed.5 Trends in the health status of the population are suggested by the White Paper for transforn1ation of Health Services (White Paper), to be important indicators of the success of the Reconstruction and Development Programme (RDP), the country's programme of transformation. 37,39 It is within that context that the KwaZulu-Natal-Department of Health (KZN-DoH) resolved to establish an Epidemiology/Demographic Unit for the province, to assist management to achieve the department's objectives of providing equitable, effective, efficient and comprehensive health services. 37,89 Purpose: To develop a provincial Epidemiological-Demographic Inforn1ation System (EDIS) that will consistently inforn1 and support rational and realistic management decisions based on accurate, timely, current and comprehensive infom1ation, moving the DoH towards evidence based policy and planning. Objectives: To provide an ED IS framework to : .develop provincial health policy .assist management with health services planning and decision-making .ensure central co-ordination of health information in order to support delivery of services at all levels of the health system . . monitor implementation and evaluation of health programmes . ensure utilization of information at the point of collection, for local planning and interventlon. Methods: A rapid appraisal of the existing Health Information System (HIS) in the province was conducted from the sub-departments of the DoH and randomly selected institutions. A cross-sectional study involving retrospective review of records from selected hospitals, clinics and other sources, was conducted. The study period was the period between January 1998 to December 1998. Capacity at district and regional levels on managing health information and epidemiological information in particular, was reviewed and established through training progranmles. Results: The rapid appraisal of existing HIS in the province revealed a relatively electronically well resourced sub-department of Informatics within the KZN-DoH, with a potential to provide quality and timely data. However, a lot of data was collected from both clinics and hospitals but not analyzed nor utilized. Some critical data was captured and analyzed nationally. There was lack of clarity between the Informatics Department staff responsible for collecting and processing provincial data and top management with regards each other's needs. Demographics: The demographic composition and distribution profile of the KZN population showed features of a third world country for Blacks with the White population displaying contrasting first world characteristics. Socio-Economic Profile: The majority of the population was unemployed, poor, illiterate, economically inactive, and earning very low income. The water supply, housing and toilet facilities seemed adequate, but in the absence of data on urban/rural distinction, this finding needs to be interpreted with caution Epidemiology: All basic indicators of socio-economic status (infant, child, neonatal mortality rates) were high and this province had the second poorest of the same indicators in the country. Adult and child morbidity and mortality profiles of the province, both at clinics and district hospitals were mainly from preventable conditions. Indicators on women and maternal health were consistent with the socio-economic status of this province; and maternal mortality rate was high with causes of mortality that were mainly preventable. The issue of HIV / AIDS complications remains unquantifiable with the limited data available. HIV is a serious epidemic in KZN and this province continues to lead all the provinces in the country, a prevalence of 32 % in 1999.86 Health Services Provision: Inmmnization coverage was almost 50% below the national target and drop out rate was very high. Termlinations of Pregnancies (TOP) occurred mainly among adult, single women, and the procedure done within the first trimester and requested for social and economic reasons. Provincial clinics (mainly fixed) and hospitals provide family planning and Ante Natal Care (ANC) services to the majority of pregnant women in the province. Conclusion : KZN is a poor province with an epidemiological profile of a country in transition but predominantly preventable health conditions. The province has a potential for producing high quality health information required for management, planning and decision making. It is recommended that management redirects resources towards improving PHC services. Establishment of an Epidemiology Unit would facilitate the DoH's health services reforms, through provision of comprehensive, accurate, timely and relevant health information . / Thesis (M.Med.)-University of Natal, Durban, 2000.

