MCur / Department of Advanced Nursing Science

The study examined the sexual and reproductive health needs of adolescents infected with HIV and AIDS. This was a qualitative study that involved semi-structured interviews and observation. The sampling method used was purposive and it entailed 10 adolescents (4 boys and 6 girls) who are living with HIV at Chiedza Child Care Centre in Zimbabwe. This study revealed that adolescents’ sexual and reproductive health needs are the desire to have sex, desire to have children, the need for prevention of unwanted pregnancy and care and treatment support. However, their knowledge of HIV and AIDS was inadequate. Adolescents also revealed their lack of proper information regarding their health care and treatment needs. However, adolescents illustrated an adequate knowledge of the services available for them for their health, treatment and care needs. The study recommended that there is need to strengthen the provision of information and services on adolescents’ sexual and reproductive health issues. The study also recommended that counsellors should improve their counselling skills so that they can empower adolescents living with HIV to be able to negotiate condom usage, matters of dating and handling relationships. / Sociology / M. A. (Social Behaviour Studies in HIV and AIDS)

Section 27(1)(a) of the Constitution of the Republic of South Africa, 1996, entrenches everyone's right of access to health care services. The purpose of this dissertation is to determine the manner in which this right must be interpreted and implemented in order to alleviate poverty to the optimal extent possible, in South Africa. As a point of departure, the relationship between poverty and health, as well as the theoretical basis of poverty, is addressed in terms of soft law. Thereafter, the theoretical basis of the right of access to health care service is analysed and explained from both an international and a South African perspective. This is followed by an investigation into international law. The manner in which the United Nations International Covenant on Economic, Social and Cultural Rights is interpreted and implemented and whether or not this contributes to poverty alleviation, is investigated. This is followed by an analysis of the right in terms of the Constitution and case law. Particular attention is paid to the manner in which the courts interpret the right of access to health care services. It is then determined whether the state is implementing the right in such a manner as to contribute to the optimal alleviation of poverty, in South Africa. Finally, a conclusion is reached and recommendations are made as to ways in which the right can be interpreted and implemented to reduce poverty to the optimal extent possible, in South Africa. / Thesis (LL.M.)--North-West University, Potchefstroom Campus, 2010.

