Abstact The diploma thesis is focused on forms and dimensions of breast-feeding support regarding different levels of women and child care in the health care system of the Czech Republic from the perspective of a woman, a mother, who is the health care recipient in the context of the legal framework of Czech legislation and relevant international documents. The findings are based on empirical research results gained from ten semi-structured in-depth interviews. Ten individual research participants gave birth in the same medical institution with the title Baby Friendly Hospital during the last three years, which is the unifying element of the participants. The perspective of a woman, based on a thematic analysis of interviews , shows a lot of perceived dimensions of the provided health care. This work identifies the most obvious women themes: their perception of breastfeeding in pregnancy, importance of breastfeeding for woman, the mother's contact with the baby after the childbirth, medical staff attitude and quality of provided care, aspects of pediatric care and support of breast-feeding out of the health care system. These themes are part of an extensive, historically based conception of health care provided in the Czech Republic, which includes a model of the relationship between a physician (medical...

The diploma thesis focuses on impact of civic engagement on health care system. It studies to what level this participation helps health care system transformation and change of a relationship between patients and political and professional authorities. It's aim is to provide a critical sociological analysis and explain social processes accompanying patients' engagement by using examples. Patient organisations - an institutionalised form of civic society with a potential to evoke social change - get into scope here. The ambition of this thesis is to show the applicability of the reflexivity concept to the area of health care, to enrich this analytical framework by multilevel approach to the health care system and therefore add to the discourse around civic engagement phenomenon by a systemic and structured view of dynamic relationships between patient organisations and health care system. The findings of the author are based on an analysis of semi-structured interviews with patient organisations representatives and available documents. The author emphasises the ambivalent impact of civic engagement which on one side reinforces individual transformations of micro, meso, macro and meta levels of health care system and also acts as a catalyst of wider sociocultural changes. On the other hand, it is accompanied...

This paper deals with medical data extraction from electronic patient record (EPR) system. Most of the medical data are stored in patient record systems, and data that are much valuable for medical research. If a researcher wants to extract medical information today, it has to be done manually because the data are stored in unstructured textual format in a system created by hospital staff. There is no way of extracting data in structure way. This paper is going to introduce an information extraction application for EPR system that allows the researcher to set up a study with inclusion and parameters for extraction for retrospective surveys in a webuser-interface environment. Inclusion is what the researcher would like to study (a defined category or criteria) and parameters specify the characteristics of inclusion the criteria. Result of this application provides an extracted clinical data that is used for retrospective surveys, downloadable to an MS-Excel file.

This thesis is based on a 10-month field work conducted in a retirement home. The empirical part is rooted in the fact that the author of this work actually became a part of the institution for a several months as its employee at the position of a certified nursing assistant. This perspective naturally enabled him to focus on a description of daily routines, taking place within the mentioned institution, from a perspective of a certified nursing assistant as well as on his interactions with the clients, which occur during these daily routines. Paying attention to the mutual interactions of both enables us to perceive how the dominant discourse in public health care works. It is particularly revealed through disciplinary techniques. The analysis of the disciplinary techniques follows the theory of power by Michel Foucault, which seems to prove that not only the clients but also the certified nursing assistants are being disciplined during the everyday practices of the given institution. Their position is at the lowest level of the hierarchy of health care system and this - in a way - dooms them to being disciplined since they are a part of the same routines as are the clients. Moreover, the analysis of the mutual power relationships between the certified nursing assistants and the clients shows that...

The thesis " Women after Mastectomy in the context of Social Work " deals with the topic of diagnosis of breast cancer, treatments and their side effects, itself, however focuses mainly on the psychological and social consequences that come along with such a serious illness. It aims to outline the possibilities that women with this diagnosis can use , and ultimately points out the great potential of social work within the health care system. Powered by TCPDF (www.tcpdf.org)

