Magister Commercii - MCom / The premise of this research was focused on ascertaining how variables such as work environment, pay, supervision, co-workers and promotion impacts on job satisfaction of civil servants at an institution residing under the Department of Health in the Western Cape. / South Africa

Introducción. En Perú, durante el servicio social en salud se han reportado problemas como condiciones laborales riesgosas, mortalidad asociada a accidentes de tránsito y déficit de cobertura de aseguramiento.Objetivo. Describir los problemas percibidos y experimentados por los profesionales de salud que realizan el Servicio Rural y Urbano Marginal de Salud (SERUMS) en Ancash, Perú, y evaluar su asociación con la práctica de los profesionales y la categoría del establecimiento donde se realiza el SERUMS.Materiales y métodos. Durante abril del 2015, se realizó un estudio transversal analítico con profesionales de salud que realizaban el SERUMS en establecimientos del Ministerio de Salud de Ancash. Se aplicaron encuestas para recolectar datos generales, características y problemas del SERUMS.Resultados. Se analizaron 364 encuestas. El 79.3% de los participantes fue de sexo femenino, la edad promedio fue de 27.4±5.0 años, 80.0% percibió carencia de insumos, 54.4% percibió carga laboral excesiva, y 14.7% sufrió algún accidente de tránsito durante el SERUMS. Ser médico y laborar en establecimientos I-1 fueron factores asociados a haber sufrido accidentes de tránsito y otros imprevistos.Conclusiones. Los encuestados reportan carga laboral excesiva, carencia de insumos y accidentes. Los accidentes son más frecuentes en médicos y en establecimientos de categoría I-1.