Section 27(1)(a) of the Constitution of the Republic of South Africa, 1996, entrenches everyone's right of access to health care services. The purpose of this dissertation is to determine the manner in which this right must be interpreted and implemented in order to alleviate poverty to the optimal extent possible, in South Africa. As a point of departure, the relationship between poverty and health, as well as the theoretical basis of poverty, is addressed in terms of soft law. Thereafter, the theoretical basis of the right of access to health care service is analysed and explained from both an international and a South African perspective. This is followed by an investigation into international law. The manner in which the United Nations International Covenant on Economic, Social and Cultural Rights is interpreted and implemented and whether or not this contributes to poverty alleviation, is investigated. This is followed by an analysis of the right in terms of the Constitution and case law. Particular attention is paid to the manner in which the courts interpret the right of access to health care services. It is then determined whether the state is implementing the right in such a manner as to contribute to the optimal alleviation of poverty, in South Africa. Finally, a conclusion is reached and recommendations are made as to ways in which the right can be interpreted and implemented to reduce poverty to the optimal extent possible, in South Africa. / Thesis (LL.M.)--North-West University, Potchefstroom Campus, 2010.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / In Brazil, Primary Health Care is the gateway of users into the health system, based on individual and collective actions, presenting as one of the fundamental principles the universal and equitable access of the population to these actions. In order for this level of attention to be strengthened, guaranteeing access, evaluation is essential, as it allows to leverage available resources according to local demands. Thus, considering the importance of Primary Health Care as a health care provider, with access as an indispensable attribute and evaluation as a tool to change realities, the present study to evaluate the access in APS services of the municipalities that are part of the 4th Regional Health Coordination from the perspective of health professionals. It is a study with a quantitative, transversal approach, carried out in the Primary Health Care services of the 4th Regional Health Coordination of Rio Grande do Sul, composed of the Entre Rios and Verdes Campos Health Regions. Data collection took place between February and July 2015, using computerized Epi Info® 7.0 software, using tablets, with application of the Primary Care Assessment Tool-Brazil professional version. The sample comprised 207 higher-level health professionals. Statistical Analysis System (SAS) version 9.0 was used to analyze the data. The score was dichotomized at low score, if <6.6 or high score, if ≥6.6. The normality of the variables was evaluated by the Shapiro Wilk test. Pearsson's Correlation was used to verify the degree of relationship between First Contact Access items and the score, and Poisson Regression to identify the dependence between the score and its socio-spatial context. The ethical precepts respected Resolution 466/2012. The article 1, a descriptive study in which the attribute First Contact Access obtained a low score (4.68), being the issues related to the time and day of operation of the health unit, the ones that most influenced this result. Article 2, a multilevel study, with contextual and individual variables found low First Contact Access score in most of the municipalities surveyed (83.6%), presenting a level of significance only in the variable population size, in which municipalities with up to five thousand inhabitants Higher prevalence of the attribute. Article 3, a study of trends about access of the elderly in Primary Health Care, shows that access does not prevail as an object of research, related to quality of life and integral care of the elderly, as well as organizational and bureaucratic barriers. Article 4, integrative review on the access of the elderly in this level of attention, showed the Family Health as a facilitator of access, work processes and infrastructure as real barriers to elderly access. In this way, it can be seen that there are still barriers in access, mainly referring to the structure of primary health care services. This study is expected to help in the expansion and quality of the population's access to this level of care. / No Brasil, a Atenção Primária à Saúde é a porta de entrada dos usuários no sistema de saúde, fundamentando-se na realização de ações individuais e coletivas, apresentando como um dos princípios fundamentais o acesso universal e equânime da população a essas ações. Para que esse nível de atenção se fortaleça, garantindo o acesso, a avaliação é essencial, pois permite potencializar os recursos disponíveis conforme as demandas locais. Assim, considerando a importância da Atenção Primária à Saúde como ordenadora do sistema de saúde, tendo o acesso como um indispensável atributo e a avaliação como uma ferramenta para mudar as realidades, o presente estudo tem como objetivo avaliar o acesso em serviços de APS dos municípios integrantes da 4ª Coordenadoria Regional de Saúde na perspectiva dos profissionais de saúde. Trata-se de estudo com abordagem quantitativa, transversal, realizado nos serviços de Atenção Primária à Saúde da 4ᵃ Coordenadoria Regional de Saúde do Rio Grande do Sul, composta pelas Regiões de Saúde Entre Rios e Verdes Campos. A coleta dos dados ocorreu entre os meses de fevereiro e julho de 2015, de maneira informatizada por meio do software Epi Info® 7.0, utilizando tabletes, com aplicação do instrumento Primary Care Assessment Tool-Brasil versão profissionais. Compuseram a amostra 207 profissionais de saúde de nível superior. Para a análise dos dados foi utilizado o Statistical Analisys System (SAS) versão 9.0. O escore foi dicotomizado em baixo escore, se <6,6 ou alto escore, se ≥6,6. A normalidade das variáveis foi avaliada pelo Teste de Shapiro Wilk. Utilizou-se a Correlação de Pearsson para verificar o grau de relacionamento entre os itens do Acesso de Primeiro Contato e o escore, e a Regressão de Poisson para identificar a dependência entre o escore e o seu contexto sócio-espacial. Os preceitos éticos respeitaram a Resolução 466/2012. O artigo 1, estudo descritivo em que o atributo Acesso de Primeiro Contato obteve-se um baixo escore (4,68), sendo as questões relativas ao horário e dia de funcionamento da unidade de saúde, as que mais contribuíram para esse resultado. O artigo 2, estudo multinível, com variáveis contextuais e individuais encontrou baixo escore Acesso de Primeiro Contato na maioria dos municípios pesquisados (83,6%), apresentando nível de significância apenas na variável porte populacional, em que os municípios com até cinco mil habitantes obtiveram maior prevalência do atributo. O artigo 3, estudo de tendências acerca do acesso do idoso na Atenção Primária à Saúde, mostra que o acesso não prevalece como objeto de pesquisa, vindo relacionado à qualidade de vida e integralidade da atenção dos idosos, além de barreiras organizacionais e burocráticas. O artigo 4, revisão integrativa sobre o acesso do idoso nesse nível de atenção, evidenciou a Saúde da Família como facilitadora do acesso, e os processos de trabalho e a infraestrutura como barreiras reais ao acesso do idoso. Dessa forma percebe-se que ainda há barreiras no acesso, principalmente referentes à estrutura dos serviços de Atenção Primária à Saúde. Espera-se que este estudo possa auxiliar na ampliação e qualidade do acesso da população esse nível de atenção.

The aim of this paper is to analyze the effects that recent health reforms adopted in Spain because of the economic crisis have had on the National Health System. It is not only a matter of mere budgetary cuts or measures of saving in the public expense. Reforms are looking for the efficiency and financial sustainability of health care services. However, a «mutation» in the public service has taken place. Reforms have affected the basic principles of the public system: the insurance model, its universality, the financing of the system and the principles of equity and cohesion of the public service. / El objeto de este trabajo es analizar los efectos que las reformas adoptadas recientemente en España con motivo de la crisis económica han tenido en el servicio público sanitario. No se trata solo de meros recortes presupuestarios y de medidas de ahorro en el gasto público. Las reformas buscan la eficiencia y la sostenibilidad económica del sistema sanitario. Sin embargo, han producido una importante «mutación» del servicio público que ha afectado a los principios básicos inspiradores del modelo, al modelo de aseguramiento, a su universalidad, a su financiación y, con ello, a los principios de equidad y cohesión del sistema.