CONTEXTE : Les critères de jugement prenant en compte le ressenti des patients, tels que la qualité de vie, deviennent des éléments déterminants pour l’évaluation des prises en charge et l’aide à la décision. Bien que les troubles mentaux représentent un fardeau considérable tant en termes de prévalence que de conséquences économiques, les connaissances sur la qualité de vie des patients pris en charge par les services de psychiatrie sont limitées, ce qui complexifie la prise de décisions éclairées dans le champ de la santé mentale.OBJECTIFS : Nos objectifs étaient d’évaluer la qualité de vie, mesurée par des scores d’utilité, des patients souffrant de troubles mentaux en France, de mesurer la perte de qualité de vie attribuable à ces troubles et d’identifier les facteurs qui y sont associés.MATERIEL ET METHODES : Après une revue de la littérature décrivant les instruments de mesure de la qualité de vie utilisés en santé mentale, nous avons évalué la qualité de vie des patients pris en charge par le secteur de psychiatrie générale en mobilisant deux instruments permettant le calcul de scores d’utilité : le SF-36, permettant le calcul de scores d’utilité via le SF-6D, et l’EQ-5D. Nous avons comparé leurs performances et avons évalué leur concordance. Nous avons confronté la qualité de vie des patients souffrant de troubles mentaux à celle de la population générale en mobilisant les données du volet « ménages » de l’enquête Handicap-Santé. Enfin, nous avons recouru à des outils de modélisation adaptés aux spécificités des distributions des scores d’utilité pour étudier les caractéristiques sociodémographiques, cliniques et les prises en charge psychiatriques des patients qui y sont associées.RESULTATS : Notre enquête a inclus 212 patients. Leurs scores d’utilité moyens s’élevaient à 0,684 dans le cas d’une mesure par le SF-6D et à 0,624 dans le cas de l’EQ-5D et étaient inférieurs de 11% à ceux de la population générale. Le fait d’être une femme et le fait d’être sévèrement malade étaient associés à des scores d’utilité plus faibles. Les patients ayant été librement hospitalisés à temps plein, par rapport à ceux ne l’ayant pas été, avaient tendance à avoir des scores SF-6D plus faibles tandis que les patients pris en charge à temps partiel présentaient des scores SF-6D plus élevés. Les scores d’utilité SF-6D et EQ-5D n’étaient pas concordants. Si les deux instruments étaient comparables en termes d’acceptabilité et de validité discriminante et convergente, l’EQ-5D était moins sensible, présentant un effet plafond, et les modèles mis en œuvre pour identifier les facteurs associés à ce score présentaient des performances modestes.CONCLUSION : Nos travaux ont permis d’objectiver l’impact négatif des troubles mentaux sur la qualité de vie des personnes atteintes. Les différences importantes identifiées entre les scores d’utilité SF-6D et EQ-5D font du choix de l’instrument le plus adapté un enjeu majeur. Le manque de sensibilité du score d’utilité EQ-5D et les difficultés rencontrées pour trouver un modèle statistique adapté aux spécificités de ce score suggèrent une meilleure adéquation du SF-6D au champ de la santé mentale. Cependant, des travaux menés sur des échantillons de taille plus conséquente seront mis en œuvre pour préciser nos résultats. / BACKGROUND: Assessment criteria which take patients’ perceptions into account, such as quality of life, are becoming increasingly important in health services assessment and policy and clinical decision-making. Despite the fact that mental disorders represent a significant burden in terms of prevalence and economic consequences, there is a lack of knowledge regarding quality of life of patients cared for by mental health care services which impedes informed decision-making in the field of psychiatry.OBJECTIVES: Our objectives were to measure quality of life using utility scores of people cared for by mental health care services in France; to assess the loss of quality of life attributable to mental disorders; and to identify factors associated with quality of life.MATERIAL AND METHODS: After a literature review describing quality of life tools used in the field of mental health, we undertook a survey to measure the quality of life of people suffering from mental disorders who were treated in the general psychiatric sector using two tools and the corresponding utility scores: the SF-36, allowing calculation of utility scores by the SF-6D, and the EQ-5D. We compared them in terms of performance, and we assessed their consistency. We evaluated the quality of life loss attributable to mental disorders considering data from the French general population-based survey on health and disabilities as a reference. Finally, we used several models adapted to the specificities of the utility score distributions to identify socio-demographic, clinical and mental health care utilization characteristics associated with quality of life.RESULTS: 212 patients were included. The mean utility score was 0.684 when assessed by the SF-6D, and 0.624 when assessed by the EQ-5D. Utility scores of patients suffering from mental disorders were 11% lower than those of the general population. Being a woman and being severely ill were factors associated with lower utility scores using both tools. In comparison with no hospitalization, voluntary hospitalization within the past 12 months was associated with lower SF-6D utility scores, whereas part-time hospitalization was linked with higher SF-6D utility scores. SF-6D and EQ-5D utility scores showed poor agreement in measuring quality of life. These instruments were similar in terms of acceptability as well as discriminant and convergent validity; however, the EQ-5D showed lower sensitivity, illustrated by a ceiling effect, and the models used to study factors associated with this score showed poor performances.CONCLUSION: We objectivized the negative impact of mental disorders on quality of life. Considering the significant differences identified between the SF-6D and EQ-5D utility scores, the choice of the most adapted instrument constitutes a major issue. The lack of sensitivity of the EQ-5D and the difficulties experienced in finding a model adapted to the specificities of this score would suggest that the SF-6D is better suited to the field of mental health. However, our results must be confirmed by analysis on larger samples.

