Please read the abstract in the front of this document. / Dissertation (MMed)--University of Pretoria, 2004. / School of Health Systems and Public Health (SHSPH) / Unrestricted

Historically, clinical spiritual care and education (or clinical pastoral education, CPE) has focused on pastoral formation, pastoral competence/conversation, pastoral understanding, and interpersonal dynamics. With the rise in holistic education in adult education this research sought to understand how students’ spirituality is affected by the CPE process. The primary research question was: Does CPE affect the spiritual lives and formation of its students? And if it does, how? A secondary research question was: Does CPE affect students’ connection to the god(s)/higher power/divine entity of their understanding? And if it does, how? First, the researcher developed a qualitative survey that allowed participants to self-define their spirituality and provide open-ended descriptions on how CPE affected their spiritual formation, or not. The survey was published with ACPE, Inc. and 17 participants answered. The data was analyzed through thematic coding and five themes emerged: Changes in Relationality, Things That Came Out of Struggle, Changes in Spiritual Beliefs & Spiritual Practices, Importance of Essential Elements in CPE, Things that Came Out of Struggling Related to Divinity. My assessment of the results of the themes is that CPE has been implicitly addressing the spiritual needs and spiritual formation of its students. Therefore, my recommendation is for Educators to find ways to make the implicit explicit thus enhancing what is already present in the curriculum.

Indiana University-Purdue University Indianapolis (IUPUI) / For the past 2,000 years, the medical and philosophical communities have been unable to formulate a clear conception of function. Yet, I argue that this debate has become of central importance to Western bioethics due to the role the concept of function plays within emerging health care justice models, and more broadly, within the debate surrounding universal health care in the United States. My thesis focuses on the relationship between species function and health care justice. Specifically, my position is that any workable formulation of just health care that is justified from a Rawlsian or politically liberal perspective must utilize conceptions of normal species function that are as neutral and stable as possible. I conclude by showing that Larry Wright’s evolutionarily-based teleological account of function is the most neutral and stable account of function within the philosophical canon, and utilize two case studies – idiopathic short stature and obesity – to help illustrate the applicability of Wright’s account to liberal health care justice formulations.

Despite being a physiological phenomenon that impacts billions of womxn worldwide, menstruation has long been understudied. In this dissertation, we first explore the menstrual characteristics of nearly 380,000 womxn, as collected via a self-tracking mobile health (mHealth) app, Clue. We examine how variation in menstrual cycle length is related to volatility in other experienced symptoms, helping to debunk the idea that menstrual cycles should be 'regular.' We then develop predictive models for menstruation utilizing this dataset, demonstrating first how a fully generative model that explicitly accounts for the possibility that self-tracked data may be flawed in terms of reliability can both outperform baselines and aid in the detection of self-tracking artifacts (i.e., instances where a user supposedly did not experience a period event, but in reality forgot or otherwise neglected to track it). Finally, we explore a hierarchical, deep generative model for symptom tracking, where we utilize a deep neural network to learn per-user parameters for tracking and retain a mechanism for modeling per-user likelihood of adherence. We find that leveraging symptom data at the time series level allows us to predict occurrence of next bleeding and non-bleeding tracking events with high accuracy. This work demonstrates the great potential that large-scale mHealth data holds to better understanding menstruation as a whole, as well as the importance of treating such data carefully.

At least eighteen countries allow transgender personnel to serve openly, but the United States is not among them. In this article, we assess whether US military policies that ban transgender service members are based on medically sound rationales. To do so, we analyze Defense Department regulations and consider a wide range of medical data. Our conclusion is that there is no compelling medical reason for the ban on service by transgender personnel, that the ban is an unnecessary barrier to health care access for transgender personnel, and that medical care for transgender individuals should be managed using the same standards that apply to all others. Removal of the military’s ban on transgender service would improve health outcomes, enable commanders to better care for their troops, and reflect the military’s commitment to providing outstanding medical care for all military personnel.

Thesis(M. Med. (Public Health Medicine)) -- University of Limpopo, 2019 / Background: Health care workers (HCWs) hands are the most common vehicle for the transmission of health care associated infections (HCAIs) between patients and the health care environment. Hand hygiene is regarded as the most important, simplest, and least expensive means of reducing the burden of HCAIs. However, hand hygiene compliance remains low among HCWs. Aim: To assess the level of knowledge, attitude and self-reported practices (KAP) of HCWs on hand hygiene and associated factors. Method: A quantitative, descriptive study using a pre-tested self-administered questionnaire was conducted among HCWs of Pietersburg Hospital. Data collection was carried out between January and February 2018. KAP scores were summarised into means, standard deviations and percentages. Chi-square and Fisher’s exact tests were used to determine association between KAP scores and selected independent variables (gender, age, profession, experience, discipline and training). Results: There were 324 respondents, mostly females (74.3%), <40 years (70.6%) and predominantly nurses (52.4%). Majority had moderate knowledge (79.3%), positive attitude (88.8%) and good practices (87.9%). Respondents had knowledge gaps on HCAIs, WHO “Five (5) moments for hand hygiene” and alcohol based hand rub. Association was found between respondent’s KAP scores and age (p<0.05). Nursing profession was associated with good practices (p=0.000). Knowledge and attitude were associated with years of clinical experience (p<0.05). Positive attitude (p=0.019) and good practices (p=0.000) were associated with training in the last 3 years. No significant relationship was found between KAP and undergraduate training. Conclusion: Most respondents had moderate knowledge, positive attitude and good practices. Respondent’s variety in KAP scores and associated factors indicate that a multimodal, multifaceted improvement approach should be undertaken to address KAP gaps.