The spiritual needs of pensioners in the residential home in Velká Bíteš Abstract: This theses focuses on spiritual needs of senior citizens living in the residential home for pensioners in Velká Bíteš. The theoretical part concentrates on the human needs, ageing and old age, healh and social services. It deals with spirituality, pastoral care, meaning of life and some religions. The practical part examinates the spiritual needs of pensioners in Velká Bíteš and tries to find out if these are sufficiently met. Further it maps the relation between the elderly to the faith, especially to some religious activities, and their cooperation with pastoral workers. The theses provides specific recommendations based on the results of the survay. The conclusion lists recommendations, which could be put into the practice and increase the quality of the spiritual care for senior citizens in residential facilities. Key words: HUMAN NEEDS, MEETING OF NEEDS, NEEDS BY MASLOW, SPIRITUAL NEEDS, AGEING OF PEOPLE, CHANGES IN OLD AGE, HEALTH CARE (SERVICES), SOCIAL CARE (SERVICES), RESIDENTIAL HOME, SPIRITUALITY, PASTORAL CARE, PASTORAL WORKER, DEATH, DYING, MEANING OF LIFE, V. E. FRANKL, SOLITUDE, RELIGION

This study examines state variations in health care services for children with Autism and other developmental disabilities across the fifty states through the Autism and Developmental Disabilities Monitoring Network (ADDM). The ADDM network monitors and tracks the number of children with Autism and other developmental disabilities. The purpose of this study is, first, to understand the differences between the states in the implementation of the ADDM network and, second, to determine what state factors (political variable, i.e., party identification; structural administrative variables, i.e., Medicaid Home and Community Based Service Waiver, HCBS (Section1915C) and the number of pediatricians per 10,000 children; Autism prevalence variable, i.e., Autism among children in special education per 10,000 children; and state economic variables, i.e., spending per pupil for children with Autism in special education, children in poverty, and state financial health) influence the likelihood of a state applying for the ADDM network. Furthermore, the purpose of this study is to consider the potential impact of these various state characteristics in order to understand what state factors might contribute to such differences. The results reveal that structural administrative and economic factors influence a state’s decision to apply for the ADDM network. Furthermore, political factors (e.g., Democratic party control of governorship and legislature) did not influence a state’s decision to apply for the ADDM network. However, when controlling for Republican political party identification, the structural administrative, economic, and political (Republican-controlled legislature) state characteristics influence whether a state applying for the ADDM network. The results indicate that political party control does not play a significant role in determining whether a state will apply for the ADDM network. In expanding the research, to include another structural administrative factor (prior application), political party control (i.e., Republican-controlled legislature) was no longer significant. Thus, the bureaucratic environment is not influencing the actions of state administrators. Instead the individual characteristics of the state is influencing whether a state will apply for the ADDM network. Understanding the differences between the states in the implementation of the ADDM network provides a comprehensive model for establishing the ADDM network or similar programs in other states.

This study aimed to identify factors affecting women’s utilisation of the prevention of mother-to-child transmission (PMTCT) of HIV, evaluate the quality of PMTCT services, describe health outcomes of mothers and infants and to identify factors that influence mother-to-child transmission (MTCT) of HIV. Structured interviews were conducted with 384 women who had utilised PMTCT services. Information was also obtained from the health records of these women and of their infants. Better educated women, who had male partners and were self-employed were more likely to use PMTCT services. Being unmarried, poor and feeling stigmatised made it difficult for women to use these services. Respondents were satisfied with PMTCT services except that clinics sometimes had no medications. The health care workers followed the Ethiopian guidelines during HIV testing and counseling but not when prescribing treatment. Although the respondents’ CD4 cell counts improved, their clinical conditions did not improve. The MTCT rate was significantly higher if infants did not receive ARVs, had APGAR scores below seven, weighed less than 2.5kg at birth, were born prematurely, and if their mothers had nipple fissures. PMTCT services could be improved if more women used these services, health care workers followed the national guidelines when prescribing ARVs, clinics had adequate supplies of medicines, all infants received ARVs, and mothers’ nipple fissures could be prevented. Antenatal care should help to avoid premature births of infants weighing less than 2.5kg and having APGAR scores below 7. Future research should compare formula feeding versus breastfeeding of infants with HIV-positive mothers / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English / The aim of this study was to gain understanding of community service nurses’ experiences of health care services at Tshwane district public hospital. This qualitative study followed an Interpretative Phenomenological Analysis (IPA) approach to explore the community services nurses’ experiences of health care services at Tshwane district public hospital. Data were collected from 11 purposively selected community service nurses using a semi-structured interview format. Data was analysed using Interpretative Phenomenological Analysis framework for data analysis. Four super-ordinates emerged from data analysis: (1) Resources, (2) Work environmental relations, (3) Supervision and support and, (4) Impact of community service experiences. The study revealed that the health care services rendered at the hospital studied are substandard. Community service nurses reported several challenges experienced during their placement in the hospital under study. Lack of human and material resources, supervision and support contributed to hindrance of smooth acquisition of their clinical skills and experience. These challenges resulted in the psychological and emotional drain of the participants. There is a need for development of guidelines to ensure constant and adequate support to all the community service nurses placed at Ratanang Hospital. / Health Studies / M.A. (Nursing Science)