After the Republic of Kosovo's declaration of independence in 2008, new municipal structures were created with the charge of monitoring the delivery of health care services; yet, no mechanism for monitoring performance was ever implemented. With the public value theory as the foundation, the purpose of this multiple case study of 3 Kosovo municipalities was to understand issues surrounding the capacity of local government health department to monitor their performance related to the delivery of services. Relevant data were collected through focus-group discussions with 10 nurses, 9 directors of family medicine centers, and 12 municipal program managers. Purposeful semistructured interviews were conducted with 3 elected officials, 3 leaders of health care services, 3 policy leaders of relevant central-level ministries, and 9 participants from the national coalition of civil society organizations. All data were transcribed and coded per thematic analysis procedures. Results indicated that integrating the threefold value system of business value, social value, and governance value into municipal work plans and policy considerations will likely create a more solution-oriented service delivery at the municipal level. Furthermore, service delivery in the 3 municipalities appears to have improved over the past 5 years because of the pressure from active citizens, increased community engagement, and the institutionalization of home visits. Positive social change implications stemming from this study include the recommendation to central and local policy makers to fully integrate performance-based reporting systems into local legislation and policies. Such efforts can result in sustainable, equitable, and inclusive development, leading to stability and prosperity in Kosovo.

The prevalence of heart failure is increasing. This is affecting the health care system; thus, making it important with change to meet the new demands. Many effective ways of treating heart failure exists, but changes are required in order to implement them. Before changes can be made, it is important to find current problem areas within the existing heart failure health care system. This study aimed to present an image of current problem areas within the heart failure health care system; in order to do so, it was necessary to speak with both care providers and heart failure patients. A total of 26 heart failure patients and 27 care providers working with heart failure patients in Stockholm County participated in the study. The participants answered survey questions concerning the heart failure care. The results from the care providers were consistent; they thought the patients’ heart failure awareness and the patient education they had received were problems within the heart failure care. In addition, they thought it was necessary for the patients to be active in their care and meet with different professions within the health care. Heart failure patients showed to be a diverse group of individuals; they wanted different kind of care and showed differences in how active they wanted to be. The results also showed differences between the care providers and patients’ perception of the heart failure care. The heart failure care needs to be more individualized to meet each heart failure patients’ needs. It is important with more patient education and to actively work with self-care. In addition, it is important that care providers get sufficient heart failure knowledge and to offer the patients the opportunity to meet with different care provider professions. / Utbredningen av hjärtsvikt ökar, vilket påverkar sjukvårdssystemet. För att möta de nya behoven är det nödvändigt med förändringar. Det finns idag många effektiva behandlingsmetoder för hjärtsvikt, men för att dessa behandlingsmetoder ska kunna implementeras behöver sjukvårdssystemet förändras. Innan dessa förändringar kan genomföras är det viktigt att identifiera problem inom hjärtsviktsvården. Målet med denna studie var att identifiera befintliga problemområden inom hjärtsviktsvården. För att kunna göra detta var det nödvändigt att prata med både sjukvårdspersonal och hjärtsviktspatienter. Sammanlagt har 26 patienter och 27 vårdgivare från Stockholms Län delaktigt. Alla delatagare har svarat på enkätfrågor rörande hjärtsviktsvården. Resultaten från vårdgivarna var konsekventa, de ansåg att patienternas kännedom om hjärtsvikt och den hjärtsviktsutbildning de fått var problemområden. Vårdgivarna ansåg vidare att det var viktigt för patienterna att vara delaktiga i sin vård, samt att de skulle få träffa olika typer av vårdgivare. Hjärtsviktspatienterna visade sig vara en blandad grupp, de ville ha olika typ av vård samt vara olika mycket aktiva i egenvård. Resultaten visade också att det fanns skillnader mellan vårdgivarnas och patienternas uppfattning av hjärtsviktsvården. Hjärtsviktsvården behöver bli mer individualiserad för att kunna tillgodose varje patients behov. Det är viktigt att utbilda patienterna samt att aktivt arbeta med egenvård. Det är även viktigt att vårdgivarna får tillräckligt med kunskap om hjärtsvikt, samt att patienterna erbjuds möjligheten till möten med olika typer av vårdgivare.

