Magister Artium (Child and Family Studies) - MA(CFS) / The aim of this study was to capture the intensity and incidence of catastrophic health care expenditures in order to describe the degree to which catastrophic health care payments occur among households. Simultaneously, the study set out to assess the extent to which people are made poor or poorer by health spending, i.e. the impoverishing effects of healthcare spending. / South Africa

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The purpose of a study of spirituality and its relationship to the compliance of hemodialysis patients is to consider changing the approach of the treatment team in the dialysis setting. The interdisciplinary treatment team at the dialysis center consists of physicians, nurses, dietitians, and social workers. One of the many roles of the dialysis social worker is to facilitate the adjustment to and acceptance of the patient's need for dialysis.

This study addressed cultural factors that prevent Hispanic diabetics from getting diagnosed early, controlling their glycemic levels, and obtaining appropriate transportation, health insurance, and better education on nutrition.

Le parcours de soins des personnes transsexuelles relève d’une prise en charge multidisciplinaire comportant des aspects médicaux, sociaux et juridiques. Ces trois pôles agissent en interaction et en complémentarité.En France, le protocole établi par la Sécurité sociale en 1989 impose un suivi psychiatrique des personnes d’au moins deux ans avant qu’elles puissent prétendre à une prise en charge de l’opération de réassignation sexuelle ; ceci dans le but, entre autres, d’évaluer la qualité de leur demande. Ces consultations sont souvent décriées par les personnes transsexuelles qui les trouvent stigmatisantes parce qu’elles associent ouvertement leur trouble à la maladie psychiatrique. Les personnes transsexuelles considèrent que le suivi psychiatrique imposé est une atteinte à leur dignité dans le sens où leur parole se trouve remise en question par des questionnaires et des évaluations, établis par un personnel médical qui ne peut ressentir ce qu’elles vivent. Actuellement, beaucoup de personnes transsexuelles ne suivent pas ce protocole médical recommandé par la Haute autorité de santé (HAS), qu’elles estiment trop rigide et éloigné de leurs besoins ; elles organisent elles-mêmes leur parcours ayant parfois recours à des actes chirurgicaux pratiqués à l’étranger. Pour finir, ce parcours de soins serait incomplet s’il n’était validé par une modification de l’état civil ; ainsi le parcours médical de transformation de la personne se trouve lié à un parcours juridique garant de l’intimité et des droits de la personne.Les origines psychologiques, psychiatriques, biologiques ou génétiques du transsexualisme sont encore discutées, sans qu’actuellement aucune réponse ne puisse être donnée de façon reproductible et fiable ; seules des interrogations sont posées. Dans ce contexte d’incertitudes, les paroles que nous avons recueillies font apparaître une réalité du terrain où la personne est, par la force des choses, au centre de l’acte de soins et heurte la conception scientifique de la médecine par ses choix et ses attitudes. Ces différents parcours de vie nous ont montré combien le respect de la personne dans sa différence, non quantifiable et inclassable, était important. Le respect de l’expertise acquise de la part du patient, le respect de sa vérité, de sa décision et de ses choix, sont des revendications qui sont apparues régulièrement. Par ailleurs, au-delà de l’aide médicale demandée, le besoin d’aide psychologique, de soutien moral et financier dessine le profil de personnes vulnérables qu’il convient de soigner et dont il convient de prendre soin. Toutefois il ne faut pas oublier la violence des actes demandés, les interrogations qu’ils suscitent chez les patients et les praticiens concernés. La décision d’entreprendre tous les traitements médicaux et chirurgicaux nécessaires au bien-être de la personne, si elle est présentée comme une décision personnelle, entraîne dans sa dynamique de nombreux acteurs. Certains choisissent d’adhérer à cette transformation, d’autres se trouvent parfois contraints de l’accepter / The care of transsexual patients calls for a multidisciplinary approach, involving medical, social and legal areas of expertise. These three areas both interact with and complement each other.The French national healthcare system drafted its standards of care in 1989, which require at least two years of psychiatric evaluation before the patient can request that their sex reassignment surgery be paid for by the health system. The purpose of this follow up is to evaluate, among other things, the merits of their request. These consultations are often criticized as stigmatizing by transsexuals, given the overt link these evaluations imply between their condition and mental illness. Transsexuals think that the mandatory psychiatric follow up is an attack on their dignity because their word is put into question by tests and evaluations performed by medical personnel who have no empathy for what they are going through. Currently, many transsexuals do not follow these standards of care, even if recommended by the HAS (Haute Autorité de Santé – the official French health standards organization), as they are considered both too rigid and too disconnected from their real needs. Therefore, transsexuals organize heir own healthcare process and sometimes have their surgery performed abroad. Last but not least, the healthcare process would be incomplete without it ending with the change in their legal identity. The medical transformation is linked in this way to a legal process, which is necessary to guarantee the individual’s privacy and personal rights.Psychological, psychiatric, biological and genetic origins of transsexualism are still subject to debate, and there are no reliable or reproducible answers, only question marks. In this uncertain context, the testimony we have gathered underline the reality of life where the person is inevitably both at the center of a series of medical treatments and a challenge to the scientific conception of medicine, both in their choices and their attitudes.These different life stories, demonstrate how important respect for the difference, unquantifiable and unclassifiable, of these people is. Respect for the expertise that the patient has acquired, respect for his or her sincerity, choices and his decisions are requests that have arisen regularly. Moreover, beyond the medical treatments that are requested, the need for psychological, moral and financial support is part of the profile of that can be drawn of a vulnerable population that needs to receive care and be cared for. We must not forget the “violence” of the procedures that are requested, as well as the questions raised by patients and practitioners. The decision to undergo medical and surgical procedures is necessary to the well being of the person. Even if this decision is presented as a personal choice, many other people are inevitably involved. Some choose to freely embrace this transformation, while others sometimes feel forced to accept it.