The study developed a model for projecting potential economies from manpower substitution among the four core mental health professions and applied the model to a proposed substitution situation which would substitute psychologists for psychiatrists in the delivery of a proportion of present private practice (fee-for-service) psychiatry services in British Columbia. The model identifies three controlling variables: treatment substitutability (TS), practice privilege constraints (PPC), and relative payment rates (RR). In the model, TS and PPC are conceptualized as determining the estimated substitutable share of costs (SSC%); RR, in combination with the values derived for SSC%, is then used to estimate potential cost savings (CS%). Two conditions were defined for each of the three controlling variables in order to provide a range of possible values for SSC% and CS%. For reasons of data availability, data were obtained from the Manitoba Health Services Commission for private practice psychiatry services for FY 1984 and estimates of SSC% calculated. These estimates were then applied to B.C. Medical Services Commission data for FY 1984, and projected values of CS% calculated. Calculations were made both for all services and for the subset of psychotherapy services, which accounted for 80 percent of the larger set of services. The results of the study indicated considerable possibilities for manpower substitution, ranging from 35 to 70 percent for all services and 40 to 75 percent for psychotherapy services. However, the study also found that while salaried psychologists offered the possibility of substantial cost savings, a fee-for-service arrangement suggested virtually no potential savings. Projected values of CS% for the salaried alternative were 20 to 40 percent for all services and 15 to 30 percent for psychotherapy services but in the fee-for-service alternative, only 4 to 8 percent for all services and 4 to 7 percent for psychotherapy services. Licensure and market rigidities which might pose barriers to implementation were evaluated and a review of professional training standards (TS), licensure standards (PPC), and funding alternatives (RR) indicated that the projected economies could be achieved with no necessity for modifications in existing arrangements. PPC appear to present almost no barriers to economies from the proposed manpower substitution and those barriers which are presented by TS and RR limitations still allow considerable potential for economies. Thus, the greatest opportunities for intervention in achieving and enhancing the projected, economies appear to be in the exploration of relative payment rates and relative effectiveness of treatment methods (e.g., psychotherapy vs. pharmacotherapy). The study concludes with a discussion of factors lying outside the boundaries of the model but which impinge, nonetheless, upon the feasibility of the proposed substitution and fall, necessarily, to policy makers to address. The existing network of B.C. community mental health centres was suggested as a possible mechanism for the delivery of the substitutable share of private practice psychiatry services. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Pre-paid medical and hospital insurance in Canada has enabled many people to obtain medical services that they could not previously afford, but equal access to health care is not yet ensured for all segments of the population. . It has been suggested that health care resources, particularly manpower, tend to concentrate in urban centres, while rural and remote areas have inadequate resources. In testing the relationship between rurality and accessibility to primary health care, this thesis aims at enriching the knowledge base for mitigation decisions. Seven groups of primary health care personnel were examined: general practitioners, pharmacists, dentists, general surgeons, pediatricians, obstetricians and psychiatrists Nine study regions were ranked by rurality and accessibility. Rurality was measured by (1) proportion of rural population residing in the study region, and (2) distance of the study region to the nearest metropolitan centre. Accessibility was measured by (1) travel distance to the nearest health care personnel, and (2) the ratio of health care personnel to the regional population. Rurality was then correlated with accessibility. Rurality was also correlated with waiting time for an appointment with a general practitioner, and statistical tests for significant difference were performed to determine if waiting time varies with community size. The relationship between practice locations of general practitioners and their personal attributes was tested (1) by correlating rurality with place and year of graduation, and (2) by testing for significant difference in place and mean year of graduation among different community size groups. Significant difference tests were also performed to test the effect of the federal policy restricting physician immigration on the proportion of foreign physicians in rural areas. The result of the accessibility test supports the hypothesis that accessibility diminishes with rurality. It also suggests that serious maldistributions occur in primary care sub-specialty personnel, namely pediatricians, obstetricians and psychiatrists, and that there are intra-regional disparities as well as inter-regional disparities. General practitioners are the least inequitably distributed. The findings reveal that population dispersion and small settlements are the primary obstacles to achieving equal access. Results of the waiting time tests were inconclusive. There is no evidence to support a linear relationship between waiting time and rurality. Long waiting times appear to associate with both the most rural and the least rural regions. Statistical tests of waiting time by community size indicate high variability, prohibiting meaningful comparison of the means. The tests of personal attributes of general practitioners indicate that age (year of graduation) decreases with rurality, and increases with community size, and that the proportion of non-B.C. graduates increases with rurality, but is not affected by community size. Federal immigration restrictions have diminished the proportion of foreign physicians in rural communities, but not in urban or metropolitan centres. The concluding discussion of policy implications covers: (1) Manpower Planning with special emphasis on the roles of the government, the Colleges and the University, and the potentials of various policy options, and (2) Regionalization and its application in health manpower planning. / Applied Science, Faculty of / Community and Regional Planning (SCARP), School of / Graduate

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Orientador: Milena Temer Jamas / Resumo: Os profissionais de saúde utilizam algumas táticas com intuito de se resguardar psiquicamente do sofrimento vivenciado por seus pacientes. Entre uma das maneiras de proteção está a concepção de que setor da maternidade seja um lugar onde surgem novas vidas e não onde elas acabam. Entretanto a maternidade pode ser marcada por acontecimentos negativos, acompanhados por perdas ao invés de ganhos, tornando a morte um assunto polêmico e desafiador nesse meio. Diante disso, o objetivo desta pesquisa foi melhorar a qualidade do atendimento da equipe de enfermagem diante das pacientes/familiares que sofreram uma perda perinatal a partir de um material instrutivo destinado aos cuidados de enfermagem em situação de óbito perinatal. Trata-se de um estudo do tipo metodológico, para construção de uma tecnologia educativa, o qual adotou as etapas de: submissão do projeto ao comitê de ética, levantamento de vivências e demandas da população alvo por meio de um estudo qualitativo, levantamento bibliográfico e elaboração do material educativo. A elaboração da cartilha seguiram as seguintes etapas: A sistematização do conteúdo; A seleção e elaboração das ilustrações; A composição da cartilha e os critérios editoriais utilizados. Foram entrevistados individualmente nove enfermeiros e dez técnicos de enfermagem que atuam na maternidade do Hospital das Clínicas de Botucatu (HC), maternidade referência regional para atendimentos de gestante alto risco. As entrevistas foram gravadas a partir da per... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Health professionals use some tactics to protect themselves psychically from the suffering experienced by their patients. One of the ways of protection is the conception that the maternity sector is a place where new lives emerge and not where they end. However, motherhood can be marked by negative events, accompanied by losses rather than gains, making death a controversial and challenging issue in this environment. Therefore, the objective of this research was to improve the quality of care provided by nursing staff to patients / family members who suffered a perinatal loss from an instructional material intended for nursing care in perinatal death situation. This is a methodological study, for the construction of an educational technology, which adopted the steps of: submission of the project to the ethics committee, survey of experiences and demands of the target population through a qualitative study, bibliographic survey and elaboration of educational material. The elaboration of the booklet followed the following steps: The systematization of the content; The selection and elaboration of the illustrations; The composition of the booklet and the editorial criteria used. Nine nurses and ten nursing technicians who work at the maternity ward of the Botucatu Hospital (HC), a regional reference maternity ward for high-risk pregnant women, were interviewed individually. The interviews were recorded from the guiding question: "What are the biggest difficulties faced by health... (Complete abstract click electronic access below) / Mestre