In Colorado in 2014, suicidal ideation or suicide attempts occurred up to 10 times more frequently among transgender persons than the general population. This reality occurred within a milieu of stigma that included transgender persons' negative perceptions of healthcare, a higher incidence of psychological distress, and an uncertain role for social isolation in their well-being. The purpose of this quantitative study was to explore the interactions between social isolation, supportive medical care, and psychological distress within the framework of Meyer's minority stress theory. Data were acquired from the 2014 Colorado Transgender Health Survey conducted by the One Colorado Education Fund (n = 417). These survey data were analyzed using multivariate techniques and structural equation modeling. Key findings were that psychological health and social integration were positively related (p < .001), supportive medical care and psychological health were positively related (p = .016) and influenced by race and gender identity (p = .05), and, social integration and supportive medical care were not significantly associated. Access to medical care and disease history influenced these relationships (p < .001), and 5 distinct gender identity/race groups emerged. The positive social change implications stemming from this study include recommendations for healthcare and policy-making bodies to improve understanding regarding gender and racial disparities in medical and psychological healthcare, to expand collection of gender identity and victimization data, to improve availability of adequate insurance coverage, and, to foster employment and housing equity. Implementation of these recommendations may improve the lives of transgender Coloradans.

This study explores the effects of income, insurance, and source of medical care on access to and utilization of health services. Profiles of dental, physician, and hospital services use are developed for more than 3,500 Oregonians. Low income, lack of health insurance, and/or an inappropriate source of medical care are hypothesized to be barriers to access and utilization. Households which face one or more of these barriers are identified as falling into a "Health Policy Gap." The data for this study were drawn from a 1978 random telephone survey of 1249 Oregon households. The survey was commissioned by the State Health Planning and Development Agency in conjunction with the Northwest Oregon Health Systems Agency, the Western Oregon Health Systems Agency, and the Eastern Oregon Health Systems Agency. The questionnaire was developed by the Oregon State University Research Center. Information was collected on use of health services, insurance coverage, income, household structure, health needs, health behaviors, and health satisfaction. A behavioral model of health services utilization was constructed, dividing the independent variables according to their relative mutability or amenity to policy intervention. Income, insurance, and source of care were selected as policy variables, while other variables less under policymakers' control were labelled household characteristics. The latter were assumed to reflect a household's propensity to consume services. They included household structure, health need, residential mobility, and health behaviors. Dependent variables included measures of dental and physician visits, use of the telephone for physician advice, preventive exams, and hospitalization during the past year. Multiple techniques of analysis were employed. Cross-tabular procedures were applied to investigate the interrelationship of income, insurance, and source of care. Multiple linear regression and partial correlation methods were used to select as control variables household characteristics highly correlated to each measure of health services use. Analysis of variance and multiple classification analysis were used to develop profiles of health services use. These last techniques allowed an examination of the relationship of each policy variable and health measure while applying increasing levels of statistical control. The initial bivariate relationship was studied in isolation; it was then studied while controlling for the other policy variables, and finally while controlling for both the other policy variables as well as selected household characteristic variables. Findings support the hypotheses. Income is found to be related to insurance coverage, and insurance coverage to source of medical care, although income is not found to be directly related to source of care. Low income, lack of insurance, and an inappropriate source of medical care depress use across almost all services. However, their relative barrier effects differ by the measure of service examined. After controlling for the effects of household structure, health need, residential mobility, and health behaviors, the greatest disparity in use of dental services remains due to income, in physician services to insurance and income, and in hospital services to insurance. Clear implications arise for policymakers, whether in the public or private sectors. The low income, the uninsured, and those with an inappropriate source of care face real barriers to access. Since the relative magnitude of these barrier effects vary by the health measure examined, neither income, insurance, nor health system delivery strategies can be assumed to evenly enhance use patterns. Their effects must be separately estimated for differing measures of health services. Furthermore, the relationship between these policy variables needs detailed study before large-scale policy interventions are undertaken. Understanding the complexity of these findings for different measures of health services as well as the interrelationship of income, health insurance, and source of care is crucial in designing and implementing more effective and equitable health policies in the future.

This work explores the development and use of patient satisfaction evaluation system in a family practice setting. The goal was to develop a system that would minimally interfere with the delivery of care while simultaneously disclosing sources of patient satisfaction and dissatisfaction. The information would then be used to improve aspects of patient care and service delivery.

Tuberculosis (TB) is one of the most deadly diseases worldwide. In the United States, TB disproportionately affects foreign-born individuals, individuals living in congregate settings, people with human immunodeficiency virus, and people who use illicit drugs. In 2005, a large homeless shelter outbreak in San Joaquin County resulted in 67 individuals diagnosed with TB with links to a homeless shelter. It is hypothesized that by using bed analysis to identify contacts that have been exposed to TB during this outbreak will allow for better identification of exposed high-risk individuals than screening alone. Demographics, exposure, screening, and QuantiFERON-Tuberculosis results were analyzed using bed assignments from the homeless shelter database and data from a homeless shelter screening (HSS) program. Individuals diagnosed with active TB disease were on average more likely to be identified through bed analysis than HSS, 95.08% versus 59.02%. Utilizing both bed analysis and HSS allows for improvement of identification and continuous testing of individuals exposed to TB.