Summary in English. / Bibliography: pages 122-126. / This dissertation studies the delivery of health care to street children. ft investigates the existing street children's facilities and the health system in Ang of a in order to determine an appropriate type of health facilities for the special health needs of these children. The study was based on a review of bibliographic material on street children and related subjects. The findings from this review were tested through a series of interviews with professionals working with street children in Angola and with ~treet children randomly selected from shelters and on the streets in Luanda. The questionnaires were designed for evaluation of the street children's facilities, the health system and to determine street children's preferences and attitudes towards formal institutions in a context where th'e main cause of family disintegration was war. The study concluded that street children's health needs in Angola would be better catered for through independent primary health centres provided with partial in-patient services (temporary sf eeping and eating facilities for children under medical care). These centres would serve mainly children with no access to shelters and those living in shelters without health centres. The study formulates guidelines and presents a design example of the type offacifity proposed.

Orientador: Alessandro Lia Mondelli / Resumo: Introdução: O Brasil é classificado pela Organização Mundial de Saúde (OMS) como um país de endemicidade intermediária para o vírus da hepatite C (VHC). Para alcançar melhorias nos serviços de acompanhamento e atendimento pela Equipe Multidisciplinar é necessário cada vez mais o aprimoramento e eficácia nas condutas terapêuticas. Objetivos: Avaliar e comparar o atendimento multidisciplinar de 5 ambulatórios de Hepatite C do Estado de São Paulo; Avaliar o grau de satisfação dos pacientes quanto à qualidade do atendimento recebido por uma equipe multidisciplinar; Descrever o grau de dificuldade no acompanhamento do tratamento dos portadores de hepatite C; Relacionar e comparar a qualidade de atendimento entre os 5 ambulatórios, descrevendo as diferenças entre ambos. Método: estudo transversal, realizado por meio de aplicação de questionário semiestruturado a 425 pacientes dos Ambulatórios, UNESP/HCFMB; UNIFESP/EPM; USP/FMRP; FAMERP/S.J.RIO PRETO e SANTOS CRAIDES. Este trabalho foi aprovado pelo Comitê de Ética em Pesquisa número 1.850.408. Resultados: na avaliação do acompanhamento e atendimento dos serviços ambulatoriais nos diversos centros observaram-se diferenças estatisticamente significantes. A avaliação direta e indireta do atendimento médico e do atendimento de enfermagem foi classificada como boa e ótima, respectivamente. No entanto, os pacientes relataram não sentir diferenças no atendimento de cada profissional. Conclusão: Os resultados desta pesquisa apontam a neces... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: According with World Health Organization (WHO), Brazil is classified as a country with intermediary endemicity for the hepatitis C virus. In order to improve monitoring and follow-up services by the Multidisciplinary Group it is necessary to improve efficacy on the therapeutic conduct. Objetivos: Evaluate and compare the Multidisciplinary care among ambulatories of Hepatitis C of the State of Sao Paulo, regarding satisfaction monitoring and follow-up services provided by the ambulatories. Methodology: cross-sectional study, conducted by applying a half structuralized questionnaire to 425 patients of the following ambulatories:, CRAIDES/SANTOS; UNIFESP; FAMERP; USPFMRP and HCFMB. Approved by the Ethics in Research Committee. Results: In the evaluation of the follow-up and care of the ambulatorial`s services in the various centers, significant