University of Macau / Faculty of Business Administration / Department of Management and Marketing

University of Macau / Faculty of Science and Technology / Department of Computer and Information Science

published_or_final_version / Public Administration / Master / Master of Public Administration

published_or_final_version / Public Administration / Master / Master of Public Administration

Thesis (M.B.A.)-Business Studies Unit, Durban University of Technology, 2006 xv, 200 leaves / Imbalance in the health workforce is a major challenge for health policy-makers, since human resources are the most important of the health systems input (Sanders & Lloyd) Several developed nations are increasingly relying on immigration as a means of coping with domestic shortages of health care professionals (Vujicic et al. 2004). The extent of migration and other losses of professional skills are difficult to quantify. However, the effects of these are multifaceted and have far reaching consequences for both the economy and the maintenance of health services in the country. The effects of this “brain drain” limit service delivery and limit the general population’s access to health services. The purpose of this study is to determine the effectiveness of contracting bursary students to the Department of Health (KwaZulu-Natal) as a specialist skills retention strategy.

Diss. Umeå : Univ., 2004.

No description available.

Substance abuse is a relapsing chronic illness. In 2014, an estimated 27 million persons reported using illicit drugs in the United States (SAMHSA, 2014). Substance abuse negatively impacts societies, productivity, healthcare costs and families. Families play an important role in relapse prevention and sobriety. With adequate family support, substance abuse positively responds to treatment. Many individuals (about 66 million Americans) play the role as an informal caregiver for a relative with chronic illnesses such as substance abuse but few studies exist on the caregiving experiences. What we know about the family caregiving experience is restricted to data from quantitative studies which do not explain the complexities and competing challenges that exist. Different approaches are thereby needed to deepen our understanding of the family caregiver burden of living with a relative with substance abuse problems. Such studies will enable us to understand the original experience and moment of learning of a relative’s substance abuse problems, decision making and support that follows thereafter. This moment calls for major decision making and encounter with treatment services. The purpose of this study was to explore the lived experience of caregivers of relatives with alcohol and opiate dependence. This study utilized Max van Manen’s (2014) Phenomenology of Practice. Ten participants (N=10) were recruited for this study. Van Manen’s guided existential inquiry was used in the analysis of experiential material collected through interviews. Four main themes emerged from the data: (1) Being in the moment: the extension of the self; (2) The dawn of reality: the being of acceptance; (3) Deciding in the moment: the healthcare experience; (4) Uncertainties and struggle: a lifelong process. These themes described how the participants: experienced, accepted and processed a relative’s substance abuse problem, encountered treatment services and experienced the uncertainties and struggles involved in caring for a relative with substance abuse problems. Two main findings emerged from these themes; the impact of guilt and stigma on seeking care and the need to see addiction as a disease instead of as a moral character failure. This calls for coalitions with stakeholders to decrease stigma, enhance acceptance process and increase access to treatment.

Chronic obstructive pulmonary disease (COPD) has been recognized as a leading cause of mortality in older adults involving acute exacerbations as life-threatening events that lead to frequent hospitalization for care. Informal caregivers have been essential to helping older adults with COPD during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). A lack of empirical knowledge exists regarding the experience of informal caregivers of older adults with AECOPD in situation awareness for recognizing, understanding, and responding to an AECOPD in an emergent situation. This qualitative descriptive study explored situation awareness and its components of perception, comprehension and projection of next steps, including the caregiver’s confidence level during the AECOPD event. Fifteen informal caregivers, ages 31-77 years (mean age 48), who provided care for older adults with COPD were interviewed from an underserved community health center. The overarching theme derived from this study was something was wrong and something needed to be done. Subthemes emerged as a heightened sense of awareness, caregiver tipping point, planning next steps, caregiver confidence, and caregiver commitment. This study utilized situation awareness theory as a relevant guiding framework in exploring the experience of lay informal caregivers caring for older adults with AECOPD events. Study findings provided a description of the complex processes involved, including confidence level, for informal caregiver’s in situation awareness to recognize and respond to an AECOPD event in the older adult. Future targeted interventions need to address strategies to enhance individualized care for older adults with AECOPD events for managing care at home.

BACKGROUND: Breastfeeding and lactation are cited as sensitive periods in the life course that contribute to the accumulation of risks or opportunities ultimately shaping vulnerability or resilience later in life. As such, breastfeeding and lactation are critical components of health equity. Despite this, Black women in the U.S. initiate and continue to breastfeed at lower rates than White women and other groups. Underlying reasons for racial inequities in breastfeeding rates are poorly understood. Exposure to racism, one manifestation of historical oppression in the U.S. has been cited as a determinant of poor health outcomes for decades but has not been extensively described in the context of breastfeeding. AIMS: To investigate the association between experiences of racism and 1.) breastfeeding initiation 2.) breastfeeding duration 3.) and the association between selected life-course factors and breastfeeding initiation and duration among participants of the Black Women’s Health Study. METHODS: This study was a prospective secondary analysis of the Black Women’s Health Study. The sample included all participants who enrolled in 1995, responded to the racism assessment in 1997 and reported the birth of a first child following the racism assessment resulting in an N=2, 995 for the initiation outcome and N= 2,392 for the duration outcome. In addition to the racism assessment, we also included life-course factors (nativity, neighborhood segregation and social mobility). For each aim, we calculated odds ratios and 95% confidence intervals using binomial and multinomial logistic regression using two models. The first adjusted for age, the second adjusted for age, BMI, education, marital status, geographic region, neighborhood SES and occupation. RESULTS: Associations between daily and institutional summary racism variables and breastfeeding initiation and duration were small and not statistically significant. Experiences of racism in the job setting was associated with lower odds of breastfeeding duration at 3-5 months compared with 3 months 95% CI [0.60, 0.98]. Experiences of racism with the police was associated with higher odds of breastfeeding initiation and duration at 3-5 months [1.01, 1.77] and at 6 months [1.10, 1.82] compared with women who did not report this experience. The participant’s nativity and the nativity of her parents were life-course factors that predicted lower odds of breastfeeding initiation and duration. Neighborhood segregation did not reach statistical significance after adjusting for covariates but results trended toward lower odds of breastfeeding initiation and duration for women who reported living in a predominately Black neighborhood (compared with White) up to age 18 and for women who reported living in a predominately Black neighborhood in 1999. CONCLUSION: Experiences of institutional racism in the job setting was associated with lower odds of breastfeeding duration. In addition to explicit experiences of racism, this study provides preliminary evidence surrounding life-course factors and breastfeeding. Individual level interventions may mitigate harmful effects of racism but structural level interventions are critical to close the gap of racial inequity in breastfeeding rates in the U.S.