The prevalence of heart failure is increasing. This is affecting the health care system; thus, making it important with change to meet the new demands. Many effective ways of treating heart failure exists, but changes are required in order to implement them. Before changes can be made, it is important to find current problem areas within the existing heart failure health care system. This study aimed to present an image of current problem areas within the heart failure health care system; in order to do so, it was necessary to speak with both care providers and heart failure patients. A total of 26 heart failure patients and 27 care providers working with heart failure patients in Stockholm County participated in the study. The participants answered survey questions concerning the heart failure care. The results from the care providers were consistent; they thought the patients’ heart failure awareness and the patient education they had received were problems within the heart failure care. In addition, they thought it was necessary for the patients to be active in their care and meet with different professions within the health care. Heart failure patients showed to be a diverse group of individuals; they wanted different kind of care and showed differences in how active they wanted to be. The results also showed differences between the care providers and patients’ perception of the heart failure care. The heart failure care needs to be more individualized to meet each heart failure patients’ needs. It is important with more patient education and to actively work with self-care. In addition, it is important that care providers get sufficient heart failure knowledge and to offer the patients the opportunity to meet with different care provider professions. / Utbredningen av hjärtsvikt ökar, vilket påverkar sjukvårdssystemet. För att möta de nya behoven är det nödvändigt med förändringar. Det finns idag många effektiva behandlingsmetoder för hjärtsvikt, men för att dessa behandlingsmetoder ska kunna implementeras behöver sjukvårdssystemet förändras. Innan dessa förändringar kan genomföras är det viktigt att identifiera problem inom hjärtsviktsvården. Målet med denna studie var att identifiera befintliga problemområden inom hjärtsviktsvården. För att kunna göra detta var det nödvändigt att prata med både sjukvårdspersonal och hjärtsviktspatienter. Sammanlagt har 26 patienter och 27 vårdgivare från Stockholms Län delaktigt. Alla delatagare har svarat på enkätfrågor rörande hjärtsviktsvården. Resultaten från vårdgivarna var konsekventa, de ansåg att patienternas kännedom om hjärtsvikt och den hjärtsviktsutbildning de fått var problemområden. Vårdgivarna ansåg vidare att det var viktigt för patienterna att vara delaktiga i sin vård, samt att de skulle få träffa olika typer av vårdgivare. Hjärtsviktspatienterna visade sig vara en blandad grupp, de ville ha olika typ av vård samt vara olika mycket aktiva i egenvård. Resultaten visade också att det fanns skillnader mellan vårdgivarnas och patienternas uppfattning av hjärtsviktsvården. Hjärtsviktsvården behöver bli mer individualiserad för att kunna tillgodose varje patients behov. Det är viktigt att utbilda patienterna samt att aktivt arbeta med egenvård. Det är även viktigt att vårdgivarna får tillräckligt med kunskap om hjärtsvikt, samt att patienterna erbjuds möjligheten till möten med olika typer av vårdgivare.

Выпускная квалификационная работа (магистерская диссертация) посвящена исследованию финансирования здравоохранения населения в Сингапуре. Предметом исследования являются медицинские накопительные счета Сингапура, которые играют основную роль в финансировании здравоохранения страны. Основной целью магистерской диссертации является рассмотрение успешного опыта финансирования здравоохранения в Сингапуре, которой возможно применить в отечественной системе здравоохранения. В заключении обозначены рекомендации по совершенствованию дальнейшего улучшения отечественной системы финансирования здравоохранения. / The final qualifying work (master's thesis) is devoted to the study of the financing of public health in Singapore. The subject of study is Singapore's medical savings accounts, which play a major role in financing the country's health care. The main purpose of the master's thesis is to consider the successful experience of financing health care in Singapore, which can be applied in the domestic health care system. In the conclusion, recommendations for improving the further improvement of the domestic system of health care financing are indicated.