statistical differences were observed. The direct and indirect evaluation of the medical care and nursing care was classified as good and excellent, respectively. However, patients reported no differences in care from one professional to another. Conclusion: The results of this research suggest that, despite the great importance of the theme, in practice, users still demonstrated the lack of knowledge of the multiprofessional team during their treatment. However, they rate the medical and nursing staff during follow-up and outpatient care as good and great. Thus, the results indicate the need for those responsible for outpat... (Complete abstract click electronic access below) / Doutor

Burnout among primary care providers, which include physicians, nurse practitioners, and physician assistants, can negatively impact patients, providers, and organizations. Researchers have reported that up to 37% of primary care physicians experience burnout, yet the prevalence, predictors, and outcomes associated with primary care nurse practitioner burnout remains unknown. Since 69% of nurse practitioners provide primary care to patients, this dissertation investigates the predictors and outcomes associated with primary care nurse practitioner burnout. A history of burnout as well as the importance of investigating burnout among primary care nurse practitioners are discussed in the first chapter. A systematic review of the predictors and outcomes of primary care provider burnout is discussed in the second chapter. The third chapter describes a cross-sectional study conducted among 396 primary care nurse practitioners from New Jersey and Pennsylvania, which investigated whether the practice environment is associated with nurse practitioner burnout. The fourth chapter describes a cross-sectional study investigating whether the use of multifunctional electronic health records is associated with primary care nurse practitioner burnout. The fifth chapter includes another cross-sectional study examining the relationship between primary care nurse practitioner burnout and quality of care, and if the practice environment moderates the relationship between burnout and quality of care. Finally, the sixth concluding chapter summarizes the findings from chapters two to five and provides recommendations for future research, practice, and policy.

One of the outgrowths of legislation enacted during the 1960's has been the deinstitutionalization of mentally retarded persons and the retention of others within the community. This study addressed the problem of nurses' perception of their competency to deal with this population wherever they might be encountered within community health care settings. The first hypothesis looked for differences in perceived competency based on the level of basic nursing education. Since sample sizes were not equal, the Kruskal Wallis test was utilized and a significant difference at the .001 alpha level was found. Hypothesis two looked for a relationship between perceived competency and degree of clinical contact with a mentally retarded population provided by the basic nursing preparation. Hypotheses three through six looked for relationships between perceived competency and adequacy of samples of content related to mental retardation provided by the basic nursing education: (1) risk factors; (2) etiology; (3) skills and techniques; (4) support systems. Hypothesis seven looked at the relationship between perception of competency and the adequacy of continuing education offerings to which nurses have been exposed. Hypothesis eight looked for a relationship between perceived competency and sustained personal contact with a mentally retarded person. A Pearson product moment correlation was run on each of these hypotheses and each revealed a positive significant relationship.