<p>The present study was conceived to examine the trend and factors affecting fertility in Nigeria and Guinea. Fertility has declined by about nineteen percent in Nigeria between 1982 and 1999. In the same period it has declined by five percent in Guinea. The decline is observed in data from censuses and surveys. Studies have reported that fertility transition is in progress in most Sub-Sahara African countries (Bongaarts 2008 / Guttmacher 2008), Nigeria (Feyisetan and Bankole 2002) and Guinea (measuredhs 2007). Studies and surveys done in some regions and among ethnic groups suggest that fertility is declining in Nigeria (Caldwell et al. 1992) and Guinea (measuredhs 2007). However, these studies and surveys are devoid of national representativeness as they are localized in specific regions or selected ethnic groups. Thus, they cannot be used as a national reference. The trend of the total fertility rate (TFR) from the three consecutive Demographic and Health Surveys in Nigeria did not show any meaningful decrease over time. In the same vein, no evidence of fertility decline was observed in Guinea from the Demographic and Health Surveys. The claim that fertility is declining in these two countries which assures the funding organizations that Family Planning programs are successful is beyond the scope of the present study. Based on Demographic and Health Surveys the claim that fertility is decreasing in Nigeria may be misleading, whereas in Guinea fertility has shown stability. This suggests that while the factors affecting fertility may be similar, their impacts differ from country to country.</p>

Background: The economic crisis that intensified in Zimbabwe between 2004 and 2009 could have exposed children under the age of 5 at an elevated risk of dying. The study investigates the determinants of childhood mortality in the country 4 years preceding the Zimbabwe Demographic and Health Survey of 2010-2011. Aims and Objectives: To establish child mortality determinants in Zimbabwe for the period 2006-2010 during the economic crisis. Methods: The study was a descriptive cross-sectional study which used data from the ZDHS 2010-2011. Using logistic regression and survival analysis, the study estimates the odds of dying and the survivorship probabilities for the birth cohort of 2006-2010. Results: The results indicate that children born to mothers age 40-49 had 88% higher chances of dying compared to children born to mothers in the age group 15-19 in a model that controls for age of mother and gender of child. Female children had 23% lower chances of dying compared to male children in a model that controls for gender and age of mother and was statistically significant at p-value<.05. Children born to mothers with higher levels of education had 16% lower chances of dying compared to children born to mothers with lower levels of education in a model that controls for maternal education, age of mother and gender of child. Children residing in households with higher socio-economic status had 12% lower chances of dying than children residing in households with lower socio-economic status in a model that controls for household socio-economic status, maternal education, age of mother and child’s gender. Children residing in rural areas had 17% lower chances of dying than children residing in urban areas in a model that controls for area of residence, household socio-economic status, maternal education, age of mother and gender of child. Children residing in some of the country’s poorest provinces namely Matabeleland North and South had 72% and 70% lower chances of dying respectively and both were statistically significant at p-value<.05 in a model that controls for province of residence, area of residence whether rural or urban, age of mother, maternal education, gender of child and household socio-economic status. Conclusions: The study established some of the determinants of childhood mortality during the country’s economic crisis. / Thesis (M.A.)--University of KwaZulu-Natal, Durban, 2013.

Background: The present study was conceived to examine the trend and factors affecting fertility in Nigeria and Guinea. Fertility has declined by about nineteen percent in Nigeria between 1982 and 1999. In the same period it has declined by five percent in Guinea. The decline is observed in data from censuses and surveys. Studies have reported that fertility transition is in progress in most Sub-Sahara African countries (Bongaarts 2008; Guttmacher 2008), Nigeria (Feyisetan and Bankole 2002) and Guinea (measuredhs 2007). Studies and surveys done in some regions and among ethnic groups suggest that fertility is declining in Nigeria (Caldwell et al. 1992) and Guinea (measuredhs 2007). However, these studies and surveys are devoid of national representativeness as they are localized in specific regions or selected ethnic groups. Thus, they cannot be used as a national reference. The trend of the total fertility rate (TFR) from the three consecutive Demographic and Health Surveys in Nigeria did not show any meaningful decrease over time. In the same vein, no evidence of fertility decline was observed in Guinea from the Demographic and Health Surveys. The claim that fertility is declining in these two countries which assures the funding organizations that Family Planning programs are successful is beyond the scope of the present study. Based on Demographic and Health Surveys the claim that fertility is decreasing in Nigeria may be misleading, whereas in Guinea fertility has shown stability. This suggests that while the factors affecting fertility may be similar, their impacts differ from country to