Summary. The purpose of this study was to assess the degree of consistency in student ratings of teacher effectiveness during the first year of medical school. Student ratings of teaching effectiveness represent a commonly used source of information that enters into the academic decision‐making process. In medical school, student evaluations often represent a major source of information that is used in promotion and tenure decisions. It is essential that the precision of such ratings be ascertained so that decision‐makers will know how much confidence to place in this source of information on teaching effectiveness. In this study, each member of a first‐year medical school class was randomly assigned a two‐digit identification number at the beginning of the spring semester, 1986. As the semester progressed students were asked to evaluate each fulltime teacher in three major courses. Multiple instructors were utilized in each course (n = 10). Each teacher was evaluated immediately after lectures during the first (T1) and second (T2) halves of the course. Students evaluated the teacher a third time (T3) as part of the end‐of‐semester overall course evaluation. The teachers were evaluated on a short eight‐item Likert‐type scale that identified several key indicators of effective teaching. Students attached their anonymous identification numbers to individual ratings so that their responses could be matched in the analysis. The results indicate that medical students are only moderately consistent in the extent to which they evaluate teachers. This inconsistency varied by course and by instructors within courses. Student perceptions of teaching effectiveness changed over the course of the semester, although the extent and direction of change varied by course. The results highlight a major difficulty in using end‐of‐semester student evaluations as a factor in academic decision‐making. Student ratings of effectiveness may vary considerably from one time period to another and may be influenced by many different factors. Decision‐makers should exercise caution in interpreting one‐shot student evaluations of instructional effectiveness.

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The Surgeon General of the United States in 2003 documented the existence of striking disparities for minorities and immigrants in mental health services and the underlying knowledge base. This thesis expands the knowledge base by examining the personal experiences and perspectives of community health workers (CHWs) employed in a mental health project. CHW interventions have been shown to increase access and reduce barriers to health care services. CHWs come from similar cultural and ethnic backgrounds as recipients of services and share similar life experiences. As cultural mediators between ethnic communities and a primary health care system, CHWs are able to provide valuable insight into immigrant mental health disparities. Through case study analysis, this thesis explores the personal experiences of CHWs employed by a grant-funded mental health project. Utilizing ethnographic research methods to better understand the CHW intervention, this thesis focuses on CHW motivations, their challenges and the impact of work on their personal lives. Results suggest that CHWs experienced many positive changes in their own lives as a result of their work. CHWs are better able to address their own physical and mental health needs. By increasing access to community and clinic services, CHWs help to improve the mental and physical health status of clients. Results suggest that the cultural competency of clinic staff, service providers and clients improved. CHWs help to strengthen community bonding or social capital by expanding social networks and empowering individuals to create change in their own lives. / Graduation date: 2006