Most LEED (Leadership in Energy and Environmental Design) certified buildings are commercial office buildings and multi-use buildings. As of October 2009, 35,000 projects were registered in the LEED system, "comprising over 4.5 billion square feet of construction space in all 50 states and 91 countries." However, as of April 30, 2009, only 43 healthcare projects had achieved LEED certification. Currently, most studies focus on the economic benefits and energy consumption of LEED certified buildings, rather than human factors. A small gain in productivity can result in a heftier financial gain. Even modest improvements in productivity and absenteeism can substantially outweigh the energy cost. This study surveyed 164 staff in the two healthcare settings for case study, and 146 staff in the six LEED certified healthcare settings for the main study in climate zone 2 and 3. Telephone interviews with the six facility managers were used to verify the survey results and further examine the healthcare facilities? performance and the effectiveness of the LEED strategies from facility managers' perspectives. Independent t-test was used to examine the difference between the LEED and Non-LEED hospitals in one healthcare system and results showed that building performance were rated higher by staff in LEED certified hospital than Non-LEED hospital. MANOVA was conducted to compare the staff's ratings between Silver and Gold certification levels, male and female, and also explore the possibility of interaction effect. Multilevel regression modeling was used to test how the building performance variables affect the overall comfort and productivity. Study results showed that staff in the Gold certified hospital had significant higher ratings in most the performance variables. Gold certified healthcare settings were significant better in rated building overall, overall comfort and controllability than Silver certified healthcare settings. And males felt more comfortable in temperature than females in healthcare facilities. Regarding the overall comfort and productivity, building design, efficiency of the space use, temperature comfort and controllability over building system were significant predictors for staff overall comfort; and lighting comfort, temperature comfort and controllability over building system had significant positive relationship with perceived productivity. LEED certified healthcare settings appear to have a good environment and building performance for occupants. Controllability, lighting, temperature, use of space, building design were important factors in staff comfort and productivity.

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The thesis focuses on multilingual communication in healthcare centres in Prague. One of its main objectives is to compare and contrast the situation in the public- and the private sector. The theoretical part of the thesis presents interpreting in healthcare settings as one of the most important and most frequent types of community interpreting. The authors focus mainly on the current state of research in diverse world regions, and subsequently analyse the specific aspects of interpreting situations in the setting in question. An integral constituent of the theoretical part of the thesis is a global overview of the current situation in terms of quantity of foreign patients in Prague hospitals, including selected relevant demographic data. In conclusion of the theoretical part, the authors briefly elaborate on the phenomenon of medical tourism. The empirical part of the thesis is based on a questionnaire survey carried out among hospital employees in Prague, the aim of which was to analyse the current situation in terms of communication with foreign country nationals and to compare and contrast the public- and the private sector in this respect. The main focus of the research is to find out how the respondents perceive the situation and whether they are satisfied with it and to what extent this is...

Chaque année les infections nosocomiales touchent plus de 4 millions de patients en Europe, avec un impact important en termes de mortalité, de morbidité et de coût. Parmi ces infections, celles causées par des bactéries multi-résistantes aux antibiotiques (BMR) jouent un rôle majeur. La modélisation mathématique des épidémies est un outil essentiel qui permet de mieux comprendre la dynamique de diffusion des BMR et d’évaluer l’efficacité des mesures de prévention.L'objectif principal de ce projet est d'étudier la dynamique de propagation de BMR au sein d'un réseau d'hôpitaux, en prenant en compte différentes échelles : intra-service, inter-services et inter-hôpitaux. Il s'agit de mettre en place une recherche méthodologique basée sur la modélisation mathématique et informatique et validée par des données recueillies au sein du réseau de soins Paris Île de France Ouest (PIFO), afin de mieux comprendre le rôle joué par chaque hôpital dans l'émergence et la sélection de BMR, de quantifier le risque de leur dissémination (y compris dans la population générale), et d'identifier des mesures de contrôle efficaces. Ce travail s'appuiera sur des méthodes d'inférence statistiques, d'analyse de sensibilité et d'analyses d'incertitude. / Each year nosocomial infections affect more than 4 million patients in Europe, with a significant impact in terms of mortality, morbidity and cost. Of these infections, those caused by multi-resistant bacteria (BMR) play a major role. Mathematical modeling of epidemics is an important tool to better understand the dynamics of dissemination of BMR and evaluate the effectiveness of prevention measures.The main objective of this project is to study the BMR propagation dynamics within a network of hospitals, taking into account different levels: intra-ward and inter-wards and inter-hospitals. This is to establish a research methodology based on mathematical and computer modeling and supported by data collected in the Paris Île de France Ouest (PIFO), to better understand the role played by each hospital in the emergence and selection of BMR, to quantify the risk of their dissemination (including in the general population), and to identify effective control measures. This work will be based on statistical inference methods, analytical sensitivity and uncertainty analysis.