country.Method: Data from the Demographic Health Surveys (DHS) conducted in Nigeria and in Guinea were used in the study. Trends in TFR by background were extracted from the censuses and DHS final reports in Nigeria and Guinea. Data from DHS 1999 and DHS 2003 in Nigeria and DHS 1999 and DHS 2005 in Guinea were used for the actual analysis. The sample sizes of 8199 and 7620 of DHS 1999 and 2003 respectively for all women aged 15 - 49 were included in Nigeria. The sample sizes for Guinea were 6753 and 7954 for DHS 1999 and 2005 respectively. The trends in knowledge and current contraceptive use, unmet needs,desires for last child, current pregnancy, visiting of health facility, visitation by family planning workers and respondent approval of Family Planning (FP) were examined by age groups. Univariate and bivariate analyses were executed to explain the association and determinants of contraceptive use by socio-demographic characteristics. Stepwise multinomial regression was carried out to determine the variables affecting total number of children ever born (TCB).Result: Total fertility rate has increased in Nigeria between 1990 and 2003 by background characteristics. It has increased by eleven and fourteen percent in rural and urban residence respectively in Nigeria within the same interval. Fertility increased by thirteen and seventeen percent among women with primary and higher education respectively in Nigeria. Unmet needs for child spacing decreased by three percent. Over seventy percent of women have never discussed FP with their partners and other people. Over sixty percent of Women neither visited a health facility (HF) nor were visited by a health worker in 2003. Forty-eight percent of the women approved of FP in 2003, which represents an increase of five percent of 1999.Over ninety percent wanted their last child and current pregnancy in 2003. However, there are incidences of mistimed and unwanted births and pregnancies. There was an association between contraceptive use and all the socio-demographic variables examined. The age of the respondent, current use of contraceptive, age at first sexual intercourse and partner’s education have positive effects on fertility. However, education of women, place of residence and age at marriage has a negative effect on fertility.Total fertility rate has remained stable in Guinea. It increased by eight percent in rural areass and decreased by fifteen percent in urban areass between 1992 and 2005. In Guinea, fertility decreased by over twenty percent for women with primary and secondary education between 1992 and 2005. Unmet needs for child spacing and limiting declined by three and one percent. Over eighty percent of women have not discussed FP with their partners and other people. Women that did not visit a HF remained stable at sixty-six percent, while ninety-two percent were not visited in their homes by a FP worker. The women who approved of FP were forty-seven percent, showing a decline by eleven percent from 1999. Over eighty percent of the women wanted their last child and current pregnancies in 2005. There was an association between contraceptive use and all the socio-demographic variables examined.The significance of the regression coefficient shows that the age of the respondent and current use of contraception has a positive effect on TCB. Education, place of residence, age at marriage and religion have negative effects on TCB.Conclusion: The general patterns observed do not give confidence that fertility is declining or showing a tendency towards declining in Nigeria. In addition the use of modern contraceptive has no bright future as a vehicle to regulate fertility in Nigeria. Fertility in Guinea shows some potential for reduction which may be transitory because some of the indicators that favour fertility reduction seem to be losing their grip. There are overall negative attitudes to contraceptive use and FP in Guinea. This is similar to the observed situation in Nigeria. Expectation that intensified campaigns on contraceptive use and FP will reduce fertility and ultimately reduce population growth in Nigeria and Guinea is not likely to be met, because the desire for large families abound. / Magister Scientiae - MSc

The problem of the study was to create a valid and reliable instrument which would measure the diabetes knowledge of college students.To reach this goal, a pool of questions containing 49 items was developed after an extensive review of the literature which addressed diabetes risk factors, diabetes knowledge, college students and health knowledge, instrument development and knowledge measurement. A nine member jury of experts composed of health education professors, those knowledgeable in instrument development, and diabetes health care providers determined content validity for the pilot test instrument which reduced the pool to 34 items. The instrument was then pilot tested on 46 Ball State University undergraduates in a personal health course. The results were analyzed and had a whole test reliability, using the Kuder-Richardson 20, of .76.General education students (n = 522) at Central Michigan and Ball State Universities were the subjects for the administration of the revised instrument. The revised instrument included 27 items. The final instrument contained 26 items and had a whole test reliability coefficient, using the Kuder-Richardson 20, of .78. In addition, it discriminated between the upper and lower 27% groups in terms of total test score, had item-test reliability coefficients of .11 or greater, and the item difficulty ranged from .17 to .87. / Department of Physiology and Health Science