Due to their contagiousness, communicable disease require healthcare staff to not only see to the needs of their patient, but also to the protection of themselves and other people from getting infected. Ethical issues and dilemmas tied to the patient’s anatomy and confidentiality arise as interventions to prevent further spread of the disease necessarily involve informing others about the risk of infection. Knowledge of and about communicable disease is necessary for acts of caution to be taken by both the person carrying it and those who are at risk of becoming infected. The Swedish communicable disease control system is regulated mainly with the Communicable Diseases Act (smittskyddslag, SFS 2004:168) and confidentiality within healthcare is regulated by the Public Access to Information and Secrecy Act (offentlighets- och sekretesslag, SFS 2009:400). In this thesis we identify dilemmas and concessions in the taking of measures to prevent the spread of communicable diseases, focusing especially on these two laws. This is done from the perspective of social work in healthcare settings with some focus on healthcare counsellors. For this purpose we have used content analysis with a deductive approach, produced a coding schedule, and analyzed relevant data in official documents. To discuss identified dilemmas and concessions further, we have used a theory of care ethics and utilitarianism. In our results we describe dilemmas consisting of situations where it is impossible to both maintain secrecy regarding the patient’s status as ill while informing others about their risk of infection, situations where differing interests arise, and situations where several principles which need to be followed differ from one another. These dilemmas are ethical in nature rather than legal, although professionals must make decisions regarding what information to share and what to keep secret. This makes for situations where practical answers to ethical dilemmas are necessary, and the contagious nature of the patient’s disease makes work more difficult. / I arbetet med smittsamma sjukdomar ska hälso- och sjukvårdspersonal inte enbart värna om patienten, utan även andra människor. Sjukdomarnas smittsamhet medför försvårande omständigheter och medför andra etiska frågor än andra sjukdomar. Inte minst uppstår etiska problem kopplade till patientens autonomi och sekretesskydd vid smittsamma sjukdomar på grund av risken för att också andra kan bli sjuka. Vetskap om sjukdomen är ett måste för att rimliga försiktighetsåtgärder ska kunna vidtas av både den smittade och osmittade personer. Smittskyddet i Sverige regleras främst genom smittskyddslagen (SFS 2004:168) och hälso- och sjukvårdens sekretess genom offentlighets- och sekretesslagen (SFS 2009:400). Vi identifierar dilemman och avvägningar i det praktiska arbetet med att besluta om och vidta smittskyddsåtgärder utifrån lagstiftningen, och diskuterar sedan dessa. Vårdetik lyfts och appliceras. Uppsatsens utgångspunkt är socialt arbete i hälso- och sjukvård, och delvis rollen som hälso- och sjukvårdskurator. Metoden består av innehållsanalytisk bearbetning, kodning, av lagtext och förarbeten med en deduktiv ansats. I resultatet redovisar vi hur balans mellan olika rättigheter och skyldigheter genomsyrar smittskyddslagen (2004), vars primära syfte är att tillgodose befolkningens behov av skydd mot smittsamma sjukdomar. För att uppnå detta görs flera avsteg från sekretessen som annars gäller i hälso- och sjukvård. Vi identifierar och beskriver de dilemman och avvägningar som uppstår som situationer där det är omöjligt att både hemlighålla patientens sjukdomsstatus och skydda andra från smitta, då det råder skilda intressen, och situationer då skilda principer behöver följas. Dessa dilemman är främst etiska och praktiska i och med att den som fattar beslut om och vidtar smittskyddsåtgärder måste besluta vilka uppgifter som ska röjas och på vilket sätt. Etiska riktlinjer är inte irrelevanta och kan utgöra både vägledning genom olika dilemman och avvägningar, men också försvåra det praktiska arbetet i och med de verkliga konsekvenser smittskyddsåtgärder har för människorna de berör. Dessutom väger alltid lagen tyngre när det gäller att instruera professionella i hur de ska agera. Skyddet mot spridning av vissa sjukdomar prioriteras över skyddet av patientens sekretess.

In the United States (US), substance use, misuse, and substance use disorders are significant public health problems. Additionally, the difference between needing substance use treatment (SUT) and receiving treatment is becoming more pronounced. Therefore, the aims of this dissertation include, 1) to synthesize evidence of barriers and facilitators to integrating SUT into mainstream health care (MHC) after the Affordable Care Act was nationally implemented in 2014, 2) to examine the rate of treatment completion and dropout, along with its associated factors, among youth who received Medication-Assisted Opioid Therapy (MAT), 3) to determine the relationship between prior treatment episodes and length of stay (LOS) among adults in residential rehabilitation facilities (RRF) and explore other predictors of LOS and, 4) to determine whether experiencing multiple treatment episodes and being in certain age groups was associated with longer wait period to enter SUT. The literature synthesis involved data from five databases and was informed by PRISMA. Quantitative analysis (aims 2-4) included log-binomial, Poisson, and logistic regression models using the Treatment Episode Data Set-Admissions and Discharges. Andersen’s Behavioral Model for Health Services was the conceptual framework used to inform aims 2-4. For aim 1, several patient, provider, and program/system-level barriers and facilitators were identified, which highlights the need to use a comprehensive approach to improve SUT adoption in MHC. For aim 2, among youth who received MAT, 43.9% completed treatment and 56.1% dropped out. Factors positively associated with treatment completion included MAT use, males, self-help group participation, admission to detoxification and residential/rehabilitation settings, and being in the Midwest/Western US; while minority races (excluding Blacks/African Americans) and being in the South resulted in lower likelihood. For aim 3, the average LOS in RRF was 16.4 days, and having ≥ 1 prior SUT episode (PSUTE) was associated with slightly higher LOS. Some predictors associated with lower LOS included age (18-34 years), males, being employed, private insurance, and being in the Northeast. For aim 4, a longer wait period was identified among clients 25-49 years and those with ≥5 PSUTEs. These factors should be considered to improve SUT use, and future studies should corroborate these findings.

Till följd av NPM (New public management) och de ökade kraven på produktivitet och effektivitet har sjuksköterskors arbetssituation försämrats alltmer under de senaste decennierna. Det har resulterat i en försämrad hälsa hos sjuksköterskorna och många sjuksköterskor har valt att lämna yrket. Det har bland annat genererat brist på erfarna sjuksköterskor på akutvårdsavdelningarna som bedrivs dygnet runt i regionerna och detta anser Socialstyrelsen utgöra ett hot mot patientsäkerheten. Ett bra verksamhetsnära ledarskap, i regionerna benämns dessa som första linjens chefer, är en betydande faktor för sjuksköterskors hälsa och vilja att stanna kvar på sin arbetsplats. Det är därför av intresse att undersöka vilka ledaregenskaper som krävs för att erfarna sjuksköterskor skall arbeta kvar på vårdavdelningar som är öppna dygnet runt. Syftet med studien är att utröna vad som är viktiga hörnstenar i det hälsofrämjande ledarskapet för att bibehålla erfarna sjuksköterskor i dygnet runt verksamhet. Som metod användes semistrukturerade kvalitativa intervjuer med en induktiv ansats, åtta intervjuer utfördes totalt. Råmaterialet analyserades med hjälp av innehållsanalys och meningsbärande enheter, koder, kategorier och teman identifierades. Resultatet utmynnade i tre teman: individuellt stöd, teamarbete och kommunikation. Informanterna lyfte bland annat individanpassade scheman, kompetensutveckling och temaarbete som viktiga aspekter för att kvarstanna på arbetsplatsen. Ett salutogent förhållningssätt och specifika hälsofrämjande ledarskapsegenskaper är grunderna för att bibehålla erfarna sjuksköterskor i verksamheter som bedrivs dygnet runt. Cheferna i en dygnet runt-verksamhet bör besitta följande förmågor: rak och tydlig kommunikation, förmåga att skapa tillit, vara lyhörda, kunna entusiasmera, prestigelöshet, vara drivna och målfokuserade samt inneha ett coachande förhållningssätt. Definition av erfarna sjuksköterskor, se sida 7 under Metod. / As a result of NPM (New public management) and the increased demands on productivity and efficiency, the work situation of nurses has deteriorated more and more in recent decades. This has resulted in a deterioration in the health of the nurses and a number of staff have chosen to leave the profession. Among other things, it has generated a shortage of experienced nurses in the Swedish emergency departments with twenty-four seven operations in the regions, and the Swedish National Board of Health and Welfare considers this to be a threat to patient safety. A leadership with the adjacent connection to the ward and the staff, are referred to as first-line managers in the Swedish regions. These mangers are significant factors for nurses' health and willingness to stay in their workplace. It is therefore of interest to investigate what leadership qualities are required for experienced1 nurses to continue working in wards that are open twenty-four seven. The purpose of the study is to find out what are important cornerstones in the health promoting leadership in order to retain experienced nurses in twenty-four seven operations. As a method, semi-structured qualitative interviews with an inductive approach were used, eight interviews were performed. The raw material was analyzed using content analysis and meaningful units, codes, categories and themes were identified. The result resulted in three themes: individual support, teamwork and communication. The informants highlighted, among other things, individualized schedules, skills development and team work as important aspects for staying in the workplace. The result was that specific health promoting leadership qualities and a salutogenic approach are the foundations for retaining experienced nurses in twenty-four seven operations. The managers in a twenty-four seven operations should possess the following abilities: straight forward and clear communication, the ability to create trust, be responsive, be able to enthuse, lack prestige, be driven and goal focused and have a coaching attitude. For a definition of experienced nurses, see page 7 under Method.